Kidney issues, NAFLD, thyroid, cholesterol and diabetes, what to eat now?

[Flaschenpost85]

Hi
My health is getting progressively worse. Or rather is has been bad and I am just finding out because the GP never gave me the full picture.
Type 2 for 12 years that I know of.

hypothyroidism for 9 years

on insulin (only levemir now) for 7 years

Elevated blood pressure for me (I actually had 90/60 until 6 years ago) but now it’s in a normal range 120/80, this is too high for me.

High cholesterol for ca 3 years now. I don’t know the breakdown, but it is down from 7 to 5.6

Ca. 4 years ago had an ultrasound and the sonographer said my liver is enlarged

I always had Protein in my urine, and an anaesthetist wasn’t too happy but went ahead with my surgery anyway. only just found out my egfr is 40.

Each condition requires a different diet. Cut out carbs, protein, salt, fat and potassium. Am I just left with eating steamed veggies now? I am so lost. I thought I was doing ok with diabetes control, but now what?

Sorry, I just really needed a rant.

Any advice/suggestions would be appropriated.

 

[zand]

I wouldn't worry about the cholesterol or BP at all. To me priority would be the kidneys and diabetes/liver. Low carb should help the diabetes and liver, moderate protein will help the kidneys. My friend found a gluten light diet helped her kidneys. Healthy fats like butter (not vegetable oils or margarine) should be fine.

But hey, that's just me, I am not a medical professional, just an ordinary person who has also had a few conditions at the same time. I'm not sure what you drink, but I personally would stay away from fizzy drinks, (even diet drinks) and alcohol.

This of course may be totally bad advice, it's just my own view. I hope someone with more sense than me will come along and be more helpful soon.

Best of luck. It's horrid when doctors don't tell you the whole picture so that you can't help yourself.

 

[optimist1]

I would ask your doctor and perhaps do a GFR test, rather than the estimated, when you are well and hydrated. Being unwell or dehydrated can throw off the kidney results.

Stage 3 CKD seems to be what is normally recommended still? 0.8g/kg LBM
https://www.davita.com/diet-nutriti...or-people-with-stage-3-chronic-kidney-disease

The blood glucose and enlarged liver (non alcoholic fatty liver disease) may respond to a lower carb diet,
https://www.dietdoctor.com/groundbreaking-study-low-carb-effective-treatment-fatty-liver

 

[Oldvatr]

Make sure your insulin dose tracks your carb intake. With low carbing, you may also need to include protein into your carb count. I do not use insulin myself, but I have seen people here say allow protein carbs at 50% of carbs. As carbs drop be mindful of hypos and juggle with the carbs so you don't go on a roller coaster ride by overcorrecting.

As an insulin user, you can just use the insulin to cover for all the carbs you eat or drink at any level, but if that is a high intake, then you may not be reducing your NAFLD fat, or any insulin resistance you may have. Dropping the carbs encourages your body to burn stored energy from the liver and adipocytes.

I presume you are taking something like Levothyroxine. This may need a regular blood test to check it is the right dose when low carbing.

As Zand says, the TC cholesterol figure and the BP are of less importance. The proteinuria needs attention but that is for the GP to advise on. He/she may advise low salt, but a low carb diet needs an increased salt input especially if exercising heavily or losing weight due to water loss, Low protein will help, but the low glucose levels may prompt the body to scavenge muscle tissue instead of glucose. Normally we increase the fat intake to provide n alternative fuel source to replace the glucose by ketones.

Last thing. The eGFR is as the name suggests an estimated flow rate, and can be upset by hydration levels and other things in the blood. It also drops naturally as we age.

 

[Flaschenpost85]

Thank you all for your input. I will have a look into these.
@Oldvatr would you mind explaining why you mean by carb counting protein? I have never heard of this before.

 

[Oldvatr]

Thank you all for your input. I will have a look into these.
@Oldvatr would you mind explaining why you mean by carb counting protein? I have never heard of this before.

This is the best I can do since it is not something I require to do on orals
https://shop.diabetes.org.uk/produc...jpqZb-C6fYNQ311NAuQEFtgyl_ipyHkAaAhQ2EALw_wcB
The PDF download is free apparently.

All I know is that there is a process in the body that only kicks in when glucose in the blood is getting low, called gluconeogenesis. This is where our body manufactures glucose from proteins as an effort to stave off starvation. It is not very efficient but is likely if you get low enough for ketosis to be triggered.

 

[JoKalsbeek]

Hi
My health is getting progressively worse. Or rather is has been bad and I am just finding out because the GP never gave me the full picture.
Type 2 for 12 years that I know of.

hypothyroidism for 9 years

on insulin (only levemir now) for 7 years

Elevated blood pressure for me (I actually had 90/60 until 6 years ago) but now it’s in a normal range 120/80, this is too high for me.

High cholesterol for ca 3 years now. I don’t know the breakdown, but it is down from 7 to 5.6

Ca. 4 years ago had an ultrasound and the sonographer said my liver is enlarged

I always had Protein in my urine, and an anaesthetist wasn’t too happy but went ahead with my surgery anyway. only just found out my egfr is 40.

Each condition requires a different diet. Cut out carbs, protein, salt, fat and potassium. Am I just left with eating steamed veggies now? I am so lost. I thought I was doing ok with diabetes control, but now what?

Sorry, I just really needed a rant.

Any advice/suggestions would be appropriated.

I can't say much about kidney issues, but when you go low carb, you automatically cut out a lot of processed foods that contain a load of salt, like bread. I always had normal blood pressure until I went low carb, now I have to add salt in to not see the room spinning or turn black when I get up. So cutting carbs can take care of that, and it would also go a very long way in fixing your NAFLD. (It resolved mine, and it was BAD.). Your cholesterol looks pretty alright to me, though a breakdown would've been helpful, so please don't rule out fats just yet. (Statins can up blood sugars by the way, just so you know.) If you do want to try low carb, keep in mind that you're likely to hypo if you don't adjust your insulin intake. Dunno whether you're on a fixed dose or not, but it could get iffy.

https://www.diabetes.co.uk/forum/blog-entry/the-nutritional-thingy.2330/ might help a little sort out your diet. Don't overdo it with the protein, but don't cut them out entirely either. Moderation might be the way to go, but like I said, kidneys are not my forte.

 

[Oldvatr]

Thank you all for your input. I will have a look into these.
@Oldvatr would you mind explaining why you mean by carb counting protein? I have never heard of this before.

I get the impression that you are on a fixed dose regime with your insulin. This could be difficult to integrate into a diet control such as low carb or low calorie. You might like to talk to your consultant about an approach that allows you to adjust your dose to suit your meal intake (such as MDI) where you set a basal dose which defines the baseline control as your current fixed dose does, but then you can inject a bolus or correction dose which you measure yourself, and this is usually done in advance of a meal and is designed to act fast and just cover the blip that comes from the meal. For that to work, you will need to estimate the amount of carbs that the meal has in it since you would be matching the bolus dose to the estimated carb content. It is not a perfect system but will allow you to adjust the insulin by yourself. It is different, but many here use this system for their control, and after the initial learning curve they manage their own condition, with the power that that brings.

The fixed-dose method is inflexible, so currently you have to eat carbs to match the insulin, so you may be eating more carbs than necessary and thus storing more as fat around your liver and pancreas.

I have no personal experience of insulin control apart from observing my T1D mother do it without a home meter and old-fashioned glass syringes that had to be steralised every day and reused. Hopefully, an insulin user will check what I have written here and make corrections ( ie offer a bolus) if I am incorrect.

 

[AndBreathe]

Make sure your insulin dose tracks your carb intake. With low carbing, you may also need to include protein into your carb count. I do not use insulin myself, but I have seen people here say allow protein carbs at 50% of carbs. As carbs drop be mindful of hypos and juggle with the carbs so you don't go on a roller coaster ride by overcorrecting.

As an insulin user, you can just use the insulin to cover for all the carbs you eat or drink at any level, but if that is a high intake, then you may not be reducing your NAFLD fat, or any insulin resistance you may have. Dropping the carbs encourages your body to burn stored energy from the liver and adipocytes.

I presume you are taking something like Levothyroxine. This may need a regular blood test to check it is the right dose when low carbing.

As Zand says, the TC cholesterol figure and the BP are of less importance. The proteinuria needs attention but that is for the GP to advise on. He/she may advise low salt, but a low carb diet needs an increased salt input especially if exercising heavily or losing weight due to water loss, Low protein will help, but the low glucose levels may prompt the body to scavenge muscle tissue instead of glucose. Normally we increase the fat intake to provide n alternative fuel source to replace the glucose by ketones.

Last thing. The eGFR is as the name suggests an estimated flow rate, and can be upset by hydration levels and other things in the blood. It also drops naturally as we age.

Olvatr, I'm curious; what is it about a low carb diet that you feel makes regular blood tests necessary for thyroid function/medication assessment?

 

[AndBreathe]

Hi
My health is getting progressively worse. Or rather is has been bad and I am just finding out because the GP never gave me the full picture.
Type 2 for 12 years that I know of.

hypothyroidism for 9 years

on insulin (only levemir now) for 7 years

Elevated blood pressure for me (I actually had 90/60 until 6 years ago) but now it’s in a normal range 120/80, this is too high for me.

High cholesterol for ca 3 years now. I don’t know the breakdown, but it is down from 7 to 5.6

Ca. 4 years ago had an ultrasound and the sonographer said my liver is enlarged

I always had Protein in my urine, and an anaesthetist wasn’t too happy but went ahead with my surgery anyway. only just found out my egfr is 40.

Each condition requires a different diet. Cut out carbs, protein, salt, fat and potassium. Am I just left with eating steamed veggies now? I am so lost. I thought I was doing ok with diabetes control, but now what?

Sorry, I just really needed a rant.

Any advice/suggestions would be appropriated.

Flaschenpost, I'm sorry you're having a tough time of things at the moment.

In your post you talk about your blood pressure being too high for you. 120/80 is a perfectly acceptable reading, well within the normal range. I appreciate with kidney challenges it's important to keep those numbers neat. Is your target, as recommended by a medical professional, lower? As we age, out blood pressure tends to trickle up a bit.

When your liver was observed to be enlarged, did you have any sort of follow up on that? Our livers are miraculous organs, with an extraordinary capacity for healing, so this issue may, or may not have resolved by now.

How did you find out about all these things? Did you recently obtain access to your medical records, or have a comprehensive health MOT?

If you have concerns about diet (and clearly you do), you should ask your health professional for specialist help - perhaps from a dietician. They would, in conjunction with other health professionals, take all your challenges into account.

 

[Oldvatr]

Olvatr, I'm curious; what is it about a low carb diet that you feel makes regular blood tests necessary for thyroid function/medication assessment?

A low carb diet, especially a ketogenic diet , may affect the thyroid function
https://pubmed.ncbi.nlm.nih.gov/3900181/
If a doctor advises the use of an exoteric thyroid hormone as in levothyroxine medication, then it follows a thyroid blood test to measure the baseline for TSH etc. This info is used to set the dose of the medication. As the carb diet takes effect the metabolism changes and the dose will need adjusting to avoid overdosing, just like the exogenous insulin needs reducing. My wife was on levothyroxine, and we had to track her doses as she shared my LCHF diet with me, and her weight dropped considerably as a result. She was not diabetic but changes were necessary,

This is what VirtaHealth has to say on this
https://www.virtahealth.coh]m/blog/does-your-thyroid-need-dietary-carbohydrates

 

[Struma]

I get the impression that you are on a fixed dose regime with your insulin. This could be difficult to integrate into a diet control such as low carb or low calorie. You might like to talk to your consultant about an approach that allows you to adjust your dose to suit your meal intake (such as MDI) where you set a basal dose which defines the baseline control as your current fixed dose does, but then you can inject a bolus or correction dose which you measure yourself, and this is usually done in advance of a meal and is designed to act fast and just cover the blip that comes from the meal. For that to work, you will need to estimate the amount of carbs that the meal has in it since you would be matching the bolus dose to the estimated carb content. It is not a perfect system but will allow you to adjust the insulin by yourself. It is different, but many here use this system for their control, and after the initial learning curve they manage their own condition, with the power that that brings.

The fixed-dose method is inflexible, so currently you have to eat carbs to match the insulin, so you may be eating more carbs than necessary and thus storing more as fat around your liver and pancreas.

I have no personal experience of insulin control apart from observing my T1D mother do it without a home meter and old-fashioned glass syringes that had to be steralised every day and reused. Hopefully, an insulin user will check what I have written here and make corrections ( ie offer a bolus) if I am incorrect.

The OP says in 1st post that only Levemir is used…

 

[AndBreathe]

A low carb diet, especially a ketogenic diet , may affect the thyroid function
https://pubmed.ncbi.nlm.nih.gov/3900181/
If a doctor advises the use of an exoteric thyroid hormone as in levothyroxine medication, then it follows a thyroid blood test to measure the baseline for TSH etc. This info is used to set the dose of the medication. As the carb diet takes effect the metabolism changes and the dose will need adjusting to avoid overdosing, just like the exogenous insulin needs reducing. My wife was on levothyroxine, and we had to track her doses as she shared my LCHF diet with me, and her weight dropped considerably as a result. She was not diabetic but changes were necessary,

This is what VirtaHealth has to say on this
https://www.virtahealth.coh]m/blog/does-your-thyroid-need-dietary-carbohydrates

Once on medication, TSH should not inform dosage titrations, as the very addition of synthetic hormone changes the pituitary involvement in thyroid function..

I have been taking both Levothyroxine and Liothyronine to help with thyroid function, but been low carb throughout.

I do however agree that regular testing is important to monitor dosage amounts. Lots of factors, including the weather influence how our thyroids cope

 

[Oldvatr]

The OP says in 1st post that only Levemir is used…

Exactly. The OP asked for advice on options. Well, that single fixed dose of Levemir removes many of the options that could be helpful for the co-morbidities such as NAFLD, cholesterol Blood Pressure,etc. The OP must always match his daily carb intake to that dose, and so options of varying diet to reduce IR or remove NAFLD are not viable.

Unless the OP is willing to consider a change to a control regime that allows him to vary his insulin intake, then we should not advise Low Carb or Low Cal or Keto types of diet. The OP must IMO use the NHS dieticians to define a suitable diet such as Eatwell or Low Salt, Low Fat as appropriate.

 

[Flaschenpost85]

Flaschenpost, I'm sorry you're having a tough time of things at the moment.

In your post you talk about your blood pressure being too high for you. 120/80 is a perfectly acceptable reading, well within the normal range. I appreciate with kidney challenges it's important to keep those numbers neat. Is your target, as recommended by a medical professional, lower? As we age, out blood pressure tends to trickle up a bit.

When your liver was observed to be enlarged, did you have any sort of follow up on that? Our livers are miraculous organs, with an extraordinary capacity for healing, so this issue may, or may not have resolved by now.

How did you find out about all these things? Did you recently obtain access to your medical records, or have a comprehensive health MOT?

If you have concerns about diet (and clearly you do), you should ask your health professional for specialist help - perhaps from a dietician. They would, in conjunction with other health professionals, take all your challenges into account.

Hi. There is never a real follow up with my gp…. They give me a sheet of food advise usually and that is that. Regarding go the liver, never a follow up except they now do bloods for it, if I hunt them down for it.
My blood pressure is my personal ‘quest’. I understand it is within the normal range, but for me personally it feels hight if that makes sense? Until 5 years ago with my second pregnancy ended, I had my ‘low’ blood pressure and has since slowly been creeping up to what it is right now. So I feel for my body it is high blood pressure, even with factoring in to at it changes with age.

I had a LLETZ surgery (removing part of the cervix) where they did pre op checks. They didn’t go into too much detail but the anaesthetist wasn’t too happy and mentioned various things. Last week I finally had a medical review with a pharmacist who was incredibly helpful and explained everything that I heard during pre op and gave me some numbers.

 

[Flaschenpost85]

Once on medication, TSH should not inform dosage titrations, as the very addition of synthetic hormone changes the pituitary involvement in thyroid function..

I have been taking both Levothyroxine and Liothyronine to help with thyroid function, but been low carb throughout.

I do however agree that regular testing is important to monitor dosage amounts. Lots of factors, including the weather influence how our thyroids cope

Did you get tested for T3 via NHS? I have mentioned to them that I feel my levo doses feel wrong but as usual, as per the GP bloods are fine and I must be imagining things…

 

[Flaschenpost85]

Exactly. The OP asked for advice on options. Well, that single fixed dose of Levemir removes many of the options that could be helpful for the co-morbidities such as NAFLD, cholesterol Blood Pressure,etc. The OP must always match his daily carb intake to that dose, and so options of varying diet to reduce IR or remove NAFLD are not viable.

Unless the OP is willing to consider a change to a control regime that allows him to vary his insulin intake, then we should not advise Low Carb or Low Cal or Keto types of diet. The OP must IMO use the NHS dieticians to define a suitable diet such as Eatwell or Low Salt, Low Fat as appropriate.

Thank you. Yes I asked for options and help because I feel rather out of my depth because I only have long acting insulin. I am looking at diet changes right now. I can’t do Keto, but I am working forwards low-carbing of ca 50-70g daily. And I was looking for information that I can use at my next review in September because I feel pushed aside by the gp.

Thank you everyone for your great input.

 

[Oldvatr]

Once on medication, TSH should not inform dosage titrations, as the very addition of synthetic hormone changes the pituitary involvement in thyroid function..

I have been taking both Levothyroxine and Liothyronine to help with thyroid function, but been low carb throughout.

I do however agree that regular testing is important to monitor dosage amounts. Lots of factors, including the weather influence how our thyroids cope

Apparently, the levothyroxine dosing is based on either body weight or BMI, so would need a review as low carbing decreases these parameters (hopefully, but not everybody loses weight) It is the T3 and T4 markers that can also take part, and that requires a different test to the normal full blood panel of an annual review.

 

[AndBreathe]

Did you get tested for T3 via NHS? I have mentioned to them that I feel my levo doses feel wrong but as usual, as per the GP bloods are fine and I must be imagining things…

Not before I was trialled on Levothyroxine, and only then randomly, despite my GP requesting it - often in capital letters.

It seems the labs only do the tests required, so TSH - if that is in range (in those not taking medication), they do no more. Where TSH is out of range then they'll do FT4. If that is in the very wide range, they do no more. If that is "off" they'll test T3.

Once I was prescribed T3, my T3 is tested every time, as now TSH is utterly meaningless, and FT4 only informative in terms of tweaking T3 doses.

What are your FT4 scores whilst taking Levothyroxine?

Apologies if you are already aware, but you should be taking your T4 (Levothyroxine) first thing in the morning, fasted, with water, then nothing - particularly anything containing milk - for about an hour.

 

[AndBreathe]

Apparently, the levothyroxine dosing is based on either body weight or BMI, so would need a review as low carbing decreases these parameters (hopefully, but not everybody loses weight) It is the T3 and T4 markers that can also take part, and that requires a different test to the normal full blood panel of an annual review.

The dosage by weight system for Levothyroxine is a very rough starter rule of thumb, and a bit like starting people on rapid action insulin being advise to carb count at 1 unit bolus per 10gr of carb. Like insulin doses, actual requirements can be very different.

Based on my weight, my dose should be c80 mcgr per day. On that, my thyroid performance was still degrading. 150mcgr still didn't stem the decline.

I am now on 125mcgr Levothyroxine, plus 50 mcgr Liothyronine per day and just about holding steady. It has taken since March 2018 to reach this point.

Many, many, MANY of those living with hypothyroidism live their lives under medicate.