Extreme Diet Survival Strategies – Jesus is for the Wounded

Who gets this?

Published on November 3, 2019November 4, 2019 by Jesus is for the WoundedLeave a comment

There have been many times when skills above being a “patient” have helped me navigate the mess that is our American healthcare system. While I am better understanding what it means to be pre-diabetic for example, I am convinced that it takes at least some college education to get the basics done! The following skills are critical.

Organization

Get lots of manila folders in January every new year and label them by categories that make sense to you. For me that means Medications/Supplements, Clinical Summaries, Insurances, Test Results, and one for any new, major diagnosis. Then I have a master notebook with the latest test results that I developed in preparation for a comprehensive evaluation at the Mayo Clinic. While most major healthcare organizations have online patient portals with all of our test results, sometimes your provider (Doctor or other skilled professional) will not be able to access them. Streamline each medical consult by having copies of pertinent reports with you at each appointment. This is particularly true when crossing over from one healthcare organization to another to see a particular specialist. GET YOUR OWN COPY of scans on DVD and go to medical records for the paper reports after each major test, test procedure, or medical procedure. Consider scanning them into Word files for when you are communicating with providers online. Searching for test results on your smart phone via the respective organization’s patient portal could be helpful but you will waste precious time with said provider. Your appointment may be over by the time you log in and access the data!

I first learned about organization when organizing ceramic molds for an occupational therapy department in a mental health hospital as a high school graduate. The patient groups ran more effectively thereafter and my supervisors were thrilled. As time went on it became clear that my love for office supply stores, blank CDs/DVDs, then little thumb drives were good things.

Put Stuff Away

For us, each year of non-medical records gets put into the same box as the same year of tax records. We keep only the past two years of tax record boxes in our home office and the rest go into the attic. After seven years the boxes can get shredded, burned, or otherwise destroyed (if we ever get around to it!). Pertinent folders relating to test results and medical conditions get filed in 4-drawer file cabinets that are alphabetized. Yes, this includes if our files spill-over into more than one file cabinet (as we have 5 of them!). A to C now takes up just one of these cabinets and may change when folders that are no longer needed will get purged. Yes, we don’t buy more file cabinets anymore; I just purge outdated information at least annually and especially when there is no more room for new records. Think it is outdated to worry about paper records? I disagree. There will always be important mail, receipts, reports, legal documents, and other pieces of paper to manage.

Any documents stored on our desktop (or laptop if we had one) should get dumped into an extra, external hard drive (our preference). These can be programmed to backup automatically weekly or to a cloud service in real time.

The importance of filing paperwork for quick access became a critical asset just 2 months ago that could serve to extend my life. I was filing some CT scan reports one weekend when I noticed that NO ONE had followed up on the finding of a new pancreatic cyst. This type of finding requires swift and specialized follow-up which began two days later. I am now in a 6-month surveillance program to make sure the particular type of cyst does not advance into cancer (that is highly fatal). Keeping-and-following good records is as important as the healthcare you seek and doing so could save your life!

Take Notes

We all probably have our favorite place to record information, whether it is on a smart phone app, calendar, daily planner, etc. The key is to be consistent: use the same method all of the time. My Mom was the queen of taking notes on partial slips of paper scattered on the back half of the kitchen counter! Her address “book” was a drawer beyond the sink filled with torn corners of paper, some tucked into the address book with a rubber band around it and some just stacked above or below it. She took out the piles each December to write her Christmas cards and vowed to update the address book before the holiday returned the next year. She never got it done. It was through these handwritten notes we combed when she passed away to make sure that important people in her life were contacted. And it was only then that I came to appreciate seeing her penmanship on pages yellowed, torn, stained, and re-used, that her system really did work for her over her entire life.

Date everything. Write down who you talked to and the phone number you called. Record the prices quoted, deadlines, and most importantly: what to do next. This way the next time you see your note-taking system on a particular topic, you can pick up and continue where the activity last ended. My Mom was an office manager and would probably find me to be a bit compulsive to include all of these data points in my note-taking and filing systems. But I submit to your that our healthcare and the complexity of life require it these days.

I learned the importance of good note-taking when trying to get some specialized cranio-mandibular care covered by any one of 3 insurance companies. I spent dozens and dozens of hours with what became a 2-inch thick folder of notes, letters, and statements accumulated over a year and a half to account for over $5,000 in out-of-pocket charges. I just knew that if some of the charges were coded correctly and sent to the correct payer, we could get such specialized care covered. I was wrong. We have received around $300 in reimbursement! I didn’t know that nearly all of my efforts would be wasted when the original provider offered to help but would not bill insurance directly . . . then did bill two of them . . . using either incorrect or out-of-date codes . . . over and over again. It was a nightmare for all of us involved.

As I write this, there’s a pile of 5 1/2 pages of billing statements, flyers, and notes stapled together and sitting next to me covered with handwritten notes regarding some new medical equipment. So the saga continues yet already I have had $20.28 in charges reversed. Along the way I asked to talk to a supervisor. Yes, I’ve learned who gets what done, aided by my 30+ years working in healthcare myself followed by 8 years of battling a serious illness and its subsequent paperwork. Organize, put stuff away (but not without looking at them first and periodically thereafter) and take notes. Then blog about it or comment below. I’d love to hear from you Gentle Reader. :JJ

Bacon as a way of life

Published on May 3, 2015October 26, 2015 by Jesus is for the Wounded2 Comments

So my beloved says to me, “look at how far you have come,” related to my diet. Indeed. When we first met I was eating gluten-free, low sugar and fat, largely organic, and sweetener-free, and dairy-free foods. I cooked a lot and was very particular what I ate at restaurants, often bringing my own nuts or dressings. Supplements? Yeah, in due time with my new doctor at the helm my pill box burgeoned to over 60 doses of something per day! Then part of the story got crazier . . .

As severe illness set in, the supplements would change and almost disappear as time went on. I could not tolerate any supplements at all after a brief hiatus required during overnight testing at the Epilepsy Center, University of Indianapolis Methodist Hospital. By then I had added a low oxalate and Candida diet too. After A YEAR on all of this with daily bone broth too, my brain fog cleared and my gut started to heal. They say that 95% of your immune system is in your gut. Perhaps part of your brain health is there as well? (Now that last part could lend itself to some embarrassing teasing if I stay here too long. Let’s move on!)

When dental pain increased, my nutritional sustenance all went into the VitaMix for about 6 weeks. I became the master of the pureed diet and many soups, sauces, smoothies, etc. My gut health slowed yet the convulsive episodes triggered by chewing diminished. Gradually I got back to a chopped diet which is where I remain, 4 weeks post surgery for the extraction of two root-canaled teeth. Healing continues. It is wonderful to be able to chew better!

Then the convulsive episodes that had diminished some returned to their prior level: 2 to 5 hours per day. So sad. Over three years into this time of serious illness and still no one has figured out how to stop them. I fasted for 24-hours, drinking only water and praying when my brain cells fired in the right direction. The episodes stopped. As intense hunger pangs overtook my weakness I decided to break the fast with an apple: easy to digest and surely a boost to my low blood sugar. I did not expect what followed. One of the most violent types of convulsive episodes started my beloved hubby out of a sound sleep and sent me into an enlightened frenzy. Enlightened? Yes, this episode was triggered by glucose!

That night and the days thereafter I quickly ventured into a ketogenic diet. I found a couple of Facebook Groups on the subject and the App they recommended to get me started. A few days into the new direction a gal from one of the groups contacted me to clarify something: was I using the diet for weight loss or medical reasons? The grams of protein/carbohydrates/fats or “macros” are different with each type of ketogenic diet. For both programs a person consumes very little carb grams yet for weight loss you eat more protein than fat; for medical ketosis to occur you must focus on more fats than proteins. But it is in consuming very little carbs (I eventually got to 21 total grams) that the body is forced to utilize fats for energy instead of carbs. The body then produces ketones that can often be picked up in a simple urine stick test or special blood glucose meter that includes ketones. Ketones are hypothesized to stop or reduce seizures and may even help treat dementia in the elderly.

This week I reached ketosis. My breath got bad and another tell-tale symptom appeared that is too much for even the transparency of this blog post! It took me three weeks to get here and it could take a minimum of 2 months, usually 4-6 months, to see if the ketogenic diet will help me at all. I am willing to try. Heck, I already have a very restricted diet anyways. And who doesn’t like (uncured, unsmoked) bacon? The MyFitnessPal App is a gift from the Lord in managing this. I would recommend it and their Facebook to everyone on a diet where a person must track macros.

So how about the blessings in all of this? Surely there were some? Indeed Gentle Reader. You know me well! You see I researched the ketogenic diet two years ago and periodically thereafter but could not find a local neurologist or dietician to guide me. Close medical oversight including lab tests every three months are needed in addition to the periodic self-monitoring via urine or blood sticks. Help has arrived just at the right time. Briefly, check this out:

My first week venturing into the food plan, the gal who messaged me off Facebook just happened to be a retired nurse from the neurosurgery center at John Hopkins Hospital in Baltimore. She manages her own true epilepsy in part with this diet. Did you know that the only medical center in the USA with a dietary research and treatment center for adults with epilepsy is at John Hopkins? I knew that and was ecstatic to spend that first Saturday night receiving mentoring from my “guardian angel” named Vicki. Thank you Lord!

Around this same time I researched a foundation known to assist children with true epilepsy. Maybe they would have some new information? Oh yeah, a medical center close to our home in a smaller town had just hired a dietician to work with children and adults in all aspects of the ketogenic diet. She had recently attended a conference with the Charlie Foundation and was added to their list of practitioners the week before! She manages all of the referrals, orders for lab tests, and consultations. And Mary is very sweet to boot. Wow, Lord.

In many ways, in many long and exhaustingly arduous ways, this new treatment direction could be one more bunny trail in the quest to recover from this wretched illness. O.k. Poor me baby. Well then again, maybe not. Sometimes you have to do more than one task to completely recover from a serious illness. Remember the phrase, “recovery is a jagged line?” The Ann Landers column about life being about the journey and not the destination? The gratitude I feel in my heart for having met you Gentle Reader? All of the computer skills I have learned about everything from ecommerce to social media? The deepening of my relationship with Christ? The revelation of the Godly character of my beloved husband? And the fact that I did not die in all of those near-death experiences? On this day I must say that I have seen the faithfulness and blessing of the Lord at some level every single day of the past 3 1/2 years. His promises have seen me through and rung true every single day. I will leave you with my fav promise from another time in my life of refining fire (and a side of bacon too please, crispy as in nearly burnt. I like it that way!) Take care, JJ

Jeremiah 29 11, Jeremiah, hope and a future, hope, plans, trust in the Lord, Christian hope, encouragin scripture, faith, ketogenic diet, chronic ilness, Christain and disability, Hope Beyond, Julie Horney — Jeremiah 29:11

LOD, GF, SF, LDF, MF Smoothies CAN Be Done!

Published on February 26, 2015October 26, 2015 by Jesus is for the Wounded1 Comment

When faced with extreme dietary measures, the faint of heart may indeed faint. And so did I initially! Now I am 5 days into a necessary pureed low oxalate, gluten-free, sugar (sweetener)-free, largely dairy-free, mold free diet and still alive. Cool beans. But without the beans of course!

Such is life when faced with the reality of dental issues triggering convulsive episodes. What’s an occupational therapist on an extended leave to do about that? Well, adapt and carry on! So carry over your best mega-blender (favoring the Vitamix) and get it screaming. This is going to be LOUD.

Notes: these recipes lack sugar, sweetener, and most seasonings that “normal” people would add to make these foods taste better. Persons not on a low oxalate diet will probably use almond, rice, or boxed coconut milk in place of the coconut milk listed. Add these to your own taste. The liquids always go in first; frozen foods are last. Flavors generally intensify, especially when “cooked” in the blender at high speeds. That generally translates to limiting the number of veggies or fruits as things can taste really weird with too many ingredients. Adding avocado or cucumber can be o.k. for fruit smoothies if you add a little more fruit. If you can, “chew” the liquid as you consume it to stimulate salivation; saliva aids in digestion and chewing helps you to feel more satisfied. Lastly, I have not had much luck freezing completed concoctions. However, I have had great results freezing small portions of yogurt and coconut milk: when allowed to thaw some first, it seems to thicken fruit smoothies nicely!

Smoothies

Start with 4 oz. grass-fed plain yogurt (vanilla coconut or almond yogurt) and 4 oz. unsweetened coconut milk (canned or Caila Farms) in the bottom of the blender.

Add 1/4 cup frozen strawberries or blueberries.

Pour in your favorite protein powder: 3/4 scoop Whey to Go Lactose-Free Protein Powder.

To make the smoothie more sustaining, add up to 1/2 avocado, 1 T. oil (avocado, grapeseed, or other organic oils. No olive oil here!) The avocado also makes it very creamy without altering the taste or color.

Add whatever seeds, wheat germ, or nuts you can tolerate: 1 T. raw pumpkin seeds, 1 t. wheat germ. If you have a yucky-tasting supplement you are taking, throw it in too!

Blend until smooth which is usually 1-2 minutes. Note that you may need to turn the blender on and off, tamp down the frozen fruit to keep it in contact with the blade, or add larger strawberries one-at-a-time to protect your unit. To make it thinner, add more liquid or blend it longer. As with all of these recipes, use a spoon (or your fingers) to get all of the smoothie out of the blades, nooks, and crannies at the bottom of the Vitamix. This stuff is gold and none should go to waste!

Soups from Leftovers

Place 4 oz beef (bone?) broth, about 1 1/2 cups of beef stew (or similar leftovers such as casserole), and about a cup of a single vegetable (if none are in the beef stew/casserole) in the blender. Last night I added about 3/4 cup of frozen peas. Yes, the smoothie was green but when hungry, you will close your eyes and get over that quickly!

Add at least 1/2 t. sea salt and don’t be surprised if you need more to make it taste better. Soups are generally pretty salty foods.

To make the soup more sustaining, add 1 T. ghee/organic butter or oil (avocado, grapeseed, or other organic oils. Olive oil is o.k. here if you like and are not LOD or MF.)

Blend for about 7 minutes or until the mixture is pulverized beyond recognition, heated, and steaming when you open the lid. Thicken if needed with 1T. potato or corn starch. Add starch in small batches after the mixture gets warm as it will thicken quickly!

This recipe might need less blending time if all of the vegetables are pre-cooked. Taste with a spoon and adjust seasonings. Give it a “cream of ____” name and enjoy in a mug or with a spoon in a bowl. Or begin again with broth, salt, leftover potatoes (or other vegetable), a few roasted leeks or onions and about 2 T. plain yogurt for a yummy potato soup! People pay big bucks for this type of delicacy at fancy restaurants you know!

Soups from Raw or Frozen Ingredients

Place 4-8 ounces of meat (or veggie, bone?) broth and half as much unsweetened coconut milk into the blender. Add at least 1/2 t. sea salt and don’t be surprised if you need more to make it taste better. Soups are generally pretty salty foods.

Add 4 oz. of cooked meat: Low Sodium Boar’s Head turkey breast has no preservatives or spices; small chicken breast or larger thigh, 5 0z. can of cooked chicken breast, trimmed & cubed pork chop, etc.

Top with about a cup of 1-2 types of vegetables that taste good together and are not both green in color! Frozen veggies in smaller pieces are easier on your blender, of course. Mixed vegetables usually don’t taste very well IMO as there are just too many flavors!

To make the soup more sustaining, add 1 T. ghee/organic butter or oil (avocado, grapeseed, or other organic oils. Olive oil is o.k. here if you like and are not LOD or MF.)

Note that you may have turn the Vitamix on and off, tamp down the ingredients, or add the frozen ingredients slowly to protect your blender. Blend for about 7 minutes total or until the mixture is pulverized beyond recognition, heated, and steaming when you open the lid. Thicken if needed with 1T. potato or corn starch. Add starch in small batches after the mixture gets warm as it will thicken quickly! If it tastes bad, add more salt (or seasonings if you can, especially onion and garlic). Follow with labeling it a gourmet name as noted above.

Breakfast!

I generally eat either dinner leftovers or a meaty dish for breakfast so I have limited ideas for what might taste o.k. for the rest of the world! In general, gluten-free instant oatmeal is softer than slow-cooked and can be made heartier with 1 t. of ghee/butter, mashed fruit, 1 scoop of Whey to Go, and powdered nuts/seeds/wheat germ. I have pulverized very crispy bacon to a powder and added it for a fabulous and blood-sugar sustaining oatmeal in the middle of the night! Remember to add the whey or protein powder LAST and after cooking; it cooks to an almost scary, crunchy brown texture in when microwaved! (White rice) grits would probably also work well with ghee/organic butter.

*************

Well there you have it: my survival plan until I can get some teeth pulled. This will also be my menu right after the dental

procedure as well. Thank the Lord and my Intended Beloved for the gracious gift of a Vitamix years ago! Steve spoiled me one Christmas with a reconditioned unit and we have used it most days of the week since then. See how the Lord is sooooooooo good to me?

Time for some more soup . . . :JJ

If I get to see you . . .

Published on January 16, 2015January 18, 2015 by Jesus is for the WoundedLeave a comment

If I get to see you in the coming year, please understand that I will be singing songs of joy in my heart! Social isolation has been one of the most devastating effects of serious illness from these past 3 years. Should the Lord allow the circumstances for me to get out for an activity other than medical or a trip to the grocery store, I CELEBRATE!!!

So if I might ask for a few accommodations when we get together and you graciously oblige and I still get sick then blame any negative symptoms you may witness in me as the consequence of illness and not you! Very few folks live in a “clean room” like we have here at home. I did not clean at this level either until it was a matter of survival. Steve did not engage in my extreme mold/contaminant behavior strategies until two years ago. These strategies are necessary for this season of our lives together. Overall I do better when we follow certain guidelines resulting in less reactivity, the worst of which are fewer seizure-like and convulsive episodes which continue daily. We are implementing some “due diligence” from what we have learned to reduce my suffering with the goal of eliminating this illness altogether. We believe that the Lord has allowed these trials for mysterious reasons and ultimately His glory. He is good!

Both Steve and I recognize that there are definite signs that I am getting better. We have trained our eye to search for even tiny changes in the pattern and intensity of episodes, pain, and reactivity to keep us hopeful that one day I will be well. It is happening! So please don’t be discouraged when either one of us might mention that I had a rough night or you witness a significant setback. Recovery is a long, jagged line of progress, setbacks, and lateral “bunny trails.” The overall trending is positive!

The most important accommodations that would be helpful if we get together are as follows.

Meeting in a public place: Select a place with less noise and less loud music. Newer buildings are generally better than older ones; please no historic buildings or ones with known basements or crawlspaces and history of flooding. Restaurants that make their own food with fresh ingredients are better able to modify dishes to meet my food sensitivities. This rules out most fast food places! Letting me know the name and phone number of the establishment ahead of time will allow me to contact them with my needs and make the experience of ordering food more pleasant for both of us! Please do not wear cologne or perfume that day. I will need to greet you and depart with a “virtual hug” to avoid exposures to hidden elements that might be on your clothing or coat. Forgive me if I sometimes forget this step in the joy of the moment when I see you!

Meeting in your home: This is still a situation that I avoid since there are too many variables at this time that may cause serious problems. I cannot come over if you have 1) ever had flooding in your home of any kind from a leaky toilet to a wet basement or 2) have older carpeting. If you are willing to have me then please remove all fragranced products at least the day before we are scheduled to be together (such as plug-in or spray air fresheners, candles whether lit or not, potpourri, etc.) Keeping windows cracked open in cooler weather or open in warmer weather to allow fresh air inside always helps (unless someone is burning something nearby outside!) I prefer to visit in the area of your home without carpeting and sit on non-upholstered furniture. Wood, plastics, and leather are best.

Staying overnight: If we are invited to stay overnight then we will either bring our own linens, blankets and towels, or ask that you wash and dry everything in fragrance-free detergent and softeners (including dryer sheets). Please replace a moldy shower curtain liner with a new one! I will bring most of my own food and hand soap where possible. Providing non-cured, non-smoked meat cooked only with salt, plain oatmeal, plain salad-type vegetables or zucchini/cauliflower without seasonings will be a HUGE treat! I will always bring the extra condiments and food that I can tolerate.

Yeah, I know that this is a lot for a busy household to prepare! Thank you for helping us out with this stuff. Steve and I are exceedingly grateful to have recently obtained a travel trailer which has helped manage all of this tremendously well. (It is a lot of work for us too, I tell ya!) Both of our families and many close friends now live out of State so travel is necessary to see them. This single change in our mode of travel has allowed me to leave our home overnight much more safely and go places from which I have been cut off for most of the past three years. We are humbled and blessed! I really like having a mobile safe house that has already opened up my world, provided privacy during setbacks on the road, and aided sleep with a really comfortable bed that can be hard to find when away from one’s own humble abode at home. Thank you Jesus!

Visiting Daniel and Elizabeth in Alabama

We are hoping that the ongoing extreme avoidance and dietary strategies are temporary; some level of precaution albeit more relaxed than the current level will likely continue for some time. How long will we need to do all of this? We simply do not know. We believe the Chronic Inflammatory Response Syndrome (or Multiple Chemical Sensitivity) is due to mercury toxicity and we finally have the correct treatment protocols to get me well. I have excellent medical guidance and a proven treatment plan to follow. We are hopeful that I will be in better health within this year! I AM GOING TO GET WELL!!!

And that Gentle Reader, is much to celebrate! JJ

Start with what you can eat . . .

Published on August 23, 2013October 26, 2015 by Jesus is for the WoundedLeave a comment

Special diets can be maddening, time consuming, expensive and an all-around bite in the shorts (if you know what I mean)! Instead of stressing, I apply a few basic food prep principles, start with what I can eat, and whip something up from there. After a few weird entrees and sauces, things will start to taste more palatable and even kind of good as you gain confidence. Who needs recipes anyways?

My husband went shopping at a big box store this evening for basic groceries including grated cheese, fruit, a few veggies, and the only meat I’ll buy there for a rare convenience: canned chicken. Since I haven’t been able to shop very much lately, preparing dinner tonight required some very special creativity! Gratefully there were onions and cabbage from our garden in the frig, a loaf of multi-grain bread in the freezer for hubby, some sliced almonds in the pantry and a few other staples here or there. Now to make a gluten/dairy/sugar free meal plus a full flavor meal for the two of us . . .

His and Hers Salads began with Canned Chicken!

Not bad, eh? Gratefully it was yummy! The base started with spring greens in both bowls with oven toasted almonds (sprayed with grapeseed oil, sprinked with celtic salt and roasted about 7 minutes in the oven at 350 degrees, stirred once halfway through the baking time). The chopped chicken salad-and-vegetable mix included all the veggies we now had in the house: cucumber, cabbage, radishes, onion, and the canned chicken.

For Him: I garnished the ceramic bowl and base of salad greens with sliced pears and grated cheese. I made a 1/3 batch of homemade mayonnaise in the Vita-Mix using sunflower and olive oils instead of GMO-laden canola oil listed in the recipe. (Yes, here’s the one exception: ya gotta follow a recipe exactly from the Vita-Mix manual for mayo to turn out right!) I mixed the mayo with half of the canned chicken-and-vegetable mix and dolloped it over the cheese and spring greens. He got a topping of toasted almonds with a little extra dressing on the side, just in case.

Basic Parmesan breads: I thawed and sliced a loaf of multi-grain bread about 3/4 inches (2 cm) thick and placed them on a cookie sheet lined with foil and brushed with melted butter. I brushed the tops of the bread liberally with butter then sprinkled on some parmesan cheese. (For garlic butter, sprinkle some garlic powder or chopped garlic into the cup before microwaving the butter, about 23 seconds.) Broil on low for about 6 minutes checking it often near the 6 minute mark. I find that the low setting allows the pan to heat up and toast the underside in addition to both melting and browning the cheese on top.

For Her: I garnished the ceramic bowl of spring greens with a non-cheese alternative (e.g. Goya shredded mozzarella). Next I made a dressing with almond butter, unsweetened. coconut milk, Mrs. Bragg’s Liquid Aminos and a pinch of celtic sea salt. This requires some minimal adjustments for taste and consistency. Then I placed the other half of the plain chopped chicken salad-and-vegetable mix on top of the remaining bowl of spring greens and poured the almond coconut dressing of it, mixing it into chopped salad slightly to coat it. I finished it off with a topping of toasted almonds as well.

Sure, this meal took a little extra time to prepare and it was worth it. To make it even more worthwhile, during the assembly phase of this meal and next to the ceramic salad bowls were two large plastic containers that are not pictured above. I made duplicate salads with every ingredient listed above except the sliced pears (since they would turn brown by lunchtime tomorrow). So we not only had a yummy dinner tonight but will look forward to a “repeat performance” for lunch tomorrow! I usually make dinner this way: setting out the storage containers for lunch and serving them up right alongside the dinner plates to save time the next day. Cool beans.

That’s it! And it’s not all bad following a protein-oil-vegetable diet, with a tiny bit of optional, extra carbs from the cheese substitute, when it tastes good too. ‘Twas tough avoiding the cheesy breads I must confess . . . ;J