Low-Carb For Any Budget Patient Guide

Publication Date: February 3, 2020
Last Updated: April 3, 2023

ABOUT THE AUTHORS

ABOUT THE AUTHORS

DR. MARK CUCUZZELLA, MD

I am a family doctor working in West Virginia, the state with the highest obesity and diabetes rates in America. I started my medical training in the 1980s, and since 1990, the incidence of both of these conditions have tripled: we now have an adult rate of type 2 diabetes close to 20% and obesity (BMI >30) well north of 40% in my state (with other states not far behind). Early in my career, until 2012, I was aware of these increasing rates but felt helpless and hopeless in how to help. The advice I was giving — eat less, exercise more, reduce fat, increase medications — often led to poor outcomes. As clinicians, we often viewed it as the patient’s fault for not “complying.” This was embedded in our training. The drugs I prescribed at best poorly managed these problems. I left the office fatigued and often felt as if we both had failed — myself and the patient.

A six month assignment in 2012 with the U.S. Air Force to re-design the running program changed my life. Realizing that obesity was a large driver of fitness test failures, I traveled to dozens of military bases asking whether anyone in the room had lost 50 lb and kept it off for a year. Usually a handful (or two out of about 100) would volunteer, and I would query what they did. From base to base, the answer was very similar: they had given up all bread and sugar or had done a paleo-type diet, which in those days was not paleo junk food. The food was mostly eggs, meat, fish, and vegetables, and a few even had the courage to say they had done “Atkins.”

I started reading about the history of obesity as well as the science. The early works of Gary Taubes in Good Calories, Bad Calories opened my mind to new ideas. These ideas were confirmed by the premier scientist Dr. Timothy Noakes in South Africa as we did a couple of courses together in his country. Paradoxically, at the same time, my blood glucose was in the prediabetic range since I was developing an insulin insufficiency type of diabetes. For many years I had been a runner, eating the traditional runner's diet of high carbohydrate and low fat. So I started a low-carb lifestyle myself. A short experiment with a continuous glucose monitor showed the dramatic response my body had to any form of carbohydrate whether it was fruit, starchy veg, cereal, any bread product, and undoubtedly the low-fat frozen yogurt. At the time I did not realize they were all basically the same thing: turned into sugars once they hit my system. For over ten years I have enjoyed every day free of medication, staying below the threshold for full diabetes.

I came back to my hospital at West Virginia University after this tour and immediately started implementing a low-carb option for patients with diabetes as we monitored their blood sugars in the hospital. The results were instantaneous and dramatic, and many staff started changing their own lifestyle and eating patterns. We even got sugary drinks out of the hospital for all patients, staff, and visitors. Since this time, millions around the world have been adopting a low-carb lifestyle, including many of my patients. These amazing people are not just managing the diabetes but rather putting it into remission and coming off their medications safely. Many other medical conditions such as blood pressure, lipid problems, joint pains and swelling, headache conditions, fatigue, skin and respiratory conditions, as well as a multitude of gastrointestinal symptoms, also seem to improve with this way of eating.

I’m often asked if this is an expensive way of eating. The short answer is definitely not. The first thing to look at is the savings you will have from all the junk food and fast food that tends to end up in your shopping cart and through your car window. Seasonal vegetables, especially the ones on sale, and local produce at the farmers market or from your own garden, are very affordable. We have a program here that doubles the value of SNAP (Supplemental Nutrition and Assistance Program) at Farmers' Markets. Extremely nutrient-dense natural foods high in essential fatty acids and proteins are not expensive if you can learn how to shop and cook. Look for less expensive varieties of chicken, pork, ground beef, and fish if you live near the sea. Eggs or cheese are incredibly nutrient-dense and inexpensive. Try new things and be a bit adventurous in your shopping and cooking. Break out of old patterns and see the effect in how you feel and the effects on health conditions. Imagine a life without dieting. It’s easy if you try.

It is a privilege to work with Dr. Kristie Sullivan on this guide. Kristie is a living example of how to restore health while engaging the family. She lives in a small town in the South where diabetes and obesity are undefeated. She has influenced hundreds of thousands through her books, YouTube videos, and weekly Facebook live sessions.

Note of Caution: When you reduce the carbohydrates in your diet, your blood sugar and blood pressure tend to improve rapidly and often dramatically, so if you are on medications for these conditions, please consult your physician about adjusting them.

To Restoring Your Health!

Mark Cucuzzella, MD FAAFP
Physician Department of Veterans Affairs
Professor West Virginia University School of Medicine
Diplomate American Board of Obesity Medicine
Mark.Cucuzzella@va.gov

DR. KRISTIE SULLIVAN, PHD

Kristie Sullivan is passionate about helping others learn how to follow and sustain a low-carb lifestyle. Her passion is fueled by her personal experience with obesity, which started in childhood. Kristie began a strict low-carbohydrate lifestyle in 2013. As a result, she has lost over 100 lbs and significantly improved her health.

Because of her personal success, she began helping others, who also struggled as she did. Kristie established a popular YouTube channel, Cooking Keto with Kristie. She has also authored five best-selling books: Journey to Health: A Journey Worth Taking, Low-carb Living Day by Day, Keto Gatherings, Crazy Busy Keto, and Growing Up Keto. Kristie focuses on a clean-eating approach to a very low-carbohydrate diet.

Through her Cooking Community, Kristie focuses on creating content through recipes, videos, and guides as well as building community. Kristie believes that enjoying low-carb foods is a significant factor in long-term success, so she offers live online cooking sessions, meal plans, a 28-day guide for people who want to start or restart keto, and eBooks focused on topics such as Batch Cooking, smoothies, ice cream, or bread recipes, all low-carb, of course! Lastly, Kristie provides product guides and up-to-date information about various topics for those who might also struggle with obesity.

Kristie holds a Ph.D. in Educational Research and Policy Analysis from North Carolina State University and enjoyed a 30-year career in higher education before retiring to help others with low-carb full time. She lives in the beautiful Sandhills region of North Carolina with her husband David and their two children, Grace and Jonathan. Kristie has a Facebook page, "Simply Keto Kristie Sullivan", and a closed Facebook group, "Low-carb Journey to Health (Cooking Keto with Kristie)". She has a website called Cooking Keto With Kristie. Kristie's Cooking Community is available at www.homemade.health. You can also find her on Twitter, Instagram, and Pinterest. You can contact Kristie at cookingketowithkristie@gmail.com or join her on social media.

Kristie Sullivan

A NOTE ON THE RECIPES AND COOKING

A NOTE ON THE RECIPES AND COOKING

With the recipes, we want you to develop an instinctive relationship with the ingredients and the flavors. This helps you keep creative and eat with the seasons. Low-carb eating makes this style even more important since you are working with a determined range of ingredients. When shopping, you will learn to buy the foods that are healthy for you and often decide what to make with them when you get home.

Some will plan a week’s meals in advance and shop accordingly. Some will do a big weekend cook-up and eat off of that for the whole week. Flexibility and knowledge, mixed with a little creativity and adventurous spirit to try new things, makes this fun. Involve your family in the cooking and have a willingness to fail every now and then.

The approach of this book is like a starter instruction manual. We provide some easy basic meals, simple and available ingredients, as well as being budget-friendly. The recipes allow for variability in tastes and liking. Be resourceful and try different things with different amounts and varieties of spices. You can make swaps with the low-carb veggies and mains (meats/fish/eggs). This way of eating can be adopted to vegetarian patterns also.

We are here to give you hope and joy, not despair.

Enjoy!
—Mark and Kristie


"The best time to plant a tree was 20 years ago. The second best time is right now." —Chinese Proverb

OVERVIEW

OVERVIEW

Prevalence of Diabetes and Prediabetes

  • The prevalence of prediabetes and type 2 diabetes has increased dramatically over several decades in parallel with the increasing prevalence of obesity (which now is over 40% of adults, across all ages).
  • Over half of Americans have prediabetes (hemoglobin A1c 5.7–6.4%) or type 2 diabetes (hemoglobin A1c ≥6.5% or on diabetes medication). These numbers have tripled since 1990.
  • Obesity, prediabetes and type 2 diabetes are all risk factors for cardiovascular disease (CVD), and their increasing prevalence is now leading to an increase in the prevalence of CVD.

Key Points

  • A low-carb diet is powerful for improving Type 2 Diabetes, Metabolic Syndrome, High Blood Pressure, and Obesity.
  • If done correctly, low-carb nutrition is healthy since it can improve blood pressure, blood sugar, and metabolism. Consult your physician before starting a low-carb diet to review whether medication changes are necessary.

Basics of Low-carb

  • Eat: Meat, fish, eggs, most vegetables growing above ground, and natural fats.
  • Avoid: Bread, pasta, rice, beans, and potatoes, and other sugary and starchy foods. Also avoid refined, processed vegetables and seeds such as canola, soybean, and margarine.

Eat only when you’re hungry and stop when you’re satisfied. Foods with protein and fat create satiety (the feeling of being full).

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ASSESSMENTS

ASSESSMENTS

Vitals and Basic Testing Essentials

It is important to keep track of your progress and vital signs while following low-carb nutritional approaches. This log can also be shared with your healthcare provider at each visit.

Weight and Waist Circumference

  • Start at the top of the hip bone, then bring the tape measure all the way around your body, level with the umbilicus. You can hold the beginning of the tape measure at the umbilicus and rotate 360° in front of you to accomplish this.
  • Make the tape snug but not tight and record the measurement right after exhalation. Note: if waist circumference multiplied by two is greater than your height, then risk is higher for metabolic syndrome. Use the same unit of measurement for both (e.g., inches).

Blood Pressure and Heart Rate

  • You should be seated, relaxed, and rested for five minutes prior to measurement. Use an appropriately sized cuff since a cuff that is too small falsely elevates the reading. Note: Many individuals with diabetes have stiff arteries, which can cause a falsely elevated blood pressure reading.
  • While not tracked at every visit, it’s also important to keep a log of the following:
    • Lipid panel, including: Total cholesterol, HDL, LDL, and triglycerides
    • Thyroid-stimulating hormone (TSH)
    • Hemoglobin A1c (HbA1c)
    • Vitamin D

D a t e W e i g h t B l oo d P r e s s u r e H e a r t R a t e W a i s t C i r c u m f erence C o m m e n t s

TESTING BLOOD GLUCOSE

TESTING BLOOD GLUCOSE

Testing Blood Glucose is Empowerment and a Behavior Modification Tool

Standard Glucometer versus Continuous Glucose Monitor (CGM)
Testing your blood glucose before and after meals as well as with exercise is essential to figure out how your body works. In the authors' opinion, there is nothing more powerful than seeing your own response to food and glucose curve and correspond to how you feel. The technology has become more accessible, affordable, and user friendly in the last year with the Freestyle Libre as an entry level CGM. Watch for reactive hypoglycemia.

Large post-meal spikes are a big issue with patients who have standard high carbohydrate dietary patterns, are insulin-resistant, and in later stage T2D with beta cell insufficiency. The CGM shows these patterns as well as a resolution of patterns with an individualized approach.


Is Low-carb Right for Me?

  • Do you have obesity, diabetes or another metabolic problem (high blood pressure, fatty liver, PCOS, cardiovascular disease, sleep apnea)?
  • Are you interested in losing belly fat, halting or reversing diabetes, and/or lowering your likelihood of cardiovascular diseases?

If you answered “YES” to any of the above, low-carb may be right for you!

  • Do you have any acute, unstable medical conditions?
  • Are you currently pregnant or breastfeeding?
  • Are you taking any medication for diabetes or high blood pressure?
If you answered “YES” to any of the above, talk to your doctor before starting low-carb!

DESCRIPTION OF APPROACHES

DESCRIPTION OF APPROACHES

Table 1. Low-carb Eating Patternsa

Having trouble viewing table?
Eating Pattern Total Carbs
grams/day
Meat Poultry Fish and Shellfish Eggs Tofu
Very Low-carb Keto ≤30c No Limitd No Limitd No Limitd No Limitd
Low-carb Keto 30–50c No Limitd No Limitd No Limitd No Limitd
Mediterranean 50–150 No Limitd No Limitd No Limitd No Limitd No Limitd
Paleoe 50–150 No Limitd No Limitd No Limitd No Limitd
Primale 50–150 No Limitd No Limitd No Limitd No Limitd
Vegetarian 100–150 No Limitd No Limitd

Carbohydrates

Eating Pattern Total Carbs
grams/day
Non-Starchy Veggies Starchy Veggiesb Leafy Greens Berries Fruit Grains
Very Low-carb Keto ≤30c 1 cup 2 cups
Low-carb Keto 30–50c 2 cups 1 cup 2 cups 1/2 cup 1 cup
Mediterranean 50–150 3 cups 1 cup No Limitd 1 cup 1 cup 2 svgs
Paleoe 50–150 3 cups 1 cup No Limitd 1/2 cup 1/2 cup
Primale 50–150 3 cups 1 cup No Limitd
Vegetarian 100–150 No Limitd No Limitd No Limitd 1 cup 1 cup 4 svgs

Note: "No Limit" does not mean "eat to excess". Enjoy these foods, eat slowly and mindfully, but you do not need to count servings or grams.

a This table is based on the most common approaches, and some variants of each nutritional approach may differ slightly from the table.
b Examples are potatoes, corn, peas, beans/legumes, acorn or butternut squash, carrots, parsnips.
c Suggest a minimum of 15 grams total carbs daily in the form of non-starchy vegetables.
d May be consumed to satiety. While no limit is specified for these foods, consuming them excessively or beyond satiety can adversely impact weight management.
e Paleo/Primal food quality emphasized: grass-fed beef, grass-fed butter, limiting omega-6 fatty acids (vegetable oil, seed oil). Major difference between the two is that Primal allows dairy, nightshade vegetables, and legumes.

COUNTING CARBS

COUNTING CARBS

There are two ways to count carbs: TOTAL CARBS or NET CARBS

Total Carbs

  • Look at the serving size and total carbohydrate sections.

    In this example, 4 grams carbohydrate = 4 total grams of carbohydrate per 1 cup of cauliflower.
  • TOTAL CARBS is used when individuals are trying to lose weight most effectively.

Net Carbs

  • Look at the serving size, total carbohydrate, and dietary fiber sections.
  • Subtract dietary fiber from total carbohydrate to get the "net carbs".

    In this example, 4 grams carbohydrate − 2 grams fiber = 2 grams "net carbs" per 1 cup of cauliflower.
  • NET CARBS is more often used for individuals trying to lose weight more gradually or maintain body weight.
  • Packaged or processed low-carbohydrate foods often contain sweeteners called sugar alcohols (e.g., erythritol, maltitol, xylitol, isomalt) that are carbohydrates. Some people think sugar alcohols can be subtracted similar to fiber when calculating "net carbs," but most of them contain about half the calories per gram that carbohydrates contain.

Figure 1. Reading a Nutrition Facts Label



Individualizing Carbohydrate Intake Level

The effective carbohydrate intake level can vary considerably from person to person, as can strategies for determining that level.

The level depends on several factors including age, gender, metabolic rate, insulin sensitivity, activity level, and quality of carbohydrate (glycemic index/load).

One effective strategy is to start at a level that is effective for most everyone, typically less than 50 grams of total carbohydrate per day (less than 20 grams is more effective in many). This level achieves weight loss and dietary ketosis (safe) in most individuals. In coronavirus terms, this is a hard lockdown on sugar and processed carbs!

Then, small amounts of carbohydrate (~5 grams) can be added to the daily amount each week in the following situations:
  • As each individual reaches the goal for weight or another goal, such as blood glucose control.
  • If cravings for carbohydrates might lead the individual to abandon the eating plan.
  • If side effects of the eating pattern (e.g., fatigue or cravings) cannot be managed otherwise and threaten continued adherence.

Ideally, 5 grams of carbohydrate from one type of food (e.g., ½ cup berries, 1 cup of non-starchy vegetables or 1 oz of nuts) is added daily for 1 week.

  • If weight loss (or weight stability, if that is the goal) continues, then another 5 grams of carbohydrate from the same or another type of food can be added.
  • In this manner, the individual can identify a level of carbohydrate intake below which weight loss can be achieved and a higher level at which weight stability can be achieved.

98 NAMES FOR SUGAR (+ HIDDEN SUGAR)


GENERAL EATING PRINCIPLES

GENERAL EATING PRINCIPLES

A low-carbohydrate nutritional approach has a natural appetite reduction effect to ease you comfortably into the consumption of smaller and smaller quantities. Therefore, counting calories is not required.

  • Eat when you are hungry and stop when you are comfortably full.
  • You do not have to eat everything on your plate “just because it’s there.”
  • You do not have to eat if you are not hungry. This usually happens spontaneously after a few weeks. Skipping meals is acceptable as long as you do not overeat or eat high carbohydrate foods later due to delayed hunger.

Overview of Eating and Suggestions

Reduce Starchy Carbs A LOT!

  • Cut out the "white stuff" like bread, pasta, rice, and potatoes.
  • Cut sugar out altogether (remember The 98 Names for Sugar).
  • Cakes and cookies are a mixture of sugar and starch that make it almost impossible to avoid food cravings; they just make you hungrier!

Fruit is Tricky

  • Some tropical fruits like bananas, oranges, grapes, mangoes or pineapples have too much sugar.
  • Berries are better and can be eaten in limited amounts. Apples and pears are also lower in sugar, but limit to a small one.

Leafy Green Vegetables and Salads are Fine

  • Eat these daily.
  • Fill your plate at mealtime by substituting veggies such as broccoli or cauliflower for your potatoes, pasta, or rice.

Eat Healthy Proteins

  • Non-processed meats, eggs, and fish are fine and can be eaten freely.
  • Plain full fat yogurt makes a good breakfast with nuts and a few berries.
  • Highly processed lunch meats are not as healthy and should only be eaten in moderation
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Natural Fats are Fine!

  • Olive oil is very useful in cooking and as a dressing for salads.
  • Butter is tastier than margarine and is better for you.
  • Coconut oil is great for stir fries.
  • Four essential vitamins A, D, E, and K are only found in natural fats or oils.
  • Be mindful of the amount if you are aiming for weight loss. You want to burn the fat on your belly, not the fat you eat.
  • Avoid processed fats such as margarine, corn oil, and vegetable oils. Beware “low fat” foods: they often have extra sugar or sweeteners added to make them palatable.
  • Full fat mayonnaise and pesto are definitely fine!

Tips for Eating Out

  • Plan ahead — check menus online, always remove bread from option (sub in a bowl or bunless burger).
  • Eliminate the starch: ban the bread and potato; choose alternate sides.
  • Add healthy fat. Get extra fresh butter or olive oil for salad.
  • Keep an eye on sauces and condiments as many contain sugar.
  • Choose drinks with care: choose water and absolutely no "free refill" sugary drinks!
  • Rethink dessert — try a coffee or tea with cream, or berries and cream.

Low-carb Beverages

  • If you need some fizz, try seltzer water with natural flavors and no artificial sweeteners.
  • Water, up to 2 liters per day, will keep you hydrated.
  • Drink coffee, tea, or herbal tea, but do not add sugar to your drinks. You may add cream to your coffee or tea.
  • Most alcoholic drinks are full of carbs, so be careful!
  • The occasional serving of dry red wine (cabernet sauvignon, merlot, malbec, pinot noir), dry white wine (sauvignon blanc, pinot grigio) or spirits can be acceptable.

A Word on Snacks

  • You will be eating a good amount of protein at each meal, and, if you are eating adequate meals, you should not be hungry between meals.
  • If you crave a snack between meals, try to notice if you are hungry or experiencing another emotion like boredom.
  • If you are truly hungry between meals, have a small low-carb snack such as a piece of cheese, hard boiled egg, salami, unsalted nuts, or a true low-carb snack bar.
Eating lots of vegetables with protein and healthy fats leaves you properly full in a way that lasts!

MEDICATION MANAGEMENT

MEDICATION MANAGEMENT

Monitoring and Adjusting Medications

It is VERY important when following a low-carbohydrate nutrition therapy to adjust medications to minimize the risk for hypoglycemia and hypotension. Consult with your physician. Checking your blood glucose and blood pressure at home is essential.

  • Reducing carbohydrate intake potently reduces blood glucose level, which means that diabetes medications can be reduced or even stopped in some cases.
  • Reducing carbohydrate intake also leads to water loss. As a result, blood pressure can decrease and dehydration can occur if water and sodium are not replenished, especially if you are taking a diuretic.

Insulin should be adjusted down and sulfonylureas (i.e., glipizide/glyburide) should be stopped ON THE SAME DAY that you are starting the new eating plan.

As weight loss continues, blood glucose levels will decline and further medication reductions may be necessary.

As you improve your insulin resistance, medications which can lower blood glucose will likely need to be reduced or eliminated. Check your blood sugar regularly! Blood pressure can improve also, so monitor with a home cuff and consult with your doctor.

  • Diabetes medications—insulin and sulfonylureas: Doses should be REDUCED or STOPPED BEFORE starting a low-carb diet to prevent hypoglycemia (low blood sugar).
  • Metformin: Can be used in a low-carb diet.
  • Blood pressure medications: A low-carb diet can improve blood pressure. If you have a pressure below 110 mmHg, headache, or feel lightheaded, your blood pressure medications may need to be changed. Diuretics especially should be reduced.
  • Blood thinners: Coumadin (warfarin) should be monitored more frequently when transitioning to a low-carb diet, especially if vegetable-intake changes.

Figure 2. Adapting Diabetes Medication for Low-carb Management of Type 2 Diabetes


MAINTENANCE AND ADHERENCE

Low-carb Timeline

General
STORED FATS ELECTRIC SUGAR GAS F F RUNNING ENGINE
  • It's important to know about some of the possible pitfalls associated with low-carb eating; that way you can take steps to prevent them, you will know what to do if you encounter difficulties, and you will understand the importance of giving your body some time to adjust to the diet.
  • Your body is used to using easily digestible and available carbohydrate for energy. With this new eating plan, your body will transition to using fat for fuel.
  • Remember: When insulin is up, you are storing fat, and when insulin is low, you can mobilize fat. The longer you have been insulin-resistant (obese or type 2 diabetic), the longer it may take to turn the fat-burning switch on.
  • The carbs you eat will have lots of fiber. This will reduce insulin levels through the day and night, and insulin sensitivity will improve. Fiber also helps to create a healthier "microbiome" (the intestinal bacterial environment).
The First 3 Days: Beat the Carb Withdrawal
You may experience carb (sugar) cravings because your prior way of eating may have had many processed carbs and your body needs time to adjust. Sugar is a powerful dopamine stimulus to the brain that triggers the "reward" response. Dietdoctor.com is a great resource.
  • Don't go hungry! A low-carb diet reduces hunger, and there's no need for snacking if you're doing it right. If you're hungry between meals, consider increasing the portion size of fat or protein a bit. Make sure to eat until you're satisfied at every meal. Remember, the initial goal is not calorie restriction or even weight loss, but rather to reduce your insulin load and improve metabolism and blood glucose.
  • Don't try heavy exercise. Get plenty of lifestyle physical activity and movement but resist doing high intensity exercise for a couple of weeks until your body adapts to using fat as fuel.
  • Be good to yourself! You are making a big change and deserve all the pats on the back you can get. It's important to take care of yourself, learn how to deal with cravings, and reward the little milestones. This will help you feel better about the entire experience.
  • Get support. Everybody needs a buddy. Find people who are on your side. There are lots of people who have experienced the same things you are experiencing right now. Whether online or in-person, you can find support from others who are happy to answer questions and share their own experiences.
  • Eat lots of fiber and good fats and proteins at every meal. Fat, protein, and fiber together produce a high degree of satiety, the feeling of being full.
  • Drink lots of water. It seems simple, but having plenty of water by your side can do wonders for your body and mind during these first days.
  • Don't overeat the foods on your allowed list. Because you're keeping your carbs lower, initially, you may find yourself reaching for more of the macronutrients you don't have to restrict: protein and fat. So be cautious with overdoing it on the meat, cheese, and nuts, as these foods contain a lot of calories. Going lower-carb isn't a license to eat as much of these foods as you want. Eat when you're hungry, and stop when you are comfortable. Your brain is being trained too, and you are learning.
  • Plan delicious things to eat. You will be giving up some of the foods you are used to eating. Rather than focusing on the things you are eliminating, find the yummiest foods your plan allows and enjoy them!
Days 3 to 5: Watch Out for "Carb Crash" or "Keto Flu"
Some people experience a phenomenon known as "carb crash" after a few days on a lower-carb diet. Your body is adapting to mobilizing body fat, and this can be sluggish at first compared to the quick release of the processed carbs you may be used to. Some of the symptoms people experience include feeling shaky or jittery, feeling irritable, feeling fatigued, or just not feeling "right."
  • If you feel shaky, fatigued, or otherwise unusually bad, add a few high-quality carbs to your diet. If this makes the feeling go away, you know you are in a carb crash. You should then modify your plan for the next few days to include a bit more carbohydrates and monitor your symptoms.
  • Drink bouillon — have a cup of bouillon a day! Dissolve half a bouillon cube in a cup of hot water and drink it. Doing this daily during the first week will help you get enough water and salt. This can help you avoid early side effects, like headache, lethargy or irritability. These side effects are common when starting a strict low-carb diet, but with the bouillon (broth) they are usually minor.
  • By the end of the first week of your new eating plan, you should start to reap the rewards of your low-carb diet. This is the stage where many people begin to experience increased energy, better mental concentration, less compulsive eating, and few or no carb cravings. Some say it's as if a fog lifted that they didn’t even know was there.
  • Avoid the temptation for a weekend “cheat day.” Remember that sugars have addictive qualities, and “moderation” often does not work. If you were quitting tobacco, you would not have a cheat day. A high carb day early in the process can also sabotage the adaptation to mobilizing fat as fuel.
Week 2: Restore Your Motivation
Getting through the first week on a low-carb diet is, indeed, the hardest part. It’s crucial to keep going during the first week. After the first week, you’ll likely feel good. You may see signs that your weight is dropping, even a notch off the belt, and energy is up. Your desire to snack is gone. You are learning new recipes and shopping habits. Keep up with your electrolytes. Here is a primer on electrolytes going into week two:
  • Sodium: Most should not restrict sodium on low-carb diets and will likely need additional sodium and hydration, especially in the first several weeks. 3–4 grams and sometimes more per day is appropriate and can be supplemented with bouillon cubes or broth. Hyponatremia may be exacerbated by SGLT2 inhibitors, diuretics, and other medications.
  • Potassium: Potassium can also become depleted, especially with diuretics (thiazides and lasix) or inadequate sodium intake. Attention should be given to adequate dietary potassium and sodium intake. Leafy greens are your friend.
  • Magnesium: Magnesium is commonly inadequate in modern diets, and an association between low magnesium intake and metabolic syndrome has been suggested. Electrolyte changes induced by a low-carb diet may increase magnesium losses. Magnesium supplementation with Slo-Mag or Mag 64 are simple, low-cost options.

  • Long-term sustainability may be improved by behavioral analogies like budgeting. The expectation is not avoidance of all carbohydrates but specific choices of foods low in digestible carbohydrate.
  • Cravings for carbohydrate-rich foods are common, and unplanned deviations from any dietary pattern or lifestyle plan are normal and to be expected. Counseling emphasis should be placed on returning to the prescribed eating pattern and developing plans to remove, avoid, or respond differently to triggers.
  • Critical for success: developing your “binge management strategies” and “emotional management strategies” initially and periodically is essential.
  • Vegetarian dietary patterns, even vegan patterns, can be adapted to a low-carbohydrate goal with the inclusion of vegetable products which are high in protein content— e.g., soybeans, tofu, tempeh, and vegetable fats such as avocados, olives, nuts, seeds, and nut butters.

  1. Build your low-carb house with bricks — not straw!
    • No matter if you’re just thinking about starting low-carb or you’ve been doing it for a while now—it’s important that you build a solid foundation. If you don’t, it’s much easier for you to crumble and fail. What does it take to build a brick low-carb house? Clean out all the processed, grainy, sugary junk from your kitchen! Stock it with low-carb friendly foods that you LIKE. Make sure some of them are quick and easy to prepare—frozen broccoli or frozen diced cauliflower and chopped chicken tossed quickly in a skillet, topped with some olive oil and pesto: simple and delicious!
  2. Set aside prep time for your week.
    • Schedule time on Sunday (or whatever day provides more downtime) to get in gear for the week. You can plan some recipes (and leftovers), hit the grocery store, and pre-cook/wash/chop anything you can. That way when you come home drained from the day, you’ll already know what’s on the menu and be able to throw together all the prepared ingredients into a tasty low-carb meal. Low-carb tip: make double, or more, of everything so that you can re-purpose one night’s dinner for tomorrow’s lunch.
  3. Prioritize you!
    • When we get busy we tend to take care of everyone and everything else at the expense of our own health and goals. Make "you" a priority. If it really seems like time is getting away from you, set a calendar appointment once a day or however often you need to commit to yourself. You can use this time to meal prep, meditate, move—whatever helps you with your low-carb goals!
Use affirmations and say to yourself daily:

"For my body, over eating and sugar are poisons. I need my body to live. I owe my body this respect and protection."


PHYSICIAN-PATIENT COMMUNICATION TOPICS

PHYSICIAN-PATIENT COMMUNICATION TOPICS

Dispelling Myths

  • Myth: Low-carb nutritional approaches are a fad.
    Response: Over the past several decades, many randomized controlled trials, both short term and long term (up to 2 years or more), have demonstrated that a low-carbohydrate eating pattern is effective for weight loss, metabolic improvement, and weight maintenance.
  • Myth: Low-carb is bad for your heart.
    Response: Carefully controlled randomized trials have demonstrated reduction in cardiometabolic risk factors and carotid intimal thickness.
  • Myth: Low-carb is not sustainable long-term.
    Response: Reducing daily carbohydrate intake has the effect of decreasing appetite and increasing satiation or sense of fullness and corresponding biomarkers. This effect assists in long term maintenance. Randomized trials typically show that patients persist with low-carbohydrate eating plans similarly to comparison diets.
  • Myth: Ketosis is dangerous.
    Response: Restricting dietary carbohydrates has been an established treatment option for children with hard-to-control epilepsy since the 1920s and has no proven deleterious effect on cognitive function or health.
  • Myth: Plant foods are reduced on a low-carb program.
    Response: Non-starchy vegetables (green leafy, cruciferous, zucchini, cucumber, celery, etc.) are the foundational foods of a low-carbohydrate eating pattern and are nutrient dense with abundant amounts of folate, potassium, vitamins, and phytonutrients. Proteins or fats can also be obtained from vegetable sources such as nuts, tofu, tempeh, olive oil, avocado, and others.
  • Myth: Ketone products and extra fats are necessary to get into nutritional ketosis.
    Response: The most important factor to attain nutritional ketosis is to consume a small amount of carbohydrate. Adding ketones or fats or oils is not necessary.
  • Myth: Low-carb eating patterns negatively influence kidney function.
    Response: This myth stems from the confusion between low-carb eating patterns and high-protein eating patterns. Low-carb does not necessarily mean high protein. Further, for people without existing kidney disease, and for those eating to satiety, higher protein intake does not appear to be related to lower kidney function.

FREQUENTLY ASKED QUESTIONS


How Low is Low-carb?

  • “Low-carb diets” can refer to a range of carbohydrate intake from less than 130 grams a day to a very low-carb or ketogenic diet where the goal is 20-35 grams of non-fiber carbohydrates per day. The goals are to reduce carbohydrate intake, which reduces your body's insulin requirement and, in ketogenic diets, to produce ketone bodies for fuel.

What is Ketosis?

  • Glucose (from sugar or other carbohydrates) is the most common fuel source for the body. Ketones are produced by the liver as an alternate fuel source when glucose is not available. Ketosis is the presence of ketones in the blood. Most people develop low levels of ketosis after an overnight fast or carbohydrate restriction. This low-level dietary ketosis is not harmful and can be therapeutic. Ketone levels induced by a low-carb diet will never approach the levels induced by frank insulin deficiency as in diabetic ketoacidosis. The breath of people in ketosis can be described as “fruity.”

How Will This Affect My Lipid Panel?

  • A low-carb diet has higher dietary fat but has positive effects on the lipid panel. HDL (good cholesterol) can increase, and triglycerides usually decrease. LDL and total cholesterol usually remain stable, especially after the new weight is maintained. Cholesterol can go up during weight loss. In almost all cases this is fine. Discuss with your doctor.

What Else Can Help?

  • A low-carb diet is part of a multifaceted lifestyle change. Adequate sleep, physical activity, reduced stress, learning to cook, support from friends and family all will help you restore your health.

Are There Any Side Effects?

  • There are a few possible side effects, and most are minor and easily managed. See Table 2 on the following page to review the most common ones, and how to resolve them.

Table 2. How to Manage/Prevent Potential Side Effects

Having trouble viewing table?
Potential Negative Effects Prevention/Management Solution
Halitosis Increase water intake, maintain good oral hygiene and use parsley, sugarless mints, or chewing gum. In some cases, modifications of macronutrient intake may be helpful.
Muscle cramps Magnesium supplementation will normally resolve any cramps, as will good hydration.
Constipation Increase fluid to 2 liters per day. Make sure you eat plenty of veggies.
Lightheadedness, weakness, fatigue Check your blood pressure and make sure that you have enough salt (e.g., bouillon 1–2 cubes/day). These symptoms typically resolve in 7–10 days. Just like the flu, you should rest and avoid heavy exertion during this initial stage of the nutrition plan if symptoms occur.

Tips for Saving Money While Staying Low-carb

  1. Buy meat and fish from the counters at supermarkets, it's usually less expensive than straight from the fridges. If you can, go to your local butcher and fish shop since they can be even cheaper.
  2. Buy loose fruit and vegetables, it's usually less expensive than prepackaged fruit and vegetables, but sometimes frozen vegetables can be cheaper. Also, buy less popular fruits and vegetables or go direct to your local greengrocer or farm shop since both alternatives can offer an even better price.
  3. Cook in bulk with dishes, then store in containers for freezing and heating up quickly the next time.
  4. Before going shopping, compare foods online for the best prices and account for any coupons that might be available.
  5. Don't go shopping on an empty stomach!

STOCKING A LOW-CARB FRIENDLY KITCHEN

STOCKING A LOW-CARB FRIENDLY KITCHEN

GREEN LIST FOODS

When you begin eating low-carb, the first and biggest obstacle can be, “What do I eat?” Use these handy shopping lists to help guide you through the grocery aisles. Green List Foods are nutrient dense, low in carbs, and satisfying.

Green list foods



YELLOW LIST FOODS

Foods on the Yellow List offer multiple health benefits but may hinder your weight loss journey if consumed without restriction. Thus, foods on this list are meant to be enjoyed in moderation.

Yellow list foods



LIGHT RED LIST FOODS

You should hardly ever consume foods on this list.

Light red list foods



RED LIST FOODS

Foods to avoid and not have in the home!

Red list foods



Food for Thought — Ask These Questions:

  • Was the food once alive?
  • What are the ingredients?
  • Are the ingredients nutritious?
  • Where did the ingredients come from?

Hint: Did your food come from something living or was it made in a plant? Buying locally-sourced food is always best.

Visit www.realmealrevolution.com for more on the world famous food lists and variation.

KRISTIE'S TOP 10 TIPS

KRISTIE'S TOP 10 TIPS

Getting Started on Low-carb or Keto

( cookingketowithkristie.com/getting-started-2/)

Often, the Best Way to Start Is to Simply Jump In!
  1. Count All the Carbs and Keep Them Low.
    • When I first started low-carb, I didn't know a macro from a micro, but I knew that I had to count carbs. Count total carbs; do not subtract fiber. That's all I knew for the first few months, and I lost over 40 lbs. in that time. I discontinued all of my medications in those first four months. This doesn't have to be complicated. Despite all the detailed information here, don't wait for perfection. Don't drive yourself insane counting macros, weighing, and measuring. For accurate carb counts, use the online USDA database to find nutritional values (ndb.nal.usda. gov/). If the food you're eating has a label, then use the nutritional information on the label. Know the carb count of EVERY food you put in your mouth BEFORE you put it in your mouth.
  2. Commit.
    • Decide you're going to follow a low-carb plan 100% for two weeks. I promised myself that at the end of my two weeks, I'd eat the entire doughnut shop if I wanted. Just two short weeks. I was desperate, and I knew I had to follow the plan 100%. Even one little Hershey's Kiss can throw your body off, and you will not see the results you want. Low-carb can be unforgiving for those of us with metabolic dysfunction. Moreover, during those two weeks, you will be able to push through cravings and enjoy the benefits. Once you accomplish two weeks of success, the plan gets easier. Commit to four short weeks; one day at a time. No sugar, no starch, no grains. Decide "Come heck or high water, I'm following this plan for four solid weeks." Then do it.
  3. Find Your Favorite Low-carb Foods to Eat
    • Use the food lists, sample meal plans, and the recipes in this book to find your new favorite foods. My favorites are steak, chicken wings, creamed spinach, and homemade Ranch salad dressing. When I'm tired of that, I've got meatloaf, taco soup, pepper steak, and coffee with heavy cream. As you identify your new low-carb foods, pick mostly from the green and yellow lists in the Getting Started Guide because those are the foods with higher fat and lower carbohydrates. You can eat from the Red List occasionally, but you may surpass your carb limit more quickly than you intend.
  4. Limit Carbs to 7–10 Grams Total Per Meal
    • The "magic" that makes a low-carb plan work is linked primarily to keeping blood glucose stable. Eating higher carb meals will raise blood glucose, which is why you have to be 100% on-plan and remain vigilant about counting carbohydrates. The physicians I follow who recommend a low-carb diet generally advise patients to count total carbs, which means not subtracting fiber. Some soluble fiber may impact blood glucose, especially in packaged foods. Therefore, counting total carbs is a more conservative, but safer, guideline. While you may find that you can tolerate up to 12–15 grams of carbs per meal, many people cannot. Cravings are worse for me when I exceed 7 grams of total carbs per meal. Through trial and error or blood glucose monitoring, you can find your carb threshold.
  5. Eat to Hunger
    • A low-carb diet does not work by starving the body. Low-carb works by eating high fat foods with adequate protein such as fatty meats, bacon, chicken with crispy skin, etc., that keep blood glucose stable. Eat when hungry. Don't gorge, but when your hunger is satisfied, stop eating. Moreover, do not eat again until you are physically hungry. As I explained to my husband, "If you're hungry, you're doing it wrong." Don't worry about how many strips of bacon make a serving. There are days when I am physically hungry: eight pieces of bacon and three eggs are not "too much" on those days. On other days, two pieces of bacon and coffee are sufficient. Fat tends to be self-limiting and can make you sick if you overeat it. You will learn quickly when you've overeaten fat.
  6. Learn to Listen to Your Body
    • Know whether you're eating what's "right" by listening to your body. An ideal low-carb meal meets these requirements:
      • A. You leave the table feeling satisfied. Not stuffed, but comfortable.
      • B. You don't feel tired or sluggish 1–2 hours after eating, but you do feel energized. If you do feel tired or sluggish, then your meal was not ideal. Feeling tired and sluggish can be linked to eating too much protein, too many carbs, or a food sensitivity. Make note of the grams of carbs, fat, and protein in your meal. Use the USDA database or the nutritional label for accurate macros.
      • C. You do not feel hunger (true physical hunger) for at least 4–6 hours after the meal. It takes a body that long to metabolize a meal when the balance of macros is right.
  7. Learn Your Hunger Cues
    • Physical hunger is not feeling anxious, frustrated, angry, or happy. Hunger is not an emotion. True hunger is not triggered by a commercial on television or by someone around you eating. Physical hunger is disruptive. It stops you from what you're doing, and says softly, "Uhm... I need a little fuel here." If you're busy and you get distracted by hunger, you're truly hungry. When you're hungry, eat. If you're not physically hungry, drink water, phone a friend, run an errand, clean, or go for a walk. Learning to trust physical hunger cues is a significant key to success.
  8. Don't Try to Take Shortcuts
    • There is no substitute for real food. Whether you're tempted by convenience of "low carb" products (that are not really low in total carbs), or tempted by supplements that promise ketosis, or simply toying with the idea of a three-day gimmicky "diet," "detox," or "fast," then don't. Learning to eat nutritious foods and changing your habits for the rest of your life is going to make you healthy in two weeks, two months, two years, and two decades. Looking for shortcuts never moved me further along on my journey for any length of time.
  9. Eat Real Foods and Pay Attention to Ingredients
    • Looking for convenience, I made this mistake. If a food is marked "low-carb," "sugar-free," or even "keto," it probably isn't a good option. When you pay attention to ingredients, you find that many sweeteners used by food products will impede your progress. For example, diet soft drinks can cause stalls, and many people find that drinking them increases hunger. Those who pay attention to ingredients are more likely to see better results.
  10. Create New Habits
    • You will not succeed by doing the same things you've always done. To be successful, you will have to think differently about food and meals. When you eat, what you eat, and why you eat are going to be different on a low-carb plan. You will have to learn to eat different foods, and create new meals. For breakfast, I often eat non-traditional breakfast foods, such as a burger with cheese and bacon, smoked sausage, bacon with cream cheese, or a skillet pizza. For quick lunches, I often eat leftovers or salad with deli meat, a boiled egg, cheese, and lots of homemade Ranch dressing. A juicy cheeseburger with bacon and mayo (hold the bun) is always delicious and easy to find on the go. Even if you don't like to cook, you can still create low carb meals that you enjoy. If you don't DO something different, you will never BE different.

A Few Extra Credit Tips From Dr. Mark

A Few Extra Credit Tips From Dr. Mark

  • Drink according to thirst. Beverages that you can drink while following a low-carb diet include water, tea with no sugar added, and coffee. Tip: make your water more tasteful by adding cucumber slices, lemon pieces, mint, or ginger parts.
  • Cook extra for leftover day! Meals that have more than one portion can be enjoyed on other days.
  • If you remain hungry, then add more fat and protein to your cooking (i.e., additional cream/butter/meat/fish/egg) to help you feel full. You may also eat more vegetables.
  • Try not to eat snacks in between meals. But if you feel the need, then choose hard cheese or salami, snack on a handful of nuts, or a hard-boiled egg.
  • Stop eating when full and eat only when hungry. You are welcome to skip meals if you don't feel hungry and to eat larger portions at other meals if you are hungrier. Save any leftovers for your next meal.
  • Drink your food and chew your drink (this means chew and enjoy the foods, and drink slowly).
  • The portions given in the recipes are just guidelines. Everyone is different and may need more or less to feel full.
  • Prepare low-carb meals in advance. That way, you will not be tempted to buy any snacks/meals that are not low-carb friendly.

Low-carb Tips from Lance King Paul who lost 150 pounds and no longer has diabetes

Low-carb Tips from Lance King Paul who lost 150 pounds and no longer has diabetes

  1. Record your BMI (a simple calculation you can do with weight and height).
  2. Know the difference between being hungry and being thirsty.
  3. It takes about 5 weeks to break a habit and about 5 weeks to form a habit.
  4. Measurements are important because you may lose inches and not weight at times.
  5. Non-Scale Victories (NSV) are important. Good for moral support.
  6. Don’t let the scale get in your head. Don’t worry too much about the scale. Follow the program for maximum benefit.
  7. MYTH: You cannot do low-carb without a gallbladder. I have heard this from hundreds of people and have been asked lots of times. FACT: You can. You may need an ox bile supplement at first, but not always.
  8. Exercise is not a must initially; however, once you start losing weight and/or regaining your health, you will feel more like doing activities you did before (exercising, hiking, roller-skating, etc.).
  9. Pickle juice and mustard are good for muscle cramps.
  10. Magnesium is good for constipation.
  11. Keto flu for beginner: use bouillon twice a day or a pinch of salt.
  12. Community is important. Reach out to a local low-carb group on social media.
  13. Be cautious about portion size on trigger foods, such as nuts.

GROCERY STORE SHOPPING LIST

GROCERY STORE SHOPPING LIST

Works for Most Discount Stores and Many Dollar Stores

Cooking interesting versus cooking average is all about what you have in the fridge and freezer with a few pantry staples. This is your toolbox for adding variety, flavor, and fun. There are lots of low-carb options at reasonable prices.

Here is an example of one shopping trip as well as some staples (spices, oils, and flavors). This basic list can be applied at almost any discount grocer and even at dollar stores. Starting on the opposing page, you'll find a list of simple recipes and meals that can be created with these ingredients.

Non-perishables Perishables Get Spicy (Try a few)
▢ Almonds
▢ Anchovies
▢ Canned chicken
▢ Canned tomatoes
▢ Canned tuna
▢ Coconut milk (high fat)
▢ Coconut oil
▢ Dark chocolate (at least 85%)
▢ Extra virgin olive oil
▢ Low-carb mayonnaise
▢ Mustards (Dijon)
▢ No-sugar nut butters
▢ Pork rinds
▢ Stevia, erythritol, monkfruit
▢ Tomato puree
▢ Tomato sauce (no sugar added)
▢ Vinegars (white or red wine)
▢ Walnuts
▢ Bacon
▢ Bologna (1 package)
▢ Butter (8 oz)
▢ Cabbage (1 head)
▢ Cheddar cheese (sharp, 8 oz)
▢ Chuck roast
▢ Country sausage (1 lb)
▢ Cream cheese
▢ Deli meat turkey
▢ Eggs (large, 1 dozen)
▢ Garlic (minced, 1 jar)
▢ Greek yogurt (Full-fat plain, 1 tub)
▢ 73% Ground beef (2 lbs)
▢ Ham steak
▢ Heavy cream (1 pint)
▢ Hot dogs (1 package)
▢ Jalapeño peppers (1 bag)
▢ Mozzarella cheese (shredded)
▢ Onions (yellow, 1 bag)
▢ Pepper jack cheese (8 oz)
▢ Pepperoni (1 package)
▢ Pickles
▢ Radishes (1 bag)
▢ String cheese
▢ Zucchinis
▢ Allspice
▢ Cinnamon
▢ Cloves
▢ Coriander
▢ Cumin
▢ Hot sauce
▢ Mustard seeds
▢ Nutmeg
▢ Oregano
▢ Paprika
▢ Star anise
▢ Turmeric

RECIPES

RECIPES

Protein, Fat, and Carb Counts are estimates. For precision, read labels and measure.

Main Dishes

ZUCCHINI PIZZAS

Makes 4 servings

Ingredients:

  • 2 medium zucchinis about 7" long, sliced lengthwise in about 1/2 thick strips
  • 2 tsp dried Italian seasoning
  • 1/2 tsp minced garlic or 1/2 tsp garlic powder
  • 1 tbsp olive oil (optional)
  • 3 oz pepperoni slices
  • 8 oz (2 cups) shredded mozzarella cheese
  • 1/4 tsp salt
  • 1 eight-oz can tomato sauce

Instructions:

  1. Preheat oven to 375 degrees.
  2. Slice the zucchini into strips about 1/2 inch thick. Each zucchini should yield 3–4 slices depending on size. The strips don't need to be perfect.
  3. Lay the zucchini strips in a single layer in a 9x13" baking dish. Sprinkle Italian seasoning and garlic over the top of the zucchini. You may drizzle olive oil over the herbs.
  4. Bake for 15–20 minutes or until the zucchini strips are lightly roasted and just tender.
  5. Top the zucchini with the slices of pepperoni, generously covering each slice.
  6. Sprinkle the cheese evenly over the entire dish.
  7. Add the salt to the tomato sauce and drizzle the sauce over the dish. There won't be enough to cover everything, but that's okay. You can also sprinkle a bit more Italian seasoning and garlic powder over the top for even more flavor.
  8. Bake for 20–30 minutes until lightly browned and bubbly.
  9. Refrigerate leftovers for up to four days.

Feel free to add as much pepperoni, cheese, sausage, etc. as you want, but please be mindful of not adding too much tomato sauce. One 8 oz can of tomato sauce will give a generous drizzle for great flavor. Remember that each standard can packs 10 grams of total carbs (7 net carbs). The tomato sauce and zucchini gives plenty of carbs per serving, so be aware of this before including onions or other ingredients that will add more carbs.

This dish is perfect for making ahead of time, refrigerating, and baking just before serving. Once baked, leftovers can be frozen for future meals or make great options for lunches.

EGG DROP SOUP

Makes 1 serving

Ingredients:

  • 2 cups chicken broth
  • 2 large eggs, beaten
  • 1 tbsp chopped green onion or 1/4 tsp minced dried onion
  • 1 tsp garlic powder
  • 1/4 tsp butter or sesame oil
  • 1/4 tsp soy sauce (optional)
  • 1 dash pepper
  • 1 tsp coconut aminos

Instructions:

  1. Bring broth to a boil on medium-high heat in a 1 1/2 quart saucepan.
  2. Add the onion and garlic powder.
  3. As the broth boils, slowly pour in the beaten eggs, adding just a bit at a time and stirring as the eggs are added.
  4. When all of the egg has been added and is cooked, remove from heat.
  5. Pour into a serving bowl.
  6. Top with the sesame oil, coconut aminos, salt, and pepper. Serve immediately.
We call this comfort food at my house because it's perfect for those times when you don't have a full kitchen, but you do have a microwave. Just be sure to add the egg a little at a time and microwave in short bursts to keep the broth hot in between adding the egg.

SIMPLE CHICKEN SALAD

Makes 2 servings

Ingredients:

  • 2 cups cooked chicken, shredded
  • 1/2 cup mayonnaise
  • 2 tbsp chopped dill pickles
  • 1 tbsp bacon pieces
  • 1 tsp dry mustard (ground mustard seeds)
  • 2 drops liquid sweetener (optional)
  • Salt and pepper to taste
  • 1 hard-boiled egg, finely chopped (optional)

Instructions:

Mix all ingredients well and refrigerate for thirty minutes before serving.

SKILLET PIZZA

Makes 1 serving

Ingredients:

  • 3 oz (3/4 cup) mozzarella cheese, shredded and divided
  • 2 oz sausage, cooked and crumbled
  • 2 oz pepperoni slices
  • 2 tbsp sliced bell pepper
  • 1/2 tsp dried Italian seasoning
  • 1 oz tomato sauce

Instructions:

  1. Heat a 7" non-stick skillet on medium heat. Sprinkle 2 oz of the cheese in the bottom of the skillet. The cheese will melt into a thin, solid layer.
  2. Lower the heat and top the melted cheese with sausage, pepperoni, and bell pepper.
  3. Cook on low heat for 3–4 minutes until the toppings are warmed.
  4. Top the pizza with the remaining cheese and sprinkle the Italian seasoning over the cheese. The pizza is done when the cheese on top is melted and when the cheese "crust" is browned.
  5. Remove from heat and let cool for 5–10 minutes before serving.
  6. Remove the pizza from the skillet and on to a plate.
  7. Use a pizza cutter to cut the pizza into slices.
  8. Serve with tomato sauce for dipping.
TIP: Nearly any pizza topping will work in this recipe. Pre-cooked bacon, black olives, and cooked mushrooms are ideal to keep carbs low.

Cooking for one or cooking on the run, this recipe uses simple ingredients that are basics in most low-carb kitchens. Also, you can customize the toppings to include whatever you have on hand. This is a recipe that older children can make for themselves. It's also a great way to use up leftover sausage or veggies. Once you've tried this, you'll wonder, "Why didn't I think of that?"

Waiting for the skillet pizza to cool before serving is the hardest part of this recipe!

BEEF STEW

Makes 4 servings

Ingredients:

  • 2 tbsp butter
  • 2 cloves garlic, minced
  • 1/4 cup onion, finely diced
  • 1 stalk celery, chopped
  • 2 cups bone broth
  • 2 eight-oz cans tomato sauce
  • 1/4 tsp salt
  • 2 bay leaves
  • 1/4 tsp ground black pepper
  • One small zucchini, chopped
  • 1/3 cup cauliflower, chopped
  • 3/4 cup cabbage, sliced in bite-sized strips
  • 1/2 cup radishes, cubed
  • 1/2 cup green beans, chopped
  • 3 cups chopped, cooked roast beef

Instructions:

  1. Melt the butter in a 2 1/2 quart saucepan on medium heat.
  2. Add the garlic, onion, and celery. Sauté until the onions are translucent and the celery is just tender.
  3. Stir in the remaining vegetables, broth, tomato sauce, salt, pepper, and bay leaves.
  4. Simmer uncovered until the vegetables are tender and the broth is thickened, about 20–25 minutes.
  5. When the vegetables are tender, mix in the cooked roast beef and continue to simmer until the beef is warm, about 5–7 minutes.
  6. Remove bay leaves before serving.

Leftover beef roast can become a low-carb vegetable beef soup. It isn't as good as my grandmother's (which was loaded with starchy veggies), but it still warms the belly. My kids love it in their packed lunches when the days turn cooler.

In this recipe, I've used 3 cups of chopped, cooked roast beef. You can also use cooked ground beef. If you want to start with raw beef, simmer the raw beef in the broth and tomato sauce for 30–45 minutes before adding the vegetables.

20 MINUTE SKILLET

Makes 4 servings

Ingredients:

  • 1 lb ground beef (80% lean)
  • 1 tbsp bacon fat
  • 1 cup finely chopped cauliflower florets
  • 2 tsp Jane's Crazy Mixed-Up Salt (seasoning salt)
  • 1/3 cup water
  • 1/2 cup (4 oz) cream cheese
  • 2 tbsp unsalted butter
  • 1 tsp onion powder
  • 1/3 cup heavy cream
  • 2 oz cheddar cheese, shredded (about 1/4 cup), plus extra for garnish if desired

Instructions:

  1. Brown the ground beef in a large skillet with a lid over medium-high heat, stirring often to crumble the meat as it cooks.
  2. Add the bacon fat, chopped cauliflower, and seasoning salt, and cook over medium heat, stirring occasionally.
  3. When the cauliflower is just beginning to soften, add the water and cover the skillet with the lid. Cook for 5–7 minutes, until the cauliflower is tender.
  4. Remove the lid and reduce the heat to low. Add the cream cheese, butter, and onion powder and stir until melted.
  5. Add the heavy cream and stir until smooth and creamy.
  6. Remove from the heat, stir in the cheddar cheese, and serve immediately. Garnish with additional shredded cheddar, if desired.

If you ever liked the boxed Hamburger Helper meals, then you will like this recipe. The texture is very similar to most of those boxed mix meals that require added cooked ground beef to make a meal. Change the flavor by using a spicy cheese or a more mild cheese.

HOT DOGS WITH CHEESE

Makes 2 servings

Ingredients:

  • 4 hot dogs - unprocessed best
  • 4 slices cheese

Instructions:

  1. Slice hot dogs lengthwise and place in a frying pan with the cut side down.
  2. Fry on medium heat until they develop a nice brown coating on the cut side.
  3. Remove from heat. Add a slice of cheese to the length of each hot dog and serve.

We call this meal "not fancy, but fed". Somehow, browning the hot dogs adds a nice burst of flavor before adding the cheese. A tablespoon of fresh chopped onions is also great with the fried hot dogs and cheese.

BUFFALO CHICKEN BAKE

Makes 6 servings

Ingredients:

  • 3 large cans of chicken (you can also use fish, or cooked and shredded chicken)
  • 2 eight-oz packages of cream cheese, softened.
  • 2 tbsp dehydrated onion (or use fresh)
  • 1/2 cup buffalo wing sauce (Frank's, Moore's or your favorite brand.) Add more if you like it spicy!
  • 3 cups shredded cheddar cheese (or 2 cups of blue cheese)
  • 1 cup Ranch dressing (or blue cheese dressing)

Instructions:

  1. Preheat oven to 350 o F.
  2. In a large bowl, mix cream cheese and chicken until well combined. Add additional ingredients and stir until thoroughly combined.
  3. Pour into a casserole dish and bake for 25–30 minutes. It should be lightly browned and bubbly when ready. Serve hot with pork rinds, celery sticks, or just enjoy with a spoon.

You can enjoy this as a main dish or as a side dish. Either way, if you like buffalo chicken wings, you will love this! Use canned chicken or any cooked chicken to make this recipe really easy. If you want to use raw chicken, just be sure to cook it (bake, fry or boil) before using it in this recipe. Blue cheese dressing and blue cheese are classic ingredients, but because of the strong taste, not everyone likes blue cheese.

FRIED DELI MEAT AND CHEESE WRAPS

Makes 1 serving

Ingredients:

  • 1/2 cup shredded cheese
  • 2 slices of deli meat

Instructions:

  1. Spread half of the cheese into a pile in a large frying pan and cook on medium-low heat. As the cheese starts to melt, top it with a slice of deli meat.
  2. When the cheese is browned on the bottom, flip the cheese and deli meat over so that the deli meat is on the skillet. Fry for an additional minute or until the deli meat is just browned.
  3. Remove from heat and carefully roll into a wrap or leave flat. Repeat with the remaining cheese and deli meat.

A meal doesn't get much easier than this! Just be patient when letting the cheese melt and keep the heat low enough to let the cheese brown. If the cheese is too melty, turn off the heat and let it cool for 3–5 minutes so that the cheese will harden.

PIZZA SAUCE

Makes 1 serving
(1/4 cup per serving)

Ingredients:

  • 8 oz tomato sauce
  • 1 generous tbsp Italian dressing
  • 1/4 generous tsp onion powder
  • 1/8 tsp garlic powder
  • 1/8 tsp salt

Instructions:

  1. Mix all ingredients in a small bowl and let sit for at least 20–30 minutes before serving as a dip. Can be used immediately as a topping for pizza crust.

This very basic sauce can be used on pizza crusts or as a dipping sauce for Skillet Pizza. The seasoning in this is minimal to appeal to younger palates. If you'd like a little more seasoning, you can increase the spices, add additional basil or oregano or even add a few hot pepper flakes for a bite of flavor.


Side Dishes

BROCCOLI SALAD

Makes 8 servings

Ingredients:

  • 4 cups of raw broccoli florets (small pieces like the tip of your pinkie)
  • 1/4 cup finely chopped onion
  • 1/2 cup bacon, chopped
  • 1 1/2 cup of cheddar cheese

Dressing:

  • 1 cup of mayonnaise
  • 1 1/2 tbsp of apple cider vinegar
  • 2 tbsp granulated sweetener or
  • 6 drops liquid sweetener
  • Salt, pepper

Instructions:

  1. In a large bowl, toss together the broccoli, onion, bacon, and cheese.
  2. In a small mixing bowl, mix together the mayo, vinegar, sweetener, salt, and pepper.
  3. Pour the dressing over the broccoli mixture and toss well to combine. Refrigerate for at least 30 minutes before serving.

LOADED ROASTED BROCCOLI

Makes 6 servings

Ingredients:

  • 4 cups broccoli florets, cleaned and trimmed
  • 1 tbsp bacon fat, melted
  • 1/2 cup cheddar cheese, shredded
  • 1/2 cup bacon pieces
  • 1 1/2 cup sour cream

Instructions:

  1. Preheat oven to 375 degrees. Line a rimmed baking sheet with foil or parchment paper.
  2. Cut the broccoli into long, thin florets. In a large bowl, toss the broccoli with bacon fat until lightly coated.
  3. Spread the pieces on baking sheet. Roast for 15–18 minutes or until lightly browned.
  4. Place the broccoli on a serving dish and cover with grated cheese while still warm. Sprinkle the bacon over the cheese. Add dollops of sour cream over the top. Serve immediately.
TIP: You can also use steamed broccoli, but roasting it adds incredible flavor to this dish.

Breakfast Dishes

FRITTATA

Makes 6 servings

Ingredients:

  • 1 cup broccoli, trimmed and chopped
  • 2 cups cubed cooked ham
  • 1 1/2 cups shredded cheddar cheese
  • 6 large eggs
  • 1 cup heavy cream
  • 1 tbsp dried, minced onion
  • 1/2 tsp salt
  • Butter

Instructions:

  1. Preheat oven to 350 degrees.
  2. Grease a 9-inch pie pan with butter. Evenly distribute the broccoli, ham, and cheese over the pie plate and set aside.
  3. Combine the eggs, cream, minced onion, and salt in a large bowl and whisk until frothy.
  4. Pour the whipped egg mixture over the asparagus, ham, and cheese.
  5. Bake for 30–35 minutes until the center is just set and lightly browned.
  6. Remove from the oven and let set for 10–15 minutes before serving.
TIP: If storing for later use, let it cool to room temperature, slice into 6 equal portions, and store in an airtight container in the refrigerator until ready to eat. Warm on reduced power in the microwave if desired. Can be eaten chilled.

Frittatas are quick and easy to put together and can be changed to include nearly any combination of ingredients, including leftovers. An easy way to plan for a fast breakfast is to cook a frittata in the evening, cut into serving sizes and then grab and go when the alarm clock sounds the next morning. They can also be enjoyed hot or cold.

CHAFFLES

Makes 1 serving
(2 mini waffles or 1 full-size waffle)

Ingredients:

  • 1/2 cup shredded mozzarella cheese
  • 1 large egg, beaten

Instructions:

  1. Preheat a mini-waffle iron.
  2. Use a small bowl to whip together the cheese and egg with a spatula or fork until it makes a chunky batter.
  3. When the waffle iron is hot, pour in about 1/4 cup (half) of the batter. Close the waffle iron and let cook for about 1 minute or until the waffle is browned and set.
  4. Carefully remove the waffle from the iron and repeat with the remaining batter.

Chaffles are super simple and can make an excellent bread replacement. For breakfast, eat them plain with melted butter, top with bacon and egg for a sandwich, or add a slice of cheese for a cheese sandwich. One of the reasons that chaffles are so well-loved is that they use simple, inexpensive ingredients and you can easily customize them.

This will taste less eggy when cooled. You can also add 2 tbsp of softened cream cheese or 2 tbsp almond flour for a less eggy taste.

SAVORY SAUSAGE GRAVY

Makes 6 servings
Ingredients:

1 lb breakfast sausage
4 oz cream cheese
1 cup heavy cream
1/2 cup beef broth
1/4 tsp garlic powder
1/4 tsp onion powder
1/2 tsp instant coffee powder (optional)
1/4 tsp salt

Instructions:

  1. Brown the sausage in a large skillet over medium-high heat.
  2. When the sausage is cooked and crumbled, add the cream cheese and set heat to low.
  3. Stir in the cream and the remaining ingredients, and continue stirring until the cream cheese is melted.
  4. Let simmer for 4–6 minutes or until the gravy is thickened. Refrigerate leftovers for up to 5 days.

Sausage gravy makes the low-carb diet perfect! Ladle it over some scrambled eggs or over the Chaffle recipe for a very good morning indeed. For variety, you can also substitute chopped, cooked bacon or ham for the sausage.


5 SIMPLE TREATS YOU CAN MAKE FROM AN ALDI SHOPPING TRIP (FOR UNDER $80)

5 SIMPLE TREATS YOU CAN MAKE FROM AN ALDI SHOPPING TRIP (FOR UNDER $80)

About Making Treats and Desserts

That sweet tooth doesn't just go away because you've gone low carb. Most often you can fight cravings with high fat options like bacon or pork rinds dipped in softened butter. But for those times when only a sweet treat will do, you still have options.

  • The real trick to making low carb treats that you can enjoy is finding a sweetener that you like. Whether it's stevia, erythritol, monkfruit, or something else, it can often take trial and error to find something you like. Be sure to add only small amounts of sweetener at a time and use the guide on the packages to see what might be the best amount to add.
  • One easy way to taste test sweeteners is to add coffee or tea before using the sweetener in a recipe. That will give you an idea of how sweet the product is when compared to real sugar.
  • Another important consideration for making treats is to keep them as an option for truly special occasions, so that they aren't consumed frequently. One tip that many find helpful is to make small treats so that portion control is easier.
  • A second option is to freeze portions so that treats are available, but not immediately so. Having an option on hand in the freezer is especially helpful for cravings, but keeps those items out of sight to avoid mindless eating.

CAUTION

Low-carb desserts are not low calorie. May stall weight loss.


BLUEBERRY CHEESECAKE TREAT (NO BAKE)

Makes 1 serving

Ingredients:

  • 2 oz cream cheese, room temperature
  • 2 tbsp heavy cream
  • 1 tbsp sweetener
  • 2 tbsp fresh or frozen blueberries

Instructions:

  1. Use a fork to mix the cream cheese, heavy cream, and sweetener until well-blended and smooth.
  2. Top with blueberries just before serving.

This simple no-bake treat requires only a fork and a bowl to make and uses only 4 common ingredients. If you don't have berries, stir in a tablespoon of lemon juice instead. You can double the recipe for multiple servings, but some find easier portion control making just one serving at a time.


PEANUT BUTTER CHEESECAKE TREAT (NO BAKE)

Makes 1 serving

Ingredients:

  • 2 oz cream cheese, room temperature
  • 2 tbsp heavy cream
  • 1 tbsp sweetener
  • 1 tbsp peanut butter
Instructions:

Use a fork to mix the cream cheese, heavy cream, and sweetener until well-blended and smooth.
Swirl in the peanut butter and enjoy!
TIP: For an even more decadent treat, sprinkle just a dusting of unsweetened cocoa powder over the top.

Frittatas are quick and easy to put together and can be changed to include nearly any combination of ingredients, including leftovers. An easy way to plan for a fast breakfast is to cook a frittata in the evening, cut into serving sizes and then grab and go when the alarm clock sounds the next morning. They can also be enjoyed hot or cold.


CHOCOLATE WITH PEANUT BUTTER

Makes 1 serving

Ingredients:

  • 1 square 85% or higher dark chocolate
  • 1 tbsp peanut butter

Instructions:

  1. Smear the peanut butter on the chocolate and enjoy small nibbles to savor the combination!
Online video: cookingketowithkristie.com/2019/11/11/keto-friendly-hot-chocolate/

Don't you just love when a recipe isn't a recipe, but it sure tastes like a treat? That's easy to do by combining just peanut butter and chocolate.


HOMEMADE HOT CHOCOLATE

Makes 2 servings

Ingredients:

  • 1 tbsp cocoa powder
  • 8 oz hot water
  • 1/4 cup heavy cream
  • 1 tbsp granulated sweetener or 3 drops of liquid sweetener
  • 1/8 tsp vanilla extract (optional)

Instructions:

  1. In a small saucepan, heat 8 ounces of hot water until boiling.
  2. Remove from heat and stir in cocoa powder until completely dissolved.
  3. Add in heavy cream, sweetener to taste, and vanilla if desired.
  4. Return to low heat until hot.
  5. Add 1 teaspoon of instant coffee for mocha flavor.

Eating low-carb doesn't mean you can't enjoy a cup of hot chocolate on occasion, and you don't need a mix to make hot cocoa. Heavy cream, sweetener, cocoa powder, and hot water (all things you may already have in your kitchen) combine to make a tasty cup of hot chocolate.


5-INGREDIENT CHOCOLATE FUDGE

Makes 8 servings

Ingredients:

  • 3 tbsp butter
  • 1/3 cup heavy cream
  • 2 tbsp cream cheese
  • 2 tbsp granulated sweetener*
  • 1 1/2 tbsp cocoa powder
  • 1/2 tsp vanilla extract (optional)
* Sweetener preference varies by personal taste and varies by sweetener brand. Start with the equivalent of two tablespoons of sugar. Add more gradually, if needed.

Instructions:

  1. Use a small saucepan on low heat to melt the butter. Add the cream, cream cheese, and sweetener, and bring to a simmer. Whisk until the cream cheese is melted and the sweetener is dissolved.
  2. Let simmer for 2–3 additional minutes on low heat until the mixture thickens.
  3. Whisk in the cocoa powder until blended and smooth. Remove from heat and, if desired, whisk in vanilla extract.
  4. Pour into a 4" by 8" glass dish. When cooled, cover with plastic wrap and refrigerate for 3–4 hours before serving. Cut into 2" squares.
  5. This fudge needs to be refrigerated. It will become very soft at room temperature.
Tip: Erythritol will become gritty when cooled, so a liquid sweetener is ideal to avoid grittiness.

Eating low-carb doesn't mean you can't enjoy a cup of hot chocolate on occasion, and you don't need a mix to make hot cocoa. Heavy cream, sweetener, cocoa powder, and hot water (all things you may already have in your kitchen) combine to make a tasty cup of hot chocolate.


Know Your "Bright Spots and Landmines"

Know Your "Bright Spots and Landmines"

OR

Bright Spots are positive behaviors and choices you want to replicate as often as possible. They are the things that you're doing right that you should try to duplicate.

Landmines are the mistakes you make over and over again that drive your blood glucose out of range, ruin your mood, or make life more difficult; you want to find ways to stumble on landmines less often.

Good luck on your journey!

—Mark and Kristie



RESOURCES

RESOURCES

www.DietDoctor.com
Lots of low-carb recipe options here. You will also find trustworthy guides and inspiring success stories. Dr. Mark is part of the DietDoctor team. Site accepts no advertising.

research.nutrition-network.org
Nutrition Network Research Database

nutritioncoalition.us
The Nutrition Coalition - non profit aiming to improve health in America by ensuring that the public receives evidence-based nutritional advice

www.phcuk.org
The Public Health Collaboration is a registered charity in the UK dedicated to informing and implementing healthy decisions for better public health. The “resource” page and “evidence” page are excellent. For famous sugar graphics www.phcuk.org/sugar


Kristie's Resources

www.CookingKetoWithKristie.com
Lots of recipes and information, including shopping tips and how to get started with a 28-day guide.

www.youtube.com/cooking+keto+with+Kristie
This is a YouTube channel with over 200 recipes and additional lifestyle resources.

www.facebook.com/ketowithkristie
Each Sunday at 8:00pm EST, Kristie and her husband go live on Facebook for Sundays with the Sullivans. This live broadcast shares easy recipes and tips for low-carb living.


Dr. Mark's Clinical Guidelines and Academic Articles on Low-carb Approach

Guideline Central: Low-Carbohydrate Nutrition Approaches in Patients with Obesity, Prediabetes, and Type 2 Diabetes
USA: GuidelineCentral.com/LC
UK: GuidelineCentral.com/LC-UK

Adapting Medication for Type 2 Diabetes to a Low Carbohydrate Diet- Frontiers 2021
https://www.frontiersin.org/articles/10.3389/fnut.2021.688540/full

A Clinician's Guide to Inpatient Low Carbohydrate Diets for Remission of Type 2 Diabetes: Towards a Standard of Care Protocol
www.openaccessjournals.com/articles/a-clinicians-guide-to-inpatient-lowcarbohydrate-diets-for-remission-of-type-2-diabetes-toward-a-standard-of-care-protocol-12898.html

A Low-Carbohydrate Survey: Evidence for Sustainable Metabolic Syndrome Reversal
insulinresistance.org/index.php/jir/article/view/30/88

Clinical Guidelines For the Prescription of Carbohydrate Restriction as a Therapeutic Intervention/Society of Metabolic Health Practitioners
https://thesmhp.org/clinical-guidelines/

JMIR Diabetes - Continuous Glucose Monitor Article
https://diabetes.jmir.org/2022/1/e34465

WE ARE PRESCRIBING HEALTH AND RESTORATION!

WE ARE PRESCRIBING HEALTH AND RESTORATION!

CHOOSE LIFESTYLE MEDICINE VERSUS A LIFETIME OF MEDICINE.


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