Last week, I flew to Montreal to be with my mom in the last days before her death. While it was hard to see how much she had changed, it was sobering to be reminded of something I started to realize six years ago — that the death of friends and family should change the way we live.
The untimely death of two college friends in 2017 was the impetus for me to finally change my own diet and lifestyle. One of my friends died of a stroke and the other of a massive heart attack and both worked in healthcare their entire lives. As mentioned several times in “A Dietitian’s Journey,” I knew that my death would be next if I didn’t lose weight, lower my very high blood pressure and blood sugar.
While it took me twice as long as it should have to accomplish my health and weight goals due to undiagnosed hypothyroidism, I was successful in losing 55 pounds and taking a foot off my waist, and in putting my hypertension and type 2 diabetes into remission. Many times I was asked why I took accomplishing my goal so seriously and my reply was always the same, “I am doing this as if my life depends on it, because it does.”
When my dad was diagnosed with Alzheimer’s disease, I once again made some lifestyle changes. Even though I had put my type 2 diabetes into remission with diet, I began taking a low dose of the prescription medication Metformin preventatively, while continuing to eat a low carb diet. But, like many people, I became somewhat complacent and maybe even a little bit smug that diet alone was enough, and in the years since my dad’s death ended up discontinuing my medication, with my doctor’s knowledge.
Something that I was missing in my decision to discontinue this medication that I took prophylactically was that my health had changed, and I didn’t know it yet.
When I was diagnosed with profound hypothyroidism a little over a year ago, my doctor told me that even with taking thyroid hormone replacement medication that it would take a year and a half to fully recover due to how advanced it was.
I wanted to understand how my body had changed, so I did lots of reading in the scientific literature and learned about how hypothyroidism affected my heart rate, my blood pressure and cholesterol and wrote about it here. For a while I took a “baby dose” of blood pressure medication and made hypothyroid-specific dietary changes but eventually stopped taking it, and waited for the thyroid medication to reverse the symptoms. In retrospect, that may have been a bit naive. I was assuming these metabolic markers would return to normal in time, thinking that all I needed to do was wait the full year and a half to fully recover.
Recently, after an increase in thyroid medication I noticed that my blood sugar was significantly higher than it had been in years even though I had been compliant eating a low carb diet. Once again, I turned to the scientific literature to determine why. It was then that I discovered that all thyroid hormone replacement — even the “natural ones” raise blood sugar, and I wrote about that here.
Given my higher blood sugar and my late dad’s diagnosis of Alzheimer’s disease, I started back on the half dose of metformin, but it wasn’t until my recent visit with my mom, that I became less complacent.
Around the time my dad was diagnosed with Alzheimer’s, my mom was diagnosed with vascular dementia secondary to some mild strokes, known as TIAs. At first, the signs were subtle — things like difficulty organizing things she wanted to do into a list, but over the past few years, she lost the ability to read and write, and sometimes couldn’t organize her thoughts into coherent sentences. My mom didn’t have high blood pressure, but struggled her whole life with being overweight and was sedentary.
The important things for me — and that I wasn’t factoring in before was that my mom having had mini strokes, and later developing vascular dementia put me at risk because I now have moderate hypertension as a result of my thyroid condition. As well, my dad having had type 2 diabetes and developing Alzheimer’s disease increased my risk now that the thyroid medication wasn’t keeping my blood sugar in the non-diabetic range, as it had been for two years with diet alone.
It’s all nice and fine that I continue to eat low carb and workout at the gym, but in light of my thyroid meds raising my blood sugar, taking Metformin only makes sense. Likewise, it’s great that I achieved remission from hypertension with diet alone, but things have changed. My blood pressure has been moderately elevated since last year and discontinuing the low dose blood pressure medication hoping improved thyroid levels will normalize them is a bit naive. They may, but they may not.
While I was away in Montreal visiting with my mom, I made a phone appointment with my doctor. I told him about my mother’s diagnosis and my current blood pressure, and said I think it makes sense to take some blood pressure medication and to monitor it regularly. I also told him that I think given my blood sugar levels are higher even though I continue to eat low carb, that I think it only makes sense to begin taking Metformin again, and continue to monitor them regularly. He agreed.
Today I buried my mom.
While she died due to pneumonia and not vascular dementia, her death has changed how I will live. I realize that I can no longer be complacent that eating a good diet, and going to the gym several days a week is “enough.”
My dad is buried beside my mom and visiting his grave reminded me in a fresh way that his death was related to him having Alzheimer’s disease, and that he had type 2 diabetes for the last 40 years of his life. While my elevated blood sugar is a side-effect of the thyroid hormone medication that I have to take, taking Metformin and continuing to eat a low carb diet and exercising only makes sense. His death has changed how I will live.
Final Thoughts
Dietary and lifestyle changes are very important and can effectively put both type 2 diabetes and hypertension into remission, however when circumstances change, it is necessary to consider medication as an adjunct.
I have no choice but to be on thyroid medication in the same way that someone with type 1 diabetes has to take insulin. Given my lack of thyroid function, as well the side effects of taking thyroid hormones, I have chosen to let my parent’s deaths change the way I live. It may not be forever, and it may be — only time will tell.
In the meantime, I will continue to eat a low carb diet to control my blood sugar as best I can, and to go to the gym several times a week to lift weights and do resistance training.
Taking medication is not a “failure”. Dying an unnecessary or premature death like my two girlfriends did, is.
And if taking medication, in addition to eating a good diet and being active helps avoid, or significantly slow dementia, all the better.
To your good health,
Joy
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I planned to go to the gym for the first time this past Wednesday, but make sure there was nothing slowing me down to “showing up”, my gym bag was already packed, and by the front door. 
I knew something was wrong, and for several months, I assumed my feeling exhausted and having joint and muscle pain was a carry-over effect from having had Covid. But a cell phone picture of myself taken just before the wedding told me it had to be something else. Gradually, over several months, I went from looking as I had been the previous two years after losing 55 pounds to looking like I had regained everything. I later found out, it wasn’t fat but an accumulation of mucin in the skin that is one of the hallmark signs of myxedema. You can read more about myxedema and the skin changes associated with hypothyroidism 
This weekend was my second son’s wedding, and the difference between how I felt in June and now is incredible! Instead of wearing medical compression stockings and orthopedic shoes so I could walk, I wore regular nylons and dress pumps.
As a clinician, I felt similarly when I lost half my hair in September of 2022. I wondered if others would consider me a “failure” for not having been able to prevent it.
It has been recommend that to reverse significant hair loss due to telogen effluvium to maintain serum ferritin at levels of >157 pmol/L (70 ng/dL) [4].
Food sources of selenium include Brazil nuts, with 2 Brazil nuts meeting the daily requirement of 200 mcg of selenium. Other good sources of selenium are mushrooms, eggs, fish such as cod and halibut, chicken and eggs. 
Eating foods rich is zinc is the safest way to ensure adequate intake and good sources of zinc include red meat, poultry, seafood such as oysters, crab and lobster, as well a nuts. 
In addition to dairy foods that are fortified with Vitamin D, foods that are naturally good sources of Vitamin D include fatty fish such as salmon, mackerel and tuna.
The blood tests confirm that I have both thyroperoxidase antibodies (TPO-Ab) and thyroglobulin antibodies (TG-Ab), which along with my symptoms, confirms my diagnosis of Hashimoto’s disease, but thankfully my blood test results indicate that neither are elevated.
This past Monday, I went to the lab to have blood tests to measure my thyroid hormones, anti-thyroid antibodies, and an iron panel. When I had met with my doctor last week, I learned that I would need to pay for the free T3 test because the British Columbia guidelines and protocols for ordering thyroid tests state that a free T3 test is only covered to rule out suspected cases of hyperthyroidism [1]. As I wrote 
How many people would be willing to order dinner at a restaurant that did not post the price of its menu items until after they ordered?
“A Dietitian’s Journey” (Part I) was my personal weight-loss and health-recovery journey that began on March 5, 2017 when I decided to make dietary and lifestyle changes so that I could reclaim my health. At that time, I was obese, had type 2 diabetes for the previous 8 years, and extremely high blood pressure. 
The next symptom that I became aware of was swelling in my ankles. It wasn’t just a little bit of swelling, but significant enough that I needed to wear compression stockings all day.
It is easy to see from the above photo that in less than 3 months on thyroid medication treatment, my face has lost its puffy, “inflated” look yet amidst the positive improvements of decreased edema and looking more like myself in some respects is the reality that I have lost ~1/2 of my hair due to telogen effluvium that often occurs with sustained hypothyroidism. You can read more different causes for hair loss 
Telogen effluvium – is the most common form of diffuse hair loss [7]. It usually occurs after a profound stress, shock or traumatic event including after childbirth, as the result of a thyroid disorder, as well as rapid weight loss. It has been reported after a sudden and significant calorie restriction diet (“crash dieting”) [8], and has also been reported associated with the popularized ‘keto’ diet [9,10], but I am in agreement with Dr. Stephen Phinney of Virta Health that it should not occur in a well-designed keto diet [11]. 
In telogen effluvium, hair often comes out in clumps in the shower, or in a brush [6]. Loss is usually from all over the scalp, but may occur more on the temples, the part and the crown of the head [7]. Once the cause telogen effluvium is removed, regrowth will usually begin within two to six months [6].
He had no idea that I was hiking in North Vancouver and Golden Ears Provincial Park for several hours at a time last summer. I knew that it was abnormal for me to feel so exhausted and for my muscles to feel so weak, and one look in the mirror told me something was very wrong.
Two years ago, in the summer of 2019, I was feeling fantastic and was in remission of type 2 diabetes and hypertension and was celebrating my “
I am from a family of people that always ‘battled with their weight’.
When I became overweight and then obese, and developed type 2 diabetes and high blood pressure, I justified that I was at high risk since both of my parents had the same. I realize now that the “high risk” was our shared diet and lifestyle, more than genetics. Our shared comorbidities were adopted.
What was true about food was also true for beverages.
Once again, my palate returned to coffee, but finding a decently roasted coffee in Vancouver BC was harder than I thought. Given that this was the “West Coast”, I was discouraged how difficult it was to find good quality Arabica beans that weren’t over roasted. I stumbled across a few small roasters that did an excellent job, but in time they modified their roasts for “local tastes”, so once again, I was back looking for a new roaster. On a few occasions, I ordered from La Vieille Europe in Montreal because in the 40 or 50 years they have been in business, they never lost their passion for properly roasted, single origin coffee.
Over the 20 years I have lived in Vancouver, I discovered the world of quality tea that is largely unknown to most non-Asian born Chinese. There was one excellent tea importer in the Chinatown that I knew of and one that is still in the Richmond Public market that have single origin estate teas that rival the diversity of the best coffee roaster. Over the past 20 years, I’ve explored different types of tea from China and have come to like a few; my favourite of which is a fermented tea known as Pu-ehr.
At the beginning of this year, I began to explore green teas from Japan when I discovered Hibiki-An, an online tea importer from Uji region of Kyoto. My culinary world expanded once again.
For the purpose of “cooling” the water to just the right temperature, there is a yuzamashi — which is a small ceramic cup with a spout that the boiled water gets poured into to cool momentarily before being poured into the kyuzu; a special tea pot with a single handle, built in mesh filter and large opening for the water (see photo, above).
The colour was a bright jade green and the taste had no hint of bitterness whatsoever!
In a little over a year I’ve lost almost 40 pounds- first eating a low carb diet and then necessarily because of significant hyperinsulinemia (high levels of circulating insulin) and insulin resistance, a ketogenic diet. I’ve put my Type 2 Diabetes into remission while reversing my high cholesterol and high blood pressure and while I’ve not yet arrived at the point where my waist circumference is half my height (lowest risk) I am getting close.