Net carbs. 9.5 per serving. Prep time: 15 minutes, not counting marinara sauce. Cooking time: 30 – 60 minutes depending on temperature choice ((not counting marinara sauce, which can be commercial).
This is basically a fish-and-marinara stew with Middle-eastern influenced spices. It is one of my absolute favorite meals, especially when I use fresh-from-the-garden tomatoes for the marinara sauce. I like it best served on a bed of arugula, but you could serve it over zoodles or cauliflower mash.
Regarding temperature: Either slow-cook/low heat or fast cook/high heat works. Slow cook is more traditional in a tagine-style dish like this, but I choose based on what else I might be needing to put in the oven. (The higher temperature and shorter cooking time works well with roasting accompanying vegetables.)
2 six – eight ounce tilapia or swai fillets
1./2 large red bell pepper, sliced
1 small leek, sliced
1 small zucchini, sliced (optional)
1/2 jalapeno pepper, seeded (can be omitted, or leave seeds in for more heat)
1 medium tomato, sliced
2 tsp paprika
1 chicken boullion cube, smashed
1/4 tsp cayenne pepper(adjust to your preference); heat lovers can add 1/4 j- 1/2 jalapeno pepper.
1/2 tsp ground coriander
1/4 tsp ground cinnamon
1/4 cup olive oil
1/4 cup water
a few sprigs of chopped parsley, dill, tarragon, or sage (combine to your taste)
1/4 cup feta cheese
1/3 tsp ground cloves
1 cup marinara sauce (Commercial or your own, made from fresh tomatoes. Flavor with herbs like oregano, thyme, plus a little garlic and ground cinnamon)
Your choice of spiralized vegetables (zucchini works well with this dish; about 1/2 zucchini per person, if you didn’t use it in the sauce) or a bed of arugula lettuce.
Preheat oven to 200 or 4250 (see cooking times, below).
Pour a thin layer of olive oil on the bottom of a glass baking dish.
Combine the dry spices (paprika, bouillon cube, cayenne, coriander, and cinnamon) with the water and the remainder of the olive oil.
Spread the spice m,ix over the fish.
Arrange the peppers, leeks, zucchinis (if using) and tomatoes in layers on the bottom of the dish.
Put the fish on top of the the peppers, leeks, and tomatoes.
Cover with about 1 cup cup of marinara sauce (more, if you like)
Sprinkle with fresh herbs (parsley, dill, tarragon, sage).
Cover with lid or foil and bake for about 1 hour at 200 or 30 minutes at 425 — in either case, until fish flakes.
While the fish is baking, sauté the spiralized vegetable noodles in a combination of olive oil and butter.
Serve the fish over spiralized vegetable noodles. Top with bits of feta cheese and more fresh dill or parsley.
Carb count includes zucchini in sauce, but does not include the bed of vegetables/lettuce you might put the sauce on, which is optional.
Approximately 3.4 g net carbs. About 10 minutes prep time and 50 – 60 minutes bake time.
Too good to be true?
Skepticism. That’s my usual response to keto recipes substituting for favorite non-keto baked goods. A fair number of recipes I’ve tried have been a bit disappointing — quite frankly, they taste just close enough to the real thing to remind me how much I used to like it. But some substitutes hit the mark. This is one of those.
Here’s the original recipe, found on one of my favorite keto sites. As usual, I changed it up a bit to try to solve some problems other testers had with it: I add coconut flour and I use whole eggs, not just egg whites. And I used salt and caraway seed as a topping rather than sesame seed, but toppings are a free-for-all zone, so follow your taste buds.
These rolls have the texture, density and taste of a whole grain bread. I’m not a big fan of the taste of psyllium husk, but the small amount here doesn’t overwhelm the flavor. These rolls can be used as burger buns (although you’d have to divide the dough into only six portions rather than eight for them to be big enough). You can also make them long and thin so they’ll work as hot dog buns, in which case, I’d probably take 5 minutes off the cooking time.
Slippery slope alert: The buns are low in net carbs, but they do have quite a bit of fiber (see nutrition information, below). So if you count whole carbs, having one of these means the rest of your daily intake has to be super strict. I count net carbs, and the approach that works for me is to treat foods with high amounts of fiber and sugar alcohols as special treats and limit them. So on a day when I’d have this bread, I’d avoid other treat foods like fruit or big portions of higher-carb veggies or anything with sugar alcohols.
1¼ cups almond flour
5 Tbsp ground psyllium husk powder. Note: some people report that psyllium husk powders can have an unpleasant purple color. I used Now Healthy Foods brand, and there was no weird color.
2 Tbsp coconut flour
2 tsp baking powder
1 tsp sea salt
2 tsp apple cider vinegar
1¼ cups boiling water
Your choice of sesame seed, caraway seed, course sea salt, or rosemary to taste: 1 – 2 tablespoons
Next time, I am going to try these with some other additions such as fine-chopped olives. And, OMG, garlic bread can be back on the menu!
Preheat the oven to 350°F.
Mix the dry ingredients in a bowl.
In another bowl, beat the eggs and add the vinegar.
Bring the water to a boil and add it to the dry ingredients while mixing with a hand-held electric mixer.
Add the eggs and vinegar and continue mixing, about 30 seconds in all, just enough to ensure a good even mix.
With wet hands, shape the dough into the desired form. This recipe makes 4 =- 8 buns, depending on the size needed. Dividing into 8 makes ideal dinner rolls.
Put the rolls on greased parchment paper on a baking dish.
If you are adding toppings (salt, caraway seed, etc) sprinkle them onto the rolls and press gently so they stay on.
Bake on a lower rack in oven for 50 minute–60 minutes (shorter time for small or narrow shapes; longer time for bigger, thicker buns). When they are ready, they will look nicely brown and will feel firm when tapped. I divided into 8 rolls and baked for 50 minutes.
Approximately 10 g net carbs. About 35 minutes prep and cook time.
Some years ago, I was hiking across France on the GR-5, a trail that winds from near Rotterdam on the North Sea to Nice on the Mediterranean Côte d’Azur. Having a healthy hiker appetite, I was enjoying the food along the way: the Dutch-Indonesian blend of rijsttafel, the Belgium mussels and frites (okay, I no longer eat rice and frites, but I sure enjoy the memory!). And pretty much French anything.
It’s really a perfect vacation: Walk 10 or 15 or 20 miles and then eat all the French food you want.
About halfway through, in the Franco-German cultural collision zone of Alsace, I encountered a meal I couldn’t imagine — and it was on virtually every menu at every restaurant.
Choucroutes aux poissons.
Sauerkraut with fish. In — of all things — a cream sauce. It seemed like France and Germany were at war again. I wanted nothing to do with it.
I’m a pretty imaginative eater, but somehow my imagination didn’t stretch that far. So I ordered other things. But the choucroute kept showing up and curiosity finally got the better of me. At which time, I discovered what was to become a favorite recipe.
The recipe below is based on a combination of sources. I started with Saveur‘s version and then altered it to match my memory. This is a flexible recipe: You can cook the fish all number of ways. The Alsatian version I liked the best involved multiple types of seafood. And for low-carb purposes, I took out the flour, added pork rind as an optional dredging ingredient, and gave the option of adding some of the fat back in.
Seafood of your choice: 2 – 3 ounces each of 3 selections: shrimp, scallops, trout fillets, haddock fillets, salmon fillets*
1/4 lb smoked bacon or speck cut into small pieces (Other smoked cured pork cuts like Coppa, country ham , Canadian bacon will work)*
½ lb. raw Sauerkraut, drained and rinsed (If you can’t find raw sauerkraut, the regular supermarket kind will do, but you’ll lose some of the popping fresh flavor not to mention the probiotics. But don’t let that dissuade you from trying this recipe. It’ll still be good.)
4 shallots, finely chopped
½ cups heavy cream
4 Tbsp. unsalted butter
3 Tbsp. olive oil (I use extra-virgin)
1 tsp. finely chopped thyme leaves*
½ tsp. cumin seeds*
2 pods star anise (fennel can be used instead)*
1 bay leaf*
1¼ cup dry white wine. Riesling is a traditional Alsatian choice*
Salt and black pepper to taste*
2 Tbs crushed pork rinds (optional)*
1 Tbsp of your choice of fresh herbs for garnish: parsley leaves, fennel leaves, tarragon, dill weed, chives, or chervil*
*These items not included in the carb calculations because they have only trace or zero carbs. But note, if you use scallops, you will have to factor in an extra 4.6 g per 3 ounces.
Heat 1 Tbsp. olive oil in a medium skillet over medium-high heat. Cook bacon, stirring occasionally, until brown and crisp, about 8 minutes. Pour off some of the fat (Your decision as to how much to take off; you can reserve some and add it back later. But leave at least 1 Tbsp in the pan).
Reduce heat to medium and add half the shallots and all the thyme, cumin, star anise, and bay leaf. Cook until shallots are soft,(about 4 minutes).
Add sauerkraut, ½ cup wine, and ⅓ cup water plus salt and pepper. Cover the skillet and let the mixture come to a boil, then reduce the heat and cook on low for about 25 minutes until the sauerkraut is soft. Check and stir every once in a while.
Set aside the skillet and remove the bay leaf and the star anise. Adjust seasonings. Cover and keep warm on a warming setting or warming plate.
The Fish and Seafood
Fish and Seafood, and then the sauce, can be cooked while sauerkraut is cooking and everything will be done at about the same time.
Season the fish and seafood with salt and pepper.
Optional: Dredge the trout or other white fish fillets in crushed pork rinds.
Heat remaining oil in a nonstick skillet over medium-high heat. Add fish and/or seafood (in separate stages, if needed).
How you cook the seafood is very flexible, depending on the seafood you choose and your favorite ways to prepare. The simplest way to pan-fry. Shrimp and bay scallops take about 4 minutes. Fish fillets can be dredged in pork-rinds (optional) and sauteed until golden brown (about 5 minutes).
This recipe (if you read French) suggests placing haddock in cold milk, then poaching for 10 minutes. It suggests cooking the other fish in the oven with lemon, shallots, salt, pepper, and butter at 410 degrees for 7 minutes.
Once the fish — however you’ve cooked them — are done, transfer fish and seafood to a plate and cover to keep warm.
Add 2 Tbsp butter to the skillets and cook the rest of the shallots on medium-high heat until soft (about 4 minutes).
Deglaze the pan with the remaining wine and cook for another 4 minutes, until reduced.
Add the cream and cook on medium-low heat, stirring occasionally, until sauce thickens (about 3 minutes).
Season with salt and pepper, remove from heat, and stir in remaining butter, allowing it to melt.
To serve, divide sauerkraut into portions on dinner plates.
Put the fish and seafood on top of the sauerkruat.
Spoon sauce around or over the fish and garnish with your choice of herbs.
Serve with dry Riesling wine.
Note: This recipe uses 6 ounces of trout per serving for the nutrition calculation. Add 4.6 carbs per 3 ounce serving of scallops, if you use them. For the label’s sake, I’ve assumed using Canadian bacon.
Another quick and simple recipe, which can be altered to suit your taste. It is based on a recipe found here. My version below is slightly different to add a few more flavors and to bring down the carbs. This recipe makes 5 servings.
*Carbs per serving: Approximately 13 net carbs This can be reduced if you cut out or lower the amount of scallops and/or sun-dried tomatoes. Nutrition information at the bottom.
Cooking and prep time: 15 to 20 minutes
1 1/2 pound seafood (your combination of medium cleaned raw shrimp and bay scallops. Note: scallops have carbs; shrimp do not.)
4 oz ground Chorizo sausage. (Remove from skin if you buy it in links)
1 large leek, diced
4 cups baby spinach; more is okay
3 tablespoons salted butter*
2 cups light cream
1/2 cup white wine, more or less to taste
1 cup grated Parmesan cheese.
4 ounces sundried tomatoes in oil, drained and cut into small pieces (These are delicious, but high in carbs. Omit if you are on a strict regimen.)
6 – 8 cloves garlic
2 Tbs chopped parsley*
1 Tbs fresh winter savory or sage (optional; dried is okay)*
2 – 3 tsp dried Italian herbs*
To taste: salt, black pepper, Italian red pepper flakes*
Optional (not included in carb count) 1 Tbs sour cream or cream cheese as thickener.*
*these items were not factored into carb count because they have only trace amounts or zero of carbs or because they are optional.
Peel and mince garlic
Remove chorizo from skin
Measure out spinach, herbs, winter savory, parsley, sun dried tomatoes, Parmesan cheese, cream
In a large skillet, melt butter over medium heat.
Add garlic and cook about one minute.
Add chorizo and cook until the meat has lost its pinkish color (about 5 minutes)
Add shrimp and cook until it starts turning pink (about 4 minutes)
Transfer shrimp and Chorizo to a bowl.
Fry leeks in the butter remaining in the skillet, adding more butter as necessary and deglazing with white wine .
After the mixture reduces and the leeks are translucent, add sun- dried tomatoes and cook for 1-2 minutes.
Reduce heat and the cream. Stir and bring to a low summer.
Add salt and pepper to taste; adjust the wine.
Add spinach leaves and stir.
After spinach has wilted, add parmesan cheese.
Summer and stir until cheese is melted. Cream cheese or sour cream can be added if you would like a thicker sauce, but I don’t use this (and it’s not included in the carb count).
Add the shrimp back into the pan.
Sprinkle with herbs and parsley.
Options and Variations
Serve over spiralized turnips or zucchini noodles
Carb counts are approximate net carbs. based on Verywell.com nutrition label calculator,
5 portions, approximate 13 net carbs per serving. Carbs count includes 8 ounces bay scallops.
This is a quick, simple, and flavorful dinner with a prep and cook time of about 15 minutes. Serves two.
Carbs per serving: 5.2 net carbs. Nutrition info at bottom.
One medium green or red bell pepper, sliced lengthwise
2 links or 8 ounces of fresh chorizo
2 ounces grated cheese (Mozarella, cheddar)
3 Tbsp fresh salsa
2 Tbsp full fat sour cream
1 cup black soy beans
1 tsp cumin, 1/4 tsp salt, 1/4 tsp black pepper,1/2 tsp Ancho chili powder. (Adjust spices to taste). *
1 Tbsp green onions
*items not included in carb count because they have negligible or zero carbs
Cut bell peppers in half lengthwise and poke holes in the bottom of them for drainage.
Stuff the peppers with the fresh Chorizo sausage (remove from skins if in links).
Cook in microwave on high about 12 minutes.
Meanwhile, in a saucepan heat the black soy beans . Cook on medium until hot.
When peppers and meat are done in the microwave, remove from microwave . Spoon and reserve the fat and juices that have collected in the pan. Then sprinkle about one ounce grated cheese over the meat. Return to the microwave and cook about another minute until cheese is melted.
Drain the beans. Add the s;pices. Add the fat from the pepper pan. Stir.
Put a layer of lettuce on each plate.
Follow with a circle of the black soy beans mixture
Place the pepper/meat combo in the middle of each plate
I did not start out to write about health, weight loss, ketogenic eating, and metabolic syndrome. And 18 months ago, when I started losing weight, my sole goal was to crash-diet so I could make the weight limit to go paragliding — I wasn’t concerned about health or a long-term lifestyle change.
That I am now being asked by friends, friends of friends, and perfect strangers for diet advice is about the weirdest thing to happen in a long while. I am not a diet guru… I am just a person who found a way to lose weight that seemed easy and satisfying. And I’m writing about it here because putting everything in one place is easier than responding individually to lots of people. Plus, I’ll have all my recipes in one place! (Once I get them up)
It just goes to show that life doesn’t always happen as we plan.
The adventure that presented itself last year had nothing to do with rock climbing or scuba diving or skiing, and everything to do with the kind of conversations middle-aged people have about their cardiac health and their cancer treatments.
Happily, David and I are (I hope) on the back side of those issues for a while. He has to watch his blood chemistry numbers and I have to watch my cancer markers, but while we are watching, we can get back to living. And I’ll get back to the fun adventures soon, weaving food, hiking, travel, skiing, music, and all that fun stuff into this hodge-podge of a blog.
I keep saying this, but it’s important: I am not a diet expert. I am just one person with one story about what worked for me. (And David makes two!) At the same time, I approached this new body of knowledge the way I approach everything: I read a shelf full of books, I dived into a hundred websites, I learned as much as I could — and then I started writing about it.
I was especially interested in the question: If the ketogenic way of eating is so successful and works so well, why do so many people give up?
The following observations may be helpful as you start — or continue, or maintain — your journey.
First, this is not a diet, it’s a way of life.
Diets don’t work. We all know that. On this way of eating, if you follow it, you will lose weight. Other metabolic issues like high blood sugar, high blood pressure, and some blood lipid numbers will probably improve, too. But if you go back to doing what you did before, you will go back to having the results you had before. I remind myself of this every single day.
Expect some bumps in the road
There’s a learning curve and an addiction to overcome. Apparently (according to the books I’ve read) wheat and sugar act on the brain’s addiction centers. On an MRI, they light up the same places where opiates hang out. (This is my non-scientific understanding.) So when you go off high-carb foods, there is a withdrawal process that can make some people feel quite ill for a day or more. When I first ditched the carbs, I crawled into bed for two days with general lethargy and a feeling of utter disgust at the prospect of eating more meat and vegetables. My stomach demanded toast, oatmeal, pasta, bread…. and threatened dire consequences if I didn’t give in. But I got over it. I’d advise getting started by throwing out all the off-list foods and stocking up with the biggest variety possible of on-list foods that you love. And if you feel ill, just tell yourself that “this too shall pass.”
Moderation is not the road to health; it is the road to hell
I think most people react the same way I did when I first heard about this: shock and outrage. No pizza? No pasta? No beer? No potatoes? No sugar? Restricted fruit? Limited root vegetables? And a whole other list of thou-shalt-nots. Surely one cookie once in a while can’t hurt? And for some people it may not.
But the folks I’ve talked to who are having the most trouble with this way of eating are those who keep telling themselves that one little cookie can’t hurt. They are the ones who tell me they are cutting carbs — even as their hands are in a bag of chips. (This literally happens!)
This is a judgment free zone: Eat what you want, do what works for you. But don’t lie to yourself and then ask me why this way of eating doesn’t work!
Personally, I’d love to be able to eat the occasional cookie — or better yet, French bread, or apple strudel — but that doesn’t seem to work for me. I think for those of us who are prone to metabolic syndrome, moderation is too slippery a slope. And some writers, like William Davis (of Wheat Belly fame; see the booklist) believe that modern wheat has been engineered in a way that makes even minuscule amounts toxic to most people (though some can handle it better than others).
I was a little bit rebellious at the beginning of my journey. I refused to give up lattes (I did go from 2 percent milk to whole milk, but milk of any kind is avoided on a strict ketogenic diet, though full-fat cream is okay). I kept drinking wine (allowed, but not recommended on a daily basis, especially at the start). My salads were bigger than recommended and had more stuff in them, which added to the carb counts.
But almost immediately, I saw how well this way of eating worked. I changed over to cream in coffee, abandoned my daily glass of wine, and counted my carbs even more carefully.
Your tastes will change
As time has passed, I’ve noticed that the occasional fruit I have tastes much sweeter because I have no other sugar in my diet (and because I have fruit so seldom). I easily pass up bread and pasta: It now strikes me as empty filler fortified with nutritional additives. The food I am eating tastes fantastic. Flavors pop more. Quality matters. I have always enjoyed food, but now, I seem top enjoy it even more.
Keep an open mind because you may just find that foods you used to think you hate taste pretty wonderful.
“Calories in-Calories out”
Traditional thinking is that people with a weight problem need to simply get over their gluttony and lose weight by virtue of managing their calorie intake and exercising more.
The low-carb view is that weight problems occur not because of a lack of willpower, but because the carb-insulin cycle goes into overdrive, putting excess glucose into fat cells and then activating hunger signals to replenish the blood with yet more glucose… which then gets put into yet more fat cells.
One of the attractions of low-carb is that we don’t have to count calories. However, that doesn’t mean that a low-carb way of eating is a license to pig out! Calories still matter. The magic of a low-carb diet is that it feels more satisfying, so we eat fewer calories. And a ketogenic diet encourages and enables our body to use its stored fat for energy (a process that cannot happen when we consume too many carbs our insulin starts the one-way process of stuffing excess glucose into fat cells).
Portion sizes change
One of the ways this way of eating works for weight loss is that ingesting fats is satiating. So I feel more satisfied with smaller portions. I’ve had to rethink what a portion is. It is much smaller than it used to be. As I follow the advice to “eat when hungry, stop when fill,” I find myself skipping the occasional meal and leaving left-overs for another day. And it has nothing to do with will power.
This will happen over time. At first, I just: Cut. The. Carbs. That’s it. Then I listened to my body. It started saying “thank you.” Then it started behaving differently around food. This is the first time in my life I have felt that food and I have a positive relationship.
Your family may be an obstacle
Many people, particularly women (the traditional caregivers) have trouble sticking with a low carb diet when others in the household are still eating favorite forbidden foods. Some people succeed in converting other people in their household (after all, if carbs truly are bad for us, do we want to serve them to people we love?) But if that doesn’t work, many people find that making simple dinners, with carbs served separately from the rest of the meal, works. So we low-carbers can have steak, Brussels sprouts, and green beans, and our carb-eating families can have add a baked potato. I was lucky that David went on this way-of-eating with me (and it turned out, with his health issues last year, HE was lucky he did it, too!) Finding good tasting substitutes for favorite foods also works. I’ll be sharing recipes starting in a week or so.
Find great foods
At this writing, I have been on this way of eating for about 18 months and I totally and completely love the food. Do I occasionally chaff at restrictions? Yes, especially when I am traveling or socializing. The foods I can’t/won’t eat at literally everywhere. Avoiding them makes me one of “those” people…. you know, the ones with all those picky dietary limitations that ruin the meal for everyone else. I try to stay quiet. I pack my own food so I don’t arrive a t a cocktail party starving only to find that every canapé has carbs.
But I have found a lifetime’s worth of recipes that look delicious. Food seems to taste much better now that it isn’t dulled by carbs. Find foods you love and you will never miss the foods you used to love.
Shop the aisles
This isn’t news. The closer you get to real food in its simplest form, the better the chances that it’s good for you.
Most keto groups I am in recommend organic chickens and grass-fed beef to be sure your meat doesn’t have hormones and antibiotics in it. Be careful with cured meats and deli products; they often have added sugars. If you do venture into the aisles (mayonnaise? salad dressings? pickles?) read labels. Know the 60 different words for “sugar”!!!!
Don’t freak out about the cost
Who can afford wild-caught salmon, European cheese, and grass-fed beef? Surprisingly, David and I aren’t spending any more on this way of eating because we are no longer paying for processed foods and grains, and of the rest — yes, our meat and fish bills are more expensive, but we eat less. It seems to have mostly evened out.
Most of what we think we know about health is probably wrong
If you talk to the average person on the street and they tell you they are “eating healthy” they are probably doing the exact opposite of what I am doing. And if you ask your doctor what “eating healthy” means, the answer may be the exact opposite, as well. (I am lucky that my doctor is on board with a low-carb way of eating, but many doctors are most definitely not okay with it. Quite honestly, I chose my doctor because a friend of mine told me his office would support a low-carb diet.)
It’s important to know that the ketogenic diet is the opposite of the high-carb low-fat approach recommended by the American Heart Association, the American Diabetes Association, and most government agencies. The writers I have been reading also take issue with traditional mainstream approaches to cholesterol and how lipid tests are read and interpreted and acted on (usually by prescribing statins).
The ketogenic diet breaks pretty much every “healthy food” rule we’ve been taught for the last 40 years — eat more fruit, eat healthy oatmeal, avoid full-fat foods, don’t touch the bacon, vegetarianism is healthy, avoid red meats, pull the skin off the chicken.
I am not going to argue whether this way of eating is healthy (these books and online resources do a much better job). We each have our own medical and metabolic issues and you will have to come to your own conclusions. All I can tell you is David and I have together lost 160 pounds. My A1c (the diabetes marker) is in the “super-optimal” range. David’s diabetes diagnosis was reversed and his A1c is in the normal range. My last blood pressure was 115/70 (technically declared “awesome”) and David’s is normal as well. I won’t get into cholesterol, because that’s a whole other controversy, but I am satisfied with our numbers.
From doctors I’ve spoken with, it seems that one reason that they aren’t always enthusiastic about this way of eating is that people, (being people) fall off the wagon and undo all the good they have done. For me, the decision to stay on the wagon is easy. Would I rather be healthy or not?
This is not one-size-fits-all
Some of the writers I’ve been reading seem to think that this is the right diet for everyone. I am not so sure. I know plenty of people who seem to do just fine eating carbs. And there are plenty of variations. For example, there is a lot of overlap between paleo diets and keto. Or between the Mediterranean diet and keto. And Whole 30 and keto. I am not coming at this from a “my way or the highway perspective.” If keto works for you, great. If some variation works for you, great. Maybe my experience can help. And if you can tolerate more carbs, good for you! Enjoy a pizza for me.
I realize that not everyone wants to read 10 books to figure out what to eat for dinner. But I found that the following books helped me wrap my mind around the science and the practice of a ketogenic way of eating. You might find all you need for free on the Internet, but books curate and organize information in a way that often makes more sense, at least to me.
My Top Picks for Ketogenic and Low-Carb Books
The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable
by Jeff Volek and Stephen Phinney
I think the title of this book neatly sums up the biggest diet issue: Sustainability and enjoyment are key issues for food and life. If we are miserable on our diets, we can’t stay on them. Not to mention (and this is important): Low-carb eating is not so much a diet as it is a long-term way of life. This book explains the science behind and the medical benefits of low-carb eating as a permanent lifestyle change.
Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health
Gary Taubes is not a doctor or a nutritionist; he is an award-winning New York Times science writer with a flare for storytelling, which made this a compelling read. I was especially stunned by the whole history of how our government-approved dietary recommendations came to be so wrong. The bottom line: According to this book, pretty much everything most people assume when they say, “I’m making healthier choices” is dead wrong. If you think you are “being good” when you choose low-fat over full-fat, eat oatmeal instead of bacon and eggs, or skip the prime rib in favor of skinless boneless chicken breast, you need a complete sea change in how you view food and health.
Why We Get Fat: And What to Do About It
News flash: According to this book, we aren’t fat because we have no will power and are lazy; we are fat and don’t have any energy because we are suffering the consequences of a perfect storm. The combination of a predisposition to metabolic system and the standard western diet is a recipe for disaster — and largely responsible for the obesity epidemic. Taubes explains how being overweight is less a cause of disease, and more of a symptom of a metabolic syndrome gone awry. And he tells us what to do to change our metabolic fate.
The New Atkins for a New You: The Ultimate Diet for Shedding Weight and Feeling Great
by Eric C. Westman , Stephen D. Phinney , Jeff S. Volek
This book, along with both the original Atkins guide and Atkins’s revised edition (described below), is a how-to-change-your-eating book that summarizes the rationale for a low-carb diet and gets into the nitty gritty of how to implement it. This books stands on Atkins’ shoulders, but it better reflects contemporary ketogenic principles and updates the science. It explains the rationale behind the low-carb diet, and offers strategies for a variety of situations including eating out. It’s a little bit cheerleadery (as were the original Atkins books) — but the information is easy to take in.
Wheat Belly: Lose the Wheat, Lose the Weight, and Find Your Path Back to Health
by William Davis, MD
While most low-carb approaches take a general “all carbs are the enemy” approach, this books zooms in on wheat as the culprit. Its basic concern is the effect of wheat on the human digestive system, metabolism, and even the brain. It also includes information about both the ancient history of wheat cultivation and the modern history of grain cultivation and genetic modification, showing how the grains we use today are different from their forebears and the effect this has on humans.
Undoctored: Why Health Care Has Failed You and How You Can Become Smarter Than Your Doctor
by William Davis, MD
I’m not sure I can ever again be undoctored… thyroid cancer has put an end to that. But cancer notwithstanding, I plan to avoid the clutches of Big Pharma, Big Food, and Big Government Medicine. Undoctored explains some of the financial interests that intrude on the relationship between you and your doctor. As with Wheat Belly, I read this book when I was already well into my weight-loss journey, and my prior research was such that I’d already started following most of Davis’s recommendations. I found this an excellent source for information about supplements.
More Books on Weight Loss and Health
Dr. Atkins’ New Diet Revolution, Revised Edition
Robert Atkins M.D.
Low-carb eating is not new…. some say our paleolithic ancestors ate this way, and that it is high-carb grain-based eating (dating only several thousand years) that is new — and unsuited — to humans. That said, the Atkins diet brought low-carb eating into the popular lexicon in the 1970s, just as the “food pyramid” was gaining traction as the medical establishment’s diet of choice. Lambasted as faddish, unhealthy, and even dangerous, the Atkins diet was shot down again and again but somehow never died. Today, it is the foundation of most ketogenic diets. Atkins was not an opponent of sugar substitutes (which have since been shown to impact blood sugar and hence insulin levels because they activate the part of the brain that thinks “I’m getting sugar!”) Nor was he an opponent of processed foods. (The current Atkins corporation bought the name and sells processed foods, which I, and many others following a ketogenic way of life, avoid.) Atkins’s books were often publicized as permission to be as gluttonous as you wanted, as long as you were scarfing down steak and bacon and not potatoes and cake. My own version of ketogenic eating follows a more moderate of avoiding sugar substitutes, avoiding as many processed foods as possible, and limiting protein to reasonable sizes based on an individual’s weight, height, and activity levels. Nonetheless, Atkins’ books are the grand-parents of modern ketogenic thinking. This one has simple, clear explanations, easy science, and an encouraging “you-can-do-it” tone that millions of people have found inspiring.
The Obesity Code: Unlocking the Secrets of Weight Loss by Jason Fung
Dr. Jason Fung is a nephrologist (nephrology refers to kidneys, which are frequently damaged or destroyed by diabetes. Diabetes is in turn associated with obesity). This book explores the relationship between insulin, carbs, blood sugar control, and obesity, and puts insulin resistance squarely at fault for most “diseases of civilization.” In addition to a ketogenic diet, Dr. Fung is a proponent of intermittent fasting. Quite frankly, fasting does not appeal to me. However, the 18-hour fasts that are a starting point (often running from an early dinner to late breakfast the next day) are something that seems to almost happen naturally and easily for me. Many mornings (including this one), I find myself on an 18-hour fast, whether intended or not. Even if you aren’t interested in fasting, this book offers clear explanations behind some of the science of low-carb eating and metabolic system disruption that occurs when the insulin cycle goes awry.
Dr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars
Richard K. Bernstein
A friend of mine (a type I diabetic who has had numerous other health issues including cancer) quite simply says that Dr. Berstein Saved his life. This book is aimed at both type 1 and type 2 diabetics. Dr. Berstein is a physician with type 1 diabetes who practices what he preaches. Here, he explains the basics of the carbohydrate-insulin cycle and metabolic syndrome, and then talks about a ketogenic diet in terms of managing blood sugars. I’m not diabetic, and David isn’t anymore (and he was never on medication for it) but I still found this book very helpful in understanding the science of metabolic diseases, pre-diabetes, and diabetes.
The Great Cholesterol Myth + 100 Recipes for Preventing and Reversing Heart Disease: Why Lowering Your Cholesterol Won’t Prevent Heart Disease and the Statin Free Plan and Diet that Will by Jonny Bowden , Stephen Sinatra ,Deirdre Rawlings
One of the concerns some doctors and many patients have about a low-carb diet is that it will increase cholesterol. And indeed, sometimes it does. This book takes the position that total cholesterol is a meaningless measure, because it adds a positive (good HDL cholesterol) to a negative (a portion of tryglicerides and LDL). Furthermore, it claims that the evidence that LDL is dangerous is far from complete. There are, it turns out, large, small, and other LDL particles, some of which are neutral and some of which are bad, and only a blood test that examines particle size and number is truly useful. On a low-carb diet, many people experience higher HDL (good) cholesterol and lower triglycerides, but also higher LDL (commonly called “bad”) cholesterol. To have a useful discussion about cholesterol and statin drugs with a doctor, patients need to have a basic understanding of the studies and controversies surrounding this issue.
Keto Comfort Foods
Who doesn’t love recipes? The absolute best way I know to stay on a diet, or, in this case, on a permanent way of eating, is to love the food you are eating. So cookbooks with great ideas help. This one occasionally includes recipes that are a bit higher-carb than a strict meat-and-greens type meal. So be careful when you plan your meals. I figure if dinner has a slightly higher-than-normal carb count, that I should be super careful the rest of the day. She also includes a lot of desserts with artificial sweeteners. Personally, I save these for only very occasional treats. Your mileage may vary. Lots of great ideas here. Enjoy!
I’m not an expert, a medical doctor, a nutritionist (etc. ). So I am sharing my personal journey and the resources I found helpful in losing more than 85 pounds over the last year and a half.
But my experience is only mine. We are each our own experiment, and I think there is variation in how different people respond. Also, except for my thyroid cancer, I am basically healthy, so my body may have reacted more easily to the change in diet. If you are on a lot of medication (particularly diabetes medication) check with a doctor before radically changing your way of eating. However, realize that many doctors are not up on low-carb science, and many counsel against it. You may need to do a lot of research to have an informed and productive discussion with an uninformed (on this issue) doctor. The following sites will get you started.
I will add resources to this page as I find them, so check back. These are resources I have personally found useful. I don’t want to overload this page… too much information being more confusing than helpful. You can also check out the book resources page.
One warning before you jump into the Internet world of low-carb eating: Sayin’ don’t make it so. Just because a food company or website or book publisher says something is “low-carb” doesn’t mean it is. Companies will do anything to get you to buy their product. Low-carb is a trend, so food companies are jumping on it, just like the co-opted the words “healthy,” “natural,” “gluten free” and “organic.” But their definition of “low-carb” may not be truly low-carb. The same goes for cook-books. You will have to decide what your carb limits are, and then make sure the foods you eat and recipes you use comply.
Internet Resources for the Ketogenic Way of Eating
Low Carb Faqs (and much more): This site contains the forums listed directly below, along with faqs, recipes, and tips. I found it useful when starting out.
Low Carber Forums: Folks here will answer just about any question you can think of and give plenty of moral support, plus there are scores of recipes and success stories to keep you on track, along with discussions of related health info (cholesterol, diabetes, etc.) They include a broad range of approaches and perspectives.
*Watch out for Facebook keto groups that are filled with sugar substitutes and dessert recipes. While David and I enjoy the occasional keto dessert, we’ve found that for us, avoidance is the best policy.
Counting Net Carbs versus Whole Carbs? Definitions: The whole carb count is the total number of carbs in a food item. The net carbs count is calculated by subtracting the amount of fiber. For example, a cup of sliced avocado might have 12 whole carbs, of which 10 carbs are from fiber. So the net carb count is 2. Obviously, with some high fiber foods, using net carbs means that you will have a wider selection. However, some experts say that some amount of fiber carbs can affect blood sugar. Also, different experts have different opinions on how many carbs to aim for, and whether those should be whole or net. You will have to experiment with your food choices. I started strict, then eased off a little, and I basically stay between 20 whole carbs and 30 net carbs a day. The article linked above goes into more detail about net versus whole carbs. The site has lots more info on it.
Counting Macros. Macro-nutrients the categories of foods we eat: carbohydrates, proteins, and fats. While some low-carb people count their proteins and fats (and, less commonly calories), I have not done so. For me, counting carbs alone has given satisfactory results. I eyeball protein (2 smallish portions per day — each portion is about the size of a hamburger). But if eyeballing is not giving you the results you want, try counting macros. This site helps figure out how grams you should be taking in of proteins, fats, and carbs, depending on height, weight, gender, activity level, etc.
Beginner’s Guide This site has a ton of useful info, including recipes and forums.
I’m also going to share a couple of links to “the opposition” (below).
The mainstream medical establishment has a long history of failing to recognize any benefits of a low-carb diet. This mistake is so long-standing and ingrained that I think they have backed themselves into a corner where they can’t or won’t admit it. I think there are a lot of well-meaning people advocating all manner of dietary approaches, but there are also people whose advocacy is based on pride or greed. There is also an argument that “Big Food” and “Big Pharma” have an interest in keeping the status quo (lots of drug-taking, junk-food-consuming sick people with diabetes. You should be aware that there is strong opposition to this way of eating in some parts of the medical community.
Studies can be cherry-picked any which way to show whatever you want them to show. And many of them are deeply flawed in design and duration. Nutrition and health are by definition multi-variable, and even the best double blind peer-reviewed studies show only statistics, not effects on individuals. I think we are all our own experiments, and that for a subset of the population, a low-carb approach is beneficial. You know what you’ve done in the past. You know whether it has worked. Only you can figure out whether it makes sense to try something different.
I believe in reading all sides of a story before making a decision. Here are two examples of opposition to the low-carb way of eating . These focus on the Atkins diet. Note that the original version of the Atkins diet was sometimes promoted or interpreted as permission to gorge on humongous steaks and pounds of bacon. No responsible current low-carb sites promote gorging, whether its on kale or pork-chops! Also note that the current Atkins corporation and sells highly processed food products, which my personal way of eating completely avoids. The corporation bought the Atkins name, and while it promotes low-carb eating, the company is separate and distinct from the late doctor who came up with the plan.
The Wikipedia entry on the Atkins diet makes no attempt to be objective, but is revealing about mainstream medicine’s position.
This link, to a 1974 American Medical Association article, takes issue with many aspects of a ketogenic diet. The site on which this article was reprinted was founded by Dr. Michael Greger, who advocates a plant-based diet with no animal products. Dr. Greger appears to be an animal rights advocate and nowhere on this site or his other sites did I find information about his actual clinical experience with patients. (During his “Animal Rights 2002” convention speech, he said, “The future of the animal liberation movement depends on our ability to unite with other social justice movements, and corporate globalization is the key bridging issue we’ve been waiting for all of our lives.”) You should be aware of opposing opinions and studies, and I am including a link to this site because this is about as oppositional as it gets. (Reading some of these sites sometimes reminds me of toddlers in a playground, each shouting “No, YOU’RE a doo-doo-head” more loudly than the other.) Obviously, the AMA article I’ve linked to here is very old, but it neatly summarizes the main points of the “opposition.” Also, Dr. Greger’s website contains other articles lambasting low-carb, as well.
For reasons explained here, I’ve been slow getting around to adding all the information on low-carb and ketogenic eating that people have asked for. So some of this is old news, but I wanted to start at the beginning and provide the backstory about how I stumbled into a way of eating that resulted in weight loss of 85 pounds.
(Also, a disclaimer: I am relating my personal experience in the hope that it can help others as they create their own experiences. I am not a health professional or a doctor, and I am not trying to “sell” low-carb. It’s a permanent commitment and way of life, and it is not for everyone. If you are on any medications — especially any kind of medications for diabetes — you absolutely must consult with a doctor before you follow this way of eating because you must adjust medication to account for declining blood sugar numbers. )
I’ll cut to the chase: Since March of 2016, I’ve lost 85 pounds. My partner David has lost 75. That means that when we climb into bed there is 160 pounds less of us (a whole person! Who knew we had a ménage à trois going for all these years!).
Ironically, my initial weight loss journey started out having nothing to do with health. In March, 2016, I got an e-mail from a public relations representative from Switzerland. I was going to a travel writers’ conference in May, and they were arranging some junkets: Did I want to go paragliding. Over the Alps.
“YES!!!” I wrote back, overusing my yearly allotment of capital letters and exclamation points in a single e-mail. There may even have been a smiley face involved.
In the middle of following night, I woke up, my sleeping brain having put together the fact that gravity, paragliding (i.e., an activity that involves falling from the sky), and my current weight, were probably not compatible.
Actually, I didn’t even know what my weight was: my way of dealing with tight clothes and unfortunate feedback from the mirror had been to avoid stepping on the scale. In doctors’ offices, I’d close my eyes and ask the nurse not to tell me the number. Denial was my strategy. Stretch pants were my friends.
Denial waged war with desire. Desire won. I looked up the outfitter on the Internet and learned that the weight limit for paragliding was 220 pounds. I stepped on the scale. It is hard for me to write the number, but I’m trying to be honest, so I’ll do it.
Naked. Before coffee.
I’m 5′ 9″ and I have broad shoulders and a strong build… but 237 (and don’t forget the point-six)???!!! It’s obese no matter what kind of mirror you look at.
The number took my breath away. How does that even happen? How, especially, does it happen to someone who hikes and skis (almost every day), who doesn’t eat sugared cereal or indulge in desserts, who shops the perimeter of the grocery store and skips the aisles, who follows guidelines to eat lots of fruit and veggies and healthy whole grains? (Let’s pause for a moment…. I’ll give you a hint: the answer is contained in the question. I’ll cover that in a subsequent post.)
Since I wasn’t planning to paraglide naked, and since I needed to account not only for clothes and shoes, but also for breakfast, coffee, and the fact that prior to going to Switzerland, I’d be on a food tour in Prague, I figured I needed to lose 27.6 pounds (give or take a tenth) to safely weigh in under the limit. I had seven weeks.
Was that even possible?
I went — where else? — to the Internet, looking for crash diets. Honestly, I didn’t care if they were banana and grapefruit or kimchi and kale; my goal was paragliding, not health. Google and Siri were glad to oblige. In short order, they pointed me in the direction of low-carb. The key benefit (as far as I was concerned): fast initial weight loss.
Low-carb forums assured me that others had lost 10, 15, even more pounds in the first two weeks, and that two pounds a week after that was possible. They also ranted about health benefits, but I skipped that part and focused on the weight loss math. It would be a close call, but maybe it could be done. I envisioned having to step on a scale in front of all my travel writing colleagues — me, Ms Big Adventure Writer — and being told I was too fat to fly. Shame was a powerful motivator.
I’d heard of low-carb, of course. In popular diet culture, it’s been around in some guise or another since I was a teenager worrying about the size of my prom dress. (The first Atkins book hit bookstore shelves in 1972.) In reality, low-carb has been around a lot longer than that — maybe even back to to caveman days. (Some writers claim that it’s the way humans evolved to eat. In the next couple of weeks, I’ll also be adding posts with reading lists for those interested. I’ll also describe the diet in more detail. )
For now, I’ll simply say: It’s strict and it’s not for everyone, and as far as I can tell, it works but you have to stay on it forever. It’s also controversial with a lot of doctors. Not to mention the American Diabetic Association and the American Heart Association and most mainline medical websites you’ll visit. (Which is why you should read as much as you can stand, and if you are on medications, check with a doctor before doing this.)
Here’s the list of things I avoided in order to lose the weight:
Other grains and grain-based foods (including cereal, bread, pasta, pizza, rice, oatmeal, even quinoa)
Sugar and almost all artificial sweeteners
Starchy root vegetables and winter squashes
Fruit juice and soda (which I never drank anyway)
In addition, there were limits on or cautions about most fruits, legumes, nuts, and seeds. The protocol I followed avoids as much processed food as possible and anything labeled low-fat. Cream is okay, milk is not, and skim milk or low-fat milk is especially not okay.
Red meat, fish, chicken, eggs, vegetables that grow above the ground (especially leafy greens and cruciferous vegetables), and many fats (olive oil, avocado oil, coconut oil, butter, ghee, meat fats and fish oils) are the mainstays of this way of eating; the details depend on the expert you follow. (There’s a lot of variation here, and some overlap between Atkins, Ketogenic, South Beach, Paleo, Whole 30 and some others.)
I wrote down what I ate and drank every day, accounting for the carbs in the cream in my coffee and checking nutrition labels to hunt for hidden sugars. I tracked carbs in the ingredients of recipes we made from scratch. I counted minuscule quantities of blueberries and olives and nuts. I cut way back on wine.
It sounds strict, and it was, but — surprisingly — after the first few days, it wasn’t nearly as difficult as I thought it would be. Besides, what did I have to lose (aside from a lot of weight)?
The answer: health risk factors.
The more I read, the more I realized that I’d stumbled not on a diet, but a permanent way of eating. And if I stayed on it, it would not only help me reach and maintain a normal weight, but would result in better health markers all around. My weight dropped, as promised: in the first two weeks, I lost about 15 pounds. Most of that was glycogen and water weight, but the paragliding people wouldn’t care about that. If what I was reading was true, my blood pressure and most health markers were also improving.
My partner, David, joined me on the same plan, which was a big help: I am convinced that the biggest threat to an individual’s health (particularly women) is the other people in the household. David had a bit less enthusiasm than I (among other things, he had absolutely no interest in paragliding and he sorely missed ice cream). With his addiction to diet soda (which he has since resolved), he wasn’t losing weight as fast as I was (my understanding is that most artificial sweeteners raise the body’s insulin response, which prevents weight loss.) Still, he dropped about ten pounds.
To make a long story short, the day I left for Europe, I had lost precisely 27.6 pounds. I was down to 210. For paragliding purposes, that gave me a ten-pound leeway for clothes, coffee, and any weight I might gain from food eaten during the bountiful meals of a travel writing junket. But I found that my tastes had changed, and even when presented with the tempting breads and pastries of a high-end European dinner, I mostly avoided straying. I deeply offended a kind Czech waiter who insisted that without bread dumplings I would not have a “complete meal.” (Confession: I did eat a piece of apple strudel. I am not made of stone.)
Most importantly, I got to run off a cliff and float into the sky, fully at peace with gravity — a thrill that was worth every single bite of pizza, pasta, and bread I had missed over the previous few weeks.
When I returned home, I was committed to staying the low-carb course. Everything was copacetic… until it wasn’t. A few weeks after my return, David had his stroke and got his diabetes diagnosis, and our world changed. Suddenly, our low-carb diet had nothing to do with getting back into smaller clothes or doing outdoor activities. Losing weight and improvising health markers was a matter (and I mean this very seriously) of life and death. David gave up the diet soda. In the hospital, he ignored the recommended diabetes menu and had omelettes for breakfast and burgers with veggies and no buns for for lunch and dinner. At home, he stuck with it. The results? You can see them in the before and after pictures below: He is now 75 pounds slimmer with normal cholesterol, normal blood pressure, and a normal, non-diabetic A1c (that is the blood test for diabetes). And my A1c marker is not merely normal, nor even optimal — it is “super-optimal.” And my blood pressure is “awesome” (the nurse’s technical term for it).
I will provide links to discussions (pro and con) of low-carb diet health in future posts.
Meantime, a lot of people have been asking for details. I can’t cover it all in one post, so over the next few weeks I will be adding and updating information, most especially links to resources, books, and recipes, in a dedicated section of this blog. Once I get those posts up, they will be indexed. You will find the link in the menu section of this blog (it’s at the top if you are reading on your computer. If you are using a device, you’ll find the low-carb section listed in the menu drop down area).
As I said earlier, I am not trying to sell low-carb eating to anyone — but I am trying to answer the questions to people who ask and are interested. As I am not an expert, I will not give advice, but I will share what has worked for me, and point you to resources that may help you make your own decisions.
My understanding is that this way of eating works for a subset of the population whose bodies respond to carbs in a certain metabolically challenged way. If you are in that group, I hope the resources I share and my experiences will help you choose your own path through the poison-laden aisles of your neighborhood supermarket.
Mostly, I think expletives betray a lack of vocabulary. Once in a while they are justified.
I know I’m not the only one who was glad to see the backside of 2016. Wishing your life away is not a good thing, but floundering on the dark side of the moon loses its appeal after a while.
But we’re now more than halfway through 2017, and the shit storm has had some staying power. Like the tornado in the Wizard of Oz, it has uprooted homes from their foundations, blown bicycles into the sky, and dropped things down topsy-turvy where they don’t belong. Like the current occupant of the White House. (But I digress.)
Yanking me into “what the hell is going on here” retrospective/introspective/give-me-some-perspective mode: The news that our friend Fred Shane died last week.
Some back story:
Almost exactly one year to the day ago, Fred ran sound for a benefit concert at Dewey Hall, a lovely New England meeting house that was built in 1887 to memorialize Orville Dewey, who had worked “to increase good and kindly feelings and to promote intelligence and cheerfulness.” The benefit was for my partner David, who’d suffered a stroke. Not one of those pesky TIAs; David got the full Monty – a stroke that paralyzed his entire right side and stole a whole lot of language. He has recovered now, mostly, after intensive therapy and with the support of our community.
That was in the summer of 2016. The rest of the year had more in store. David dealt with a diabetes diagnosis (since reversed — yes, reversed; I’ll talk about that in another post). And an emergency appendectomy, the appendicitis presenting while he was in therapy to deal with the after effects of the stroke.
We may have been self-absorbed in our own little cocoon of crisis, but we weren’t the only ones hammered. Joe, our student and good friend got a cancer diagnosis which necessitated his move to another city for multiple surgeries, radiation, a bout of MRSA infection, skin grafts, and more radiation. My elderly mom was coping with an unending string of problems from legal blindness to infections to hating the food at the facility where she lives. Other friends and family had issues. And on and on.
New Year’s couldn’t come fast enough. Out with the old, and all that.
I slid into 2017 with resolutions. At that point, I’d lost about 55 pounds (more on THAT in another post). The health catastrophes surrounding me had encouraged me to put health maintenance back on track. Right after New Year’s, I showed up for a routine physical. With a confidence born of weight loss, I expected the usual: blood pressure, weight, lab work, a lecture about eating more healthy whole grains and doing more exercise. Hand over the co-pay, and I’d be on my way.
Yeah… on my way and out the door — to a series of specialists’ offices, mostly involving CAT scans, biopsies, and the word oncology.
First the good news: the gynecological cancers that were suspected turned out to be a collection of benign issues. True, I had to have a complete abdominal hysterectomy. And they removed a fibroid that weighed more than 5 pounds – ie, a growth as big as a viable baby! But hey, at least it wasn’t cancer.
The bad news: A barely perceptible swelling in my neck was thyroid cancer, metastatic to the lymph nodes.
In a blur of shock, I fixated on what everyone seemed so eager to tell me: that thyroid cancer is the “good cancer.” Most thyroid cancer patients, I learned later, hate that phrase. They feel it minimizes what they are going through. But in those first days, I took it as reassurance, and it made me feel more optimistic.
At about the same time that I was diagnosed with thyroid cancer, Joe was undergoing radiation in Boston, and Fred got his diagnosis, stage 4 colon cancer.
Compared to Joe’s sarcoma and Fred’s colon cancer, I have to say yes, I won the cancer lottery. To wit: Fred’s treatments were harsher, more life-disruptive, and ultimately, not successful. Joe’s were prolonged and painful with multiple complications. From where I sit, I think I did indeed pull the lucky straw.
But the “good cancer” is not without its own charms. In January, I had a total thyroidectomy and lateral neck dissection, leaving me with a smiley-shaped scar that matches the abdominal scar I got from my hysterectomy in March.
I also need to take thyroid replacement medication every day for the rest of my life. That sounds like a small thing. But for someone who has never been on any chronic medication, it’s been a hard hit, maybe because it seems a daily reminder of mortality, of how things can go so suddenly wrong.
And there is a vulnerability, a surprising sense of dependence on “the system.” Remember Y2K? The fears and questions: Would digital meltdown stop computers – and trains, planes, phones, the electric grid… hospital equipment? I remember a conversation I had with a friend: She asked if I was worried, and I said that I had a water filter for backpacking, and there was a stream near where I lived. I had a fireplace and wood and warm clothes and a pantry full of food. I could survive.
If we had the same conversation today, I’d have to factor in getting my pills. What if the lights went out at the pharmacy? Or at the factory where they make the medicine?
I know, I know…. It’s fanciful and far-fetched and overly-dramatic. I do not believe the world will melt down, current politics notwithstanding. But I’m amazed at the overshadowing presence of that tiny purple pill in my life.
In February, I had the radioactive iodine treatment.
Radioactive iodine treatment is simply a matter of taking a pill that works like a heat-seeking missile. The radioactive iodine can only be taken up by thyroid cells, which it then destroys, like a bad Airbnb guest in an unsupervised apartment.
The protocol surrounding the seemingly small act of swallowing this pill is scarily surreal.
To enable your thyroid cells to take up the iodine, you start with two shots, which cost thousands – yes, THOUSANDS of dollars. I don’t know precisely how many thousands of dollars because the insurance company that pays for it didn’t provide that information. (I am writing this in August 2017, when the despicable government this country has idiotically elected has been trying, so far unsuccessfully, to decimate affordable health care. But I digress.)
To actually take the pill, you go to the hospital. I was told to park in a special lot, and enter and (more importantly) exit the building through a seldom-used hallway in order to minimize encounters with other patients and staff. Anyone I merely passed in the hall would be contaminated by the radiation emanating from me once I took the pill.
Think about it: The “good cancer” was making me ingest a pill so toxic that merely passing someone in a hallway could be dangerous to them.
As soon as I arrived in the waiting room, the receptionist, and then the lab tech, and then the doctor, all demanded whether I’d parked in the appropriate place.
In short: Not a casual vibe.
The pill arrived in a protective, lined metal case imprinted with danger warnings. A lab tech stood on the far side of a protective screen, wearing protective lab clothes and protective gloves. He spilled the pill out onto a counter and used a tool to nudge it toward me. The doctors – a nuclear medicine doctor and a nuclear physicist – stood as far away as possible at the other end of the room, trying to look like they just happened to be casually perched there.
Down the hatch.
I did not feel different. I did not start glowing. Anticlimactically, off I went, through the back hall and the back door, back home, where I had to live in total isolation from anyone else for a few days.
For an introverted book addict like me, that was the easy part.
And the rest is all test and watch and wait and test… pretty much forever, if I understand it right.
March was the hysterectomy, complete with happy results.
Since then, life has ebbed back to a new kind of normal. My brain is full of stuff – strokes, statins, cancer stages, blood sugars, A1c ranges, cholesterol particles, carb counts – that it never knew about before, and I have a whole new vocabulary of words like salpingo-oophorectomy and atorvastatin. I feel healthy. I hope it is not an illusion. Things can change on a dime. I always knew that, but I know it differently now.
Ironically, we missed Fred’s farewell party – we were playing music in the Washington D.C. area with the group of friends who had played at David’s benefit the year before. The farewell party had been moved up a week, and we learned about it too late. And then he was gone.
I try to find meaning in it all, but the universe is sometimes heartlessly random. I grew up Catholic, and the only phrase that ever made sense to me is “the mystery of life.” The Old Testament God – fickle, temperamental, and occasionally not very nice – makes sense in a year like this. A manic-depressive god who could create a world full of butterflies and coral reefs and bird song at dawn — then throw down floods and toss a person into the belly of a whale or torment a believer with a thousand afflictions.
A mystery, indeed.
And yet, doctor’s appointments or no, tomorrow comes, then tomorrow after that, each one with its endless possibilities. Until it doesn’t, I suppose.
Cliches abound. One day at a time. Living life to the fullest. Live every day as if it were your last. Homilies that are at once on point and annoying.
I think most of us are just struggling through, mostly trying to do the best we can. My friend Joe and I compared notes, agreeing that we were both struck by how ordinary all of this seems. You live your life thinking that the word cancer is the worst thing that can happen. And then you hear that word and you cross that Rubicon, and you realize that life on the other side is still the life you had. Different in some ways – and more different for some than for others. But still life, filled with the good things it’s always had. And you still have to pay your taxes!
At the moment, there is music, and travel. There is the view from my back porch and the family and friends whose lives intersect with mine. There are the books I want to write, and the photographs I want to take, the trails I hike on near my home and the trails I want to hike far away, and the art I want to try to make, and the garden that needs weeding. There is the light of late summer, taking on that rich, deep-hued gold, and the sweet smell of mature grass and harvest time and the woods of summer camp. There is time to savor; there is no time to waste.
The funny thing about hiking above treeline is that the challenges and the views are always changing. So I have no idea what my perspective will be tomorrow. I might be on my knees, cowering among the krummholtz and the boulders, praying for relief from the lightning and shelter from the wind and rain. Or I may have a 100-mile view under cornflower skies. If I stick around long enough, most probably, I will experience both.
I am growing above treeline, whether I want to or not, growing on the days of endless, heart-expanding views, growing as I am tossed about by the shit storm. And I wonder what Fred’s view is now, from his vantage point in the great beyond.
Perhaps he would say “Don’t get cancer.” (Fred said that a lot) “But if you do get cancer, squeeze every bit of life and love out of it that you can.”
I will keep writing about what I learn. I have no idea what it will be. But isn’t that the point?