It would be funny if it wasn’t so tragic. Gary Fettke, a Tasmanian orthopaedic surgeon has been banned from talking to patients about the nutritional changes they can make to prevent amputations.
His wife, a nurse, tells his story here:
Gary’s presentation on you tube is here:
As you start a low carbohydrate diet your kidneys get better at excreting salt thus you will usually find that you lose a lot of water from the tissues of the body. This can make you instantly slimmer, particularly around the legs, but also can give some cramps in the muscles when you exert yourself. Be aware of this and add extra salt to your food, and drink plenty of water. When you are on a low carbohydrate natural foods diet you will be consuming considerably less sodium chloride, which is present in many processed foods including sweet ones. Bread for instance has a lot of added salt that most people are completely unaware of, therefore feel free to be liberal with the salt cellar.
Blood pressure comes down, partly due to less water retention, but also due to lowered natural insulin levels in the body. As the weight comes down as well, blood pressure tends to drop. For most people who are not on any antihypertensive drugs they may feel slightly lightheaded from time-to-time. This can be abolished by adding more salt to the diet.
For people who are on medication to reduce their blood pressure they should have their blood pressure measured by their general practitioner and cut back on medication on embarking on a low carbohydrate diet if their blood pressure is under 140/90. After a few weeks on a low carbohydrate diet they will be adjusted to a lower level of blood pressure. Thereafter blood pressure only requires to be checked on several occasions with each extra half stone of fat loss.
It is helpful to buy your own blood pressure monitor as measurements done when you are relaxed at home tend to be more accurate than those undertaken in a surgery.
As many blood pressure medications have more than one use, and different effects on the body, it is worth discussing with your general practitioner which ones would be better to cut out altogether or which ones could be reduced in dose. This is because certain drugs such as ACE inhibitors and sartans have an extra protective effect on the kidney and this can be important for diabetic patients. They also help improve heart function in cardiac failure.
Beta-blockers are sometimes given to people with atrial fibrillation, or who have had a heart attack, or who suffer from angina, and continuing these may be a priority for some individuals.
BLOOD SUGAR REDUCTIONS
Blood sugar reductions happen rapidly with a low carbohydrate diet. This is mainly due to the lack of sugar and starch being turned into blood glucose. This has several effects.
The most pronounced and rapid effect could be on the eyesight. The lens of the eye adjusts to a particular blood sugar and if the level goes suddenly up, or suddenly down, your vision can become blurry, particularly for reading print. It is worthwhile avoiding getting new spectacles for about 6 months to give time for the lens of your eye to adjust otherwise you can end up having to get another pair of spectacles at a very short interval and this can be rather expensive.
INSULIN and ORAL HYPOGLYCAEMIC DRUG USERS NEED TO TAKE EXTRA PRECAUTIONS
Type 1 diabetics will have been using insulin from the time of diagnosis. Increasing numbers of Type 2 patients are going on insulin as their pancreas needs more support as time goes on. A rapid change in pattern of sugar and starch intake can give dangerously low levels of blood sugar unless the insulin dose is proportionately reduced from the outset of the diet. The amount of reduction will depend on how high your blood sugars run normally, and how strict your low carbohydrate diet is.
For many people who are taking insulin, or sulphonylurea drugs which also have a marked blood sugar reduction effect, starting on a moderately low carb diet of 100g or so a day may cushion the effect somewhat.
Most diabetics will need to cut their insulin quite dramatically, particularly if they go on less than 50g of carbohydrate a day. It is normal to have to cut insulin by a half or even two thirds in some individuals.
A close eye on blood sugar monitoring needs to be done and we would recommend that, for particularly people who are operating machinery or driving, they start a low carbohydrate diet over a period of holiday when there are other people around who can assist them should they have low blood sugars, and also people to undertake driving on their behalf.
Your own general practitioner or hospital endocrinologist is the best person with whom to discuss your planned reduction in insulin or sulphonylurea medications.
Many patients on sulphonylureas are able to stop these drugs completely prior to starting a low carbohydrate diet and thus remove the risk of low blood sugars completely. People who use insulin however are not able to do this and must have a degree of background insulin to prevent them developing dangerously high blood sugars and ketoacidosis.
The normal blood sugar ranges between 4 and 7 at most times. Drivers must not drive unless their blood sugar is at least 5, and they should re-check their blood sugar after every 1-2 hours of driving. To treat a hypo use 15-20g of glucose and do not drive till blood sugars are completely normal and you have fully recovered.
Setting an alarm to check blood sugars in the middle of the night, and taking blood sugars at 2½ hourly intervals through the day is advised in the first few days for insulin users.
The normal correction dose is one unit of rapid acting insulin for every 2.5 units of blood sugar elevation. This can be helpful to know if you have cut down your insulin doses a bit too much.
Aiming for blood sugars between 6 and 8 mmol can be a safe strategy in the first 2 weeks after starting a low carbohydrate diet. Thereafter the blood sugars can be tightened up when insulin requirements are more predictable. To prevent blood sugars going up and down unpredictably it is best to stick to 3 main meals a day and avoid snacking.
For insulin users and people on sulphonylureas it is best to fully understand the implications of a low carbohydrate diet and know how to control your blood sugars and insulin as well as having a good grasp of carb counting prior to undertaking a low carbohydrate diet. There are many educational resources on the web to do this. Some of these resources are Dr Bernstein’s Diabetes University on you tube, diabetes.co.uk website and Low Carbohydrate Course which is web based, and diabetesdietblog.com which has two written courses.
Although it can be daunting to think about the initial difficulties that can occur with a low carbohydrate diet, the long term benefits of improved blood sugars, weight, blood pressure and lipids make the outlook for pre-diabetics, the overweight and people suffering from diabetes much brighter indeed. It is worth educating yourself about your condition and how to effectively use a low carbohydrate diet to change your health destiny. The extra planning that you need to do for meals, more frequent shopping for fresh ingredients and often increased expense are worth the long term health benefits.
Alcohol can be a pleasant part of life. Many alcoholic drinks are high in sugar, such as beer and sweet wines, and also cocktails. These need to be eliminated for success in a low carbohydrate diet. Spirits such as whisky, gin and vodka have less impact on the blood sugar, and dry red and white wines are also suitable.
For insulin users, and particularly Type 1 insulin users however, alcohol can tip them into unexpected hypoglycaemia if they are consuming more than 1-2 units of alcohol without a corresponding increase in dietary carbohydrate. This is because alcohol limits the ability of the liver to manufacture glucose, and also blood sugars tend to run much more towards the normal range, around 4.6, when diabetes undergoes an apparent reversal on a low carbohydrate diet.
Exercise is a very beneficial and pleasant adjunct to a low carbohydrate diet for increased mood and health. For insulin users and those on medication such as sulphonylureas, adding exercise into the regime early on in the stages of a low carbohydrate diet add an increasing layer of complexity to blood sugar management. We therefore recommend that unaccustomed exercise is avoided for the first 2 weeks until blood sugar stability is achieved.
Dr Katharine Morrison
This is the link to the Public Health Collaboration site where you can download for free or order print versions, at a modest cost, of illustrated health booklets that will help you:
know what to eat for a wide variety of good health outcomes
plan your meals
count your carbohydrates
Hopefully you will end up somewhere between the extremes of our sisters up there!
Dr Lois Jovanovic from Santa Barbara is an expert in getting great results with diabetic women in pregnancy. This video series from Diabetes in Control covers in depth interviews with Lois. Even if you are not pregnant or intending to be you can pick up information on how to get excellent blood sugar control in these videos.
Lois Jovanovic, MD, is Clinical Professor of Medicine, University of Southern California-Los Angeles Medical Center. Consultant: Hyperglycemia in Pregnancy. Dr. Jovanovic is an international expert, multiple award winning endocrinologist, in the research and clinical management of diabetes. She specializes in the ages and stages of women with diabetes, and hyperglycemia in pregnancy.
If you prefer to view the entire video, click here.
To view other segments in this video:
Part 1; Taking Care of Diabetes in Utero
Part 2: Low Carb Diets for Pregnant Women
Part 3: Insulin Dosage During Pregnancy
Part 4: What’s Healthy for Mothers and Babies
Part 5: Prevalence of Glucose Intolerance in Pregnancy
Part 6: One-Step Test for Glucose Intolerance
Part 7: The Artificial Pancreas and Pregnant Women
Part 8: Use of Insulin Pumps in Pregnancy with Type 1
Part 9: Managing Blood Sugar During Pregnancy
Part 10: What is “Normal” A1C in Pregnancy?
Part 11: Think Pregnancy First
Part 12: Prediabetes and Gestational Diabetes
Part 13: Limitations of Fasting Bloodwork
Part 14: Centers of Excellence for Diabetes and Pregnancy
Part 15: Risks of Poor A1C Control in Pregnancy
Part 16: Exercise During Pregnancy
The flavor of shellfish benefits significantly from grilling. Removing the shellfish from the grill before they become too well done and rubbery is the biggest challenge. Watching closely for shellfish to turn opaque (non-transparent), removing them from the grill and serving them immediately are key to delicious tasting fish.
Prepare scallops for grilling by cutting off the curved shaped appendage that is attached to the side of the body, if still intact.
Prepare shrimp by removing the shell and the vein that runs along the back. Personal preference dictates whether to leave the tail on or off.
Marinating shellfish in a flavorful oil will help to prevent the tendency of the scallops and shrimp to dry out.
Two skewers work best to prevent the seafood from spinning or turning on the grill.
Grill shrimp on each side for 2-3 minutes, depending on the thickness of the shrimp. Cook scallops for 2-3 minutes on each side, depending on their size.
Make room on the grill for vegetables. The caramelized, smoky flavor that comes with grilling does wonders for vegetables. A lot of veggies do well on the grill, but some really stand out — asparagus, corn, eggplant, squash, mushrooms, peppers and onions.
Most vegetables cook better and are less likely to stick if they’re marinated first or brushed lightly with vegetable oil.
For added flavor, sprinkle grilled vegetables with chopped fresh herbs. Cut the vegetables all about the same size for even cooking.
If you use wooden skewers, soak them in warm water for 20 minutes.
Whisk all the marinade ingredients together in a measuring cup. Divide in half. Use one half for the shellfish and one half for the vegetables.
For 2 servings
For 2 servings
Marinate the shellfish and vegetables separately for 30 minutes. Drain and thread the scallops on one double skewer and the shrimp on a second double skewer.
Do the same with the vegetables. Save any marinade left in the bowl to use as a basting sauce.
Preheat an outdoor grill to high and grease the grill grates with oil.
Place the vegetable skewers on the grill first, since they will take longer to cook. Cook until the vegetables are tender, turning and basting them with the olive oil mixture occasionally, about 15 minutes.
After the vegetables have cooked for 10 minutes, place the shellfish skewers on the grill. Cook for 2-3 minutes on each side.
Serve the grilled shellfish and vegetables with the Green Goddess Dressing.
This may be used immediately or stored in the refrigerator for up to 3 days. This dressing is also delicious drizzled over hard-boiled eggs.
Makes 1 cup
Place the chives, parsley, anchovy fillets, tarragon and vinegar in a food processor and pulse a few times to combine.
With the motor running, add the olive oil in a steady stream, scraping down the sides, and process until pureed. Add the sour cream and process until smooth. Season with salt and pepper.
Store in the refrigerator until serving time.
Dana, what is the range of health conditions that you have seen respond to a low carb diet in your readers?
The most exciting, perhaps, is polycystic ovarian syndrome, the most common cause of female infertility, and very definitely an insulin-driven illness. Back when I was still self-published, I got an email from a woman who had tried for years to get pregnant, but couldn’t because of PCOS. She read How I Gave Up My Low Fat Diet and Lost 40 Pounds, went low carb, got pregnant, and carried the child to term. That’s the kind of thing that keeps me grinning for days.
Commonly, I hear of vastly improved blood work – one fellow had his triglycerides plummet by 1200 points in 2 weeks. People regularly report low trigs and high HDL.
Blood pressure reliably drops, too. It’s common for detractors to say “Oh, you only lost water weight on that diet.” That’s nonsense, of course, but it is true that the very rapid loss of 5-10 pounds in the first week or so is largely water. That’s because when insulin levels drop the kidneys resume excreting sodium properly, and with it the water it was holding. Because of this, blood pressure comes down quickly. (For this reason, people who are medicated for high blood pressure must be under a doctor’s care when they first go low carb. They may need a reduction in medication within days.)
By the way, the proper excretion of sodium means that many low carbers need to increase their salt intake – I’m one of them. If a new low carber is feeling tired, achy, dizzy, headache-y, the first thing to try is increasing salt – heavily salted broth or bouillon works wonderfully.
Energy swings vanish when the blood sugar swings stop. Many annoying symptoms of generalized inflammation, such as arthritis, are reduced or eliminated.
Gastroesophageal reflux, aka heartburn, generally clears up.
And all kinds of little things – skin conditions, bleeding gums, stuff like that. My husband, who has a mouth full of crowns, hasn’t had a single new cavity since we went low carb 20 years ago. (I still have no fillings at the age of 57.)
Perhaps most surprising was the woman who wrote me to say that since she and her husband had gone low carb, a range of problems had cleared up, including that he had “stopped coughing up blood.” She finished with “You have been a miracle for our family.”
I have no idea how a low carb diet would stop the coughing up of blood, but I’m certainly glad it did.
Dana Carpender is the author of nine cookbooks, including the best-selling 500 Low-Carb Recipes.