A Dietitian’s Journey – visibly evident progress after 5 months

For the last 2 weeks, the Lower Mainland has been covered in smoke due to hundreds of wildfires in the area.  The very poor air quality had made going for a walk impossible.

Everywhere I went, I needed to wear an N95 mask to filter out the particulate matter and with the excessive heat and reddish-yellow skies, I had no desire to be out any longer than I needed to.

Over the weekend, cool marine finally air arrived and the air cleared for the first time in weeks. Finally it didn’t look like I was living on Tatooine.

When I woke up yesterday, the first thing I wanted to do was go for a morning walk. I walked 3 km around the local track and today I went again and decided to make a short video. When I went to upload it, I noticed how very different my face looked than from my first walk, 5 months ago (March 16 2017).

LEFT: March 16, 2017 | RIGHT: August 15 2017

I’ve only lost 13 pounds in the last 5 months since I began eating Low Carb High Healthy Fat, but the difference in how I look and how I feel is quite evident.  As I’ve covered in previous “A Dietitian’s Journey” blogs, my blood work has certainly reflected the change.

I don’t really do any exercise outside of walking and even then, I only started doing it regularly 7 weeks ago (June 22, 2017) and not for the last 2 weeks (due to the air quality advisory). Five weeks of walking has helped me tone my muscles a bit and lower my overall blood sugar, but not had any significant impact my weight loss. While for the last 8 weeks, I’ve delayed the start of my first meal (intermittent fasting) which has impacted my fasting blood sugar, it hasn’t really impacted my weight, as I consume the same amount of protein, fat and carbs per day, just over a shorter period.

My weight loss has really only been accomplished by doing what I have been teaching my professional clients to do over the last 2 yearseating low carb and high healthy fat. I was tired of being the “fat Dietitian”! Now I’m now “practicing what I preach”.

Is it hard?  Not at all! This has to be the easiest way to eat and requires little, if no culinary skill. Sure, one can get pretty creative making all kinds of exciting ethnic foods if they know how to cook, but it is certainly not required!

The difference in how I feel is truly all the motivation to keep doing it! Losing weight is a bonus.

Want to know how I can help you achieve your own health and nutrition goals? Why not send me a note using the “Contact Us” form above.

To our good health!

Joy


Here is the short video that I made today:

 

 

A Dietitian’s Journey – living on Tatooine

For the last two weeks, I have been living on Tatooine.  Not really, but it certainly has felt like that – with smoky, red sunrises and sunsets, inhospitable heat and high levels of ground-level ozone.  British Columbia, where I live, remains under a state of emergency as 148 wildfires continue to burn across the province, with this being BC’s worst fire season in almost sixty years. As a result, the air quality in many communities, including mine, has deteriorated to dangerous levels.

This is what the sunrise has looked like from my backyard the last two weeks:

There have been high concentrations of fine particulate matter known as PM2.5  in the air, which are solid or liquid droplets with a diameter of ≤2.5µm (micrometres). Due to their small size, these particles easily penetrate indoors, even when windows are closed and are small enough to pass from the lungs into the bloodstream – putting people with lung or heart disease, Diabetes or asthma at risk.

In addition to the smoky air, temperatures each day have been in the low- to mid-thirties Celcius (90-95 degrees Fahrenheit) which is highly unusual. Here in the Greater Vancouver area, we’ll get a few days in a row like that once or twice each summer, but not for two weeks solid!  Thankfully I have air conditioning, but it has been brutal to be outdoors.

Concentrations of ground-level ozone have reached and stayed at advisory levels.  This is formed when pollutants given off by the forest fires and compounds from the solvents used to put out the fires react in the air, in the presence of sunlight.

Even wearing an N95 mask outside which is designed to filter out the small smoke particles, I have found my breathing very laboured.

Needless to say, my morning and after-dinner walks have been impossible. I tried exercising indoors, but my lungs were simply too irritated from the small smoke particles.

I have continued with intermittent fasting but for shorter periods of time (as my body is under physiological stress) and I continue to eat a low carb high fat diet. My weight has dropped another pound over these last two weeks, despite no exercise at all. My blood sugar on the other hand is considerably higher without the walks.

An air quality analyst with Metro Vancouver has reported that the weather is expected to shift this coming weekend, allowing some of the smoke to begin to dissipate. Until then, part of taking care of my health is not to exercise.

Reporting from Tatooine, British Columbia, I’m Joy Kiddie, practicing what I preach.

A Dietitian’s Journey – 5 month update

It’s been 5 months since I began my own weight-loss journey, following a low carb high healthy fat diet and here is a short update. 

Fasting Blood Glucose

When I began this journey at the beginning of March, my fasting blood glucose was averaging 12 mmol/L. Four months into eating low carb high fat, my fasting blood sugar was averaging 8.5 mmol/L. 

July 25th, it was measured at the lab and on my home glucometer as 8.0 mmol/L – still way above the cutoffs for those with Type 2 Diabetes of 6.0 mmol/L, and way above the normal levels of 4.5-5.5 mmol/L.  

It is highest is in the morning, I believe due to cortisol’s effect (see 4 month update, for details).

2 hour Post-Prandial Blood Glucose

I’ve been tracking my blood glucose regularly since I started implementing the dietary and lifestyle changes 5 months ago, and my 2 hr post prandial (after a meal) glucose had been averaging ~7.2 mmol/L, which is much better than the 7.7 – 8.6 mmol/L which is what it was at the beginning of March, but still no where good enough!

…but I noticed that after I go for my brisk 3-4 km each morning, it is 5.4 mmol/L. This gave me an idea (see below).

Blood Glucose through the night – effects of Cortisol

For about a week, I measured my blood glucose at 1 AM and 4 AM and 6 AM (in the interest of science, of course!) with a brand new glucometer that I standardized at the lab, when I had my fasting blood glucose and fasting insulin done on July 25th. My morning fasting blood glucose would rise to ~6.6 – 6.8 mmol/L (119 – 123 mg/dl) from the 5.4 mmol/L it was when I went to bed, even though I hadn’t eating or had anything to drink.  This had to be the effect of cortisol!

Fasting Cortisol

I had my fasting cortisol assessed the same day that I had my fasting blood glucose assessed (July 25 2017) and it was, as I suspected, high421 (125-536) nmol/L 

…and this is with walking 4 km / day and sleeping 8 hours (restful sleep). 

I need to come up with some additional strategies for lowering stress.

Fasting Insulin & Calculating Insulin Resistance

I also had my fasting insulin assessed the same day that I had my fasting blood glucose and fasting cortisol assessed (July 25 2017).

Based on the July 25th lab work, I calculated my Insulin Resistance using both Matthews (1985) Equations (HOMA1-IR), as well as using Oxford University Center for Diabetes, Endocrinology and Metabolism homeostasis model assessment (HOMA2-IR)  calculator (2013).

From when my fasting insulin and fasting blood glucose was last tested 2 years ago in August 10, 2015, my insulin resistance  calculated by HOMA2-IR had gone down from 3.06 to 2.77, but it’s still too high, because my fasting blood glucose remains high.

Average Insulin Resistance – in the normal population

One study reported that the average HOMA2-IR in the general (non-Diabetic) population is 2.1 +/- 2.2 (Diabetes Care, Volume 24, Number 3, March 2001), so I am guessing that a HOMA2-IR of 1.00 would be a healthy target – one that will likely take me a year to approximate.

Whether that will be possible with diet and lifestyle change alone, has yet to be seen.

That is my goal.

High Morning Glucose – assessing the problem

I believe the reason that my blood glucose remains high in the morning is due to a combination of residual hepatic (liver) insulin resistance (from years of eating way too many carbs) and high cortisol that is stimulating an overproduction of waking glucose.

Effect of Walking

The last 5 months, my fasting blood glucose has been consistently high at 8.0 – 8.5 mmol/L (144 – 153 mg/dl) and my 2 hour postprandial is fine for a Type 2 Diabetic at ~7.2 mmol/L – but a far cry from the non-Diabetic range I am seeking.

…but I noticed that after I go for my brisk 3-4 km walk each morning, my fasting blood glucose is 5.4 mmol/L (yes, I go fasting).

The effect of moderate exercise seems substantial, so I decided to see what effect there would be on my early morning fasting blood glucose levels if if I took a short walk after dinner.

The results were dramatic!

For the last week and a half, my blood glucose drops to ~5.2 – 5.4 mmol/L (94-97 mg/dl) after a very leisurely 15-20 minute walk around my neighbourhood.

High Morning Glucose – assessing the solution

Based on my high fasting blood glucose of 8.0 mmol/L on July 25th, my physician’s colleague naturally recommended that I go on Metformin, but I have decided to hold off on introducing it for 3 months provided that;

(1) I continue the dietary and lifestyle changes I have been doing for the last 5 months and…

(2) I add a 20-minute walk after dinner.

Plan to Reassess in Three Months

I am requesting that my physician provide me with a requisition to have my fasting insulin and FBG re-run in October, when I update my HbA1c, so I can recalculate my HOMA2-IR again and see how much less insulin resistant I am by then.

I want to know the magnitude of the insulin levels dropping, not just the fasting blood glucose, which I expect, will drop…after all, the goal is to lower the very high levels of insulin. High blood glucose is a symptom – the cause is too much insulin being released, due to insulin resistance.

Blood Pressure

As mentioned previously, I asked to be started on a very low dose of Ramipril (Altace) about 6 weeks ago, as my blood pressure had begun to creep up again. When I saw 160/90 mmHg two days in a row, I went to see my doctor.

10% of the time I am ≤ 119 / 79 mmHg, considered normal blood pressure

64% of the time I am ≤ 120/80 mmHg, categorized as “Prehypertension”.

…and 26% of the time, measured before I take my medication, I am ≤ 138/90 mmHg, categorized as “Stage 1 Hypertension”.

I will continue to take the blood pressure medication as a temporary measure to offer some protection against heart attack, stroke and kidney damage until I lose some more weight, and my blood pressure stays down on its own.

Weight

Overall, in the last 5 months, I have lost 12 pounds and ~3 inches off my waist. I’ve lost about the same number of inches off my neck circumference (3 inches) which has had a dramatic effect on how I look.  I have a neck and ONE chin.

I’ve lost overall about an inch off my mid-arm, an inch off on my thighs (gaining muscle and losing fat, at the same time) and lost around an inch off my chest.

Lowering Stress, Lowering Insulin

I need to get my cortisol levels down, as these are driving my high morning fasting blood glucose levels. Walking in the morning has been good, adding the short evening walk even better. Now I am adding (on alternate days from my 3-4 km walks) a workout with 5 and 10 pound weights and other forms of resistance training. I am even jumping rope (which has gotten much harder since when I last did it at around age 16!).

The goal is to get my insulin levels down, and I am already doing everything that needs to happen for that; eating ≤ 35 gm carbs per day, no excess protein, and extending the time between meals to as much as 24 hours (i.e. intermittent fasting), a few days per week.

It is going to take time

Over the next 3-6 months, I expect fasting insulin will keep falling.

My goal is to reach a ‘normal’ 2 hour postprandial peak of 60 mIU/L (430.5 pmol/L) as determined by Dr. Kraft’s Insulin Response curves, which should be an Insulin Resistance (HOMA2-IR) of between 1.0 and 2.0.

Over time, the fat in my liver (“hepatic adiposity“) will continue to decrease, and the derangement which took time to develop will resolve.

While the rate of resolution to for me to achieve normal insulin metabolism is unknown, I know if I keep doing what I am doing, it will happen.

Have questions?

Want to know how I can help you achieve your health and weight goals? Why not send me a note using the “Contact Us” form, above.

To our good health!

Joy


 https://twitter.com/joykiddieRD

  https://www.facebook.com/BetterByDesignNutrition/


Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read or heard in our content. 

 

 

 

Fasting Blood Glucose – the evening walk

As I’ve made it a habit to do each weekday, this morning I went out for my walk, using Nordic poles.  I had an appointment to keep, so I kept it to 3 km at a brisk pace, around that beautiful lake that I’ve previously posted a video update from.

Despite eating very low carb (~35 gm or less) and intermittent fasting (which is delaying the amount of time between meals) each weekday, my fasting blood sugars remain high.  I’ve noticed that after I walk in the morning, they come down significantly, so I’ve decided to integrate a short walk around my neighbourhood after dinner, to see if my fasting blood glucose lowers.  It should, which leaves me to determine how long a walk is ideal. I don’t want to make it a “workout”, as that can interfere with sleep, but I also don’t want to make it so short that it doesn’t have any effect.  Today I started with a 15 minute walk at a comfortably brisk pace.  Tomorrow, I’ll try longer, to see if it changes the results in the morning, and if so by how much.

As I began my walk, I realized that I’ve lived in this neighbourhood for several years, yet never walk around it.  I guess it’s time I get to take in the beauty that is all around me.

Practicing what I preach!

Joy

UPDATE

It turns out, that a leisurely 20 minute walk after dinner results in my blood glucose dropping to ~5.2 – 5.4 mmol/L  (94-97 mg/dl) and staying that way through the night (measured at 1 AM and 4 AM and 6 AM in the interest of science, of course!).

This is now part of my routine!


 https://twitter.com/joykiddieRD

  https://www.facebook.com/BetterByDesignNutrition/


Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read or heard in our content. 

A Dietitian’s Journey – what’s that on the floor?

This morning, as I was getting ready to go out for my walk, I noticed something on the floor.  As I started to bend down to pick it up, I realized it was my own toes! There they were – peeking out from under my shrinking abdomen! It shouldn’t be that the sight of one’s own toes while standing elicits such a surprised reaction, but it did.

As usual, I went walking this morning – something that has become a routine, since I fractured a rib 5 weeks ago (washing a bathtub, of all things!).  It was supposed to reduce the associated muscle pain (which it did) and after a few weeks, I realized I was really enjoying this “me” time, walking around a local lake. This week, I started Nordic walking (using Trek poles) and have really enjoyed the full-body exercise.  Even the drizzle wasn’t going to stop me today. After all, that’s what rain shells are for.  In fact, the one I grabbed this morning was the one I bought two years ago online, but that was too small, but today I put it on and zipped it right up. Finally, my body is changing! After 4 months of seeing very slow progress, the progress is becoming more and more evident.

Three weeks ago, at the encouragement of a local area physician whose practice focuses on low carb eating, I decided to take some body measurements, to track my progress.  I measured mid arm circumference (between the point of my elbow and the pointy part of my shoulder blade), the my midpoint on my neck, my chest (where a brassiere would sit), my thigh (midway between my knee and my hip, at the widest part) and my abdomen at my umbilicus (or belly button) – which I have been tracking from the beginning.

[I don’t bother tracking my “waist” because this is smaller than the umbilicus, and what I want to assess is abdominal fat, which is better measured at the belly button.]

In the last three weeks, I’ve lost:

1/2 inch off my mid-arm

2 inches off my neck (yes I checked and rechecked this one!)

1 inch off my chest

1 inch off my umbilicus circumference

and gained 1/2 inch (of muscle) on my thighs.

Also during the last 3 weeks, I’ve lost 2 1/2 pounds and my fat percent has dropped 1.2%.

And today, I saw my toes!!

Yes, I have a long way to go, but I am not focusing on the destination but on the journey.  

I am enjoying eating real food and not feeling uncomfortably full afterwards (something absent since I gave up eat carb-based foods!).

I enjoy being able to delay the time between meals (intermittent fasting) without feeling hungry, tired, grumpy or deprived). Since I’m a Dietitian, I talk or write about food all day during the work week and most days I eat only supper.  Today I was hungry, so I ate a meal at 11am – but I still had a 16 hour ‘fast’ from supper last night until I ate today, where I hadn’t eaten anything. This time is so important, to enable my insulin levels to fall, and lower my insulin resistance that had been created by me previously eating 3 meals and 2-3 snacks per day, all centered around complex carbs – for years.

I like the feeling of being active; having gone from being totally sedentary (inactive) to being moderately active (45 minutes 5 days / week). I don’t exercise in order to lose weight, but because it is good for my heart and brain and it lowers my stress level (lowering cortisol).  This in turn is good for my blood pressure and for overall health. I enjoy doing it early in the morning and enjoying the feeling of well-being and satisfaction all day long.

For the first time in many years, I don’t eat because I am craving something, I eat because I am hungry!  In fact, I don’t crave anything!  I eat a small amount of dark chocolate each day (for health, of course) and even while intermittent fasting, I can walk through a bakery section of a store and not be the slightest bit interested in any of it.  My body is happily burning my own fat (which I have plenty of!) so I’m good.  I’m always drinking sparkling water (which I make at home) and usually finish 2 litres (a little less than 2 quarts) by the time I return from my morning Nordic walk.

I am sleeping so much better than I have in many years and have discontinued the prescription that I would keep on hand for the frequent nights I was unable to fall asleep. I still wake up sometimes because of my healing fractured rib (if I roll over) but other than that I wake up rested.  What a thought – waking up rested AND seeing my toes! I can get used to this.

Have questions?

Want to know how I can help you achieve your own health goals?  Why not send me a note using the “Contact Us” tab above.

To our good health!

Joy

 https://twitter.com/joykiddieRD

  https://www.facebook.com/BetterByDesignNutrition/


Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read or heard in our content. 

A Dietitian’s Journey – four month update (with lab test results)

It’s been 4 months since I began my own weight-loss journey, following a low carb high healthy fat diet and I’ve been to the lab and had my blood tests.  Here is an update on my progress to date.

Blood sugar

Fasting blood sugar

When I began this journey at the beginning of March, my fasting blood glucose was averaging 12 mmol/L – and this was when I was eating the ‘standard recommended diet’ for someone with Type 2 Diabetes. My diet was high in complex carbs, and low in saturated fat. Also, as has been traditionally recommended for someone with Type 2 Diabetes, I ate 3 meals per day and made sure to have 2 – 3 snacks per day (each with complex carbs and some protein).

Now, four months into eating low carb high fat, my fasting blood sugar is averaging 8.5 mmol/L. It is significantly better, but not what I had hoped which was to be at or below 6.0 mmol/L (below the Diabetic cutoff range) in this time.  There were factors that I was not considering.

Firstly, my blood sugar has been persistently high in the morning since I have been in nutritional ketosis – significantly higher than 2 hours after a meal.  At first, I couldn’t figure out why. I’d been tracking my blood glucose at various times of the day; fasting, before I eat, 2 hours after I eat, before bed etc., but regardless what I ate the night before, it was highest in the morning.  It was then that I began to suspect that the effect of the hormone cortisol might be a factor. 

Cortisol is our “fright and flight” hormone and under stressful conditions, such as being chased by someone or something, cortisol  provides the body with an immediate source of glucose by breaking down our glycogen stores in our muscle and liver (a process called glycogenolysis) and uses them to manufacture glucose in the liver (a process known as gluconeogenesis).

All hormones have a natural cycle of rising and falling throughout the day and this is known as a hormone’s circadian rhythm and over the course of the night, cortisol production begins to climb around midnight and reaches and is highest level between 6 am to 8 am.  When I began to track my blood sugar from 10 pm until 8 am, I noticed that it would start going up in the wee hours of the morning and keep rising until 6:30 or 7 am, am when I would take it. It was then that it became evident that my fasting blood sugar was rising with cortisol.

Chan S, Debono M. Replication of cortisol circadian rhythm: new advances in hydrocortisone replacement therapy. Therapeutic Advances in Endocrinology and Metabolism. 2010;1(3):129-138. doi:10.1177/2042018810380214.

When we sleep, our body breaks down the glycogen stored in our muscle and liver and converts it to glucose for our blood – an entirely normal process. Since I am following a low carb high fat diet and have been in nutritional ketosis for while, my body uses ketones as its primary fuel source and make all the glucose it needs for my blood from the protein and fat in my diet. When it runs out of that, it burns my stored fat for fuel – which is exactly what I want it to do! Since I’d been keeping my carbohydrate intake ~50 gm per day, when cortisol levels would rise over night, my body would break down my glycogen first, then my own fat stores to make glucose for my blood, which I suspect is the origin of my high fasting blood glucose. That, combined with my liver still being insulin resistant, the glucose has no where to go.

This made sense to me and explained why my fasting blood glucose remained high, despite no carb creep (more carbs than planned for).

Since I’m keeping myself in nutritional ketosis, I’m not concerned about my fasting blood glucose remaining higher, although I may try distributing my carbs differently – with fewer at night. Since my goal is lower insulin resistance, I am going to continue to focus on that. High blood sugar is a symptom.  The problem is insulin resistance.

My blood glucose 2 hours after meals has been getting better. It is now averaging around 6.0 mmol/L (sometimes hovering around 5.5 mmol/L) which is much better than 7.2 – 8.6 mmol/L which is what it was at the beginning of March. My goal is to see it consistently below 5.0 mmol/L after meals by mid-November.

HbA1C – glycosolated Hemoglobin

Glycosolated hemoglobin (HbA1C) is the hemoglobin in our red blood cells that gets sugar molecules attached to it proportional to the amount of sugar in our blood. It is used to measure the three-month average plasma glucose concentration, based on the fact that the lifespan of a red blood cell is four months (120 days). The advantage of this test, is that one does not need to be fasting to have it.

HbA1C is most strongly correlated with fasting blood glucose (as opposed to pre-meal blood sugar or to 2 hour post-meal blood sugar) and since my fasting blood glucose has been consistently high, my HbA1C results naturally reflected this.  Lab tests indicate it is 7.5%, which is above the upper cutoff for Type 2 Diabetics of 7.0% – and higher than what I was aiming for, which was below 6.0%, the Diabetic range cutoff. However, since neither fasting blood glucose nor HbA1C  measure what I am trying to change (which is insulin sensitivity), I’ve decided that in November, I will pay to have my fasting insulin re-assessed.  After all, the goal is to lower insulin – which underlies the high blood sugar!

Lowering Stress

I knew that I needed to get my cortisol levels down, as cortisol drives appetite, which drives eating which in turn, causes insulin to be released. More insulin means my body will be focused on fat storage, not fat burning which is the opposite of what I want. Since my goal is lowering insulin resistance, lowering cortisol makes sense. Since I can’t change cortisol’s natural circadian rhythm, I had to focus on lowering the whole curve!  Lowering stress wasn’t going to happen sitting at my desk working. I had to get moving.  More on that, below.

Blood Pressure

As mentioned in my last update, a month ago I asked to be started on a very low dose of Ramipril (Altace), as my blood pressure had begun to creep up again. When I saw 160/90 mmHg two days in a row, I went to see my doctor.  He wasn’t there, but the locum agreed with my assessment that it was wise to protect my heart, brain and kidneys while I continued to make the dietary and lifestyle changes.  She asked me to delay getting my blood work for a few weeks, to assess my electrolytes (sodium and potassium) level which can be affected by the medication.

Even two years ago, my potassium was at the high end of normal – and this was when I was dutifully eating a diet high in complex carbs and low in saturated fat, as I ate a diet high in potassium-rich foods.

This time my potassium was at the upper normal limit, so I’m tracking my intake of it and keeping it approximately 1/3 to 1/2 of what it was previously.

Taking the blood pressure medication is a temporary measure that I decided on in order to offer some protection against heart attack, stroke and kidney damage until I lose more weight, and my blood pressure stays down on its own.

Thankfully, my overall kidney function is now better than it was 2 years ago, although I did need to make a few dietary changes to be sure that I avoid getting kidney stones (something that runs in my family).  When I started exercising regularly a month ago, I didn’t adequately increase my water intake – which I’ve since corrected.  I had also added a calcium supplement when I stopped drinking milk in March and which was binding with certain food components in the veggies and nuts I was eating.  This was probably what was resulting in calcium-oxalate being detectable in my urine. I’m no longer taking the calcium supplement and have added more hard cheese into my diet, instead.

Cholesterol

My LDL was at the high-end cutoff two years ago, but after 4 months on a low carb high healthy fat diet, it is approaching what is considered by the existing / popular standards of “optimal LDL” for someone who is high risk (family history of cardiovascular disease). My LDL is 2.60 mmol/L (1.14 mg/dl), my triglycerides (TG) were 0.64 mmol/L and my HDL was 1.97 mmol/L

Using more significant measures, my TG:HDL ratio is now 0.32 (with <0.87 considered ideal). According to several studies (that I will go into more detail in an upcoming article), a very low TG:HDL ratio is associated with lots of large, fluffy LDL – the kind associated the lowest risk of cardiovascular disease (CVD) such as heart attack and stroke. It is the higher density, small LDL particles that are associated with CVD.

Walking

A month ago, I began walking every morning during the weekdays.  I had just fractured a rib (slipping washing a bathtub!) and read that walking was good to reduce pain. Since reducing pain was high up on my “to do” list, I started with walking 1 km each morning during the week, before I began my office hours.  I gradually increased it to 2 km. The last week and a half it has been 3 km.

At the beginning of last week, I saw a fellow who was in very good shape using Nordic walking poles, so I asked him why he used them. He explained that as he digs the poles into the dirt on the path and pushes himself off of them, it gives him a good upper body as well as the lower body workout that comes from walking briskly. I decided to get myself some.

I researched what height they needed to be and decided whether I would get adjustable height ones or not, and purchased them on Friday and over the weekend, I read about how to use them properly. It seemed as thought it would be pretty intuitive for me, given that I have (and use) a Nordic Track ski machine when the weather is not conducive to going out to exercise.

Nordic Walking Poles

I was skeptical that using them could actually increase the calories I burned by 30%, for the same distance walked until I tried them this morning.

I am no longer skeptical!

I was very well aware of how much better a workout I had gotten after 2 km, but did another 1 km anyways.  I can’t wait to go again tomorrow.

Getting Even More Serious

Reducing Carbs

A month ago my weight was still ‘stuck’ at its 6 pound weight loss, so I decided to reduce my carbs from ~50 gms/day to +/- 35 gm/day and to monitor my intake of nuts and dark chocolate, which could easily cause me to exceed my carb ceiling.

Bingo!

Intermittent Fasting

Monday – Friday I wasn’t hungry in the morning, because I would eat a very satisfying meal the night before (with adequate protein and lots of healthy fats and low carb veggies), so I was and am quite content to have only a coffee and cream for breakfast, and then go for my walk.

When I come home, most days I’m really not hungry, because my body had finally figured out how to burn my own fat stores for energy!

At first when I started exercising (nothing crazy…I was just walking briskly!) and intermittent fasting, my blood sugar would get quite low in the late afternoon (+/- 4.0 mmol/L), so at that point I would eat something like a piece of cheese, as I prepared dinner.

Here is a graph showing my blood glucose since I started walking and intermittent fasting;

Blood glucose since beginning walking and intermittent fasting

Weight Loss

In the last 3 weeks, my weight has dropped another 4 pounds, making it a total weight loss of 10 pounds, in all so far.  I expect as I continue to walk 4 days a week and intermittent fast most weekdays and limit my carbs, that the weight and inches will continue to come off.

I am not suffering in any way!

As a Dietitian, I talk about or write about food all day long and I’m intermittent fasting and feel just fine! I’m not hungry.  As I jokingly posted last week;

“My body has finally figured out how to make glucose from my fat on a low carb high fat diet. I may potentially have found the source of immortality.

Final Thoughts…

I still have at least another 30 pounds to go to get to the “goal weight” that I set at the beginning of this journey, and am now aiming to lose another 40-45 pounds instead in order to reach my ideal (healthiest) waist to height ratio. I clearly won’t accomplish this by mid-November, but if I reach close to my initial goal weight, I will be quite content.

They say a picture speaks a thousand words, so below are two photos. The one on the left, with the blue shirt is me at the beginning of this journey.  The one on the right, with the burgundy shirt is me now. I am starting to see a face I recognize.

Have questions?

Want to know how I can help you reach your own nutrition goals? Please send me a note using the “Contact Us” form above, letting me know how I can help.

To our good health!

Joy

 https://twitter.com/joykiddieRD

  https://www.facebook.com/BetterByDesignNutrition/


Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read or heard in our content. 

 

A Dietitian’s Journey – how I got my weight moving again

INTRO: After a seeming endless 6 week plateau with my weight barely budging, I decided to do some serious intermittent fasting and lower my carbs and bingo – my weight is dropping nicely!  Not only that, my fasting blood sugar is the best it has been since I was diagnosed as Diabetic ~10 years ago. Here’s an update.

Yesterday was my third day of intermittent fasting (IF) this week – where I didn’t eat anything after supper at night, until supper the next day.  This is my second week of doing intermittent fasting Monday to Friday and eating a regular, low carb high healthy fat supper at night.

Here’s an example of what I ate on one night, to give you an idea.  It was some Thai chicken thighs that had been marinated in coconut milk, red curry paste and curry and grilled on the barbecue, along with a huge mixed green salad, with some shaved Parmesan, raspberries, pepitas (pumpkin seeds) and homemade raspberry vinaigrette (great thing to do with over ripe berries!) that was made with Dijon mustard, wine vinegar and extra virgin olive oil. To start with, I also ate about a cup of snap peas with ~ 1  1/2 Tbsp of taramasalata (Greek carp roe spread) that didn’t have any of the usual bread in the recipe.

Keeping in mind that I am only a “sample set of 1”, here are my results;

Last week, which was my first week of regular IF, my fasting blood sugar, which had been stuck at the high to mid- 6 mmol/L (117 mg/dL) range for weeks, dropped to the mid- 5 mmol/L range (~99 mg/dL) for several days in row.

 

Yesterday, which was my third day of IF this week, my blood sugar just before dinner was the lowest it has been since I was diagnosed as Type 2 Diabetic ~10 years ago.

While I felt totally fine and had been working a full clinical day, I knew it was time to eat something!  I ate about 10 salted almonds and went about preparing dinner.

Blood glucose values from June 22nd until June 29th, inclusive

I should add, that last week I also started walking daily ~ 2-3 km (1  1/4 -2 miles) around a local man-made lake (I posted a video below, so you can see it).  The first two days I could only go once around, as I had fractured a rib last Friday and it was still quite painful.  I starting walking daily because it was supposed to be good to alleviate the muscle pain accompanying my injury and I found it helped a lot, so I kept doing it each morning.  Then I realized how great it felt to be walking in such a beautiful place, so now it has become a morning routine.

My blood pressure is doing amazing now.

It had stalled between Stage 1 hypertension and pre-hypertension for about a month, but when it creeped back up to Stage 2 hypertension for two days in a row, I decided to go see my doctor and get prescription for a ‘baby-dose’ of Ramipril (2.5 mg).

 

There is a strong family risk of heart attack and stroke, and a blood pressure that hit 160/90 was not something to fool around with.

I plan to staying on the meds until I lose another 20 pounds, or until my blood pressure becomes too low – whichever comes first.

Look at my blood pressure now.

The only day that was high (Stage 1) was last Friday, before I started on the lowest dose of Ramipril.

The rest of the time I am in pre-hypertension and one day was totally normal! I am looking forward to seeing the continued dietary changes, bring it down even further.

As I planned to do 3 months after I started eating low carb, I have a requisition for blood work and an appointment for mid-July to have that done.  I will be getting my HbA1C checked and my cholesterol, along with some liver and kidney function tests as well as electrolytes (important on this hypertensive medication).

One of the other dietary changes that I made, besides the intermittent fasting, was that I cut my carbs considerably. I was not doing well on 50 gm of carb per day, my weight loss had been stalled, my blood pressure as well and it had been a month of no significant progress, even though I was in low stage ketosis. I cut my carbs down to 35 gms per day (sometimes a little less), but making sure to have lots of non-starchy vegetables and protein and of course, plenty of healthy fats in the form of olive oil, coconut milk and nuts.

In short, I feel amazing.

The weight is dropping, the inches are dropping, my blood sugar is approaching more normal values and my blood pressure is being kept in check, while I continue this process of eating low carb high healthy fat and daily walks. I’m not hungry during the day even though I am not eating, because my body is happily accessing my own fat stores for energy. I think the limiting factor at this point is that my body is not quite used to synthesizing the enzymes needed for it to make glucose from my stored fat (a process called gluconeogenesis), so I will be monitoring my blood sugar closely, to make sure it doesn’t get too low.

I want to encourage you, that if your weight is staying stable for longer than you’d like, I’ve posted some things on the blog that would be helpful (located under the Food For Thought tab). One article is on tracking carbs, and the next one is on where calories factor in.

If your weight has plateaued, and you’ve been eating low carb high fat and your not losing weight as you’d like to, these two articles should help.

If you’d like to learn more about how I can help you accomplish your own weight loss or insulin-resistance lowering goals, please send me a note using the “Contact Us” form above.

Keep in mind that for the month of July only, I am offering a substantial savings on taking both an assessment package and a weight management package, so please visit the front page to find out more about the Canada Day special.

To our good health!

Joy

Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read in our content. 


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A Dietitian’s Journey – a few thoughts on “exercise”

There are two words that I’ve noticed aren’t talked about much in low carb high fat (LCHF) circles; one is “calories” and the other is “exercise“. I think that’s because both have been tied to the old “calories in, calories out” model.

I think it’s important to reframe both of these within a LCHF context, because both have a role to play in us being successful in improving health as well as losing weight, even though the reasons for that are very different than in the “calories in, calories out” model.

In the traditional high carb, low fat paradigm, restricting calories and increasing exercise are seen as the foundation of weight loss – based on the assumption that “calories out” is only the calories we burn in activity.  As explained in this week’s blog on “Do Calories Matter When Eating Low Carb“, there are other demands on the energy we take it (calories) that are higher priority than exercise, such as regulating our body temperature and providing energy to keep our heart pumping.

(You can read about that here: http://www.bbdnutrition.com/2017/06/19/do-calories-matter-when-eating-low-carb/)

In the low carb, high fat model, overall calories need to be understood within a diet that is 70% fat and <10% carbohydrate and exercise needs to be understood within the context of lowering stress levels (i.e. cortisol), as well as increasing metabolic rate so that fat stores continue to be burned long after activity ends.

Below is a very short video from my morning walk, with a few thoughts on “exercise”.

To our health!

Joy


 https://twitter.com/joykiddieRD

  https://www.facebook.com/BetterByDesignNutrition/


Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read or heard in our content. 

A Dietitian’s Journey – 3 month update

Today marks 3 months since I started my own weight-loss and getting-healthy journey and so I’m posting this short update.

While I’ve only lost 7 pounds, I’ve lost a remarkable 4 inches off my waist, which is greatly encouraging, as I still have another 6 inches to lose (based on my height-to-waist ratio). I know without a doubt that this is entirely ‘doable’!

I look in the mirror and recognize the person looking back. I recently bought new jeans that are a full size smaller and when the weather has been hot, I’ve not only worn shorts, but I’ve wore them out of the house.

My blood pressure is very stable and now fluctuates between stage 1 hypertension and pre-hypertension; a dramatic improvement from the wildly erratic fluctuations between stage 2 and stage 1 hypertension, with a hypertensive emergency thrown in for excitement. It was that crazy high blood pressure which started me on this journey, but what keeps me on it, is how I feel. I feel great!

My blood sugar has been great after meals, but recently has become quite a bit higher several hours after eating, even though I have not eaten or drunk anything except water. From the reading I’ve been doing in the literature, this has been reported in those who previously had what is called “dawn syndrome” (high morning fasting blood glucose – which I had) after they’ve adopted a low carb high fat diet.  It seems that the second of the two stages of insulin release is suppressed in those such as myself, causing blood glucose to remain higher for a longer period of time. One way of addressing this is via exercise, so it seems I will be doing this more than once in a while to manage this.

This morning it was gorgeous out; clear sky, cool temperatures and the track was beckoning me, and so I went. I haven’t worked out more than 2 or 3 times a month since I began my journey, but despite that, I noticed a huge improvement in my fitness level today. I can only attribute that to the loss of fat around my middle. I did an extra two rounds on the track at a pretty decent clip, with a total distance of 3.2 km (2 miles). I could have done another round (maybe two) but thought I might be too stiff tomorrow, and since my goal is to do this more often to address my second stage insulin suppression, I decided to ‘call it a day’ after 3 km. As I was leaving the track, I decided to take a short video to post along with this 3-month update. Have a look at the video which is posted below, and compare it with the one from 3 months ago (http://tinyurl.com/yb3unuff). My progress is evident.

Want to know how I can help you accomplish your own health and fitness goals?

Please send me a note using the “Contact Us” form above and I’ll be happy to reply.

To our good health!

Joy

Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read in our content. 


You can follow me at:

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A Dietitian’s Journey – practicing what I preach (9 week video update)

This coming Monday will be 9 weeks since I started this journey. The weight loss has been slow yet steady. I’ve lost 7 pounds and 2 1/2 inches off my waist. I can’t tell you how amazing it is to take jeans out of the dryer and put them on easily!

When I look in the mirror, I am starting to recognize the image that looks back. “She” had a neck and a chin – and “her” face is oval, not round. I know that person!

My blood pressure remains very stable (stage 1 hypertension) – down from the wildly erratic fluctuations between stage 2 hypertension, right up to a hypertensive emergency. It was that which started me on the journey, but what keeps me on it, is how I feel. I feel amazing.

My blood sugar is continuing to fall gradually, and for the last 2 weeks I’ve been in mild ketosis and am now “fat adapted”.

I no longer wake up with stiff, swollen fingers and for the first time in years, I fall asleep easily. Yes, I wake up several times to use the washroom, but I can certainly live with that.

This update, I am not going to post any statistics, no graphs, no fat percentages – in fact, I haven’t even taken it since last time.  I’m not obsessing over every pound, every inch, or every percent.  I’m just doing what I know to do and letting the results come as they come.

Two weeks after I started (March 16, 2017), I posted a video of me walking at the local track. It wasn’t “pretty” but it was real. The reason I posted it was because I believe it removes the barrier that somehow because I’m a Dietitian with a post-grad degree that I can’t really understand what it is like for my clients.  I do.

I have to get healthy and make lifestyle changes, the same way as everybody else…one day at a time.

So instead of statistics, and charts and graphs, I am going to post the two videos.  They’ve not been edited in any way – they are as-shot.

Want to know more?

Please send me a note using the “Contact Us” form above, and I’d be happy to get back to you.

To your health!

Joy

 


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Walking at Town Centre Track – March 19 2017

https://youtu.be/6VjayL5UOTc

 

 

 

Nordic Track workout – April 29 2017 (6 weeks later)

https://youtu.be/qrqxzuNj7YA

 

 

 

 

A Dietitian’s Journal – seven weeks eating a low carb high fat diet

It has been a little over seven weeks since I started eating a low carb high healthy fat diet, so here’s an update on my progress.

Weight

In 7 weeks (1 March – 16 April), I’ve lost ~6 lbs, which is quite a reasonable weight loss for someone who was not obese. Most of my weight loss was in the first few weeks, which according to Phinney and Volek (The Art and Science of Low Carbohydrate Living) is quite common for numerous reasons, not the least of which is that our bodies excrete sodium as our insulin levels fall and as a result we lose excess water.

But as mentioned in the previous article, a scale is not an effective measure of short-term changes as the average adult’s weight can fluctuate by as much as 4  1/2 pounds per day, due to water alone.

[see http://www.bbdnutrition.com/2017/04/20/the-limitations-of-common-ways-of-determining-weight-loss/]

WAIST CIRCUMFERENCE

From 1 March – 16 April, I lost 2 inches off my waist. That is alot, but is it significant?

Since it is unknown how much of that decrease was due to water excretion and how much due to fat loss, the decrease in my waist circumference does not provide much information in the short-term.

BODY FAT PERCENT

Based on a Body Fat Analysis, my body fat percentage is down from 40.2% to 39.0% – a decrease of ~ 1.2% but as mentioned in the previous article, Body Fat Analyzers use electrical impedance to determine fat percentage, and this measurement is affected by a number of conditions, including environmental (room) temperature, a person’s hydration status, as well as emotional stress.

Since hydration status can fluctuate by ~4 pounds per day, a body fat analyzer is no more accurate a short-term measure than a standard bathroom scale.

As a result of the limitations of a scale, tape measure and body fat analyzer to capture short-term weight loss, I was left with two ways to assess my progress:

(1) people’s observations of me having lost “so much weight”

(2) how my clothes fit.

VISUAL ASSESSMENT

Over the last number of weeks, I have had quite a number of people remark about my ‘significant weight loss’, but given that I (seemingly) lost a nominal amount, this surprised me.  Over the same period, I’ve been comfortably wearing clothes I could not even get into previously. Surprisingly, it was an inadvertent ‘before’ and ‘after’ photo that provided the most accurate measure of the effect low-carb eating has had on my body weight.

In filing a photo that was taken last week, I found another picture that was taken just before I started eating low carb – where I happened to be wearing the exact same outfit.

The difference was evident.

In progress – before and after

They say the “camera never lies“.

In retrospect, I would have deliberately taken ‘before’ pictures.

CLOTHES

Prior to coming face-to-face with my own denial, I was wriggling into most clothes – particularly pants.  I had set aside some clothes because I simply could not get into them. Wash day always raised the uncertainty as to whether I would be able to get my clean clothes on after they came out of the dryer. 

Now there are no clothes that I own that I can’t wear.  That does not mean they all look great (by no means!), but I can easily close buttons, zippers and actually sit in them! Some clothes that I fit ‘before’ are now beginning to feel loose.

OTHER MEASURES OF LOW CARB SUCCESS

Fasting Blood Glucose

Five weeks ago my monthly average fasting blood glucose was 8.8 mmol/L. Two weeks ago, it was ~8.6 mmol/L. Now it is 8.0 mmol/L.  The last time I had it taken by the lab (a year and a half ago), it was 9.7 mmol/L!

I am aiming for a fasting blood glucose of 5.0 mmol/L by November of this year.

Post Prandial blood glucose (2 hours after a meal)

My blood sugar 2 hours after lunch has dropped from 7.4 mmol/L to 7.0 mmol/L and after dinner, it has dropped from 7.7 mmol/L to 7.3 mmol/L. This is well below the target of < 10.0 mmol/L for a Type 2 Diabetic.

I am aiming for a 2 hour post-prandial blood glucose of between 5.0 – 6.00 mmol/L by November of this year.

BLOOD PRESSURE

For those that have been following my journey over the last 7 weeks, you may recall that it was a ridiculously high blood pressure that was the impetus to change the way I ate.

I’ve gone from ~30% Stage 2 Hypertension, 50% Stage 1 hypertension 15% pre-hypertension and the rest a hypertensive emergency (yikes!) to 80-85% Stage 1 Hypertension and 15-20% pre-hypertension.

This last week (week 7) my blood pressure has been 100% Stage 1 Hypertension, which one would think at first glance was a “setback”, but I don’t view it that way. Firstly, blood pressure that fluctuates a lot is much harder on the heart than blood pressure that is stable.

Secondly, the last two weeks I have been supplementing sodium to eliminate the headaches I had been getting and the periodic arrhythmia (irregular heart beats) that I started to get.

Phinney and Volek (The Art and Science of Low Carbohydrate Living) explain that if one is eating less than 60 gms of carbs per day, that 2-3 grams of sodium should be added to the diet (provided the person is not taking any diuretics or other blood pressure medication). A half a teaspoon of table or sea salt provides 1000 mg or 1 gram of sodium.

Failing to supplement sodium in a low-carb diet can result in really bad headaches and if sodium remains low, potassium will also be excreted to keep a necessary sodium-potassium balance. The drop in potassium can result in irregular heart beat, a condition known as arrhythmia.

Currently, I seem to do best on 1 to 1  1/2 tsp of sea salt, which provides 2 – 2.5 grams sodium. Of course, once the weather starts getting warmer or my exercise starts becoming more strenuous, I will need to increase that.

The ‘side effect’ of keeping my sodium levels constant is that my blood pressure has stabilized – and this is a good thing.  Now I can watch it fall over time, without the wild fluctuations I had been experiencing when I was eating a high carb diet.

OTHER MEASURES – FASTING INSULIN, AM-CORTISOL AND C-PEPTIDE

Fasting Insulin

A year and a half ago, I asked my GP to assess my Fasting Insulin and Fasting Cortisol and he would not as he said he was unable to provide interpretive information. Instead, he referred me to an Endocrinologist.

The Endocrinologist assessed my Fasting Insulin (August 2015) and it was 49 pmol/L (20-180 pmol/L) – but she would not provide me with interpretative information, either. So I had this number, that meant nothing to me at the time. 

I did some ‘digging’ in the literature and found a 2009 study from the European Journal of Endocrinology [European Journal of Endocrinology (2009) 161 223–230] which reported that Fasting Insulin was a strong and independent contributor to cardiovascular risk and atherosclerosis and that women with Fasting Insulin in the lower quartile (25 pmol/L) had significantly lower risk of systemic atherosclerosis, than those in the higher quartile (44 pmol/L).  Now my Fasting Insulin result had some meaning – and it wasn’t good! My fasting insulin was above the higher quartile (49 pmol/L).

My goal is to lower my fasting insulin to at or below 25 pmol/L by November of this year- and the way to lower insulin is by (1) eating a low-carb diet and through (2) intermittent fasting which is what I have been doing.

Now I have even more motivation to stick with this long-term.

My journey is more about health and reduced cardiovascular risk than it is about looking good.  Looking better is a great side benefit.

C-Peptide

Elevated C-peptide (not the same as C-Reactive Protein) is reported to be associated with the higher level of heart disease, including myocardial infarction and coronary artery disease – even in those whose fasting glucose is not impaired (Reference: Diab Vasc Dis Res. 2015 May;12(3):199-207).

Since my C-Peptide was 569 pmol/L (325-1090 pmol/L) a year and a half ago, my goal is to bring that number much closer to the lower end of the range (~350 pmol/L). I will be researching in the literature to determine what factors affect C-Peptide the most.

Cortisol

Cortisol, the so-called “stress hormone” is highest between 6 and 8 AM and it gradually falls during the day, reaching its lowest point around noon. A year and a half ago, my AM Cortisol was 451 nmol/L (140-690 nmol/L) and since cortisol is the hormone that is responsible for mobilizing glucose as part of the “fright and flight response”, it may contribute to my fasting blood glucose being so high.

My goal will be to look into ways to lower my AM Cortisol levels through diet, exercise and stress management.

Final Thoughts

This is a “journey”; one which is as much about the process of getting to my destination as the destination itself.

It is about having a healthy relationship with food and about eating when I’m hungry; not because “it is time to eat”.

It is about the process of enabling insulin levels to fall simply by delaying when I eat and what I eat. 

It is about addressing my body’s inability to process carbohydrates – no differently than I would address an inability to tolerate lactose or inablity to tolerate gluten.  Instead of lactose intolerance or Celiac disease, I have carbohydrate intolerance and as a Dietitian, the path forward is clear. I limit carbs to those contained in non-starchy vegetables, nuts and seeds and use healthy fats as my predominant fuel source.  This allows my insulin levels to fall, lowering insulin resistance and enables me to access my own (abundant) fat stores for energy.

For the first time in years, I am sleeping well and the inflammation in my joints that plagued me for years, is largely gone. Just as a newly-diagnosed Celiac feels well for the first time once they eliminate gluten from their diet, so too do I feel so much better without eating carbs, as carbs.

Have questions about how I can help you?

Feel free to send me a note using the form on the “Contact Us” tab, above.

To your good health!

Joy

Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read in our content. 


follow me at:

 https://twitter.com/joykiddieRD

  https://www.facebook.com/BetterByDesignNutrition/


 

A Dietitian’s Dichotomy

Two years ago, the paradigm from which I’ve understood nutrition shifted dramatically. That was when a friend, a retired physician, asked my professional opinion on the approach that Dr. Jason Fung was expressing in his blog, Intensive Dietary Management. I began to read it from the beginning and after almost 3 weeks of reading, I concluded that the physiology was what we learned in our undergraduate degrees – and promptly set aside when we specialized in our respective professions. As healthcare professionals, we talk about “evidenced based decisions” and at that point, I had to decide whether the evidence was sufficiently strong to change the way I thought and practiced.  This was this Dietitian’s dichotomy.

Fast forward 2 years, and the learning-curve continues as I read through further studies and watch conference talks from some of the leading researchers and practitioners in the low carb high fat world.

Five weeks ago, I started practicing what I preached, and began eating what I call a “low carb high healthy fat” diet, myself.

So how’s that been going?

Well, I am definitely out of denial. I am overweight, insulin resistant, my LDL was too high and so was my blood pressure – and no matter how I looked at it last week, I had 30-40 more pounds to lose.

But here it is a week later, and I still have 30-40 pounds to lose. Am I discouraged or concerned? No. Here’s why;

Weight and Waist Circumference

I had to ask myself – or shall I say, ‘re-ask’ myself “how do I measure success”? If it is by the scale or a tape measure alone, then clearly I am ‘failing’. But am I?

My fat percentage is down from 40.2% to 39.8% – which means, despite NO CHANGE in my weight or my waist circumference, I’ve lost body fat.

How was that accomplished if I didn’t lose weight or “inches“?

Ketone sticks – for measuring ketones in urine – high

This past week, I’ve been maintaining a higher level of ketones then I did last week, so my body has been breaking down triglycerides (fat!) in my liver and fat cells, to make ketones for my brain and to synthesize glucose for my blood. 

Electrolytes and Water Balance

Something that has been slow for me to grasp hold of, is the need to add salt to my food.  I have been used to eating fresh foods with no added salt and preparing foods with the minimum of salt, but with insulin levels falling, so does the kidney’s retention of sodium.

By eating only when hungry and only until no longer hungry, my insulin levels have the opportunity to fall to baseline – something they do naturally after not eating for 12 hours. On days where I extend the time until I eat by a few hours (i.e. “intermittent fasting”), my insulin levels stay low for an even longer period of time.  In response, my kidneys excrete sodium, in a process called naturesis.

The one thing that has to be monitored closely – even for people like myself who are not on any kind of medication for Diabetes or high blood pressure, is that my sodium levels don’t fall too low, as well as potassium, calcium and magnesium. Sodium and potassium and calcium and magnesium are used in pairs in a number of systems in the body and I’ve learned quickly how important these are. All the more important for anyone taking medication to lower blood sugar or blood pressure! After having one or two excruciating headaches from letting my sodium fall too low, I learned quickly that if I feels certain symptoms, I need to take some salt. As well, I’ve learned that people that let their potassium get to low sometimes experience heart palpitations – not a pleasant feeling. I already was supplementing Calcium and Magnesium (along with Vitamin D) prior to adopting a low carb high fat diet, but how to get adequate sodium and potassium?

“KETO-WATER”

It’s fairly difficult to meet the potassium Dietary Reference Intake on a regular diet, but even with a very high non-starchy vegetable intake, it is still hard.  Many of the good sources of potassium, such as potato and yams are not part of the low carb high fat diet. I do eat a lot of mushrooms (high in potassium) but am severely allergic to avocado, one of the best sources, so I make what I call “keto-water”.  Keto-water is club soda (I make mine at home with my Sodastream!) to which 1/8 tsp of half-sodium / half potassium salt has been added. I put a tiny twist of lime or lemon to round out the taste and also to add a source of Vitamin C to my diet and voila, “keto-water“!

Keto-water salts

Provided I drink two liters of “keto-water” per day, I feel great!

No doubt, drinking keto-water has resulted in my body retaining more water, along with the sodium (which is what it is supposed to do!) which would account for my loss of fat, with no change in my weight or waist circumference.

MY BLOOD SUGAR

Here is a snapshot of what has occurred with my blood glucose over the last 5 weeks.

My fasting blood glucose started off averaging 8.6 and then went up, as I began to mobilize fat reserves to supply my blood glucose. Now, my average fasting blood glucose is 7.4 – with dips as low as 6.2 (this morning!) and higher levels in the low 8’s.

My postprandial (2 hours after a meal) blood glucose is great after lunch, a bit higher later in the day (I’m guessing due to the circadian rhythms of cortisol) but then drops nicely before bed. Keep in mind, these results have been realized in only 5 weeks of eating a low carb high healthy fat diet!

BLOOD PRESSURE

Now this is a beautiful thing! For those that have been following this journey over the last 5 weeks, you may recall that it was a crazy-high blood pressure that was my impetus to change the way I ate.

Week One

The first week my blood pressure was divided up between

50% Stage 1 hypertension

~30% Sage 2 Hypertension

hypertensive emergency (not good!)

<15% pre-hypertension


Week Two

The second week my blood pressure dropped to;

>80% Stage 1 Hypertension

<20% pre-hypertension 

This can largely be explained by naturesis (kidneys getting rid of the excess salt through the urine) in response to the insulin drop.


Week Three

The third week my blood pressure was;

~85% Stage 1 Hypertension

~15% pre-hypertension 

Yes, it was a tiny bit higher, but very stable, with my diastolic pressure (the second number in blood pressure) hitting normal levels several times.

Week Four

The 4th week my blood pressure was;

~81% Stage 1 Hypertension

~19% pre-hypertension 

It has been pretty steady the last 2-3 weeks but certainly down from what it was.

Week Five – this week

Look at this!

From 3 weeks in a row stalled at ~80% Stage 1 Hypertension and ~20% pre-hypertension, it is almost 60% / 40% now…and that is WITH taking sodium and potassium “keto-water”!

This is how I measure success.

Final Thoughts

Success is about achieving goals and my goals have been about lowering my insulin resistance and blood pressure and losing weight and inches in the process.  Success is attained when you measure the appropriate outcomes.

Have questions? 

Wonder how I might be able to help you accomplish your goals?

Whether you live in the Lower Mainland or hundreds of kilometers away, I have service options to meet a wide variety of needs. Please send me a note using the form on the “Contact Us” tab, above.

To your health!

Joy

Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read in our content. 


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A Dietitian’s Journey – out of denial and approaching health

Today it’s 4 weeks since I began “practicing what I preach” when it comes to a low carb high fat diet and to be frank, the results have astounded me.  Over the last two years, I’ve been reading through the literature on this topic and while I knew that eating this way could produce significant results – I had no idea that it would be possible to see blood sugar and blood pressure come down this much in this short a time, especially given how well, and much I eat. Then there is the weight and inches lost. This is a summary of my progress to date.


Out of Denial

Part of this ‘journey’ of getting healthy myself, has been 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 omitting to find out the magnitude of reality.

In psychological terms, I was in denial.

Out of Diabetes Denial

In the first entry in this journal, I mentioned how I didn’t know how high my blood sugar was because I hadn’t measured it in ages. I hadn’t had my HbA1C measured in a year and a half.  I didn’t want to know how bad it was. Despite being a Dietitian with a post graduate degree in Human Nutrition, I didn’t want to know how unhealthy I was.

In 6 months from the time that I began this journey, I want to know what my labs show. HbA1C measures the amount of glucose bound to hemoglobin (glycated hemoglobin) and since it takes 3 months for the red blood cells in our bodies to turn over, it takes that long for HbA1C to begin to reflect the dietary changes made. Having my HbA1C measured in 6 months will show my average plasma glucose level since I started eating a low carb, high healthy fat diet.

Using good scientific methodology, I should have measured my fasting blood glucose and HbA1C at baselinebefore I started to change what I am doing and then measure them again in 6 months.  That way, I could calculate the magnitude of change.

There’s one small problem.

I have a long-standing physician who is my age and who would have without question, sent me home with prescription for a oral diabetes medicine – likely metformin once the results came in. I know that my blood sugar has been ~12 mmol/L because that’s what it would be this past month when I would eat more ~ 50 gm of carbs. Before I started this journey, I was eating significantly more carbs than that.

Furthermore, the previous three years, my fasting blood glucose was 7.9 mmol/L (Feb 2013), 9.1 mmol/L (Sept 2014) and 9.7 (Aug 2015). Extrapolating that data to the present date brings it pretty close to 12 mmol/L.

Note: I am not advocating for anyone not to take oral diabetes medication, if prescribed it. It was my choice, as an allied healthcare professional to take an alternate route before being prescribed medication.

out of Hypertension Denial

Without question, prior to a month ago, I would have been diagnosed with hypertension (high blood pressure) as the first week of this journey, my blood pressure was 1/3 of the time in Stage 2 Hypertension with one hypertensive emergency (i.e. higher than Stage 3 hypertension) and 50% of the time I was in Stage 1 hypertension, with the remaining ~ 15% in pre-hypertension.

The last time my GP measured my blood pressure was a year and a half ago (Aug 2015), I was straddling Stage 1 and Stage 2 hypertension.

It’s not rocket-science to figure out that had I gone to my doctor following my hypertensive emergency, I would have come home with a prescription for hydrochlorothiazide, a diuretic-based blood pressure medication. 

Note: I’m not advocating for anyone to avoid taking anti-hypertensive medication, if prescribed it. As a healthcare professional, I chose a different route before being prescribed medication.

Instead, that ridiculously high blood pressure was the impetus for me to change.  That day, I became my ‘first client’.  That day, I began practicing what I preach. I began eating low carb, high healthy fat, myself.

out of Dyslipemia (Cholesterol) Denial

I have no idea what my lipids were when I started changing how I eat, but I know what they were for the last 3 consecutive years. My LDL cholesterol (so-called “bad cholesterol”) was hovering around 3.00 mmol/L, with the normal range for low risk individuals being 1.50-3.39 mmol/L. However due to having Diabetes as well as a family history of high cholesterol, I am high risk and my LDL levels need to be ≤ 2.00 mmol/L. 

My HDL cholesterol (so-called “good cholesterol”) was high; ranging between 1.76 mmol/L three years ago, to 1.91 mmol/L two years ago, to 2.25 mmol/L – significantly above the 1.10 mmol/L cutoff, however my GP did not consider that protective. As he told me, he only looks at LDL as the determination for putting someone on lipid lowering medication (statins). Assuming my HDL continued to be around the 2.00 mmol/L mark, more than likely had I had lab tests done now, I would have come home from his office with atorvastatin (brand name: Lipitor) or one of the other statin medication – just as he told me he would do a year and a half ago.

Note: Again, I am not advocating for anyone to not take medication prescribed it.  I decided to change my lifestyle prior to being prescribed medication for dyslipidemia.

Instead, of getting my baseline labs measured and coming home with a prescription for Metformin, Lipitor and hydrochloridethiazide, I decided instead to follow a low carb high healthy fat diet and get my labs taken in 3 months.

out of obesity and overweight Denial

I knew how much I weighed a month ago, but it had been a year and a half – since August 2015 since I calculated my BMI – and more significantly, since I measured my waist circumference. Today, after a month of significant diet changes, I came out of denial with respect to my weight, and calculate my “numbers” – just as I do for my clients. After all, I am now my ‘first client’.

It turns out, I am overweight now – which means I was just in the obese category at a BMI of 30.5 (obese is a BMI > 30) when I began this journey.

No matter how I calculate it, I still need to lose at least another 30-40 pounds.

By the Scale

Based on the scale, I need to lose 29 pounds for my BMI to reach the high end of the “normal weight” category (< 25). To put myself in the mid-range of the normal weight category, I should lose another 35 pounds. 

By Fat Percentage

Based on my fat percentage, I need to lose 17% of my body weight (29. 1/2 pounds) to be at a healthy 23% (non-athlete, female). That’s another 30 pounds.

By Waist to Height Ratio

For my waist circumference (in inches) to be half my height (in inches), I need to lose 30 pounds.

How do I know?

Because all these years, I kept my leather pant belt from when I was that size and I remember well how much I weighed, then.


MY RESULTS – ONE MONTH UPDATE

So how am I doing after one month eating low carb high healthy fat?

my Weight

It is now the end of the 4th week and I have lost 5 pounds.

That’s right, I didn’t lose a thing this week.  Am I upset?  Not at all, because I lost another half off my waist.

my Waist Circumference

In the first two weeks, I lost an inch off my waist, the third week, another 1/2 inch came off and today I measured my waist again – without sucking in my belly (what would that prove?!) and it is down another half inch. In total, in one month, I lost 2 inches off my waist.

Based on my Waist to Height Ratio (WHTR), I still have another 8 inches to lose off my waist – which would have seemed so discouraging a few weeks ago, except that 2 inches came off effortlessly, with me following the Meal Plan that I designed for myself.

It's great having the skills to take my health into my own hands, knowing I am getting all the micronutrients that I need - but for those that need help getting started, there are Dietitians such as myself who can help!

During the entire 4 weeks I was never hungry (if I was, I could eat!) and I’ve been meeting my daily requirement for protein as well as Calcium, Magnesium, Potassium, Vitamin K, Vitamin A, Vitamin C and Vitamin E.

Yes, my fat intake is high (~75% of calories) but much of the fat I choose to eat is monounsaturated fat (such as cold pressed olive- and avocado oil) as well as omega-3 fats from fatty fish (such as salmon, mackerel) and other fish (such as cod). Based on the reading I have been doing in the literature, I do not believe that eating this way poses any adverse health risk to me. If it did, I wouldn’t eat this way.

Based on the literature, there is nothing inherently "bad" about eating saturated fat. Our bodies actually make it in the form of palmitic acid. I eat whole eggs (with the yolk!), full fat cheese and put cream and/or low lactose milk in my coffee but when it comes to my main sources of fat, I look to cold pressed olive oil which is 65-80% monounsaturated (oleic), 7-16% saturates (palmitic) or cold pressed avocado oil which are 76% monounsaturated (oleic and palmitoleic acids), 12% polyunsaturates (linoleic and linolenic acids) and 12% saturates (palmitic and stearic acids), as well as fat from nuts (almonds, pine nuts, macadamia nuts) and seeds (pumpkin, mostly).

The only thing that is “low” in my diet is carbs, but since I am meeting my daily micro-nutrient and protein requirements, I can see no physiological purpose for having more carbs.

my Fat percentage

I’ve gone from ~ 41.5 % body fat to 40 % body fat in a month. Okay, I’ve a long way to go, but I am doing what I need to do, the results will come.

My Blood Sugar

I should mention that to track my blood glucose accurately, I am using two glucometers; (1) one that is a year old made by GE and using it with brand new blood glucose test strips and (2) a brand new glucometer, made by Abbott which also takes Ketone Strips, so I can track my ketone levels.

I am purposely keeping my ketones low at this point, as I want to make sure I feel well eating this way first, and that the "numbers" (weight, waist circumference,fat%, blood glucose and blood pressure) decrease slowly and steadily.

Ketone meter – measuring B-hydroxybutyrate
Ketone sticks – for measuring ketones in urine

As long as I kept my net carbs (carbohydrate minus fiber) at ~35 gm of carbs per day, I did very well, but above that my body could not handle the sugar load. Without a doubt, I was very insulin resistant –which is no surprise, considering I was diagnosed with Diabetes ~ 10 years ago.

This past week, I tracked my carbs carefully (easy to do and requiring no apps) and kept them at or below 35 gm per day and my blood glucose continued to decrease this past week, in a linear fashion at all times of the day .

My body is doing exactly what it was designed to do; happily breaking down the fat I have stored up over the years and converting it into glucose for my blood.

This was my blood sugar last night, 2 hours after supper. 

I haven’t seen post-prandial (after-a-meal) blood glucose levels like this since I’ve been Diabetic, which is 10 years!

This was supper;

zucchini spaghetti – with meat sauce and Asiago cheese
mixed green salad with extra virgin olive oil, goat feta and pumpkin seeds

As you can see, I am hardly starving!

I used to love fruit on my salad, but have found that snap peas cut up have just the right amount of sweetness, lots of fiber and a whole lot less carbs!

Blood Pressure

I should mention that to track my blood pressure accurately, I purchased a brand new, top-of-the-line sphygmomanometer which measures my blood pressure automatically 3 times, one minute apart and takes the average. 

Week One

The first week my blood pressure was divided up between

50% Stage 1 hypertension

~30% Sage 2 Hypertension

hypertensive emergency (not good!)

<15% pre-hypertension

 


Week Two

The second week my blood pressure dropped to;

>80% Stage 1 Hypertension

<20% pre-hypertension 

This can largely be explained by naturesis (kidneys getting rid of the excess salt through the urine) in response to the insulin drop.


Week Three

The third week my blood pressure was;

~85% Stage 1 Hypertension

~15% pre-hypertension 

Yes, it was a tiny bit higher, but very stable, with my diastolic pressure (the second number in blood pressure) hitting normal levels several times.

Week Four

This week my blood pressure was;

~81% Stage 1 Hypertension

~19% pre-hypertension 

 

Its getting progressively lower each week.

The last few nights, I saw “normal” blood pressure readings;

March 25 2017
March 26 2017

 

 

 

 

No, my blood pressure readings are not (yet) always normal, it has only been FOUR WEEKS! On average, my blood pressure has come down 1 mmHg / day for 4 weeks in a row.

Final Thoughts

Data is data and while not scientifically ‘objective’ data and with a sample set of only 1, the “numbers” are convincing.

I feel well, I am eating better than I have in years. My sleep has improved significantly. My clothes fit looser and when I look in the mirror, the face that looks back is more familiar.  An added benefit is that my fingers, which have been stiff for years, are much less so.

I can’t think of any drawback to eating this way, except for the space required to have lots and lots of fresh vegetables in the house and that I am going through them at an alarming rate!  Thankfully, I have an extra fridge in the garage, so I don’t need to shop more than once a week. 

Even food cost, which was a bit of a shock the first week (as I had to purchase ingredients I didn’t use before, and certainly not in that quantity) has leveled off. I spend a lot less money on milk and large amounts of cheese and a lot more on the best quality olive oil and avocado oil.  Protein quantities are about the same as before, except there is more animal protein now, as I used to be mostly vegetarian. Protein sources are mainly fresh fish, chicken, and marinated flank steak. None of these are high in saturated fat, so even those of my peers that might worry about people who may be physiologically sensitive to higher saturated fat levels would not be concerned about the way I am eating. Yes, I am eating “high fat” but 80% of it is what even the most conservative health care practitioner would admit are “healthy” fats. Studies seem to show that even those who eat a much higher saturated fat diet, suffer no adverse health issues. At the end of the day, I am meeting all my dietary needs and the only thing that is missing is the “carbs”.  So?

Unless someone can present me with a compelling reason why I need those carbs, I will keep eating the way I am eating and teaching others who wish to do so, the same.

To our health!

Joy

Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read in our content. 


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A Dietitian’s Journey – three weeks in

INTRO: Three weeks ago, the pain of changing was less than the pain of remaining the same and so I changed. At that time, my blood pressure had hit dangerously high levels and I didn’t even know what my blood sugar levels were, as I hadn’t checked them in ages. I didn’t want to know. Despite being a Dietitian, I was in classic denial. March 1st, I began eating low carb high fat (LCHF) and doing short periods of intermittent- and alternate-day fasting (IF). Keep in mind, three weeks is an incredibly short period of time and I did not expect to see these kinds of results.  There was not only significant weight loss and loss of inches around the waist, but lower blood sugar and blood pressure, as well.

Today is three weeks since my journey began and here is an update on my progress – three weeks in.

Blood Sugar

In the first two weeks, my blood sugar decreased substantially even on the days I was not intermittent fasting – provided I ate very few carbs. When I was eating what most would consider “low carb”, my blood sugar would spike.

arrows indicated 2 periods of eating 10-15% carbs

It became clear that as long as I kept my net carbs (carbohydrate minus fiber) at or below 35 gm I did very well, but above that my body could not handle the sugar load. You can see this from the graph above.

The two periods where I was eating between 35-50 gm of carbohydrate per day (Saturdays) is indicated by the grey arrows, below the graph. That is when my blood glucose would spike.

As a Dietitian, I could see clearly that I was very insulin resistant –which is no surprise, considering I was diagnosed with Diabetes ~ 10 years ago. Despite my pancreas producing more and more insulin in response to eating carbs, the insulin was unable to take the glucose (sugar) from my blood in a reasonable amount of time, to store it in my liver.

[Note: As it turns out, between 65-75% of people with normal blood sugar are insulin resistant - that is, they have the same risk of hardening of the arteries and heart attack as those with Diabetes!  They just don't know it! That's is very sobering. See the "Insulin Resistance" tab, above.]

Since realizing how sensitive I was to more than the carbs naturally found in non-starchy vegetables and nuts and seeds, I cut out all other sources – including my beloved Hawaiian purple yam and homemade (baked) yam fries…for now, until my blood sugar levels are consistently in the non-diabetic range and my insulin levels, normalized. Even then, I know I will only be able to eat such things once in a while and in small servings, but that’s okay. As one of my sons would say “dying is bad“.

A week ago, I began tracking my carbs (easy to do and requiring no apps – not even a pencil). I kept them at or below 35 gm per day and as you can see from the graph below, there has been linear decrease in my blood glucose levels at all times of the day – including first thing in the morning, after lunch, after dinner and before bed. It’s only been three weeks!

Week three – March 15 – Mar 21

Interestingly, the little ‘spike’ yesterday was in the early morning after – I hadn’t eaten for 12 hours!

My body was breaking down the fat I have stored and was converting it into glucose for my blood – a process known as lipolysis. This is a ‘good’ thing. My body was doing exactly what it was designed to do;

(1) store excess glucose as fat, in times of plenty,

(2) break down stored fat for glucose, in lean times.

The issue is, there have been no “lean times”.

Blood Pressure

Week One

The first week my blood pressure was divided up between

50% Stage 1 hypertension

~30% Sage 2 Hypertension

hypertensive emergency (not good!)

<15% pre-hypertension

It was all over the place (very hard on the heart) and the systolic pressure (the first number in a blood pressure) was very high.

After the issue with my eyes (which was non-diet or lifestyle-related) having hypertension (high blood pressure) put me at risk for blindness. I took this very seriously!


Week Two

The second week my blood pressure dropped to;

>80% Stage 1 Hypertension

<20% pre-hypertension 

This can largely be explained by the fact that the first thing that happens when we reduce insulin levels (a response to eating low carb) is something called naturesis. That is simply a medical term meaning our kidneys get rid of the excess salt by making us pee a lot. This period usually lasts ~4-10 days following going low carb.


Week Three

This week my blood pressure was;

~85% Stage 1 Hypertension

~15% pre-hypertension 

Yes, it was a tiny bit higher, but very stable.

The first two weeks I ate very low sodium as I usually did, but this week I actually had to start adding salt into my diet as my kidneys had expelled all the excess sodium it was retaining and my sodium levels were too low.  I felt a bit lethargic and light-headed.  The reading I’ve been doing in the literature and the Conference Proceedings I’ve been watching from some of the world’s leading physicians that treat diseases (such as Diabetes, hypertension / high blood pressure, dyslipidemia / high cholesterol as well as Alzheimer’s and some cancers) using a low carb high fat diet, mentioned this need for increasing sodium after the first 10 days.

A pleasant surprise was seeing my diastolic pressure (the second number in blood pressure) hit normal levels several times.

One of the roles of insulin (besides taking the glucose in our blood and storing it in our livers as glycogen or fat) is to signal the kidney to retain salt.  That makes us bloated and causes our blood pressure to go up.

Being Diabetic or insulin resistant (65-75% of people aged 3- 90 years, according to Dr. Joseph Kraft’s robust studies) causes people to retain sodium and raises their blood pressure. Hypertension (high blood pressure) is called “the silent killer” – but much of this is entirely diet related.  For the most part, is not too much salt, but too many carbs and too little green leafy veggies (rich in potassium) that underlies high blood pressure.

Anthropometrics

Weight

The first week and a half, my weight dropped ~4 pounds – much of it was water, from my kidneys expelling the excess sodium.  My weight didn’t budge for most of the last week and a half, but I didn’t let that discourage me.  My body was now burning fat and not carbs and the weight loss necessarily had to follow.

It is now the end of the 3rd week, and I have lost 5 pounds all together.

Waist Circumference

In the first two weeks, I lost 1 inch off my waist and this week, another 1/2 inch came off.  That is a very good thing – but for a different reason than I thought.

As Dietitians, we were taught that BMI (weight-to-height ratio) and waist-to-hip ratio allows us to factor in the greatest risk of cardiovascular events (heart attacks, strokes) but current research is showing that there is a much better predictor years of life lost (YLL) due to overweight, and that is the waist-to-height ratio.

Years of Life Lost (YLL) compared to Waist to Height Ration (WHtR)

Most of us have heard that where we carry our fat is even more important than how much of it we actually have. This is true.

Carrying it around the abdomen (belly fat, what Dietitians and Doctors call “central adiposity“) is a greater predictor of cardiovascular risk than BMI (weight to height ratio). Simply put, being an “apple” as opposed to a “pear” is not good.

But what should our waist circumference be?

A meta-analysis from 2012 pooled data from multiple studies which in total looked at more than 300, 000 adults in several ethnic groups, found that Waist to Heigh Ratop (WHTR) was a far better predictor than BMI or Waist Circumference of cardiovasular or metabolic risk factors in both sexes.

Ashwell M, Gunn P, Gibson S (2012) Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev 13: 275–286

The least amount of years of life lost is associated with a Waist to Height Ratio of 0.5 (mine was not anywhere near that!).

That is, take your height and divide it by 2.

NOTE: Measure your waist at the location that is the mid-point between your last rib and the top of your hip bone, with the front and back of a flexible seamstress-type tape measure at the same height, and your belly fully relaxed.  This is not the time to suck it in!If you measure your height in inches, measure your waist in inches and if you measure your height in cm then measure your waist in cm.

If the result of your Waist to Height ratio is greater than 0.5, then welcome to the club.  The question is, what to do about it?

That’s where I can help.

Practicing what I preach,

Joy

Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read in our content. 


follow me at:

 https://twitter.com/joykiddieRD

  https://www.facebook.com/BetterByDesignNutrition/

A Dietitian’s Journey – the road to better health

A Dietitian’s Journey – the road to better health

In the previous article titled “A Dietitian’s Journey – the beginning“, I shared about why I am following a low carb high healthy fat diet and why I am using intermittent fasting (http://www.bbdnutrition.com/2017/03/14/a-dietitians-journey/in my pursuit of improved health.  In this post, I talk about the smaller third.

In future posts, I will explain the science of why I am doing this, in simple terms that everyone can understand, because as a Registered Dietitian, I believe that best clinical practice necessarily has to be based on evidence as available in the scientific literature. Why I am doing this is because quite literally, my life depends on it.

This “journey” is my road to better health – to optimal health.

As a Registered Dietitian in private practice, I’ve spent the last decade helping people in the Lower Mainland of Vancouver learn how to eat healthier, lose weight, lower their blood sugar and blood pressure and have cholesterol that is in the healthy range.  While I had lost 50 pounds myself a few years ago, little by little over the last 2 years, I’d put 1/2 of it back and along with the higher weight, came higher blood sugar levels, followed by high blood pressure.

My “fat picture” – prior to losing 50 lbs.

I had two choices; (1) go on medication or (2) change my lifestyle. I chose the latter. March 1 2017 was the beginning of the journey, on the road to better health.

But what was the “road”?

Over the last 2 years, I’ve done a lot of reading with regards to the physiology of why and how diets high in carbs underlie the “obesity epidemic”.  I understood how excess carbs that were not needed for energy were converted to fat and stored in the liver. I also understood how this excess fat in the liver negatively impacted cholesterol levels – that it wasn’t eating fat that gave people high cholesterol (except for a very small minority with genetic conditions) but eating too many carbs.

Day in, day out in my private practice I’d explain to people how eating “plenty of fruit and vegetables” was making things worse for them because of the carb content in these foods – foods that were eaten with- and between meals. I knew that following the standard recommendations of the last 40 years – to eat low fat and high carbohydrate and restricting portions was not going to accomplish my goal.

I decided to “practice what I preach” by eating a low carb, high fat diet (LCHF), and by using ‘intermittent fasting’ (which is not as ominous as it sounds!) and eventually, by incorporating short periods of high intensity interval training (HIIT).

I knew that while what I ate and when and how long I didn’t eat was the most important component of my “journey”, I still had to get moving to lower my stress, and with it, lower my cortisol levels which were driving vicious cycle.

Since I am not yet “fat adapted” – that is, my body hasn’t yet switched over to using my own fat stores as a fuel source, I knew that I needed to postpone the high intensity interval training and just start with walking.

Yesterday, I set an appointment with myself to do just that, and while I was 3 hours later than I planned to be today, my ipod wasn’t charged and it was 5° C and pouring rain, I went to the track and did what I said I would do.

Here’s a clip from my first workout:

Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read or heard in our content. 


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A Dietitian’s Journey – the beginning

A Dietitian’s Journey – the road to better health

Two years ago, my Endocrinologist gave me the choice between a low-carb-high-healthy-fat diet with occasional periods of fasting or taking medication for Diabetes, high cholesterol & blood pressure. Two weeks ago, I made my choice.


As a Dietitian, I’ve heard of many different types of diets; some good and others not-so-much and I’ve also heard people tell of their success and failures with each of them. I’ve heard of the pounds lost and amount-and-then-some gained back and the feeling that somewhere along the line these people feel as though have failed. But did they?  Was it really a lack of will-power or was something else going on?

In past blogs, I have talked about the changes to Canada’s Food Guide, which paralleled changes to the US Food Pyramid, both which began in 1977.  Both countries made dietary recommendations that focused on low-fat, high carb diets; all with the promise of lower rates of heart disease, but what we got instead was what some have called the “Diabetes Epidemic“.

What effect have these dietary recommendations had on obesity statistics?

In 1978, only 15% of children and adolescents in Canada were overweight or obese but by 2007, that rate doubled to 29% ! By 2011, obesity prevalence alone was 15.1% for boys aged 5 to 17 years, and 8.0% for girls of the same age.

What about adults?

In the period of 1970-72, the prevalence of obesity* in Canadian adults increased from 10% to 26% in 2009-11.

Obesity is defined as having a body mass index (BMI) ≥ 30 kg/m 2

Based on waist circumference 37% of adults and 13% of youth are abdominally obese – and this kind of fat, which lies around and between our organs increases risk of heart attack and stroke far more than fat under the skin (sub-cutaneous fat).

As of 2013, there were approximately 7 million obese adults and 600 000 obese school-aged children in Canada!  Not just “overweight”, but OBESE!

These statistics and a discussion with a friend who is a physician resulted in me beginning to question whether this dramatic increase in obesity and overweight after 1977 was correlated to the changes in the dietary recommendations of Canada’s Food Guide and the US Food Pyramid toward lower fat, higher carbohydrate diets.

I began to question whether the ‘standard’ three-meals-and-two-or-three snacks per day, with 45-65% of calories coming from carbohydrate really was best. And so began the process of me changing not only what I believed, but what I practiced.

A Dietitian’s Journey – the beginning

I remember back at McGill, when I was doing my undergrad training as a Dietitian, one of my professors saying that most people chose Dietetics because they came from a background of disordered eating or diet-related health issues.  True to form, most of my extended family were obese and most had Diabetes, high blood pressure and high cholesterol and were on a whole host of medications for each.

Fast-forward 20 years (and several children later) and despite losing 35 of the 60 pounds I had to lose, I became Diabetic. More recently, I’ve had high blood pressure.

Unable to answer my questions regarding addressing both of these through a low-carb-high-healthy-fat eating plan, my GP referred me to an Endocrinologist. After a thorough physical examination and a whole host of blood work, she asked me about how I planned to address this, given that I am a Dietitian.  Hesitantly, I told her that I planned to eat a high healthy-fat diet and low carb diet with a medium amount of protein and use intermittent fasting to lower insulin resistance. She asked me what percent of “net-carbs” (total carbs minus fiber) I was aiming for and what percentage of protein and what my fat sources would be, and I told her.  I was waiting for an extremely negative reaction, but instead was completely taken aback by her reply. She said that from she’s been reading in the literature, my plan was not only evidenced-based, but that if I didn’t don’t lose the rest of the weight and eat this way, that I will end up on both medication for my blood sugar, and cholesterol and likely for my blood pressure, too.

I began to implement the dietary and lifestyle changes and was seeing my “numbers” coming down, but like many people, life happened and I didn’t follow through. The weight crept up and presumably so did my blood sugar and pressure, but I had stopped monitoring those ages ago. But it was a problem with my eyes — one whose cause was unrelated to being Diabetic or having high blood pressure that was a game-changer for me. Having these conditions put me at higher risk of losing my vision and this was simply not something I was willing to risk.

Two weeks ago, I arrived at a fork-in-the-road. One direction was the same as most of my family took; with medication for blood sugar, blood pressure and cholesterol. The other was the road that I am taking; the one less traveled, but very well-researched, and with the encouragement of my Endocrinologist – a low-carb-high-healthy-fat way of eating, with days of fasting in the day but eating supper, and periods of days of eating and then not eating.

Not “starving”, but “intermittent fasting”. The difference?

Starving results in the body lowering its metabolism to spare calories and intermittent fasting and alternate-day fasting results in the body raising its metabolism and burning stored fat.

The expected outcome?

The first goal begins with lowering insulin resistance; which is the underlying cause of Type 2 Diabetes, and with lower insulin resistance follows lower blood sugar levels – both fasting blood sugar and A1C (3 month average).

A change in diet and strategic use of fasting, lowers insulin and cortisol levels which in turn, lower triglycerides (TG). TG are largely a byproduct of a high-carb diet (especially affected by fructose), so lowering these results in lower TG and in turn, lower levels of LDL (bad cholesterol) and higher levels of HDL (good cholesterol).  Lower insulin and cortisol as well as less abdominal fat, results in lower, more normalized blood pressure.

Will it work?  The research seems to indicate it will and over the weeks to come, I will posting the results of some of that research so that the context of what I’m doing can be understood.  After all, I am a Dietitian and a scientist — it has to be evidenced-based.

The First Two Weeks – off to a good start

Blood Sugar

Of course this is an incredibly small period of time to look at, but in the first two weeks since I started my low-carb-high-healthy-fat eating with intermittent- and alternate-day fasting , my blood sugar has decreased substantially even on the days I was eating, provided I was eating very few carbs.

arrows indicated 2 periods of eating 10-15% carbs

Blood Pressure

My blood pressure went from 50% Stage 1 hypertension with 1 hypertensive emergency (scary!) and ~30% Stage 2 Hypertension the first week:

…to approximately 80% Stage 1 Hypertension and almost 20% Prehypertension the second week.

That is a significant change!

My weight is only down ~ 4 pounds, but I’ve lost 1 inch off my waist.

I am not hungry on my intermittent-fast days …and keep in mind, I talk about food all day long with my clients. If I am not talking about food, I am working on meal plans and writing about food!  If I was hungry, this would be torture, but it’s not. In fact, the last time I ate was last night at supper and I feel fine. I should have had a coffee though (as I get caffeine headaches if I don’t).  I’ll make one soon.

I’ve only taken one alternative-day fast so far and it went fine.  I drank “bone-broth” (I’ll explain in coming blogs!) and had my morning coffee with a little cream, no milk because of the carbs. I don’t really like cream, but it was okay.  Bone broth is interesting — a bit like chicken broth, but different.

One side-bonus that I never expected, is that I am sleeping better than I have in years.  Crazy good sleep and waking up rested.  What a great added bonus.

I have a long way to go to get to my goals (plural) because I’ve set the bar very high…and why not? If the literature indicates that this works, then I want;

(1) blood sugar in the non-diabetic range

(2) normal blood pressure

(3) normal / ideal cholesterol levels

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

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

So join me in my journey – a journey of change, of good health and on a road less traveled.

Joy

Copyright ©2017 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 regular monitoring by a Registered Dietitian and with the knowledge of 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 something you have read in our content. 


follow me at:

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