Nancyelle’s low carb pizza

JIM NEDVED’S TAKE ON NANCYELLE’S LOW-CARB PIZZA
WITH EGG, CHEESE & HERB CRUST.   This is a Neved family favourite which is
delicious, and avoids the excess moisture of cauliflower crusts.  You will need parchment or silicone liner and a pizza pie dish with perforations to allow steam to escape.                          

THIN AND CRISPY PIZZA CRUST

8 ounces mozzarella cheese, shredded
8 ounces cheddar cheese, shredded
(reserve a bit of cheese for sprinkling top, for final 4-5 minute broil)
4 eggs
1 teaspoon garlic powder
1 teaspoon basil, optional

OTHER INGREDIENTS

 Store-bought spaghetti sauce (lowest sugar content you can find) or use tomato paste.

A bit of olive oil

Toppings of your choice such as:

 Mushrooms
Onions (sliced)
Peppers (all colors, chopped fairly large)
Italian sweet sausage (raw)
Pepperoni (sliced at store for pizza)

pic of pizza tin used for cheese-egg crust pizza (use w parchment paper)


First, p
re-bake crust:  Mix the cheeses, eggs, garlic powder & basil well. Line 16-inch perforated pizza pan with parchment paper. Evenly spread cheese mixture on parchment, almost to edge of pan, making it as thin as possible. Bake with oven rack in center position at 450 for 15-20 minutes until golden brown. I suggest checking it after about 10 minutes. If it’s getting very dark on the edges and top, turn the oven down to 400 and continue baking until brown all over and no longer pale on the bottom. Pat off any excess grease.  Let cool a few minutes.  Spread on a 1/2 cup spaghetti sauce with spatula.

pic of cheese-egg pizza crust

Cook toppings – while they’re hot, you’ll top the pre-baked crust with them: Using 2 separate fry pans (1) cook Italian sausage, add pepperoni & warm, then put onto pre-baked crust which has sauce already on it; (2) in other fry pan, sauté in olive oil your mushrooms, peppers & onions till as done as you want when you eat them; then put onto pizza, on top of meat.  NOW INTO THE OVEN FOR A SHORT BROIL:  Sprinkle cheese you’ve reserved on top.  Keeping oven rack in center position, put in pizza (which already has all the hot ingredients on it) under the broiler until topping cheese & pre-cooked ingredients are bubbly, about 4-5 minutes.

Enjoy!

Makes 8 servings
Can be frozen

Nancyelle’s recipe was posted at LowCarbFriends®, a registered mark of Netrition, Inc.
On April 5, 2018, Low Carb Friends’ management announced that LCF’s forums would be permanently shut down.

pic - close up of finished pizza on cheese-egg crust                               

 

 

 

 

 

 

 

 

 

 

                               

 

 

 

      

RCGP: When is a sick child seriously ill?

Adapted from RCGP, Acutely ill children by Ann Van den Bruel and Matthew Thompson June 14

A feverish child is very common and many of them consult the GP or go to the A and E department. Emergency admissions to hospital with febrile illness are increasing even though admissions for serious causes of infections are relatively rare at less than one percent of febrile children seen in primary care. These serious illnesses are mainly caused by pneumonia, urinary tract infection and many fewer by sepsis, meningitis and osteomyelitis. The trick is to be able to recognise the very few children with serious illnesses as soon as possible.  This is where it becomes so difficult as the early stages of illness are non specific.  Up to half of children with meningococcal disease, for example, are not recognised as such at first contact.

Parents often correctly realise that their child has a much more serious illness than usual, indeed this indicates 14 times the likelihood that there is a serious illness,  but other times their description of catastrophe bears little resemblance to what the doctor or nurse sees.

Some clinical signs are more useful than others. For instance if the temperature is over 40 degrees, the risk of serious illness is raised from 1% to 5%. Other important signs are cyanosis (blue lips), poor peripheral circulation (mottled hands and feet), rapid breathing, crackles on listening to the lungs, reduced breath sounds, meningeal irritation (causing a high pitched cry or a stiff neck), petechial bruising, (non blanching bruised looking rash), and reduced level of consciousness, ( drowsy or incoherent).

Combinations of features can help sort out potentially serious from not serious causes.

The only prediction rule that has been tested is this.  If one of these is present then there is a 6% chance of a serious infection:

the clinician has a gut feeling something is wrong, the child is breathless, the temperature is over 39.5 degrees, and there is diarrhea in a child aged 1-2.5 years.

If NONE of these are present however there is a 0% chance of a serious infection. That is,  no concern from a doctor, no breathlessness, a fever under 39.5 and no diarrhea aged 1-2.5 or diarrhea but in a child out with this age range.

Symptoms and signs can change over time of course so vigilance from the parents is still needed.

Meningitis

Meningococcal disease may be lethal. The trouble is that in the first 8 hours of the illness, it presents with the usual flu like symptoms of fever, headache and sore throat.  Typical symptoms of meningitis only occur after 13 to 16 hours. These include neck stiffness, rash, fits or loss of consciousness. They also don’t occur in all children with the illness. Other symptoms that can help are leg pain and also the less distinguishing skin pallor or blueness and cold hands and feet.

Pneumonia

80% of all serious infections are due to pneumonia. This is obvious when you have an ill looking child, who is breathing fast and has a low oxygen saturation and on blood testing a raised CRP.

If a doctor has no concerns about the child AND there is no shortness of breath however, it is very unlikely that the child has pneumonia.

Heart rates and breathing rates can be raised in sick children but when this becomes abnormal is still a matter of debate.

If a doctor has concerns about a child, this raises the chances of serious illness from less than 1% to 11%.

Blood testing is rarely done in primary care but when done  perhaps in the A and E department, CRPs under 20 and procalcitonin levels under 0.5 ng/ml rule out serious infections.

Safety netting advice is particularly important if the diagnosis is not clear, there could be complications of a particular diagnosis or the child is at a higher risk of getting complications.

Although children are getting healthier, acute infections remain common, and parental concern leads to many presentations at the surgery or in A and E.  How to distinguish serious illness that needs quick intervention from non serious illness that can be managed at home remains a challenge.

 

Vegetable oil ingestion not so sunny after all

Adapted from BMJ 9 Feb 13 Use of dietary linoleic acid for secondary prevention  of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. Christopher E Ramsden et al

Despite lack of evidence to the contrary I still see NHS dieticians telling patients to avoid naturally occurring saturated fat such as butter, cream and the fat in animal meats. This study didn’t get much publicity at the time so here it is again.

The question was, does increasing dietary omega 6 linoleic acid in the place of saturated fat reduce the risk of death from coronary heart disease?

What happened was that in the Sydney Diet Heart Study, a RCT done between 1966 and 1973, saturated fat (thought to produce heart attacks) was replaced by omega 6 fatty acids from Safflower oil ( vegetable oil and margarines, thought to be heart healthy). Although the blood cholesterol levels decreased in the intervention group, deaths from all causes, coronary heart disease and cardiovascular disease, all increased.

The subjects were all men aged 30-59 who had had a recent heart attack.  As an example, all cause mortality was 17.2% in the intervention group compared to 11.8% in the control group. Results for cardiovascular disease were similar.

It is mystifying that dietary advice telling people to swap lard for vegetable oils and butter for margarine is still going on. Very telling is that date that this study was done. The results would have been out by 1975.

Koolaidmom: Moroccan Chicken in the slow cooker

Slow Cooker Moroccan Chicken
• Servings: 6-8
• Time: 5 minutes prep. 6-8 hours on low
• Difficulty: easy

Ingredients:
• 3-4 lbs. split chicken breasts
• 2 tablespoons butter
• 1/2 onion, diced
• 2 teaspoons cumin
• 1 teaspoon turmeric
• 1/2 teaspoon coriander
• 1 teaspoon cinnamon
• 1/2 teaspoon cardamom
• 1/2 teaspoon Cayenne pepper
• 1/2 teaspoon powdered ginger
• 4 cloves garlic, minced
• 1 teaspoon salt
• 2 cups chicken stock
• 1 cup dried apricots, roughly chopped

Directions:
1. Optional: In a large skillet over medium heat melt butter. Add chicken to pan and brown on both sides. Remove chicken to bowl of slow cooker. Add onions to pan and cook until softened. Add onions to bowl of slow cooker. This will add more flavor to the dish but if you wish you can add chicken and onions to bowl of slow cooker without cooking. (My comment: doing this really makes a difference to the appearance and flavour of this dish)
2. Sprinkle cumin, turmeric, coriander, cinnamon, cardamom, Cayenne pepper, powdered ginger, garlic, and salt over the chicken. Pour the chicken stock over the chicken and cook on high 5-6 hours. After 3 hours add the apricots.
3. Once cooked through remove the chicken and shred if desired.

Beware of alternative causes of neuropathy in diabetes

Diabetes in Control: Disasters averted

Not All Neuropathies in Diabetes are Caused by Diabetes
May 10, 2016

A woman, 57 years of age, type 2 diabetes, metformin 1,000mg twice daily for 12 years, came in with weakness, anemia, tingling of fingers and toes. Her A1C had always been below 7%. Some in my office thought she had developed diabetic peripheral neuropathy. I could not disagree, but I also knew metformin can cause vitamin B12 deficiency. I immediately ordered lab including a B12 level. Sure enough, her B12 was low. We recommended B12 lozenges, 500mcg daily, and her symptoms as well as her B12 levels improved. This was good news because neurological symptoms don’t always improve with B12 therapy, but hers did. (My comment: they need to be treated within six months of onset)
Lessons Learned:
• For patients taking metformin, check B12 levels at least annually.
• Consider recommending B12 supplementation to patients who take metformin, or at least teach of the possibility of this side effect.
• Teach patients who are on metformin therapy to eat foods high in vitamin B12 such as animal sources of foods including beef, poultry, seafood, eggs, dairy and foods fortified with B12.
• When a patient with diabetes presents with peripheral neuropathy, check vitamin B12 levels, and treat accordingly.

BMJ: How to get a better sleep if you work night shifts

From Optimising sleep for night shifts by Helen McKenna and Matt Wilkes 3rd March 2018

Night shift work happens when your body would rather be asleep. Alertness, cognitive function, psychomotor co-ordination and mood all reach their lowest point between 3am and 5am.

After a night shift is over, the worker has to try to sleep when the body would prefer to be awake. This shift away from the circadian phase compounds the fatigue and can lead to chronic  sleep disturbance. There is  more likelihood of occupational accidents, obesity, type 2 diabetes, heart disease and breast, prostate and colorectal cancers. Psychological and physical well being is affected and accidents or near misses when travelling home are much more likely to occur.

Performance on the night shift gets worse as people get older and it takes longer to recover from a night on.

On average most people sleep about 8 hours a night.  Some people cope with sleep deprivation better than others. Performance will be impaired after two hours of sleep deprivation and gets worse as sleep debt accumulates. Therefore before starting a set of night shifts it is wise to sleep in the morning before, avoid caffeine that day,  and if you can take a nap in the afternoon between 2pm and 6pm.  For a nap to be most effective you need 60-90 minutes asleep.

When you start the shift, try to fit in a nap of about 30 minutes if this is the sort of job that allows this, but have a coffee immediately before the nap, and don’t have any more caffeine after the nap.  Sleeping longer than 30 minutes can make you feel groggy as you move into deep sleep and are the roused from it. Caffeine can help performance but you also want to try to sleep the next morning. Avoid it for the 3-6 hours before you plan to go to sleep in the morning. If you are doing critical tasks especially between 3-5am it is wise to build in more checks to your work.

Working in bright light can perk you up on the night shift.

When it comes to eating you are probably best to eat your main meal immediately before the night shift then eat just enough to feel comfortable as the shift goes on.

Jet lag improves at the rate of one day for every hour you are out of phase.  Circadian adaptation is therefore impossible during short term rotating shift work. Therefore you have to do your best to optimise your sleep between the shifts so as to keep the sleep debt minimal.

If you can possibly arrange lifts home or travelling home on public transport after a night shift, do so.

You can try to improve the situation by wearing sunglasses in daylight on the way home, avoiding electronic device screens, using blackout blinds, ear plugs and eye masks or even white noise generators.  A warm bath and then sleeping in a not cold but cool room and wearing woollen nightwear may help. Melatonin taken in the morning after a night shift has been shown to improve sleep duration by up to 24 minutes. Avoid alcohol and caffeine as these won’t help. Drugs such as Zopiclone can improve sleep if taken during the day but it can be addictive and needs a prescription.

After a run of night shift work you may get into the swing of your regular routine by having a 90 or 180 minute sleep, as this is one or two sleep cycles,  or sleeping in to noon and then getting up and getting outside for some exercise in bright light. Do your best to include meals at the usual times and socialise a little.  You will also need to pay attention to paying back your sleep debt by going to bed earlier than usual and sleeping in later than usual for a few days. It is best to avoid day time naps during the recovery from shift phase.

The path to sleep optimisation is an individual thing. Feel free to experiment.

Obesity makes asthma particularly difficult to control

From British Thoracic Society Winter Scientific Meeting December 2017 London

Researchers have demonstrated that diet induced obesity leads to the development of airways hyper-reactivity through the interplay of an immunological and metabolic pathway.

Resultant asthma can affect children as well as adults. Unfortunately obesity associated asthma responds poorly to standard asthma medications including steroids and can result in more hospitalisation and a reduced quality of life.

The most effective obesity treatment is probably bariatric surgery to achieve sustained weight loss. In contrast dietary management and drugs are far less effective.