A geriatric nurse practitioner disabled with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) living as well as I can with a chronic illness. Always a bit introverted, tendency to geek out about medicine, health, nutrition, gardening/permaculture. Hoping to make someone's path easier by sharing information on diet, medical research and what I've found works for me ~~ Ellie Strand, MSN, RN, APRN (Ret.)
Stiina Marie is an American who blogs from Norway. I flirt with prediabetes (100-125 mg/dl) when my diet is carb-heavy. I’ve thought long and hard about how I would manage my day, my meals and my exercise if I passed the arbitrary 125 mg/dl cut off point. I know I would be as frustrated as she is. This is why I take precautions, such as losing weight (down to 177.5–a loss of 2.5 lbs this past month) keeping my fasting blood sugar below 100 mg/dl and eating real food instead of processed.
I sat there, once again in the chair, ready to be bombarded with weight, exercise and eating questions. This was like my brain, 24/7. Don’t they understand? I plan all my meals, my drinks, my exercise, and weigh myself several times a day hoping the number changes. I don’t need to be constantly reminded I could die if I don’t care as much as I do about my habits and body. I don’t like being told it’s not enough but I’m told that every time I sit in that chair.
This has been my life for five years.
Medical personnel don’t seem to realize the mental toll it can take on a diabetic. I wondered if this kind of talk and constant reminding could conjure an eating disorder. I was sadly right. These are disorders common to specifically those with diabetes:
Orthorexia: A fairly new disorder label, this disease is about being obsessive about what you eat to the point that you actually hurt yourself. One cares so much about nutrients and what not to eat they can become almost phobic of certain foods that are deemed “impure”, leave out foods/food groups in their diet, worry obsessively about their next meal and need to be in control of what they consume. Hours are spent planning out food, researching and looking at food.
Diabulima: This type of disorder refers to stopping, lessening or skipping insulin injections and running a high blood sugar in order to lose weight. This is very dangerous to do because high blood sugars can land you in a coma and/or cause death. They can also cause problems in the long run such as kidney failure and blindness. I will not mention how this is done specifically because it can be well hidden from doctors and other people.
Considering these are indeed issues in the diabetic community, I am shocked and appalled there isn’t much light shed on them through medical personnel know of them. I know they do because I was asked if I was skipping insulin doses to lose weight (diabulima). I told them I didn’t have a clue that skipping insulin would do that. She politely nodded and said okay and moved on without much explaining. Google researching told me about diabulimia and another blog author’s information lead me to find orthorexia.
I really believe these two disorders should be added to that fancy-shmancy DSM manual thing. Oh yeah, they aren’t officially disorders. Strange, huh? These disorders won’t go away as long as diabetes is becoming more common and healthcare professionals don’t acknowledge them as an issue. There needs to be a plan. How do you talk about diabetic needs without making the diabetic individual obsessive? How do you discuss positive body image when diabetics typically have weight problems? More importantly, how do you treat individuals with diabulima and/or orthorexia that are still diabetic?
Our fifth installment of photos that make me relax just by looking at them. I’m posting in the hope that they will also be relaxing to other spoonies. If you don’t know what a spoonie is, here’s a short article that explains it.
Want to see something in particular? Let me know below.
The debate between following a low-fat, weight-loss diet and eating to lower carbohydrates and thereby lose weight appears to be settled after a large medical study. Some people, including many ketogenic and paleo dieters, believe cutting back on carbohydrates helps them lose weight. Others, including many physicians and medical centers, promote diets that cut back on saturated fats found in red meats and dairy products, as recommended by the US Department of Agriculture in its Food Pyramid.
In a 600-person, year-long study, the two eating styles helped dieters drop almost exactly the same number of pounds — and there didn’t seem to be much rhyme or reason as to who succeeded on which plan.
Going into the study, which was published today in the Journal of the American Medical Association, researchers wanted to settle the debate but they also wanted to know if blood insulin levels or genotype had an effect on weight loss.
High blood levels of insulin are a sign of insulin resistance, which often precedes Type 2 diabetes. Many believe high serum insulin promotes storing calories as fat. Researchers looked at the genetic profile of each participant and determined which ones had particular genetic traits thought to lead to weight gain. To the researchers’ surprise, neither genetic predisposition nor high insulin levels had any effect.
Results show you can lose weight with either eating plan
People studied were between 18 and 50 years old, and all overweight or obese but otherwise healthy. They attended nutrition classes taught by a health educator. There were no calorie restrictions. Everyone was directed to minimize their intake of sugars, refined flours, and trans fats. At the same time, they were encouraged to eat vegetables and nutrient-dense foods. Everyone was encouraged to adopt healthy habits like cooking at home and sitting down for structured meals with family members.
As you would expect, not everyone on the diets lost weight and some had dramatic losses. The outliers were one individual who gained 20 pounds and another who lost 60. However, the average weight loss in each group was almost identical: 11 pounds in the low-fat group, compared to 13 pounds in the low-carb group.
“It’s not so much about that food — it’s really about [changing] this crazy way that Americans eat.”
About 30% of people in the study had a genetic signature that, in theory, should have pointed to success on the low-fat diet, while 40% had a low-carb “profile”. But the data didn’t show any strong similarity between these genetic markers and weight loss on the corresponding diet. Neither did measures of insulin resistance, which the team also thought would be related to success.
The successful dieters, regardless of which group they were in, credited their achievement to a reframed relationship with food. They began eating more mindfully, cooking at home more often and focusing on whole foods instead of processed, packaged foodstuff.
According to the lead researcher, Christopher D. Gardner, Ph.D., “That was more powerful than differentiating between low-carb or low-fat. Just getting them to be a lot more mindful about what they were eating. It’s not so much about that food — it’s really about [changing] this crazy way that Americans eat.”
This is the fourth installment of photographs that help me relax. By publishing them I hope to give a bit of serenity to the lives of spoonies everywhere. If you don’t know what a spoonie is, here’s a brief article that explains it.
Let me know if there are particular themes you would like to see in these photos.
A recent examination of patients taking acetaminophen (Tylenol ) for pain unexpectedly found that the common painkiller alters sex hormones. If taken during pregnancy it may cause male babies to be born with urogenital malformations. (Source)
Acetaminophen (APAP) has been in use for over 50 years, but researchers still don’t know all the ways it works in the body.
The effect on one sex hormone was roughly equivalent to the effect of 35 years of aging, or the normal decrease in levels seen in menopause. Fortunately, the effect only lasts for 48 hours if no additional APAP is taken
Taking APAP every day for pain causes some hormones to become menopausal–regardless of age.
Acetaminophen also causes false highs, by a rather large margin, in people with continuous glucose monitors, according to another study reported in Diabetes Care. This obviously is a concern for the many diabetics who use continuous glucose monitoring (CGM), which is swiftly becoming the standard of care for Type 1 diabetics.
Blood Sugar Measurement Also Affected
For example, three patients in the study had blood glucose meter values less than 70 mg/dL with much higher CGM readings — 63 vs 138 mg/dL, 46 vs 175 mg/dL, and 51 vs 184 mg/dL.
In 10 patients, the CGM values read higher than 180 mg/dL, but the meter reading was over 100 mg/dL lower. The effect appears to be limited to CGM since finger stick glucometer readings were used as a control.
Newer blood sugar measurement technology under development will take this consequence into account. Until then people who use CGM need to be aware of the APAP effect.
The study that found the sex hormone effect with APAP also was able to shed light on how the painkiller works in the body. People who took acetaminophen had very low levels of neurosteroids made by the brain itself, such as pregnenolone sulfate and DHEAS [dehydroepiandrosterone]. The drug also works with three distinct metabolic pathways–one of them being the endocannabinoid system, which produces marijuana-like molecules.
This may explain the calming effects experienced by some individuals and acetaminophen’s use as a mild sedative in children. The uncertainty and growing number of proposed mechanisms raise the possibility that there are further actions involving central nervous system (CNS) cell receptors. (Source)
The findings are significant because they show how the body is impacted by seemingly innocuous everyday medications. There are hundreds of other drugs that no one has done this research for.
No doubt you’ve heard or read about a ketogenic diet, going keto or even just keto as the newest diet trend. Actually, a ketogenic diet is much more than a trend. “Ketogenic” is a term for a low-carb diet (like the Atkins diet). The basic idea is to get more calories from protein and fat and much less from carbohydrates. It was originally developed to use with children who had seizures many times each day. Now it is promoted for weight loss, improving athletic performance and halting inflammation.
Most of the carbs that are easy to digest, like sugar, soda, pastries, and white bread are the first to go.
White bread is a no-no
These types of processed carbs start to change into sugar molecules in your mouth. Take a piece of white bread and hold it in your mouth for a few minutes. You will be surprised at how sweet the piece of bread becomes–thanks to the work of enzymes in saliva.
I’ve been half-heartedly following a sort-of keto diet for the past year or so. I started it to lose weight, but never went fully keto even after I lost 10 pounds. At this time, I was baking sourdough bread using an ancient wheat variety called Einkorn. The loaves were so healthy and tasty I didn’t want to give up bread. Also, I was concerned about following a strict keto diet when my underlying health was so poor. My conventional medical training scared me off of it.
Ketosis is a mild form of ketoacidosis
Any extremely low (20-30 grams) or no-carbohydrate diet forces the body into a state of ketosis. This occurs when people eat a low/no-carb diet and molecules called ketones build up in their bloodstream. Low carbohydrate intake causes blood sugar levels to drop. The body begins breaking down fat to use as energy. A body in ketosis is actually a mild form of ketoacidosis, the leading cause of death for people under 24 with Type 1 diabetes. I saw several patients in ketoacidosis when I worked in hospitals. It was always an emergency. Additionally, I had a patient die from ketoacidosis when I was doing home-based medical care.
I searched the literature for ketogenic diet research on this damn disease. However, no studies were done on the effects of ketogenic diets in Chronic fatigue syndrome. Some CFS clinicians recommend ketogenic diets as a management strategy citing mitochondrial, immune, and neuroinflammation as pathways through which ketogenic diets could confer some benefit (Source). A ketogenic diet is well-known for the way it reduces inflammation, especially in the brain.
Char, from Chronically Hopeful, started going keto last year about this time. Here’s her story.
I often get asked what this ketogenic diet has done for me. What benefits have I had? Why should somebody give up those delicious carbs and starchy foods? Are the benefits really worth the sacrifice? In this post I’ll explain my journey so far. In short, in my opinion, the answer is yes – it’s […]
In her blog, Char writes about following Dr. Sarah Myhill, a British doctor running her own specialist M.E. clinic in Wales, United Kingdom. Her website is an extensive resource of articles and information based on her treatment of patients. The website runs to 920 web pages and has had over 6 million individual visits. Dr. Myhill believes the disease is characterized by a cellular mitochondrial dysfunction and has published several studies. She has treated in excess of 10,000 CFS/ME sufferers over her 30-year career (Source).
Tracking Protein, Carbs and Fat AKA The Macros
So, with Char’s results in mind, and a long look through Dr. Myhill’s site, I started back on a ketogenic diet, one that is low-carb, moderate protein and high fat. This time I’m using a smartphone app to track my carbs, protein and fat intake to be certain I get enough nutrition and remain in ketosis. Again, I have Char to thank for her instructions.
The thought of tracking macros scares many people into delaying their keto journey, but it’s really not as complicated at it might seem. There are some great tools available that make the whole process so easy. 40 more words
So, with Char’s results in mind, and a long look through Dr. Myhill’s site, I started back on a ketogenic diet, one that is low-carb, moderate protein and high fat. This time I’m using a smartphone app to track my carbs, protein and fat intake to be certain I get enough nutrition and remain in ketosis. Again, I have Char to thank for her blog entry.
My lean body mass, the weight I would be at if there were no fat clogging things up is 108 pounds. I think I weighed that in grade school. 😉 That means I should shoot for 65 grams of protein, 25 grams of carbs and a whopping 132 grams of fat.
So here we are, the second day into my ketosis journey–but hopefully not ketoacidosis. I’m almost 66, overweight and have a family history of Type 2 diabetes so this is a real possibility. However, I wasn’t diabetic the last time my blood sugar levels were tested. But I will be careful and listen to my body and its signals.
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