Hello, I'm A Gp Who Helps People Learn Low Carb Ways Of Eating

[fatismyfriend]

Hello @fatismyfriend and welcome.........you have no idea how your attitude brings hope to those of us who have struggled with the snot nosed and biased "I'm a HCP, I know best" types over many years.........many of us have been harangued and belittled because we couldn't manage to make happen what they thought we should accomplish........we have a saying here that may seem silly to some but "unless you live with diabetes of any type on a daily basis you have no idea of the frustration it produces"........its a moving goalpost on a moment by moment basis and what worked yesterday may not work today.........but at least Low Carb gives us a fighting chance of being in the right area some of the time.
I am a slim non producer t2 and been on insulin since diagnosis and whilst I cant do the High Fat bit because of other problems it has helped me reduce my need for insulin to what I consider much more reasonable levels, so fewer hypers and hypos, resulting in my latest hbA1c of 39.....putting me in the non diabetic range but my need for insulin remains.

I am sorry to hear of the trouble you have had with some members of the healthcare world, but delighted to see how you have found a way out.
Well done!

 

[Rachox]

Rachox- those are super results and on 50g a day. I advise my patients whom I see face to face to start on 30g a day, but say that some people may need less, and some may need or choose more. They gauge their need by their results and aim to keep their blood glucose between 4 and 7 after meals( one to two hours after the meal)

Thank you for your compliment I actually started on keeping under 100g per day then after six weeks reduced to around 70 when my blood sugars plateaued, I then naturally lowered it further and yes now maintain things on no more than 50g/day, rarely below 30g. I broke myself in gently and at the same time I avoided carb flu. I’m very happy at my current level.

 

[fatismyfriend]

Thank you for your compliment I actually started on keeping under 100g per day then after six weeks reduced to around 70 when my blood sugars plateaued, I then naturally lowered it further and yes now maintain things on no more than 50g/day, rarely below 30g. I broke myself in gently and at the same time I avoided carb flu. I’m very happy at my current level.

What a good idea. One of my patient's yesterday had really bad low carb flu, and it is worth avoiding by doing exactly as you have described, rather than dropping right away. Did you need to have extra salt?

 

[fatismyfriend]

Welcome to the forum, Joanne @fatismyfriend We get stories of doctors and nurses every day telling diabetes patients that they must eat up their carbs and cut down on fats, so what you are doing is really important.
Joanne has a web site here, http://www.fatismyfriend.co.uk/
Keep up the good work,
Sally

Thanks Sally

 

[Guzzler]

May I ask a question too, please? What are your and Dr. Unwin's approach with TOFIs? No weight to lose except that which may be ectopic fat and reacting 'a little too well' to the weight loss on LCHF?
I realise you are busy, so no rush.

 

[Resurgam]

What a relief to find a doctor not only willing to accept low carb but advise it too.
I started to low carb back in the 1970s and when pregnant with my second child in 1985 was threatened with being taken away and fed properly if I continued - result was pre-eclampsia.
I did a few days of meat only straight after diagnosis - but I'd been eating loads of carbs - to lower cholesterol - doctors orders - but was amused to discover that by eating 50 gm of carbs, just as when doing Atkins to control weight, I stayed under 8mmol/l after meals, but then saw my numbers reducing month by month on the same amount.
It was very encouraging - I felt that I was watching my metabolism mending.
When I saw 5.6mmol/l after Christmas Eve and Christmas Day dinners just over a year from diagnosis I thought I'd won.

 

[Oldvatr]

Dr McComarck - quick question for you. Why do you suggest coming off sglt2 inbibiors (canegefozin etc.) before going low carb? My non medical understanding is that these drugs cause excretion of glucose via the kidneys. In your practical experience do they not work well when going low carb or are they simply superfluous?

Questions to specific people are best dealt with by PM via a private conversation. also it is best not to identify people by name or contact details on a general thread since there are bots that trawl these corridors looking for info.

There have been warnings regarding those drugs and LC diets not being compatible, but I am not aware of any specific instances. It may be that LC diets can lead to dehydration in the early stages, which is why LC starters are sometimes advised to increase their salt intake. On the other hand it may be a vague connection that dietary ketones from the diet may exacerbate the possibility of DKA which is probably fake news.

Edit to add:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578500/
This does seem to be dehydration due to fast drop in body weight which was probably the glucogen and water stores being emptied first.
Then it seems she was not producing her own insulin when admitted to A&E, and was put on insulin therapy, which seems to be continued after release. So it would appear that her condition changed rapidly from orals only to insulin dependant in a space of 13 days. This may be a natural progression of T2D or may have been bought about by SGLT-2 med with LC, She had a high glucose level and HbA1c on admission showing that her bgl control had been poor for a while before admission even on an LC diet, so again points to insulin failing before the SGLT-2 was started. This is probably not directly caused either by the diet or the meds.

 

[NicoleC1971]

Questions to specific people are best dealt with by PM via a private conversation. also it is best not to identify people by name or contact details on a general thread since there are bots that trawl these corridors looking for info.

There have been warnings regarding those drugs and LC diets not being compatible, but I am not aware of any specific instances. It may be that LC diets can lead to dehydration in the early stages, which is why LC starters are sometimes advised to increase their salt intake. On the other hand it may be a vague connection that dietary ketones from the diet may exacerbate the possibility of DKA which is probably fake news.

The OP left her name on the end of the post and has answered my query which I thought would be useful info for those looking at the thread (SGLt2 inibitors take glucose out via the kidneys so are not needed in the context of a low carb diet and DKA is a factor for type 1s with uncontrolled BGs but nothing to to with this drug class or the use of a low carb diet by type 2s as far as I am aware).

 

[Rachox]

What a good idea. One of my patient's yesterday had really bad low carb flu, and it is worth avoiding by doing exactly as you have described, rather than dropping right away. Did you need to have extra salt?

I used very little added salt prior to my Diabetes diagnosis but I did suffer badly with cramps in my ankles and feet at night in the early days of low carbing. After a bit of research I found it may be due salt and/or magnesium deficiency. I started using pink Himalayan Salt which contains magnesium and potassium as well as sodium. I eat a low carb coconut ‘porridge’ (not real porridge) for breakfast every day which calls for salt so use the pink salt for that. I also bought some magnesium spray as I gather magnesium is better absorbed transdermally rather than orally. I rarely get cramp now but if I do I just treat with the magnesium spray for a couple of nights.

 

[Oldvatr]

The OP left her name on the end of the post and has answered my query which I thought would be useful info for those looking at the thread (SGLt2 inibitors take glucose out via the kidneys so are not needed in the context of a low carb diet and DKA is a factor for type 1s with uncontrolled BGs but nothing to to with this drug class or the use of a low carb diet by type 2s as far as I am aware).

Apologies. I will leave my post standing since as a general reminder it is still useful for all to bear in mind. We do attract trolls on occasions so keeping to usernames provides some protection.

 

[ickihun]

My endo/diabesity specialist nurse now knows about low carb eating and weight loss even on insulin. My endo called it a fad diet. My bariatric surgeon just wants my target weight off then I'm good for a full bypass op date to reduce my hidious and huge insulin resistance since i'll be on triple strength basal (Toujeo300) and metformin and/or novarapid for life. Currently not tolerating metformin with new developed IBS. I've been type2 since I was six but not diagnosed til 2002. I've benefitted from metformin originally for PCOS on London trials in 1990s and it's infertility side affect. Failed IVF later I fell pregnant successfully resulting in 2 live births due to consultant metformin only treatment. I lose 2st on metformin treatment. Or gain when not tolerated.
I hugely believe metformin shows us how type2 and liver function improvements on low carb eating gives hope to so many.
Metformin has saved my life as without it I would have been mental broken without my status of mummy x2.
Newish to low carb eating it has turned around my fatty liver status and now PCOS is resolved.
A new hiccup has flagged recently due to iron deficiency and high prolactin levels from lansoprozol for GERD.
Hopefully GERD and IBS will be resolved by roux en y op soon. So sugary mebeverine and strained lansoprozol benefits versus side affects will disappear.
Since doing low carb I have inherited fast heart beat but levothyroxine levels being reassessed hasn't resolved without betablockers.
I don't benefit from low carb without these new problems.
I think for diabetic only patients low carb is so much more free and easy. With far less complications and nearly instantly beneficial.
I lost nearly 4st on insulin and metformin doing 50g carb but due to severe palpitations I raised my carb limit to 150g. This is under a dietician linked to bariatric unit who carries carbs and cals book and has seen my weight loss throughout.

I wish i had no complications. What I thought was further complicated by menopause seems premature as blood test say otherwise.
I readded 2st due to stopping metformin and have regained no more.
I'm struggling to get the remaining 2kgs off for my life changing op.

I appreciate @fatismyfriend you would be better off helping the straight forward cases first but even people like me hugely benefit from low carb eating, even on insulin.

 

[Alexandra100]

I've benefitted from metformin originally for PCOS and it's infertility side affect. Failed IVF later I fell pregnant successfully resulting in 2 live births due to consultant metformin only treatment. I lose 2st on metformin treatment

Good to read someone standing up for Metformin. I always feel so sad when newly diagnosed people reject it, assuming that it is always preferable to manage without meds, even if that means living with higher bg levels. I accept that a LC diet is more effective than Metformin, but why should anyone have to choose between them?

 

[donnellysdogs]

@ickihun we are all routing for you to lose those last 2kg!!!

Thank you for a very informative life story which has made me appreciate the difficulties of others, more so than previously.

Good luck when those last 2kg go....xx

 

[satindoll]

I am sorry to hear of the trouble you have had with some members of the healthcare world, but delighted to see how you have found a way out.
Well done!

Thank you for your encouragement.........could I suggest you remind your students that the person in front of them may have other health problems, that they may not just be coping with diabetes and whatever they advise the patient to do for their diabetes may have an adverse effect on the patients other troubles........things like IBS, diverticular disease, ME, hyper or hypothyroidism, raised blood pressure or any of the many other co-morbidities lots of the folk here wrestle with on a daily basis can and do make a big difference to their success in following any diet/way of eating..........as long as they remember every patient is unique and individual so their help and advice should be tailored to that patients needs and capabilities, then your program should go a long way in helping both the HCP's and their patients to a better life.

 

[fatismyfriend]

Yes, I will.
We all need to remember that people have all sorts of things going on in their bodies and lives. For this reason I always start with a question- a year from now and you are a lot healthier, what does healthier mean to you? And from that I find out what the person dreams of, and talk about how they are going to get there, and if they are ready to start the journey today, or if they want to put it off to a later date.

 

[fatismyfriend]

My endo/diabesity specialist nurse now knows about low carb eating and weight loss even on insulin. My endo called it a fad diet. My bariatric surgeon just wants my target weight off then I'm good for a full bypass op date to reduce my hidious and huge insulin resistance since i'll be on triple strength basal (Toujeo300) and metformin and/or novarapid for life. Currently not tolerating metformin with new developed IBS. I've been type2 since I was six but not diagnosed til 2002. I've benefitted from metformin originally for PCOS on London trials in 1990s and it's infertility side affect. Failed IVF later I fell pregnant successfully resulting in 2 live births due to consultant metformin only treatment. I lose 2st on metformin treatment. Or gain when not tolerated.
I hugely believe metformin shows us how type2 and liver function improvements on low carb eating gives hope to so many.
Metformin has saved my life as without it I would have been mental broken without my status of mummy x2.
Newish to low carb eating it has turned around my fatty liver status and now PCOS is resolved.
A new hiccup has flagged recently due to iron deficiency and high prolactin levels from lansoprozol for GERD.
Hopefully GERD and IBS will be resolved by roux en y op soon. So sugary mebeverine and strained lansoprozol benefits versus side affects will disappear.
Since doing low carb I have inherited fast heart beat but levothyroxine levels being reassessed hasn't resolved without betablockers.
I don't benefit from low carb without these new problems.
I think for diabetic only patients low carb is so much more free and easy. With far less complications and nearly instantly beneficial.
I lost nearly 4st on insulin and metformin doing 50g carb but due to severe palpitations I raised my carb limit to 150g. This is under a dietician linked to bariatric unit who carries carbs and cals book and has seen my weight loss throughout.

I wish i had no complications. What I thought was further complicated by menopause seems premature as blood test say otherwise.
I readded 2st due to stopping metformin and have regained no more.
I'm struggling to get the remaining 2kgs off for my life changing op.

I appreciate @fatismyfriend you would be better off helping the straight forward cases first but even people like me hugely benefit from low carb eating, even on insulin.

You are correct that people like you benefit from low carb eating. Your bariatric surgeon will advise this to get the weight off by cutting your carbs- that is the standard advice before surgery. You have said your liver has improved and I am not surprised by that. I cannot give medical advice, and this is just me talking to you about what I have seen on the internet as an ordinary person looking around, and it is amazing. Have you seen the zero carbers? People like 'Jeff Cyr- how a ketogenic diet saved my life' who is on a site called www.zerocarbzen.com. I will say no more, so have a look and talk to them by email. They were a revelation to me.

 

[Chronicle_Cat]

I used very little added salt prior to my Diabetes diagnosis but I did suffer badly with cramps in my ankles and feet at night in the early days of low carbing. After a bit of research I found it may be due salt and/or magnesium deficiency. I started using pink Himalayan Salt which contains magnesium and potassium as well as sodium. I eat a low carb coconut ‘porridge’ (not real porridge) for breakfast every day which calls for salt so use the pink salt for that. I also bought some magnesium spray as I gather magnesium is better absorbed transdermally rather than orally. I rarely get cramp now but if I do I just treat with the magnesium spray for a couple of nights.

Rachox, the timing of this post is wonderful. For the last 2 mornings, I've had feet/leg cramps. I added extra sodium to my diet when I went lower carb but I did not know about magnesium spray or pink Himalayan sea salt.

Thank you.

 

[Deleted member 308541]

pink Himalayan sea salt.

If I did not know better, I would call this a oxymoron...

 

[ickihun]

You are correct that people like you benefit from low carb eating. Your bariatric surgeon will advise this to get the weight off by cutting your carbs- that is the standard advice before surgery. You have said your liver has improved and I am not surprised by that. I cannot give medical advice, and this is just me talking to you about what I have seen on the internet as an ordinary person looking around, and it is amazing. Have you seen the zero carbers? People like 'Jeff Cyr- how a ketogenic diet saved my life' who is on a site called www.zerocarbzen.com. I will say no more, so have a look and talk to them by email. They were a revelation to me.

I'm ill on too low a low carb diet but that doesn't mean after my op I will be. Fingers crossed. I'm scared of the serious meds I'm on and whether they'll over react to zero carb diets. These I feel need reducing or changing slowly, rather than me out of the blue going on zero carbs. It would be silly to do that on all the meds I take. They can kill me, especially insulin.
A task I know needs monitoring carefully and I'm not qualified to do this myself. Insulin reduction I'm very confident with but betablockers, blood pressure, diuretics and thyroid meds... Gulp! I'm not. You?
I ask out of curiosity not for medical advice. I'm fortunate in that I have the best endo in the North of England. I know because I've travelled all over UK in my job and lived out of hotel rooms and bought/sold various homes in various areas. I've seen a few endo's, even in pregnancies. I remember my Hastings endo who was waiting for me to finish breast feeding to try injected Victoza. We were so excited at its prospects. Higher dose did absolutely nothing for me.

 

[ickihun]

Yes, I will.
We all need to remember that people have all sorts of things going on in their bodies and lives. For this reason I always start with a question- a year from now and you are a lot healthier, what does healthier mean to you? And from that I find out what the person dreams of, and talk about how they are going to get there, and if they are ready to start the journey today, or if they want to put it off to a later date.

My MSK consultant/physio does the same. He has told me that first and foremost diabetes control affects my walking improvements.
I forgot to say I have S1 nipped and hoping weight loss will release it and stop scatica and neuropathy in toes getting worse. Balance is off and on even with an aid. Swimming is stunted, especially under water as diagnosed with asthma but I'm suspecting a symptom from low iron and reoccuring iron deficiency and/or medication (betablockers or/and lansoprozol).
I've walked more miles than I've driven. Walking only now til I feel safer behind the wheel, especially if kids are in the car. Even Automatic Golf.
I have sooo much hanging on weight loss improving my severe insulin resistance and getting my normal life back.
I'm lucky my GP saw my natural efforts before insulin therapy. Mind you I was high as a kite on high bgs as no meds worked.

I know GPs see alot.
My old GP was the SE Doc and attended traffic accidents and train crashes (attempted suicides) in East Sussex. A courageous man. A brilliant GP, too.