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.


DISCLAIMER: This article is 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 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

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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.

 

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.

 

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.

 

About My Book – Low Carb Breads of the World

I never planned to write a low carb bread book, but it came about due to both interest and need.  Beginning in September 2021, I began to experiment with low carb breads that were not made from nut flour. By mid-December I was finally successful and posted the recipe for Low Carb High Protein Yeast Bread, and this bread turned out to be a “game changer”.  It was what I called “real bread that happens to be low carb.” But, most impressive were the macros! Each slice of Low Carb High Protein Yeast Bread had only 1.6g net carbs and 11.4 g protein. I knew I was onto something.

The ingredient that made this first ‘real bread’ possible was vital wheat gluten, which is not wheat flour but one of several types of wheat protein isolate. Wheat protein isolate is to wheat, what whey protein isolate is to dairy, and both are proteins that have been used in food production and as a protein supplement. This ingredient gives bread its distinct “pully” texture and makes bread different from cake or pastry. Discovering this and other low-carb ingredients resulted in me re-visiting my old hobby of bread baking – something I did over the previous 35 years before adopting a low carb diet in March 2017.

After posting the recipe for Low Carb High Protein Yeast Bread in mid-December 2021, I began to have people contact me on social media to request that I bake the breads and ship them to them. One person wanted me to courier them several loaves, and I had to explain that I am a Dietitian in full-time private practice and had no time to bake bread as a sideline. A few people tried to convince me to open a low-carb bakery (which I also had no interest in), and then some said I should write a cookbook featuring recipes for these low-carb bread. I mentioned this to one of my young adult sons, who thought I should consider the idea. Without really thinking it through, I created a Twitter poll asking who would be interested in such a book and then asked the same question on Facebook and Instagram. The responses were overwhelmingly in favor, so the following morning, I looked at my young adult son and said, “it looks like I am writing a low-carb bread book.”

And so, it began…

The recipes in this book form a completely different category of low-carb bread. They contain no nut or seed flour, and while cheese and egg may be included as ingredients in a recipe, they do not form the basis of the bread. In addition, these bread contain no psyllium, chia seed, xanthan gum, guar gum, or inulin, as these ingredients often cause digestive issues. As a result, Low Carb Breads of the World may remove unnecessary barriers that people currently have to adopt a low-carb lifestyle. This book makes culturally appropriate and ingredient-appropriate bread available to people from bread-centric cultures with high rates of type 2 diabetes, including Southeast Asian and Hispanic.

Low Carb Breads of the World is more than a cookbook or a collection of recipes. It introduces novel ingredients for baking low-carb bread and explains how to use them successfully in different types of recipes.  The recipes provide an opportunity to utilize the ingredients and the methods to produce a variety of breads of the world. These recipes are not perfect replicas of the high-carb originals but are as close as I was able to get them using readily available low-carb ingredients with minimal allergens or ingredients that cause digestive issues.

I hope that people from a wide range of backgrounds will apply the information in my book to create low-carb versions of bread central to their cultures, thereby making a low-carb diet accessible to those who would not have otherwise considered it.

While I never set out to write a low-carb bread book, I realize that this book will do what I do in my private practice: help people pursue a healthier lifestyle.

You can click on the “free download” button below to get a FREE 27-page booklet that explains the essentials about this new category of homemade low-carb breads and includes the “game changer” that led to the development of the others.

To your good health!

Joy Y. Kiddie MSc, RD

 

FREE DOWNLOAD

 

Includes the “game changer” recipe that led to the development of all the others.

Click on the free download button below to get your FREE 27-page booklet with recipe.

 

Embracing the Unchangeable

With the new Covid-19 variant now in circulation, widespread flooding in the Pacific Northwest and out East, and the resulting supply shortages in many areas affecting food prices, many people feel overwhelmed.  I find that I do best in these situations when I embrace that which is unchangeable, while focusing on changing the things that I can.

I think that circumstances are more about how we look at them and respond, than about the situations themselves, and our reaction to the weather around us exemplifies this. 

Viktor Frankl was an Austrian neurologist, psychiatrist and Holocaust survivor who said that there is a ‘space’ between a stimulus (or an event) and our response, and in that space we have the power to choose our response. This includes our reaction to a new strain of Covid, environmental events such as the weather, and the condition of our own health.

”Between stimulus and response there is a space. In that space is our power to choose our response.” ~Viktor Frankl

When I woke up to the snow this morning, I decided to embrace the unchangeable, and this  short video touches on that.

We have the power to choose how we are going to respond in any situation, and this includes everything from the weather, to our own health.  We can choose to change the things that we can, while embracing the unchangeable.

When I set out to restore my health four years ago, that’s exactly what I did.  Maintaining it simply takes making those same choices, daily.  It really does come down to recognizing that there is a space between the circumstances and our response, where we have the power to choose.

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.

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:

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

Another Client Journey — freedom from food addiction

After reading the journey of one of my clients, “J” asked if she could tell her story. I thought it would be good for others to hear of her past struggles with disordered eating and how she came to realize she was a food addict. This is “J”, in her own words.


“I could not stop eating. I ate in secret and until I was ill. I repeated this behaviour over and over again, despite the negative consequences. For 20 years of my life, from the age of 9 to the age of 29, I struggled with food addiction, disordered eating, obesity, and yo-yo dieting. My mind was incessantly focused on one of three things:

      • what I was going to eat
      • how I was going to keep myself from eating, or
      • how to compensate for what I had eaten

In addition to disordered eating and food addiction, I faced severe depression and ADHD.  I isolated myself, struggled with exhaustion, and was unable to focus on my work. I frequently wished I had not been born, or that my life would end.  I attempted numerous diets and attended eating disorder treatment programs, but was unable to stop my binge eating and associated compensatory behaviours for any significant amount of time. Twice, I successfully lost approximately 70 pounds but on both occasions, I gained back all of the weight back, and more.

Approximately two years ago, I reached my highest weight of 250 pounds and decided to make one more attempt to lose weight, and began researching low-carbohydrate and ketogenic diets. Through this research, I discovered books, articles, and podcasts about food addiction. As I read and listened, I became certain that I qualified as a food- and sugar addict. I learned that sugar and flour are addictive substances and decided to remove them from my diet. I searched the internet for a dietitian who could help me to formulate a meal plan that eliminated the foods that I found addictive. I discovered The Low Carb Healthy Fat Dietitian’s website and contacted Joy Kiddie to schedule a Complete Assessment Package. Joy developed a meal plan for me that excluded the foods that were addictive for me and which allowed me to feel satisfied and energized, while losing weight. For the first time, weight loss did not feel like work.

I have so many reasons to recommend Joy as a dietitian. She supports me in my health, weight loss, weight maintenance, and sugar addiction recovery goals while also understanding and taking into consideration my history of disordered eating. She provides me with much-needed accountability. I am able to troubleshoot any challenges I am having with my health or weight loss, and she helps me adjust my meal plan to address these issues. Joy is incredibly knowledgeable about food and nutrition, and is a dependable support in my life.

I have lost well over a 100 pounds, and am a normal body weight and a waist circumference. I am so thankful for my weight loss, and my improved physical health. Even more importantly however, my depression has been significantly better, and I am truly enjoying life. In addition, my ADHD symptoms have greatly decreased, and my mental capacity has significantly improved. For the first time in my life, I can complete my work with little procrastinating.

I have been profoundly blessed and am so thankful for the role that Joy has played in my healing journey. I know there are many others who struggle with food addiction, and I hope my story provides some hope.”

 


og:imageI feel it is important to add that as a Dietitian, I do not specialize in food addiction or disordered eating — but I do help with the “eating end” of things for those who are getting support for these issues through other means.

Some people with food addiction find a 12-step group helpful, while others prefer individual counselling with a trained food-addiction counsellor. Many do both.  Whatever works best for them is fine with me. I am only a part of their recovery process.

While it is a sensitive topic, I am mindful that for some with a background of disordered eating, a “keto” diet can sometimes be another form of food restriction. When it makes sense to achieve clinical outcomes, I may choose to use a low carb diet, rather than a keto diet if I am concerned that food restriction may be an issue.

I do not encourage food restriction except when it comes to person’s specific “trigger foods” that have been identified in their process of their recovery, and for those with a disordered eating past, this sometimes takes some negotiation.  While weighing and measuring food is not what I want for the majority of my clients, many food-addiction counsellors do recommend this and  I am happy to support my clients in this way.  

NOTE: Just like I am in remission of T2D and HTN, I believe that people like “J”  are in remission of food addiction and disordered eating. We aren’t “cured”.  It is my belief that for both of us to remain in remission requires us to keep walking in what enabled us to get there in the first place, one day at a time.

More Info?

If you would like more information about my services, please have a look on the tab above, or 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.

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.

One Client Journey – down over 200 pounds

Introduction: It’s been almost three years since I started working with my client Karen D. in February of 2018 and in that time she has lost over 200 pounds. Yes, two hundred pounds!

When she came to see me the first time, I was only one year into my own weight-loss and health-recovery “journey”,  and was still very much overweight and metabolically unwell, but had come to understand from the scientific literature that a well-designed low carbohydrate diet was both safe and effective for weight loss, as well as for helping put some metabolic conditions into remission.  

In April 2019, Karen private messaged me on social media and sent me a photo of herself, after she had lost 150 pounds. It was both delightful and very rewarding to receive this from a client and to see that she had continued to apply what she had learned, and was doing exactly what she set out to do. She gave me permission to share it on social media with only her first name and initial of her last name, which I did. All people knew is that this was what one client had accomplished in a year.

Last week instead of private messaging me an update,  Karen decided to post a compilation photo of herself under one I had posted of myself on Facebook.  Even though I had not spoken to her in over a year, there was her picture for everyone, including me, to see! Wow!! Karen had lost more than 200 pounds, and had every reason to be proud of her accomplishment! 

In response to her initiative to share her progress publicly on Facebook, I ask Karen if she would be willing to tell her story in her own words from a client perspective and she agreed — and her reason for doing so is this;

“I don’t want others living the same life I was stuck in”.

So, if you think you can’t “do it” and that your weight loss goals are “impossible”, this post is for you.

This is one client story. This is Karen’s journey.


Karen D. – January 2018, 440 pounds

“I started keto on my own in January 2018, but it really stressed me out. There is so much information ‘out there’, and everything contradicted itself. It didn’t make sense to me. Macros, IF, fat bombs…..even in my coffee. Seriously, don’t mess with my coffee.

I needed help!

In one way I felt ‘lost’, but I did know that not eating lots of “complex carbohydrates” was right for me. I knew that keto was the right option, but this high fat thing scared me, largely because of my history of having had eating disorders since I was 12 years old.

There was something about this way of eating that made me feel like I had control over food for a change, instead of food having control over me but I didn’t feel like I grasped it enough to be successful.

I researched dietitians that specialized in low carb eating, as I’d seen dietitians before that just pulled out the Canadian Food Guide and told me to eat oatmeal for breakfast. I came across Joy.  Boy did I get excited! You see, I have severe anxiety and always feel like I’m doing something wrong. When I tried to do keto on my own, it was hard to know if it was wrong, or I just felt it was. I needed clear answers and directions.  And I was desperate. I had to loose weight.

I started at over 440lbs, last time a scale was able to weigh me. I’d been successful at loosing some weight on my own since January but I was on a mission. I was going to do it this time. For me, for my kids, for everything I had. The prospect of working with Joy meant clear answers to my questions, directions on how to really achieve my goals, and SUPPORT! I was going to have help, and not have to try to figure this out myself!

How I felt leading up to seeing Joy (from my Facebook)

Leading up the appointment was nerve racking for me. As a morbidly obese person, you get used to being told how far gone you are and how your health is at jeopardy.  Just asking for help sometimes is scary as you don’t know how judged you are going to be. I had so many questions that I wanted to ask, and was just hoping I’d really be “heard”.

My biggest question as a client was “why do I have to eat so much fat?” Is that really necessary?

And my second big question as a client was “do I really need to track my macros?” because that flares up my eating disorders.  I end up punishing myself if I see how much I’ve actually eaten.

It was the day of my appointment and I arrived at Joy’s office. She greeted me so warmly. Off to a good start. Honestly, the first bit is a bit of a blur as my anxiety was pretty high. I remember us talking about my health,  my back, my fibromyalgia, my families health diseases.  But I also remember how encouraging Joy was about the success I had already accomplished on my own. She was excited for me. I was freely able to talk about my eating disorders and we were able to come up with solutions with my meal plan to help me, not freak out over the calories and macros! And we discussed ‘fat’. Enough fat for flavor,  enjoy your food, have that piece of avocado, but I had enough fat on me that my body will take that for fuel. It was not necessary to eat high fat.

[more info about that here]

Joy put together a meal plan for me that made sense and that eased my fears as her client. She explained to me what my body needed, and I needed her explanation. It gave me ‘permission’ not to have to eat all that fat, and I was able to get my head to wrap around this way of eating. Now it made sense. I had the tools and I had the backup!

When I started seeing and feeling the results, it created the motivation to continue. 

This is me after I lost the first 50 pounds.

June 1, 2018, down 50 pounds

 

 

 

 

 

 

 

 

And this is what I wrote on my Facebook:

Eating low carb is a very anti-inflammatory way of eating, so my body just started to feel so much better without all the sugar.  I was starting to see huge changes in the way my body moved and looked. I was experiencing amazing non-scale victories that just kept me driven to keep going and wanting more.

January 1, 2019, down 100 pounds

It wasn’t always easy. Sure, there where set backs and temptations. It took a great mind-change to see things differently.

 

 

Karen D. down 150 pounds January 2018 – April 25, 2019

I didn’t make alternative foods. Didn’t try to find alternative to chips and rice and pasta. I just didn’t eat them anymore.

If I accidentally ate an ingredient that wasn’t keto friendly, that didn’t mean I ruined my whole day and should start over tomorrow. It just meant one bad thing went in my mouth.

Same as if I gave into temptation.  “Give yourself a break“, I would say to myself. “We aren’t perfect,  don’t make your success suffer because of one small stumble. Why start over tomorrow when you can continue today?”

This is me today.

I’m passionate about this because I’m working on my journey, and it has changed my life.

I went from being bed-bound for sometimes weeks at a time, to living a full life now.

I’m working hard to regain my life to the fullest and know that it is something that is possible for anyone who wants to do it.

I still have a bit to go before I’m at my ideal weight, but I can see the finish line. I’m going to be there soon.”

~ Karen D, January 3, 2021

A picture tells a thousand words (January 2018 – January 2021)

More Info?

If you would like more information about my services, please have a look on the tab above, or 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.

Too Much and Too Little is Killing Us- reducing comorbidities

I just got “the call” that my mother who lives on the other side of the country, has tested positive for Covid-19. She has all of the major comorbidities, so prognosis is not good. Following the news, most of us know that age, obesity, hypertension and diabetes are known to significantly increase the risk of requiring hospitalization and death from Covid-19 (you can read more about that here, here and here), yet all but one of these comorbidities can be put into remission.  We can’t change our age, but we CAN reduce our weight, lower our blood pressure and normalize our blood sugar. To improve our quality of life outside of the pandemic, and to have the best chance of fighting it off if (or more likely when) we get it, we need to put our energy into achieving a normal body weight (and waist circumference), blood pressure and blood sugar now.

I am from a family of people that always ‘battled with their weight’.

My dad was tall and very fit when he was younger, a boxer and a ski-jumper but as he aged he accumulated excess weight around his middle. He then developed type 2 diabetes, high blood pressure and heart issues and eventually was diagnosed with Alzheimer’s disease, which is sometimes referred to as ‘type 3 diabetes’ by some clinicians. I wrote this article about that when he was first diagnosed.

My dad died just a few weeks shy of his 91st birthday, which is a ‘ripe old age’ of course, but for the last 40 years of his life, he was not in good health. He took multiple medications; due to multiple metabolic conditions related to his diet and lifestyle. Except for his age, many of these conditions could have been put into remission — or at very least, been much better controlled with a change in diet and lifestyle.

My mom will be turning 85 this fall, and has been overweight since I was little. She too has type 2 diabetes and takes multiple medications for various conditions, many related to diet and lifestyle; conditions which could have been greatly improved, if not put into remission with a change in diet and lifestyle. It wasn’t for lack of trying “diets”. When I was young, she weighed her food, counted points and went to “groups” and at times she lost weight, only to put it all back, and then some. Eventually, she stopped trying. I can’t say that I blame her, given what I now know about the drivers to hunger.

Shared comorbidities

When I became overweight and then obese, and developed type 2 diabetes and high blood pressure, I justified that I was at high risk since both of my parents had the same.  I realize now that the “high risk” was our shared diet and lifestyle, more than genetics. Our shared comorbidities were adopted.

I grew up loving to eat good food and unfortunately considered food as both a reward, and a comfort. When someone was happy, we celebrated with good food. When someone was sad, we consoled with “comfort food”.  Food was “medicine”, but not in a good way. It didn’t heal, but contributed to the underlying hyperinsulinemia that drove the disease process. (I’ve written several articles about this topic, but if you only want to read one, I’d recommend this one.)

Those who have followed me for some time know that 3 years ago I began what I call my “journey”.  It took almost two years to do, but I lost ~60 pounds and a foot off my waist and I put my dangerously high blood pressure and uncontrolled type 2 diabetes into remission, as a result.  I recently posted a summary here, to mark my three year health recovery anniversary; two years of active weight loss and a year of maintenance.

Left: April 2017, Middle: April 2019, Right: April 2020

So why am I writing this post?

Like many people, I am upset by this whole “Covid thing” — not just because of my mom being diagnosed. I’ve been following the news, and realize that the hope for a vaccine any time soon is dim, and effective treatments are still lacking. An article published in the journal The Lancet the other day reported that while ~90% of those who have been hospitalized with severe Covid-19 develop IgG antibodies in the first 2 weeks, in non-hospitalized individuals with milder disease or with no symptoms, under 10% develop specific IgG antibodies to the disease.  That means that except for the sickest people who actually survive being hospitalized for several weeks with Covid-19, more than 90% of people who get Covid-19 and recover outside of hospital don’t develop antibodies to this virus [1]. Since the whole purpose to develop a vaccine is to challenge the body to develop antibodies to the virus — the very fact that most of the time people who don’t get that sick don’t develop antibodies, means that the likelihood of most people developing antibodies to a vaccine may be minimal.  As well, in light of this data herd immunity is also a dim prospect because most people that get this disease don’t produce antibodies, which means they aren’t immune and can probably get this virus again.

With little immediate hope of an effective vaccine or of herd immunity, what CAN we do to lower our risk?

I think that we first need to realize that many experts believe it is simply a matter of time until we are all exposed to the SARS-CoV2 virus and develop Covid-19, so we must look at lowering our risk of having a poor outcome. We can’t change our age, which is the biggest risk factor but we CAN do something to change the high risk comorbidities such as obesity, high blood pressure and diabetes.

Too Much and Too Little is Killing Us

For many of us, having both too much and too little is killing us.

We have diets with way too much refined carbohydrate, usually combined with large amounts of refined fat, and our usual diet is full of these in the form of pizza, pastries, take out foods and snack foods.  We now know from a study that was published almost 2 years ago[2] that this combination of both refined carbs and fat results in huge amounts of the neurotransmitter dopamine being released from the reward centre of our brain — way more than when we eat foods with only carbohydrate, or only fat separately. This huge amount of released dopamine results in us wanting to eat these foods, and craving these foods, and being willing to pay more for these foods than foods with only carbs or only fat [2]. Dopamine makes us feel good, and is the same neurotransmitter that is released during sex and that is involved in the addictive ”runner’s high” familiar to athletes. This is one powerful neurotransmitter! It is this dopamine that is driving why so many people on “lock-down” have turned to baking bread and pastries for comfort, and buying snack foods with this same combination once they finally get through a long line to get into a grocery store! 

Too much of these refined “foods” is contributing to 1/3 of Americans and 1/4 of Canadians being obese, and another 1/3 in both countries being overweight. These foods are driving the hyperinsulinemia that underlies many metabolic conditions, including type 2 diabetes and hypertension.  These diseases were killing a great many of us before Covid-19, but knowing that these comorbidities increase our risk of hospitalization and death when we get the virus, why don’t we consider limiting these? I think it is because eating these foods make us feel good and so we self-medicate our stressful lives with something that is socially acceptable. High carbohydrate and fat foods are much more socially acceptable but what will it take for us to see that this for what it is and to consider that we need to change how we eat. If we aren’t willing to admit that our obesity, high blood sugar and high blood pressure are a problem, then maybe we are simply in denial. I certainly was, and wrote about this in “A Dietitian’s Journey”, the account of my own health recovery.

No, I am NOT saying that “all carbs are evil” and I’ve written about this previously, but we need to differentiate between what most of us eat as “carbs” and whole, real food that have carbs in them. I believe we need to eat significantly less of the refined foods that are contributing to our collective weight problem and metabolic health issues, and eat more of the real, whole foods that have gone by the wayside in our diet. I’ve written about the science behind this type of dietary change in many previous articles, and that eating this way is both safe and effective. What I can’t do is motivate people to want to change.

It is my hope that by presenting the evidence, as I have in several recent articles posted on this website that comorbidities such as obesity, hypertension and diabetes are significant risk factors to requiring hospitalization or of dying of Covid-19, that it may motivate some people to consider making some changes. If not now, when — especially given that the hope of a vaccine and/or herd immunity is likely a long way off.

I wish each of you good health and a long life.

If I can help, please let me know.

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 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.

Reference

  1. Altmann DM, Douek D, Boyton RJ, What policy makers need to know about COVID-19 protective immunity, The Lancet, April 27, 2020, DOI:https://doi.org/10.1016/S0140-6736(20)30985-5
  2. Di Feliceantonio et al., 2018, Supra-Additive Effects of Combining
    Fat and Carbohydrate on Food Reward, Cell Metabolism 28, 1—12

 

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
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.

Two Clinical Reactions: seeing the possibilities or being a pessimist

Yesterday, a client of mine who was on insulin 13 weeks ago and who went off of it with her Endocrinologist’s knowledge and oversight to follow a low carbohydrate diet had her regular two-month follow-up visit, where she saw both the Dietitian and the Endocrinologist. Their respective reactions to her progress really highlights how some clinicians can be transformed by seeing the clinical possibilities of what can be accomplished by someone following a well-designed low carbohydrate diet, whereas others remain pessimistic regardless of the clinical evidence.

This is the 4th article about this young woman’s incredible progress from injecting insulin to following an individually designed low carbohydrate diet. You can read about the first two weeks at the start of her journey here, about her achieving normalized blood glucose in 10 weeks here, and about here achieving target HbA1C in less than 12 weeks here.

NOTE: The different reactions that these clinicians had are in no way reflective of their respective professions; it could have easily been in reverse. It could have been entirely different healthcare professions. There are clinicians in every field who are willing to consider emerging evidence and respond by being open to the clinical possibilities, and there are others who are not.


When this young woman arrived for her appointment, she saw the Dietitian first, which was the same one that she saw the visit before, and who told her that she should be eating ‘60 g of carbohydrate per meal plus snacks’ (see Sept 6 update, here). At yesterday’s visit, the Dietitian only looked at her blood glucose numbers from the last two weeks and not the last 8 weeks since she was last seen. She said her ‘numbers look good’, and asked the name of the Dietitian she was seeing, and my client told her my name.  She responded and said “I hope she told you that you can’t get your numbers under 7 with just Metformin“. My client pointed out that she recently got TWO fasting blood glucose of 4.7 mmol/L, and the Dietitian said she didn’t see that. My client pointed out the two dates where she did, to which the Dietitian said nothing, as she was only considering the numbers from the last two weeks. My client said to me that at this point, she “just shut down” and waited to see the Endocrinologist.

My client then saw her Endocrinologist who had a medical student with him. This is the same Endocrinologist that told her 8 weeks ago that it was unrealistic for her to think that she could lower her HbA1C to below 7 mmol/L following a low carbohydrate diet, and that she should go back on insulin (see more here). The endocrinologist said to her yesterday “these numbers are amazing! What are you doing?”. My client responded by saying she was following a low carbohydrate diet designed by me. He also asked her who her Dietitian was, and my client told her my name.  He said “it would be great if you could get those fasting blood glucose numbers under 7 so keep doing what you’re doing”.  He then added, that should my client get pregnant, that he “might need to talk to her about taking insulin, if she doesn’t continue to eat a low carbohydrate diet”. He added, “you are going down the right path. Keep doing what you’re doing!”.

The contrast between the reactions of these two clinicians is striking. As I said above in the disclaimer, it has nothing to do with their respective professions, but about their willingness as individual clinicians to be open to different clinical possibilities, in light of the evidence. Some are, and some aren’t.

As a Dietitian, I wonder how the advice to someone with type 2 diabetes to “eat 60 g of carbs per meals plus snacksandget fasting blood glucose under 7.0 mmol/L” can be reconciled without prescribing insulin. I don’t see that it can be. It is still expected that “Diabetes is a chronic, progressive disease” and it need not be.

By recognizing a low carbohydrate and very low carbohydrate (keto) diet as two of the options of Medical Nutrition Therapy in the treatment of diabetes (both type 1 and type 2), the American Diabetes Association (ADA) has opened the way for Diabetes to NOT be a chronic, progressive disease! (For more information about the policy changes at the ADA, you can read any one of several articles from April 2019 that are posted under the Science Made Simple tab above, including this one.)

As to the belief that “you can’t get your blood glucose under 7 with just Metformin”, people with type 2 diabetes routinely have fasting blood glucose well under 7.0 mmol/L (126 mg/dl) following a well-designed low carbohydrate diet — both with and without Metformin, and clinicians should be current with the literature to know this. In fact, in the April 2019 Consensus Report on Diabetes and Pre-Diabetes the ADA said;

Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences.”

The ADA’s Guidelines do not apply in Canada, but as healthcare professionals, we need to know they exist.

We also need to know that at their annual National Conference, hundreds of Certified Diabetes Educators (CDEs) in the US were recently taught to use a low-carbohydrate diet and a very low carbohydrate (ketogenic) diet as Medical Nutrition Therapy with people with both type 1 and type 2 diabetes, as well as how to manage the many medications prescribed for people with diabetes (you can read about this in this post and this one). As clinicians we need to be aware that a low carbohydrate and a very low carbohydrate (keto) diet are both safe and effective for those with Diabetes, even if it is not public policy in Canada yet.

There are plenty of peer-reviewed studies demonstrating the safety and effectiveness of a well-designed low carb or ketogenic diet for weight loss, as well as for normalizing blood glucose and blood pressure. Many have been reviewed on this site (for more information, please click on the For Physicians & Allied Health Providers tab above).


As I’ve done in previous articles about this client’s progress, I asked her on our weekly call to write in her own words what her visit was like yesterday. This is what she wrote;

“I was excited for my Endocrinologist to see my lowered A1C number and decreasing blood glucose numbers. I went into the appointment knowing that I would see the Dietitian first to review my numbers. She mentioned that the numbers were better, but my fasting glucose was still not ideal. I discussed that they are definitely coming down, although I realize they are not where they should be, and I even got a few under 7 in the past month. This Dietitian was only interested in the past two weeks and mentioned that Joy would not be able to enable me get my fasting glucose under 7 with just Metformin. Seeing the Dietitian really shut me down to discussing anything further with her. I let her gather her information and wanted to move on to my Endo.

Seeing my Endo was a turnaround. He was so amazed with my results, especially with my A1C having come down so much, that he encouraged me to just keep going. I felt so proud and encouraged. He gave me the motivation I was looking for and now I am ready to continue down this path to show him (and that Dietitian!) that it can be done without insulin.”

She has every reason to be proud of her accomplishments! She has been very intentional; about what she eats, about testing her blood sugar and in tweaking the timing of her Meformin.

If you would like more information about my services, please have a look 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

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 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.

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Achieving the “Impossible”: from injecting insulin to achieving target HbA1C

A few weeks after requesting that her endocrinologist take her off insulin so that she could begin a low carbohydrate diet with his and her GP’s oversight (article here), this young woman was told she needed to get her HbA1C to ≤7.0%, which is the therapeutic target for adults with type 2 diabetes. She was told that it was unrealistic for her to think that she could do so following a low carbohydrate diet, and that she should go back on insulin.  She replied that she wanted to continue to eat a low carbohydrate diet for a total of 12 weeks, and her endocrinologist replied that more than likely he would need to put her back on insulin then, because it was not realistic for her to accomplish those goals using diet, even with Metformin support.

*Metformin doesn’t lower blood sugar, but helps the body become more insulin sensitive and to keep it from manufacturing glucose from stored fat or protein which is what underlies high morning blood sugar.

Well, she achieved the “impossible”!

She had her blood tests yesterday and when she checked her results on-line last night she could not believe it!! Her results were below the 7.0% therapeutic target. . . and this was (1) despite me starting her on a moderate low carbohydrate diet for the first several weeks and only gradually lowering carbohydrate content in order to meet clinical outcomes*, and (2) despite her having two weeks of weddings in mid-July where she ate a little ‘off-track’, which caused her blood sugar levels to rise).

In spite of these, she did it!!

Note: weight loss was only ~5% of her original weight, so would not account for her significant improvement in HbA1C results.

Here are her results:

from injecting insulin to HbA1c within target

*I was asked on social media after the previous update on her progress why I didn’t start this young woman on a very low carbohydrate, ketogenic diet from the outset. This is what I replied; “Diabetes Canada has not (yet?) deemed a LC or very LC diet as safe and effective medical nutrition therapy. I start people at 130 g of carbs, then reduce carbs as necessary to achieve clinical outcomes as a prudent approach. Hence why I conclude the article w/ hope of future policy change.

After this young woman picked up her blood test results last night, she sent me this short email which I have her permission to share here;

“JOY!!!

Such overwhelming feelings right now. We will talk tomorrow but I took my blood test today and have attached the results! Please tell me I am seeing the number I am seeing because it is hard to believe! Also, for the graph this week, I had to change the minimum limit from 5 to 4 to account for my TWO readings of 4.7!! “

As relayed in the second article about her progress (posted here), in 10 weeks this young woman went from a fasting blood glucose of 16.8 mmol/L (303 mg/dl) to 4.7 mmol/L (85 mg/dl). . . and this past week she had her second fasting blood glucose reading of 4.7 mmol/L! Twice in one week, she achieved normal fasting blood glucose numbers; the first time since being diagnosed as having type 2 diabetes in 2017.

As she said in the previous article, she is “invested” in her health and that investment translated to her own determination and hard work to follow her Meal Plan, to speak to her endocrinologist about adding an extra dose of Metformin at bed-time, and to determine when was the best timing to take her before bedtime dose and her early morning dose, in order to prevent her blood sugar from spiking in the morning due to Dawn Phenomena. Yes, I helped but she did the work! 

I asked her to write in her own words what it was like to get her blood test results last night, and this is what she wrote:

“I feel so happy and proud of myself. Patience and consistency has paid off.

Typically, if I were doing this on my own or changing how I was eating, I never stuck with it long enough to see changes.  The number on the scale or one bad meal would take me further back than when I started.  However, keeping track of my blood sugars and being accountable to someone have kept me going, and I feel like nothing can hold me back now.

I am so motivated to keep going and giving myself time to progress. I know I can do this!”

I am so proud of her hard work and accomplishments!

I look forward a day when Diabetes Canada updates its Clinical Practice Guidelines to enable clinicians to recommend a low carb or ketogenic diet as a therapeutic option for those with diabetes ⁠— just like the American Diabetes Association (ADA) did last year.

For more information about the clinical changes at the ADA, you can read any one of several articles from April 2019 that are posted under the Science Made Simple tab above, including this one.

UPDATE (Sept 6, 2019): During our weekly call, this young woman told me that she is meeting her endocrinologist this week and is looking forward to his reaction to her accomplishments, as well as that of his diabetes nurses.  She said during her last visit 8 weeks ago (4 weeks after coming off insulin and beginning a low carbohydrate diet) her doctor told her that she is ‘not eating rice and needs to be eating that’ and reminded her that the ‘insulin will cover that’.  The diabetes nurse also told her ‘she should be eating 60 g of carbohydrate per meal plus snacks’ (which is still the recommendations for those with diabetes in Canada). She assured them that she is carefully monitoring her blood sugar multiple times per day and that they are coming down, and she feels great.

If you would like more information about my services, please have a look 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

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 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.

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From Injecting Insulin to Normalized Blood Sugar – in 10 weeks

Ten weeks ago, with her endocrinologist’s knowledge, this young woman discontinued insulin to begin a low carb diet. She has been gradually achieving normalized blood sugar, but this morning she had her first totally normal fasting blood sugar level since being diagnosed as type 2 diabetic! How cool is that?

As relayed in the first part of this account (posted here), at this young woman’s insistence her doctor gave her 12 weeks to ‘try a low carb diet’ and then he would put her back on insulin.  Needless to say, he was not optimistic that changing her diet would ‘work’.

When she saw him a few weeks after beginning a low carbohydrate diet, and after lowering her fasting blood blood sugar from 16.8 mmol/L (303 mg/dl) to approximately 7.5 mmol/l, he told her that that the only way she could get her blood sugar below 7.0 mmol/L was to begin injecting insulin again. She responded by saying that she was not even half-way through her 12-week “trial period” and that she wanted to continue. As a result of her on-going “dawn phenomenon” (and upon my recommendation) she asked her endocrinologist to add an extra dose of Metformin* at bed-time to prevent her liver from making so much glucose in the morning (via gluconeogensis) and while he agreed, he said that if her HbA1C was not below 7.0 mmol/L (126 mg/dl) the next time she has it checked, he was putting her back on insulin.

*Metformin does not lower blood sugar, but helps the body become more insulin sensitive and to keep it from manufacturing glucose from stored fat or protein which is what underlies high morning blood sugar.

This coming week she is having her 3 month blood work and she and I both realize that it is unlikely her HbA1C will be below 7.0 mmol/L because there was a two week period this summer where she had several friend’s weddings, and got off-plan a bit. While she was quite disciplined, a few things she ate that were low glycemic index complex carbs still caused her blood sugar to rise above the levels she had been achieving. She got right back on plan after the weddings, and has been doing absolutely amazing! I am so very proud of her!

Here is a graph of her blood work over the past 10 weeks, including the ‘blip’ in the middle from the weddings;

From injecting insulin to normalized blood sugar in 10 weeks

She is not “there” yet, but this week she began having much less variation in blood sugar and the graph continues to be shifted downward. She is doing so well.

She has begun delaying the first meal of the day to noon because she doesn’t feel hungry in the morning, and is making extra effort to try different timing for taking her late-night and early-morning Metformin, so as to maximize the reduction in fasting blood sugar from dawn-phenomena (gluconeogenesis). This morning, while we were on our weekly Skype call, she took her blood glucose. 4.7 mmol/L (85 mg/dl)!  This was her first normal early morning glucose since being diagnosed as being Type 2 diabetic in 2017!! I asked her to hold the meter up to the screen and took a picture of it!

Note: I’ve edited out her name and made the numbers a bit more readable.

In just 10 weeks, this young woman has gone from a 2 hour post-meal glucose reading of 18.7 mmol/L (337 mg/dl) to between 6.5 mmol/L (117 mg/dl) and 7.9 mmol/L (142 mg/dl).

The normal “goal” for 2 hour post-prandial glucose for someone with type 2 diabetes is ≤ 7.8 mmol/L (141 mg/dl) and in just 10 weeks, she is already doing considerably better than that!

As I did in the first post about her progress, I asked her to write in her own words what it has been like and how she feels.  This is what she wrote today;

“I have been working together with Joy for close to 3 months now and I am amazed at the progress being made. Monitoring my blood glucose levels consistently has given me more insight into how and when I should be eating and taking my medication. This is key to the progress that I have made. There have been highs and lows, with life and weddings getting in the way, but getting back on track from any deviation is crucial. Knowing that I was accountable to Joy and my blood glucose monitor motivated me to get back to those lower numbers.

With the guidance of Joy, I have adjusted the timing of my Metformin and made tweaks to my diet which will help lower my numbers and prevent spikes. I found that I was not hungry in the mornings and all I needed was my coffee, so I pushed my first meal to lunch and my second meal has been dinner. My cravings have been close to eliminated and I don’t feel the need to snack between meals.

The biggest issue has been my increased fasting glucose due to the dawn phenomenon. To avoid a nightly prescription of insulin (which I never want to take again), I have been invested in figuring out when the nighttime spike is occurring and how I can adjust the timing of my Metformin to minimize it. For the past couple of nights, I have been checking my blood glucose levels every 1-2 hours, and have narrowed down the time at which the spike occurs. This investigation has lead me to my lowest ever fasting glucose reading today of 4.7!!! This is a number I never thought I would see. I couldn’t believe it. I still can’t believe it. I keep checking to see if I read the number wrong but there it is every time!

This has been a slow and steady road, but being consistent and invested in my health is starting to pay off. It has all been worth it and I cannot wait to see what the next 3 months bring!.”

Note: This is what only one person has been able to achieve following a well-designed low carbohydrate diet the last 10 weeks, but these results are quite consistent with Virta Health‘s 10-week results from their outpatient study with 238 subjects published in October 2017 and outlined in this post.

Post-publication addendum (August 23, 2019): I was asked on social media yesterday why I didn’t start this young woman on a very low carbohydrate, ketogenic diet from the outset. This is what I replied; “Diabetes Canada has not (yet?) deemed a LC or very LC diet as safe and effective medical nutrition therapy. I start people at 130 g of carbs, then reduce carbs as necessary to achieve clinical outcomes as a prudent approach. Hence why I conclude the article w/ hope of future policy change.


I partner with people’s GPs and Endocrinologists to enable them to oversee reduction and de-prescription of injected insulin (or other medications that may result in low blood sugar when following a low carbohydrate diet) while their patients follow a well-designed low carbohydrate diet to effectively manage their blood sugar. It is fantastic to see people such as this very determined young woman replicate what hundreds have done under the care of knowledgeable clinicians and as published in an ever increasing number of peer-reviewed studies.

It was so exciting to recently witness hundreds of CDEs in the United States being taught how to use a low-carbohydrate diet and a very low carbohydrate (ketogenic) diet as medical nutrition therapy with people with both type 1 and type 2 diabetes and how to manage the many medications prescribed for people with diabetes (you can read about these two presentation in this post and this one)!

I long for the day that Diabetes Canada releases an update to Clinical Practice Guidelines similar to what the American Diabetes Association (ADA) did last year, which enables clinicians to recommend a low carb or ketogenic diet as a therapeutic option for those with diabetes.

For more information about the clinical changes at the ADA, you can read any one of several articles from April 2019 that are posted under the Science Made Simple tab above, including this one.

If you would like more information about my services, please have a look 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

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 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.

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From Injecting Insulin to a Low Carb Diet – the first two weeks

Note: This article is a personal account, and I have written consent from the person whose story this is, to share these details in this article. She hopes it encourages someone. Keep in mind, individual results following a low carb or ketogenic diet vary person-to-person.

At the end of May, a young woman was coming to see me for an assessment appointment, and as I was reviewing her chart in preparation, I noticed that she was taking insulin. It was apparent that she didn’t see the notice on  my web page that I don’t treat Type 1 Diabetics or Type 2 Diabetics on insulin, as I am not a CDE (Certified Diabetes Educator).

Discontinuing Insulin

When she arrived, we discussed some of the options she had, and she decided to go and see her endocrinologist and request that they discontinue her insulin and give her 12 weeks to follow a Meal Plan that I would design for her. She then signed and sent me the Confirmation of Non-Insulin Use Form, indicating that with her doctor’s permission and oversight, that she was no longer taking insulin. To support her in being successful, she decided to book weekly 1/2 hour check ins with me for the following 12 weeks.

Note: If you are taking insulin to manage blood glucose in Type 2 Diabetes or other medications do not attempt to discontinue these on your own, as the results can be very serious. Please read this post titled “Don’t Try This at Home – the need for medical supervision” for more information.

Last Friday was her first follow up appointment and she was very excited to show me her blood sugar results, her first week off insulin.  Here is the graph;

Week 1 - no insulin, low carbAs can be seen, her fasting blood sugar the first morning was 16.8 mmol (303 mg/dl) which went up to 18.7 mmol/L (337 mg/dl) 2 hours after her low carbohydrate breakfast.

The following morning her fasting blood glucose was 12 mmol/L (216 mg/dl) where it stayed more or less for a few days, then dropped to 9.9 mmol/L (178 mg/dl). This was after only one week.

I asked her to speak to her doctor to see if they would be willing to add a dose of Metformin at bedtime, to help control “dawn phenomenon”; the rise in glucose due to gluconeogenesis of the liver.  Her doctor agreed and this week she started that.

This morning was her second follow up appointment and again, she was so excited to show me her blood sugar results.

As can be seen, her fasting blood sugar the first morning of the second week was 10.8 mmol (195 mg/dl) which hardly went up at all to 10.9 mmol/L (196 mg/dl) 2 hours after her low carbohydrate breakfast.

The second morning of the second week, her fasting blood glucose was 9.2 mmol/L (166 mg/dl). The rest of the week, her morning fasting blood sugar ranged from 8.4 mmol/L (151 mg/dl) to 9.6 (173 mg/dl) where it stayed. This was only her second week off insulin.

Moderate Low Carb (not Ketogenic) Diet

Understand, that this young woman (aged 33 years of age) achieved these results eating a moderate low carbohydrate diet of 130 g of carbs per day — which is no where near the level of 25-35 g per day that most women would need to be at in order to be in ketosis, and she has been Type 2 Diabetic since 2017.

2 weeks graph – June 8 – 20, 2019 – moderate low carb diet

Here is the graph of her first two weeks of blood glucose results, tracked at fasting, before a meal, and 2 hours after a meal. The steady, linear drop is quite apparent.

She saw her GP yesterday and he is thrilled with her progress! He agreed to provide her with a requisition to do the fasting insulin that I requested, along with a fasting blood glucose and HbA1C — which we have agreed together to have re-run in 3 months, at the end of the 12 weeks.

For this week, no changes are being made in the number of carbs she is eating, however this may be adjusted in the future in order to achieve clinical outcomes.

These results speak for themselves in terms of the effectiveness of a  moderate-low carbohydrate diet to significantly lower blood sugar, as well as the adjunct treatment with Metformin, largely to control early morning gluconeogenesis.

These results also speak to the incredible benefits of her having the support of a healthcare team; me designing and monitoring her Meal Plan and her GP overseeing her care, along with her Endocrinologist.

In two weeks she will see her Endocrinologist again and she (and I!) are looking forward to hearing their response to her progress at that point in time. Given her results the first two weeks, I am confident that she will have much to be proud of!

When I asked her to send me her written consent to share these details in a blog article, I ask her to say a few words about what it was like for her to go from injecting insulin to control her blood sugar, to eating real, whole food to do it — and achieving these types of results.

This is what she wrote;

“I had done so much research into diet and lifestyle changes for Type 2 diabetes as I did not want to go on insulin. Prior to starting on insulin, I was put on Metformin and given the chance from my endocrinologist to change my diet. There was so much information about a low carb diet and its positive effect on blood sugar, so I gave it a try. It could be that I was overwhelmed, but I followed what I believed to be a low carb diet and did not see any significant changes to my blood sugar levels. They were all over the place with huge spikes, even when I would have zero carbs. Clearly something was not right. It gave me no motivation to continue and really made me feel defeated.

I knew I needed help and the only answer my endocrinologist gave me was a prescription for insulin.

I started insulin and was on it for 2 weeks without seeing any significant changes in my blood sugar levels again. This was not working.

So I decided to look for help on the nutrition side of it. Then I found you, Joy Kiddie. I read a little bit about your journey and it inspired me that you have been in my position and therefore would understand my challenges. Your journey gave me hope that there is still something that can be done. Meeting with you was even more of a motivation because you wanted what I wanted; lower A1C and more importantly, no insulin!

These past two weeks, following your guidance and eating a LCHF diet the right way, has been eye opening. I never thought I would get results like this in such a short time.

I used to hate checking my blood sugar levels and poking my poor fingers just to see a discouraging number. Now, I could check all day long because I see numbers that I never thought I would.

Seeing the levels come down and that linear decline in the graph just encourages me to continue down this path and work with you to create a healthier lifestyle.

I cannot wait to see what next week brings!”

For the last 4 years I have been working with those with Type 2 Diabetes and seen so many significantly improve their blood glucose management, and lose weight. Working with this young woman has inspired me to consider learning about insulin management and writing the CDE (Certified Diabetes Educator) certification exam next year while I will  continue to partner with people’s GPs and Endocrinologists (as is my current practice) to wean them off insulin while using a well-designed low carbohydrate diet to effectively manage their blood sugar. The literature, including the studies from Virta Health demonstrate it can be done safely and effectively and the American Diabetes Association recognize both a low carbohydrate meal pattern, and a very low carbohydrate (ketogenic) meal pattern as Medical Nutrition Therapy in the management of pre-diabetes, as well as Type 1 and Type 2 Diabetes in adults.  For more information on this, please see several articles from April 2019, under the Science Made Simple tab including this one.

My hope is that  in the days ahead, Diabetes Canada will arrive at a similar conclusion as the American Diabetes Association, the EASD, Diabetes Australia and others and recognize a low carbohydrate and ketogenic diet as options for those with Diabetes in Canada. Towards that end, I want to be credentialed as a Certified Diabetes Educator in order to be able to support those using insulin.

If you would like more information about my services, please have a look 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

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 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.

 

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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.

 

Both Sides of the Clinical Desk

Introduction: Making Health a Habit picks up where A Dietitian’s Journey left off and provides general health information that can be applied to almost anyone for lowering insulin resistance, keeping blood sugar at a healthy level, maintaining a healthy body weight, or building muscle mass, or may simply be my opinion on different matters related to a low carb or ketogenic diet. Making Health a Habit are short videos (< 5 minutes) or short blogs on health-related topics and are quite different than Science Made Simple articles, which are longer, research-focused articles.

This is the 4th entry in the new series titled “Making Health a Habit”, which can be found here.

This photo was liked 370 times on Twitter and 120 times on Facebook in less than 24 hours, which astounded me.  I think it’s because people can identify with what I looked like on the left. 

I am a Dietitian but I clearly had a “weight problem”. Despite having 2 degrees on the wall that indicate that I should have “known better” I was still obese. While the BSc from McGill in Nutritional Sciences and the MSc from UBC in Human Nutrition gave me tools that I could apply to myself to lose weight,  I found it very difficult to eat a low fat, calorie restricted diet, especially given that all I do all day is talk about food.

Not only was I obese, but I  also had Type 2 Diabetes for 8 years and my HbA1C kept gradually rising, year after year. Like many who are in the same boat, I then developed high blood pressure.

I was a mess.

I was a fat Dietitian.

Then I heard about the therapeutic use of a low carbohydrate diet from a retired physician friend and my life, and my clinical practice changed.  Not right away, of course — but the more I read in the literature about it, the more I became convinced that this was not something I could simply write off as another “fad diet”.

I began using a low carbohydrate approach with some of my clients and then when I was sick enough and tired enough of feeling ‘sick and tired’, I did for myself what I do for others. I designed a Meal Plan for myself. And the rest, as they say, is ‘history’.

The photo below was the result of a whim to wear the same camisole and crocheted top on Friday night that I wore two years ago — just to see the difference when I’d later compare the two pictures.

When I compared them, it was almost unreal.

I used to look like that and what was far worse, was that I was really metabolically sick.

I’m not any more and I think THAT I am not struck a chord with people.

That is why I think it was liked and shared so much in such a short period of time — because people could identify with the process (either because they’ve been through it themselves or because they want to).

Twitter post, April 20, 2019

The whole story of reclaiming my healthy (March 5-2017 – March 4, 2019) is under “A Dietitian’s Journey”. 

In short, I lost 55 pounds, put the symptoms of Type 2 Diabetes into remission and lowered my blood pressure. I did it without being hungry all the time and without taking medication to accomplish it. I did what I teach my clients to do and no surprise, it worked.

I made reclaiming my health a priority.

As I’ve often explained, I did it “as if my life depended on it” because it did.

Yes, I understand the process from both sides of the clinical desk — as a Dietitian and as a formerly obese person with major health issues.

I hope that by having my “fat pictures” out there from the beginning, I’ve encouraged you that I believed in advance that I was going to be successful.  I did.

And here I am.

I haven’t “arrived”.  I am simply making health a habit.

If I can help you do the same, please let me know.

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 ©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.

What To Do if You Think that Green Tea Tastes Terrible

Recently, I came across a social media post about someone that wanted to drink green tea for it’s health benefits, but just couldn’t get over it’s “bad taste”.  I followed the origin of the thread to Reddit, where people guessed whether green tea’s “off taste” for that person may be genetic, like the taste of cilantro. While that can be the case (i.e. genetic sensitivity to a compound called 6-n-propylthiouracil which is found in some flavonoids), others touched on whether it was because the person was making tea using supermarket green tea bags rather than loose tea, whereas a few people hit on the complexity of the issue.  In this post I will discuss some of the factors that affects whether your green tea has a pleasant or “off taste”,  because after all green tea should be something you actually enjoy and not only drink for it’s health benefits.

NOTE: The first part of this article are some personal details of my experience learning to prepare multi-ethnic food and beverages and the second part of the article is specifically about the preparation of green tea and its health benefits.


Once a Foodie, Always a Foodie

I have been adventurous in trying different kinds of food and beverages since I’m little and I remember my parents taking me to an authentic Japanese restaurant even as a kid.  As a teen, I enjoyed cooking multi-ethnic food and learned authentic Cantonese cooking in the 1970s when my mom took a course in Chinatown. In the 1980’s, I learned authentic Thai cooking from the friend of a family business associate who was from Thailand and in those days one couldn’t buy pre-made Thai curry pastes that are available everywhere now, so I sourced the raw ingredients in Lao-Thai groceries and hand-pounded them myself in a mortar and pestle (that I still own and use!). I still have the recipe books sent to me from Thailand.

It didn’t matter whether it was Asian, Middle Eastern or Jamaican, I was a bit of a purist; wanting the ingredients and cooking method to be as authentic as possible. For me, the best way to find out how to make something was to ask someone from that culture that loved to cook.

What was true about food was also true for beverages.

I couldn’t just enjoy a cup of coffee or glass of wine without knowing more. Whether it was the origin of the coffee beans, the length of time the beans were roasted, or how long the water is in contact with the beans — I needed to know, and I was interested in such things when it was not popular either.

Before “West Coast coffee” was a thing and before there ever was Starbucks® or Peet’s, there was a place called La Vieille Europe on St. Laurent Blvd in Montreal which was where I got my single origin, whole bean coffee. As I found out years later, the son of the roaster that owned that store taught the original roaster from Peet’s in the US how to roast beans. Small world.

When I lived in wine country (Sonoma county) of California for a few years in the early 2000s, I was determined to educate my palate to distinguish between different types of wine, which I did. I knew what I liked — which turned out to be an expensive habit when I returned to Canada after 9/11.  At the beginning I explored the wines of Australia and found some I really liked, but missed the delicious and inexpensive  wines of Sonoma and Napa.

Once again, my palate returned to coffee, but finding a decently roasted coffee in Vancouver BC was harder than I thought. Given that this was the “West Coast”, I was discouraged how difficult it was to find good quality Arabica beans that weren’t over roasted. I stumbled across a few small roasters that did an excellent job, but in time they modified their roasts for “local tastes”, so once again, I was back looking for a new roaster. On a few occasions, I ordered from La Vieille Europe in Montreal because in the 40 or 50 years they have been in business, they never lost their passion for properly roasted, single origin coffee.

Over the 20 years I have lived in Vancouver, I discovered the world of quality tea that is largely unknown to most non-Asian born Chinese. There was one excellent tea importer in the Chinatown that I knew of and one that is still in the Richmond Public market that have single origin estate teas that rival the diversity of the best coffee roaster. Over the past 20 years, I’ve explored different types of tea from China and  have come to like a few; my favourite of which is a fermented tea known as Pu-ehr.

A number of years ago, I stumbled across matcha tea in a specialty Japanese store before it was a “thing”.  Knowing nothing about it, I have since found out that I had been using ‘culinary matcha‘ (designed for making Japanese sweets) for drinking.  No wonder it tasted bitter and I needed to blend it with other ingredients to make it palatable. Thankfully, when fresh it had the same health benefits, which I wrote about in 2013 in this article about the Role of Green Tea Powder (Matcha) in Weight and Abdominal Fat Loss. As you’ll read below, I have since learned about making and enjoying real ceremonial-grade matcha, which is intended for drinking from large matcha bowls.

Learning about Japanese Green Tea

At the beginning of this year, I began to explore green teas from Japan when I discovered Hibiki-An, an online tea importer from Uji region of Kyoto. My culinary world expanded once again.

Unable to decide between the many different types and grades of tea that they carry, I order a sampler of 3 types of green teas (Sencha, Gyokuro Superior and Sencha Fukamushi).  They came in 4 oz individual bags — the quantity that can be reasonably be used up within 3 months, when it is fresh.  All 3 teas were all of “superior” grade, which is not the best quality (as my palate is not developed yet) but is a high grade tea.

When the tea arrived, it came with very specific brewing instructions (a summary of the much more detailed instructions on their web page). I’ve since learned that different types of green tea require different water temperatures and different lengths of brewing time.

Wow, who knew?

For the purpose of “cooling” the water to just the right temperature, there is a yuzamashi — which is a small ceramic cup with a spout that the boiled water gets poured into to cool momentarily before being poured into the kyuzu; a special tea pot with a single handle, built in mesh filter and large opening for the water (see photo, above).

You don’t need the get fancy, though.  I had these things for years from my days exploring different regional teas, but one can use an ordinary bowl to cool the water and any plain ceramic tea pot to brew the tea in!

Tea to Water Ratio, Water Temperature and Steeping Time

Each type of green tea has a very specific ratio of green tea leaves to water, and very specific water temperatures and steeping time.

For example, of the three teas in my sample set, Sencha is brewed at 80° Celsius (176 ° Fahrenheit) for one minute, Gyokuro is brewed at 60-70 ° Celicus (140-158° Fahrenheit) for 1 -1/2 to 2 minutes and Sencha Fukamushi is brewed at the same temperature as regular Sencha, but for only 40-45 seconds.

I’ve discovered that following these guidelines using good quality, fresh tea leaves makes a cup of tea that is like nothing I’ve tasted anywhere before. It is not simply snobbery, but the science of what makes for a good cup of tea.

Note: I downloaded several studies that have researched the difference in brewing time, water to tea leaf ratio and water temperature but have decided against boring anyone with the details.

Recently, I became ready to move onto “realmatcha tea and ordered some from the same supplier in Japan.

It came in tiny cans (quantities that should be used up in a 3 week period).

The colour was a bright jade green and the taste had no hint of bitterness whatsoever!

It tastes amazing!

My teas ordered from Japan are my “weekend teas” and during the week I used run-of-the-mill Sencha purchased locally at a Japanese store.

I drink them because I like them and for the health benefits.

Health Benefits of Green Tea

The health benefits of green tea are many. Several large-scale population studies have linked increased green tea consumption with significant reductions in the symptoms of metabolic syndrome; a cluster of clinical symptoms which include insulin resistance and hyperinsulinemia (high levels of circulating insulin), Type 2 Diabetes, high blood pressure, and cardiovascular disease including coronary heart disease and atherosclerosis.

Catechins make up ~ 30% of green tea’s dry weight, of which 60—80% are catechins. Oolong and black tea which are produced from partially fermented or completely fermented tea leaves contains approximately half the catechin content of green tea

It is believed that epigallocatechin gallate (EGCG) which is the most abundant catechin in green tea actually mimics the action of insulin, which has positive health effects for people with insulin resistance or Type 2 Diabetes [Kao et al].

EGCG also lowers blood pressure almost as effectively as the ACE-inhibitor drug, Enalapril, having significant implications for people with hypertension (high blood pressure) and cardiovascular disease [Kim et al].

Green tea catechins also have benefit for weight loss. A 2009 meta-analysis of 11 green tea catechin studies found that subjects consuming between 270 to 1200 mg green tea catechins / day (1 — 4 tsp of matcha powder per day) lost an average of 1.31 kg (~ 3 lbs) over 12 weeks with no other dietary or activity changes [Hursel].

Drinking 8-10 cups of green tea per day is enough to increase blood levels of EGCG into a measurably significant range [Kim et al], but matcha contains  137 times greater concentration of EGCG compared to green tip tea [Weiss et al].

WARNING TO PREGNANT WOMEN While EGCG has also been found to be similar in its effect to etoposide anddoxorubicin, a potent anti-cancer drug used in chemotherapy [Bandele et al], high intake of polyphenolic compounds during pregnancy is suspected to increase risk of neonatal leukemia. Bioflavonoid supplements (including green tea catechins) should not be used by pregnant women [Paolini et al].

Green Tea Shouldn’t Taste Bad!

The reason someone would find green tea has an “off flavor” was because the tea was either not fresh, not of a half-decent quality, was brewed at the wrong temperature or for the wrong length of time. Think about it this way; it all a person ever drank was cheap pre-ground coffee, they might think coffee tasted bad, too.

The fact is, one doesn’t need to order tea from Japan to enjoy a decent cup of green tea! I found the green teas below at a local Japanese grocery store and when brewed properly they are great as everyday tea.

If you aren’t adventurous to explore ethnic markets or time is limited, I can highly recommend the online supplier I mentioned above as having excellent price for the quality of green tea, very good explanations on their web page and quick delivery.

For everyday use, I have a little water cooler (yuzamashi) bowl and small single handed tea pot (kyuzu) so brewing a decent quality sencha green tea (my daily tea of choice) has become second nature, but as I mentioned above, one doesn’t need special equipment to make a decent cup of green tea!  All you need is the  right amount of fresh, good quality tea leaves steeped for the right length of time in hot water that’s at the right temperature. The only thing to keep in mind is that once the package of tea is opened, it needs to be stored in a sealed, airtight, light-proof container and used up within 3 months or sooner.

Making a good cup of green tea is not really much different than brewing a good cup of coffee. To make a good cup of coffee, one needs to consider the country / countries of origin of the beans, the bean roasting time and temperature, the brewing method involved (drip, espresso, French press, etc), the required water temperatures needed for that method, and the different grind of beans and a specific water-to-ground-bean ratio required for that brewing method. It sound’s complicated, but if you a few types of coffee regularly, it’s not hard.

It’s the same with green tea.

In one sense, there is a lot to learn at first to make a good cup of green tea but on the other hand, once you know a few basics and find a green tea or two you really enjoy, the rest is easy!

Tea has amazing health benefits, but unlike the cough medicine Buckley’s®, there is no need to drink tea that “tastes terrible, but it works”!

If you would like to know more about what I do as a Dietitian and how I can help you with weight loss or to seek to reverse the symptoms of metabolic syndrome, including Type 2 Diabetes, high blood pressure and other related markers, please send me a note using the Contact Me form on this web page.

If you would like to learn more about the services I offer and their costs, please click on the Service tab or have a look in the Shop.

To your good health!

Joy

You can follow me at:

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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.

References

Gayathri Devi A, Henderson SA, Drewnowski A. Sensory acceptance of Japanese green tea and soy products is linked to genetic sensitivity to 6-n-propylthiouracil. Nutr Cancer. 1997;29(2):146-51

Hursel R, Viechtbauer W, Westerterp-Plantenga MS. The effects of green tea on weight loss and weight maintenance: a meta-analysis. Int J Obes (Lond) 2009;33:956—61.

Paolini, M, Sapone, A, Valgimigli, L, ”Avoidance of bioflavonoid supplements during pregnancy: a pathway to infant leukemia?”. Mutat Res 527 (1—2): 99—101. (Jun 2003)

Kao YH, Chang MJ, Chen CL, Tea, Obesity, and Diabetes, Molecular Nutrition & Food Research, 50 (2): 188—210, February 2006

Kim JA, Formoso G, Li Y, Potenza MA, Marasciulo FL, Montagnani M, Quon MJ., Epigallocatechin gallate, a green tea polyphenol, mediates NO-dependent vasodilation using signaling pathways in vascular endothelium requiring reactive oxygen species and Fyn, J Biol Chem. 2007 May 4;282(18):13736-45. Epub 2007 Mar 15.

Weiss, DJ, Anderton CR, Determination of catechins in matcha green tea by micellar electrokinetic chromatography, Journal of Chromatography A, Vol 1011(1—2):173-180, September 2003

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:

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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.

Healthy Men on Low Carb – building muscle while burning fat

Much of the time in podcast interviews and in articles, I highlight the particular challenges that women face, especially when it comes to losing fat without losing muscle, but women aren’t my only clients.  I also help  healthy middle aged— and older men who want to lose weight and gain muscle, and young men who want to gain muscle and shed excess fat, as well as those who are metabolically unwell and who have much weight to lose. The amount of protein, fat and carbohydrates that is best for each of these groups of people will depend on multiple individual factors; including their age, activity level and whether they are insulin sensitive or insulin resistant and whether they are taking any medications.

Much to the frustration of their women friends, men — whether young, middle aged or older often lose weight fairly easily and it often doesn’t matter whether they add protein or fat, provided they cut their carb intake. If men want to lose body fat however, adding lots of extra dietary fat doesn’t make much sense.  Generally women need to be more diligent with respect to how much added fat is in their diet and find reaching their goal easier when focusing on good sources of leaner protein— especially when they are peri- or post-menopausal, when the tendency to lose muscle mass along with body fat is a concern.

One common theme amongst my male clients is that regardless of age, they often want to build muscle along with reducing their body fat but don’t necessarily have lots of time to dedicate to going to the gym. What I’ve noticed in practice is that this often occurs quite naturally provided their muscles are challenged regularly. It doesn’t necessarily need to be engaging in ‘resistance training’ or ‘weight strengthening’ but can be as mundane as engaging in tasks under a weight-bearing load.  I’ve seen quite a number of men of all ages who have been able build muscle while losing excess body fat simply by the work that they do in labour jobs, as well as those that spend their leisure time being modestly active in activities such as camping and hunting.

This post documents the progress of one healthy young man in his mid-twenties who initially wanted to follow a low carb lifestyle in order to lose a bit of excess body fat, and who hoped to ‘tone up’ in the process. With his permission, I’ll share what he’s been able to accomplish by changing nothing other than what he ate.

Note: Individual results following this or any dietary plan differ. This article simply documents what one person accomplished and how.

Two years ago, a young man who I’ll call “Nathan” was slightly overweight, with a BMI (body mass index) of 25.6. His height was 5 foot 6 inches-and-a bit-tall and he weighed 160 pounds. He wasn’t what anyone would have described as “overweight”, in fact, he was unremarkably average for his age. Nathan worked as a carpenter, so while he was used to engaging in regular weight-bearing activity it was not what one would think of as extremely demanding.

When I first assessed Nathan, his waist was 37 – 3/4 inches when measured halfway between his lowest rib and the top of his hip bone, his hips were 41 – 1/2 inches and he wore size 32 pants.

The photo on the left is a photo that is fairly close to what he looked liked 23 months ago.

Nathan’s diet was healthy by conventional standards — breakfast was a bowl of whole grain cereal with 2% milk, a cup of coffee with 2% milk and a piece of fruit. Lunch was usually a sandwich or a sandwich and a half made on whole-grain bread which consisted of anything from lean cold cuts or cheese and lettuce, to peanut butter, sliced banana and a drizzle of honey. At lunch, he would usually eat a piece of fruit. Dinner was usually some kind of lean protein with rice or potato or a plate of pasta with sauce, or perogies and sausage, along with some type of salad and usually a cooked vegetable, too. He rarely ate “junk food” — having an aversion to it from having worked at a fast-food restaurant during high school, but tended to enjoy ‘treats’ such as ice cream, a chocolate bar, or a slice or two of pumpkin pie a few times per week. Before bed he would usually have a large glass of chocolate milk, made with 2% milk and some chocolate syrup. There was nothing particularly remarkable about his dietary intake except perhaps that it was incredibly ‘average’, even healthier than most.

Except for being slightly overweight and a little insulin resistant, Nathan was in good health. He wanted to lean out and maybe put on a bit of muscle and while he intended to work out with free weights at home, that never ended up occurring as he worked full time and began attending school two night per week, and studying occupied much of his spare time.

I started Nathan on a moderate low-carb diet and over the first few months we lowered his carbohydrates down to around 50 gm per day, which is usually a ketogenic level for men.

He never counted ‘macros’ (grams of protein, carbs and fat) but rather focused on building his meal around good quality lean protein, the fat that came naturally with his protein source, and plenty of non-starchy vegetables. I encouraged him to eat enough so that at the end of the meal he felt satisfied, but not “stuffed”. When it came to added fat, I explained that if he liked the skin on chicken when it was fresh off the barbecue to go ahead and enjoy it, but if he didn’t really like it if the chicken was was cooked in the oven or on top of the stove, then to eat it without the skin and explained something similar when it came to meat; remove the excess fat trim or ‘fat cap’ before grilling a steak, but then enjoy the steak with the fat that came with it. Nathan rarely added cream, butter or oil at the table, but would be very generous with adding a good quality olive oil on salad. He often topped his salad with pumpkin seeds and a healthy handful of Parmesan curls, and when available a few berries.

Breakfast was almost always some form of eggs (almost always 3) and several slices of cooked breakfast meat or an omelette with fresh veggies and cheese — something he never seemed to tire of.  If after his egg and meat breakfast, he was still hungry, he would open a few cans of tuna or salmon and mix them up with a good quality avocado oil mayonnaise and eat that too. He liked a big breakfast because in his work, he wasn’t always able to stop to eat, but when he did, lunch was almost always a reheated container of leftovers from a supper meal which included protein and non-starchy vegetable. Dinner was usually 6 oz or more of some kind of meat, fish or poultry along with non-starchy vegetables (cooked and/or raw) and the occasional serving of whole-food carbohydrate in the form of cooked yam, winter squash or a 1/2 cup of berries on top of a mixed green salad. When freshly barbecued burgers were on the menu for dinner, Nathan admitted to eating 3 or 4 of those, wrapped in a lettuce leaf “bun” and topped with a slice of fresh tomato and dill pickle, along with a big side salad, as described above. If he could, he’d forego the salad and eat just burgers wrapped in lettuce and stuffed with pickle (and skip the tomato). His food wasn’t complicated, but it was real, whole food with the simplest of preparation. Nathan was encourage to eat until he was satiated and to avoid snacking between meals or after dinner, with the exception of an ounce or two of 72% dark chocolate immediately after dinner. Admittedly, he often at more than an ounce or two of dark chocolate on the weekend and sometimes indulged in some “low carb” ice cream.

Even though he had a scale at home, Nathan literally never weighed himself.  He bought smaller sized pants and shirts after about 6 months, when adding more holes to his belt wasn’t enough. He kept doing the same amount of physical activity as he did before (mostly at his job) but noted how much easier those tasks became and how he could carry more without effort and without getting more tired. After almost 2 years of adopting a low carbohydrate lifestyle, Nathan asked me for a “weigh in” and to have me take measurements, which provided some very interested data. Most of the weight loss occurred in the first 6 months, but according to Nathan the muscle changes occurred gradually in the months following. With his permission, I am sharing those here.

In 23 months of doing nothing different but eating low carb (mostly higher lean animal protein with moderate fat), this was Nathan’s progress;

Weight lost: 22 pounds
Waist (inches): -6.5 inches
Hips (inches): -5.5 inches
Body Fat: from 15.7% to 7.7%

Nathan is not the type person who is interested in posting photos of himself without a shirt, but he certainly could do so with pride.  He is now muscular with a defined chest and abdominal muscles, with little discernible fat. His  BMI is 22.1, and for his height his muscle to fat ratio is excellent.  Nathan didn’t deliberately “work out” in any way— only continued in his trade as a carpenter, while eating low carb, higher protein and the fat that came naturally with his protein source. I’ve observed other male clients to have made impressive progress in weight loss and muscle gain when combining a low carb diet with resistance training, but what I found quite remarkable with Nathan was the change in his body composition given the only thing he changed was how he was eating!

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

To your good health!

Joy

You can follow me at:

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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.