Medication, Measuring & Carb Counting

Your medication Before starting the low carbohydrate way of eating you may need to adjust your medication for lowering your blood glucose.

Metformin- no change needed

Other drugs:
Sitagliptin- halve your dose
Gliclazide- halve your dose
Canagliflozin, dapagliflozin, or andempagliflozin- stop them before you start low carb.

Insulin- consult your doctor first- but dose usually goes down to half or even to a third of what it is on a higher carbohydrate way of eating, depending on your blood glucose.
Any other medication like BP drugs – please ask your GP. Your BP may well go down.

Your blood glucose testing Get a machine from your practice nurse or the Internet.

If on any drug above, apart from metformin, you will need to check your blood sugar every 2 hours and even in the middle of the night at first to ensure it is stable. Don’t forget to check 1-2 hours after meals, and especially if you deviate from the recommended foods – see what happens so you know-and go easy on yourself, you are learning.
Learn what happens with different foods, so you can make further changes as needed. Write the blood glucose results and foods/meals down in a book or spreadsheet to help you see what happens over time. Alter what you do to keep your blood glucose between 4 and 7( 4 ‘is the floor’)

Your carbs I recommend no more than 30g carbs a day, which you can work out from the Carbs and Cals book or app. Carbs are best divided 6/12/12, but could be 15, 15, or 10,10,10. Don’t forget to count and adjust for any snacks or drinks.

Measure and get measured

HB
Hba1c
Lipids, liver function, kidney function
Weight
Height, & waist or hip
Photo before and after
BP

Dr McCormack 14.8.2018

Introduction to the 8 week course

This is an 8 week course that helps you change your eating and drinking habits permanently. I get emails from people many months and years down the line telling me they are still doing it and that could be you! It’s not just about food and drink, but also about sleep, movement and exercise, relaxation and stress management and getting over processed food addiction. Addressing these things will help you achieve your goals and so become much healthier.

First up, what does healthier” mean to you….would you think of YOUR hopes, dreams and goals and write them down- how would you like to feel a year from now, what would better look like? Build up a detailed picture in your mind of the things you would like to be doing, who you will be with, and how you will look & feel as this new healthier you.

Ask yourself what you eat and drink now meal by meal, drink by drink, snack by snack? If you eat bread, rice, pasta, potatoes, cakes, biscuits or sweets and are ready for change there is a brilliant chance of success. If you secretly eat a lot of junk, you are not alone, and can change with the right approaches.Look here.

What is low carb/ low GI food and drink? What do you know about it? This link will show you. Look at the plate and click through the dots.. 🍽

Clearing your cupboard of processed food is an important first step, so do it with your partner, friend or family and maybe one of them will join you on the 8 week plan. All that sugary and starchy stuff has to go- so pile it up and give it away.

1 recipe- breakfast– and food samples to taste

Breakfast ideas

Set YOUR quit day

and if you try and don’t succeed , try again. It is much easier if you have none of that rubbish food in the house, and you avoid places where you are tempted.

Can you involve the rest of your family- like who does shopping and cooking? Get them on board if you can, and bring them to the group, but if they are not ready, just get on with it yourself.

If you are diabetic, get a blood glucose meter from your practice nurse or online, and check your blood glucose 1-2h after meals and learn what happens. We are aiming for 4-7 and 4 is the floor! Write down your results so you can avoid foods that raise your blood glucose too high- it will vary day to day so try things with & without exercise and learn how your body responds. See your GP with one of my medication letters if you are on medication for diabetes before you start.

Move more- do what do you enjoy, think of what would you like to do that is fun. If you have a lot of weight to lose, start with chair or floor based exercise or walking and build it up gradually. Would you consider giving yoga a go?

Mindful eating– what does it mean to you? To me, it means taking my time, enjoying the tastes and textures, and turning off the TV.

Habit releaser of the week: For one week sit in a different chair when you watch TV or eat a meal. A little habit change like this enables bigger habit changes!

Sleep– try to go to bed and get up at the same time each day from now on as this reduces your stress hormones and improves your health.

Blood requests and record charts- would you like to get your blood tests and measurements done before you start? These include…. weight, height, waist, HBA1C, lipids, liver function and kidney function. Do you want to do BEFORE photos, to compare with your AFTER ones?

Website list, books, social media links Look to the bottom of the page.

How much healthy fat should you eat?

Where does the healthy fat in #LCHF come from?
Is it from your food, or is it from your body?
What sorts of fats are you comfortable with?

Many people are fat phobic, and fear that fat in food becomes fat on their bodies. The problem is that many people eat a high fat, high carb way and this is definitely fattening for many of us, as is low fat processed food which is high in sugar. Initially, it may be helpful to use recipes like those on DietDoctor but use minimal quantities of the high fat foods, like dairy, and oils, in order to feel comfortable with what is a radical change of lifestyle.

If you have a lot of weight to lose, do not overdo the fat in your food, especially if you dislike eating fat, as it may make you feel sick. Eat low carb, and do not ramp up your fat intake. Avoid those bullet proof coffees, and don’t add copious quantities of butter to your food. Be guided by your individual responses in terms of weight loss( a pound a week is fine), and blood glucose( it should be between 4 and 7).

I find most people are comfortable eating the fats that are in oily fish, olives, avocados and nuts, but are less comfortable with animal fats in butter, lard, beef, pork, lamb and chicken. All are healthy. The fats to avoid are trans-fats found in cakes, biscuits, donuts, and deep fried foods like chips, and also seed oils themselves, which become trans-fats at high temperatures.

For more detail click here.

Consent form

We need consent so that we can analyse and publish the programme results. You do not have to do this to take part in the programme.

This is the form it takes:

Stockton Heath Medical Centre, The Forge Stockton Heath.

We would like to use anonymous data to help us and other doctors and nurses learn what can be done with low carb ways of eating. In this way, we hope that the knowledge of this method will spread throughout the country, enabling better health for many more people.

If you consent to sharing your anonymised data please sign a consent form and give the form to me when we next have a group meeting.

I hereby consent to the anonymous sharing of my data as part of the 8 week low carb behavioural change programme.

Name

Signature

Date

Dates of Low Carb meetings at Stockton Heath Medical Centre

Don’t forget to book in via reception!Please note: *NO GROUP today-13th July*

20th July
3rd August
10th August
17th August
24th August
31st August
14th September
28th September
19th October
26th October
After that we will have a break for the Winter and evaluate how it has been received, and how well it has worked.
Tell me how you have liked it and anything you would like to be done differently at joannemccormack@nhs.net
All groups 6-7pm held upstairs in the medical centre
If you cannot manage stairs I will do a separate group 12.30-1.30 on the same days downstairs- just ask me via email or reception.

Dr Jo’s Change 4 Life

Modern life can have a significant impact upon us being active. Would YOU like to do something different to watching TV, playing computer games, and eating convenience and fast food? It is all about YOU so it is your choice!

Being overweight and underactive isn’t just about the way you look. You KNOW can lead to more aches and pains, problems sleeping and a loss of energy and confidence. You KNOW it also increases your chances of getting heart disease, type 2 diabetes and some cancers.

But by eating differently and moving more – two simple changes –YOU can reduce the associated health risks and live longer.

Eating well means being smart as to what IS HAPPENING TO YOUR BODY HERE AND NOW in response to what YOU are eating and drinking. Is it working for you? Do you feel well?

Moving more keeps your heart healthier, reduces the risk of serious illness and strengthens muscles and bones. It can also be a great way of lifting your mood if you’re feeling down. Do you need to move more, or are you doing enough already?

Try these healthy eating and moving tips to help you make healthier choices.

• Base your meals on starchy carbohydrates only if that works for you and you stay nice, slim and free from illness. Once you are overweight, pre diabetic or diabetic you can ask me or your dietitian for a lower carb plan if you want, as recommended by NICE (low GI, individualised choice). A great one is on www.diabetes.co.uk and see your dietitian for more details if you need them.

Eat lots of vegetables that grow above the ground and fruit like berries if that works for you( not everyone wants to eat fruit or veg- some people are zero carbers!).
If you dislike fruit, just eat vegetables for less sugar and calories. Do not drink your calories- eat the whole vegetables and fruit as the fibre keeps you full for longer. 5 a day is something that is recommended, but not necessarily affordable or desirable for YOU, and not all fruit and vegetables are the same. Stick to the lower sugar/lower starch varieties for a lower blood sugar.

Eat fish – including a portion of oily fish
Fish is a good source of protein and contains many vitamins and minerals. Aim to eat at least two portions of fish a week, including at least one portion of oily fish, or more if you do not eat meat. Tinned will do nicely, but fresh is even better.

Cut out fat and sugar combinations like in cakes, biscuits, pies and pizza. They are terribly more-ish. Eat good fats instead as in olive oil, oily fish, walnuts, almonds and avocados. You do need healthy fats!

The best way to eat less salt is to avoid processed food. Most people think of processed food as cakes and biscuits, but pies, cereals, and breads all contain salt. People with high blood pressure are more likely to develop heart disease or have a stroke. If you eat completely unprocessed food, there is so little salt that you may even need to add some in to keep your blood pressure up. The maximum is a teaspoon a day if you eat completely unprocessed food.

Get active and be a healthy weight
Being active doesn’t have to mean hours at the gym, for example, try getting off the bus one stop early on the way home from work, and walking. Tai chi and yoga are getting very popular in Warrington- would you like to give one of them a go?

Drink water, not sugar!
We need to drink plenty of water to stop us getting thirsty–do you need 6-8 glasses a day? Count them and see. Tap water is much more affordable, and possibly safer, than anything out of a bottle.

Don’t skip breakfast?
Some people skip breakfast because they think it will help them lose weight. In fact, some research shows that some people who regularly eat breakfast are less likely to be overweight. Other research shows that people who never eat breakfast who are asked to eat it every day, do put on weight. I say go with the flow of your natural inclination. If you feel hungry, eat. There is something called time restricted eating where people eat only two meals a day and no snacks. With lunch and evening meal or breakfast and evening meal only, many people become a normal weight.

Other ideas-
Eat with your friends or family
Cook or learn to cook and teach your kids
Avoid eating out often
Eat at a table with a knife and fork and take your time.
Enjoy your food.
Eat unprocessed food.
Eat real food.

Addicted to processed food? Set a quit date and give it up, like giving up smoking… don’t give up on giving up!!
You will already try to avoid sugar, but look for hidden sugar- and avoid anything ending in –ose.
Labels wise, look for the amount of sugar in grams and divide it by 4- that gives you how many teaspoons of sugar in that portion. And watch your portion- you may be eating double.
Be mindful of what you are doing and if it is working here and now for YOU!
A year from now and you are a lot healthier.. what does healthier mean to YOU and how are YOU going to get there? ☺

Week 6 How to Change your Eating in 8 weeks

Remind us, and yourselves, of your hopes and goals Imagine a healthier, happier new you, one year from now. How will you look, how will you feel, what will you be doing differently? The more detailed your picture the better.
How have you been getting on? What have been your challenges and successes, and would you like to share them with us?

Have you heard of mindful eating? It can help you develop a better relationship with your food.
I will be doing a mindfulness exercise tonight to give you a taster.

Mindfulness books can be very useful so here are two to think about- Mindfull-ness by Elaine Hillides and Mindfulness- a practical guide to finding peace in a frantic world by Mark Williams & Danny Penman.
Stress increases cortisol, adrenaline and noradrenaline, which make it harder for some people to eat healthily, so it makes sense to reduce your stress via mindfulness or other methods like yoga. You can try yoga in St Thomas Church Hall 5-6pm on Mondays with Dr Hemma, or at many places round the country.

How can you eat bread on the low carb diet? Here is a recipe to try.
You could also try some ‘Non bread” from the Real Food Cookbook by Ellen Picton and Zoe Harcombe. It is great with curries!
Exercise- what’s gone well and what not so well?

I do recommend using a blood glucose meter, so that you remain safe, and so you know the effects of different meals and foods. Look up your meter on YouTube for a demonstration of your particular meter.
Do check your readings 1 to 1 and a half hours after your meals and after any deviation from the low carb plan. It is important learn the effects of foods that raise your glucose significantly . Be kind to yourself, and accept that you are human and cannot be perfect 🙂 Learn what happens when you eat what your body cannot tolerate. Learn what happens when you eat your favourite meals and alter them so they are lower in carbohydrate. Take note of the readings so you have a record.
Remember you are aiming for between 4 and 7, so change the foods to lower carb ones if you are getting higher than that. I advise 30g a day of carbohydrate, but lower or higher if that is what works for you. Use Carbs and cals as a guide

You will see how the blood glucose readings vary according to how much sleep you have and how much exercise you get, as well as what you eat.
Do you have any questions? – write to me at joannemccormack@nhs.net

Week 5: How to Change your Eating in 8 weeks

Remind us of your hopes and goals- I will to add them to our flip chart as a visual memory.

How have you been getting on? What are your challenges and your successes? Would you like to share them with me or the group?

Give me your questions on the night or email me at joannemccormack@nhs.net

Moving and exercise- where are you now, and what would you like to build up to? Remember you cannot outrun a bad diet.

Recipe- easy granola

Your recipes and how we can adapt them- I will pick some of my favourites and ask you for yours. Don’t forget to bring your recipe books. There are now many vegetable noodles or zoodles around like courgetti or spaghetti squash, and rice substitutes like cauliflower rice and broccoli rice. Many of you make them, with all sorts added like garlic, onions, and spices, but others want it in a packet. If it’s fresh and low in carbs, that’s fine.

Let’s talk about birthdays and treats this week, and email me with your favourite tips with lower sugar living..

The national dietary guidance of Brazil! something to set you thinking..

Week 4 How to Change your Eating in 8 weeks

Here is a link to Suzy Glaskie, health coach, of Peppermint Wellness. Suzy came along to one of our groups and I was very impressed. She connected with each of us about processed food addiction, and how we can leave it behind us! Follow the link and think about how you can address your addiction to processed food. Most of us have it to a certain extent- I know I did.

Do remind yourself of your hopes and goals! Recently, one of my group shared that she dreamed of running with her dog. She also has managed to get on her bike for the first time in 10years, so I’m sure she will do the run. I look forward to getting a photo.
How have you been getting on? Challenges and successes are very good to share, plus photos and stories. Send them to me or share on social media and tag me.
Your questions? email me joannemccormack@nhs.net
How are you involving your family, friends and workmates?
1 recipe- “fathead pizza” if you like pizza & want something lowcarb this is very tasty.

Habit change and addiction, and cravings?
Don’t give up on giving up!
Many of you ask about sweeteners so here is a 4 minute video from Dr David Perlmutter

Week 3- How to Change your Eating in 8 weeks

Remind us of YOUR hopes and goals. Mine were, and are, to reduce my risk of dementia. My dad and grandmother had dementia, and it is associated with diabetes. In reducing my risk of diabetes, I hope to reduce my risk of dementia.
This week a few people in my group shared that they were now able to get down on the floor and play with their grandchildren, and get up again. How lovely!
How have you been getting on? What are your challenges and successes?
Email them to me if you like, or ask me a question, on joannemccormack@nhs.net
Low carb snacks and fermented foods– examples are provided on the night.
Recipe for sauerkraut
Exercise chat- what have you been doing? You cannot exercise enough to compensate for eating the wrong sort of food. Remember that Sumo wrestlers eat lots of rice and drink lots of beer and despite doing lots of exercise they maintain a high weight.
Non food treats
Not to forget:
Set your quit day– processed food addiction affects many of us, don’t give up on giving up!
Get your measurements and/or photos done. The tests to be done now and in 3 months are HBA1C, liver, kidney, lipids, thyroid, weight, height, and waist measurements.
Be mindful
Habit releaser of the week- have a night- or a week- off TV, and see what else you can enjoy.
See me or your GP for advice about your diabetes medication before your quit day.