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

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

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:

       https://twitter.com/lchfRD

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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.