Kac Para Yarismasi

Arthritis Diet and Exercises


A mom tried keto diet for 30 days. Things went wrong for her, just weeks after
starting it. This is what happened, to her pancreas. JC is a 32 year old woman, presenting to the
emergency room with progressively worsening speech, vision, and strength. She opens her mouth to speak to the admitting
nurse, but the words don’t make any sense. 4 months ago, JC became a new mom. She decided that she would feed her daughter,
naturally. JC was an elite athlete in her past life. She always lived an active lifestyle, and
motherhood wasn’t going to change that. During her pregnancy, she had gained 30 pounds. Now that baby’s out, JC tried the Keto diet,
where she’d restrict all carbohydrates to zero, while eating only proteins and fats. Paired with an hour of exercise daily, JC
was determined, she was going to shed that baby weight. In the weeks following her daughter’s birth,
JC felt a numbness in her legs during her morning runs. This was without pain. Without burning sensations. One day at breakfast, JC’s husband noticed
her repeatedly pour water from one bottle to another and back, while quietly growling
to herself. When asked about this after eating, she had
no memory of breakfast. As the weeks passed, JC felt a panic and anxiety
start to overcome her. She started crying everyday. She couldn’t sleep through the night. Breaking her keto diet, and eating carbs would
make her feel better, but she resisted every urge. She realized something was wrong. At the doctor’s office days later, JC was
diagnosed with postpartum depression. These changes in her body are normal. She just had a baby. Shifts in hormones and increased sensitivity
to these changes, can affect anyone. But the doctor had other concerns. JC was feeding her daughter. Human milk incorporates 50 grams of sugar
per day. If she’s not eating those sugars because
of her keto diet, this COULD be a problem. Proteins and fats can be converted to sugar
for use in milk, but that conversion doesn’t happen quickly. It doesn’t happen easily. And it MIGHT not be enough to keep up with
JC’s lactation. This can be problematic if it causes blood
sugar levels become too low. And in JC, those levels are too low. A blood test at that visit revealed severe
hypoglycemia. Hypo meaning low. Glyce from Ancient Greek referring to sugar. And emia meaning presence in blood. Low sugar presence in blood. The brain uses sugar as its most immediate
energy source. When sugar is suddenly low in the body, this
will cause mental status changes and mood swings as the brain’s energy supply is disrupted. And when combined with postpartum depression,
then this explains everything that’s happening to JC. She was sent home with medicines. She was given advice to stop the strict keto
diet, so long as she was still feeding her daughter. It didn’t need to be a permanent stop, but
a necessary change for the time being. JC was on her way. She was feeling great with this flexible diet. But only for a few weeks. One morning, JC stepped on the scale. She had gained another 20 pounds since she
relaxed her foods after that doctors visit. She thought that the medicines were working
well on her mood, so that postpartum depression must have been the only problem. She saw no reason to continue the relaxed
diet, as she vowed again to shed that baby weight . She broke the doctor’s recommendation and
returned to her strict keto diet, while still feeding her daughter. It was time to wean baby off, anyways she
thought. As the days went by, JC felt great. But one morning, 2 weeks later, her vision
started to double. She felt a tingling in her fingers. She spoke words to her husband, but he couldn’t
understand them. He thought she was joking, but realized something
was wrong, when she tried to put baby in the refrigerator. After breakfast, JC had no recollection of
anything. The same episodes, would repeat every morning. She would snap out of it after her breakfast
of greek yogurt and eggs. Her husband shrugged it off as a joke because
it kept happening, every day. But then JC’s anxiety came back. The crying and the insomnia. Over the next 4 days, JC’s vision starts
to go dark as her bouts of panic intensify. She describes to her husband a mental fog
clouding her thoughts. And as the night falls, anxiety shrouds her
as she knows the insomnia was waiting for her. One morning, JC got out of bed. She laid on the floor, arms raised. She was conscious but not responsive. She was speaking, but incoherent. She rolled over on her side, and began to
seize as 911 was called and she is brought to the emergency room where we are now. At examination, JC isn’t visibly ill. She’s verbal, but she’s incoherent. She’s responsive, but not oriented. A blood test again reveals hypoglycemia, but
this time, less than half the lower limit of normal. The medical team administers a sugar water
mixture intravenously to JC, her consciousness improves in minutes. All other signs and exams return normal, as
she appears to be her normal self. More tests are done on her, and it’s found
that nothing is wrong with her kidneys, liver and heart. Overall, it looks like nothing ever happened. She’s admitted into the hospital because
even if she looks ok, something is clearly amiss. The next morning, the medical team on rounds
finds JC on the floor again, arms raised. This time, unresponsive but conscious. Incoherent, but still speaking, as she rolls
over and starts seizing again. Doctors order another test for her blood sugar. Severe hypoglycemia found again. Another glucose IV was infused in to her. JC is conscious, coherent and oriented again,
with no recollection at all of what just happened, as this now gives the medical team some clues
as to what’s happening. Most immediately, JC is showing neuroglycopenic
symptoms. Neuro referring to the brain. Glyco referring to glucose, another name for
sugar And (suffix)-penia meaning a deficiency of. A deficiency of sugar, in the brain. The brain needs sugar to function. But exactly, how much? Well, at rest, the brain accounts for 60%
of all sugar consumption, even though it’s less than 3% the mass of the whole body. In normal function, the body has protections
in place to prevent hypoglycemia so that bad things don’t happen to the brain. This glucose homeostasis, is the equilibrium,
or balance of sugar in the body. Most of the body’s sugar is stored in the
liver. When blood sugar decreases, hormones tell
the liver to start breaking down those stores and to release them so that levels are steady. This is called glycogenolysis. The liver also generates sugar from proteins
and fats, a process called gluconeogenesis. Both of these increase blood sugar, so defects
here can cause a decrease in blood sugar. Nothing here was wrong, because JC’s liver
function was found to be normal, but there’s more. The liver produces ketones, which are a secondary
energy source to sugar that can be used by the brain. But they’re not as efficient as glucose. If someone has been on keto diet for long
enough, the liver’s sugar stores become depleted, forcing ketogenesis, giving way
for the namesake of JC’s diet But lactation can also increase the production
of ketones. So, if she’s doing both the keto diet, and
feeding her daughter, then it means that JC should have a high ketone presence in blood. The medical team orders JC to fast for 72-hours. Over these 3 days, they will monitor her blood
sugar and ketones. (+proinsulin and C-peptide— students, what
are those for?) Things seem to be going well just a couple
hours in to the fast. But at 7 hours in, JC started slurring her
speech. She was no longer oriented again as she lay
on the floor, her arms up. On measurement of her blood glucose, the results
return— less than half the lower limit of normal. Ketones, which should be high, were virtually
absent, bringing us back to glucose homeostasis. Upstream the process, from the liver, is the
pancreas. This organ produces a hormone named insulin,
which is released when blood sugar is high. Most commonly, this happens after one eats. Insulin tells the body’s cells, to absorb
the sugar in the blood. To take in as much of it as possible, until
the levels normalize. If insulin is high for a long time, then blood
sugar will be low. Results from JC’s fast show that her insulin
levels were 3 times the upper limit of normal, meaning that something is causing her pancreas
to secrete too much insulin. But what could it be? Well, It’s probably not medicines because
nothing she’s been taking in the hospital would do this. It’s not her liver because it’s functioning
normally, downstream the process. It’s not performing glycogenolysis or gluconeogenesis
as a result of the high insulin presence in blood. And it’s not her kidneys since they would
filter the blood, functioning as intended in JC. Meaning there could be an overgrowth or a
tumor in her pancreas, that’s releasing insulin with no regard to the feedback mechanisms
in place. This is called an insulinoma. At this realization, the medical team orders
an abdominal MRI with contrast. Images reveal a well-defined tumor, 11 millimeters
in diameter, in the body of JC’s pancreas. Its appearance doesn’t look like pancreatic
cancer. It could be a cancer from somewhere else in
her body that has spread to the pancreas, or it could be a functional neuroendocrine
tumor, something releases hormones inappropriately. The extreme hypoglycemia. The regular pattern of neuroglycopenic symptoms. The resolution of her mental status after
correction of her blood sugar. [this is called Whipple’s Triad btw] The medical team makes a clinical diagnosis
of insulinoma as JC was sent in for surgery. Parts of her pancreas were removed along with
the tumor, as her depression medicines were tapered and then discontinued. The mornings were the toughest times for JC
because of the overnight fasting period where blood sugars are low in everyone. The unregulated release of insulin by a tumor,
made those levels even lower before breakfast. The cause of the tumor, is unknown. It wasn’t caused by her pregnancy. But the timing of this, just happened to coincide
with the pregnancy In the late term, insulin resistance builds
in the mother, which would make JC’s body less responsive to insulin. Meaning that the symptoms would be masked. But after the baby is delivered, the mother
becomes more responsive to insulin, which for JC, resulted in pronounced symptoms. This is described in several case reports
of insulinoma diagnosed during pregnancy. And this is also touched upon in the documentary
Microbirth, which you can see on CuriosityStream, who sponsored today’s video. CuriosityStream is a subscription streaming
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are completely free. The three medical related documentaries I
really enjoyed are Our Genes Under Influence, Proteom Code, and Vitamania by fellow YouTuber
Veritasium. Sign up at curiositystream.com/chubbyemu and
enter code chubbyemu. In her first doctor’s visit, JC noted that
eating carbs solved her panic, anxiety and insomnia, all of which are neuroglycopenic
symptoms, meaning she may not have had postpartum depression from the start, but we can’t
say for sure. The 20 pounds she gained in just a couple
of weeks after relaxing her diet the first time is a normal function of aberrant insulin
secretion, as it stored that excess glucose, as adipose tissue. All of this was worsened because JC was simultaneously
feeding her daughter and following a strict keto diet. In the medical world, hypoglycemia
is considered as more acutely dangerous than hyperglycemia, because low sugar can take
someone out instantly. As she recovered from the operation, her blood
sugar levels stayed within normal limits. She was able to return home in good mood. Back to her family. Back to normal life. And she was able to live the lifestyle, that
she originally wanted. Thanks so much for watching. Take care of yourself and be well.

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