Listen to Jimmy and me answer rapid fire KetoTalk Mailbox questions for a solid hour on our most recent (released today) KetoTalk podcast #14 (available on iTunes). This was a fun podcast. I hope you enjoy it as much as I did recording it.
Let me know what you think.
Maria’s Quick & Easy Ketogenic Cooking: Meal Plans and Time Saving Paleo Recipes to Inspire Health and Shed Weight
Check them out!!
“Doc, how do I get six-pack abs?”
I get this question almost daily. Sorry to burst your bubble, but there is NO exercise program that will give you “six-pack” abs.
Really. You can do sit-ups, leg lifts and crunches ’till the cows come home and it will do nothing other than give you abdominal cramps. It will also make you hungry. I don’t care what Men’s Fitness, Bodybuilding.com, Muscle Magazine, Shape or even Doctor Oz said. There are no “6 Best Exercises for Ripped Abs.” There is only one exercise . . . throwing the carbs in the trash (or giving them to the neighbor you don’t like.)
The “12 Step Ab Program” really only has ONE STEP . . . cut the carbs. Let me repeat that. There is only ONE STEP to “six-pack abs,” . . . cut the carbs. Cardiovascular exercise does nothing for amazingly toned abdominal muscles, other than make you hungry. Resistance exercise improves insulin resistance, but doesn’t build the abs. Avoiding the milk, rice, wheat, oatmeal and fruit allows the abs to appear. Yes, I’m serious. What do bears eat? Berries.
When did you last see the a bear with “six-pack abs?”
The only way to see your “six-pack” is to remove the fat covering your “six-pack.” The only way to get rid of fat covering your “six-pack” is to stop drinking it and lower the carbohydrate content to less than 20 grams per day. Seriously . . .
So you’ve done 100 crunches a day for six months? Do you see your “six-pack” now? Exactly.
I’ve said it before and I’ll say it again. Insanity is doing the same thing over and over and expecting a different result.
Follow the principles outlined in my past articles like The Principle Based Ketogenic Lifestyle . . . Part I & Ketogenic Principles . . . Part II and make sure you are avoiding Common Ketosis Killers.
Staying in ketosis and adding 2-3 days of resistance training will melt 2-5 lbs of abdominal fat away each month. Yes, I know it is slow . . . but that is weight (fat) that will stay off. Use whole foods high in fat, moderate in protein and low in carbohydrate. Use supplements like Keto//OS & Adapt bars to help when you don’t have access to a good meal or as a snack when you are hungry. Look at the list of Low Carb Links above to get great ideas for meal preparation and sweeteners that you can use.
How we look at lifestyle choices can often be from very different perspectives and those perspectives powerfully influence our diets. Oh, by the way, today is National Pig Appreciation Day. You probably didn’t know it, but the holiday celebration was started in 1972 by sisters Ellen Stanley, a teacher in Lubbock, Texas, and Mary Lynne Rave of Beaufort, North Carolina. According to Rave the purpose of National Pig Day is “to accord the pig its rightful, though generally unrecognized, place as one of man’s most intellectual and domesticated animals” (1).
“Why would you even think about this stuff?” you may be asking yourself. I specialize in ketogenic diets, using fat to treat disease, lower cholesterol, reverse diabetes and lose weight. Yes, you could call me a “fat doctor.” Bacon is approximately 45-50% fat and so, this specially cured super-food is one of those “wonder foods” that helps cure disease in the ketogenic world.
I had the opportunity to attend a low carbohydrate/ketogenic dietary medical conference this last weekend. The world leaders in Low Carbohydrate, High Fat, Ketogenic diets from every corner of the globe all gathered together in Colorado to share knowledge about treating the diseases of civilization with diet.
The underlying theme was a focus on the use of fat and protein with more effectiveness. Even among “those who know,” opinions differ as to how much fat and how much protein. I find it interesting that if you have a conversation with three doctors all together in the same room, you will end up with five opinions. However, the cause of weight gain that we all agree on is excess production of insulin. Increased insulin in the blood causes fat storage. Weight gain is hormonal.
Wait . . . let me say it again. We gain weight because of hormones, not because of over consumption of calories.
We have known for many years that carbohydrate restriction is so important for turning off the hormone signal to store fat (see The Dreaded Seven . . . Seven Detrimental Things Caused By High Insulin Loads). In my office, I recommend starting at less than 20 grams of carbohydrate per day. This level of restriction seems to be most effective for most of my patients beginning the ketogenic lifestyle. If you’re new to ketosis and/or low carb diets see my two articles about the principles of the Ketogenic Lifestyle: The Principle Based Ketogenic Lifestyle . . . Part I & Ketogenic Principles . . . Part II.
The magic that most people never realize is that in order for fat to become therapeutic in treating the diseases of civilization, you must increase your natural fat intake to greater than 50-60% of your total caloric consumption per day and lower your carbohydrate intake to less than 20 grams per day. However, even when carbohydrates lowered or eliminated, I still see a number of patient’s who hit plateaus with their weight. They often tell me that they are “strictly following their carbohydrate restriction,” and I believe that they are truly trying. However, the lab work that we do regularly usually tells another story. You see, inflammatory markers and hormones don’t lie. Insulin is a hormone that directly stimulates markers of inflammation. Carbohydrates are not the only things that stimulate insulin.
If you are struggling with weight loss plateau’s, keep a food journal. If you tell me what you eat, I’ll tell you why you’re gaining or not losing weight. Things that stimulate insulin and/or inflammatory response:
Lab markers implying high insulin response or inflammation:
If your weight is plateauing, the lists above will give you a starting point. I recommend you follow up with your doctor, someone who can help tease out the subtle causes of plateauing weight loss.
While at the conference, I also got some great in depth education about using exogenous ketones like Keto//OS. I’ve been watching their use from the periphery for quite some time. My interest has been peaked in the last few months as I have seen some significant successes with their use. In fact, I tried them out while skiing with my son at the conference. This 46 year old found he could keep up with his son due to increased energy, greater clarity of thought and appetite suppression while using them, as well as enhanced ability to maintain ketosis throughout the three days that I tried them out. The benefit of using exogenous ketones can also be found in a fuel source that doesn’t increase insulin, and has some documented effect on re-balancing bacterial colonies in the gut. If you’re interested in using them for your ketogenic lifestyle (yes, this is the shameless plug for one of the supplements that I personally use), click on the image below.
I also tried using a new ADAPT high fat bars and fat shots. These are a great option for high fat replacement or supplementation without all the “carbage.”
Both products are fantastic options to add to the ketogenic lifestyle for the elite athlete or the busy mom who just needs a quick ketogenic snack while at her son’s soccer game.
See this evenings Periscope video about National Pig Appreciation Day and my answers to a number of burning ketogenic questions from around the world:
(Proceeds from affiliate sales go to covering the cost for continued great content here on DocMuscles.com)
References:
Yes, that’s what I said, “impossible” only means you haven’t yet found the solution. That is the 5th Lifestyle Rule. Nothing is impossible.
I’ve been thinking about impossible today because I re-read one of my favorite stories in the New Testament found in the 17th chapter of Matthew. It is one of my favorites, for a few reasons, which I will point out, but it brings all of the elements of a ketogenic lifestyle together in a light which overcomes impossibilities. The story, found in verses 14-21, present a father who brings his son to Christ’s disciples to be healed from a disease they called “lunatick,” a presentation that strongly resembles what the modern day physician might interpret as a seizure disorder, epilepsy or even a form of autism, and a pretty severe case according to the record.
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The Holy Bible
Get your searchable edition of The King James Bible available for handhelds, desktops and laptops that includes the Old & New Testaments, a wonderful tool to keep the scriptures at your fingertips. |
Christ’s disciples are unable to cure him, and Jesus requested that the young man be brought to him. Upon seeing the child, Christ “rebuked the devil and he departed out of him,” (1) and the child was immediately healed. (My intent here is not to discuss the literal or figurative religious meaning of what actually transpired, but to discuss the “how” of possibility). Later, the disciples of Jesus approach and ask him why they didn’t have the ability to heal the young man.
Christ’s response was one that has always fascinated me. He said, “. . . this kind goeth not out but by prayer and fasting” (2). If find it fascinating because, first, he implies that a sense of the possible is obtained through prayer and/or meditation, an expression of one’s faith (I address the need for belief, faith and/or meditation here in the Psychology of a Ketogenic Lifestyle). What is even more amazing to me is that epilepsy is very effectively treated today by a ketogenic state, a metabolic state that is induced by fasting, the second part of his answer. This second piece has been the one that I have been pondering for many years. How does a state of ketosis unlock the impossible? (see The Principle Based Ketogenic Lifestyle – Part I & Ketogenic Principles – Part II)
I was told in medical school that diabetes mellitus was not curable, yet I now have multiple patients, once diabetic by medical standard, who now no longer fit the definition of diabetes. It did not happen over night, and in most cases took over two years, but that’s where the faith took place. They reached this state of health through their faith that it was possible, and the continued physical induction of ketosis.
For many years the world was “flat” . . . or was it? For the last 50 years “eating fat makes you fat” . . . or does it? Impossible is just a word used by those who don’t know the solution.
We often refer to the overcoming of impossibility as miraculous, and rightly so. But I find it interesting that the formula, written in a 2000 year old text, is applicable today. What I take this to mean is that health is more than just a diet.
It is for this reason that I refer this approach as the Ketodynamic Lifestyle. It is one that requires the involvement of not just the body, but the spirit and the mind. Because, as I said, nothing is impossible.
References:
I am a family physician. Each door I open holds another challenge, another question or another puzzle. You never know what will be behind door number 2 or number 3. This leads to becoming very adept at understanding and thinking about the random. Door #1 one holds the rash. Door #2 holds the patient with diabetes. Door #3 . . . rectal bleeding. Yes, my morning often starts out just that way.
While randomly thinking about the randomness that my career choice brought to my life, I’ve made a few random decisions that relate to our health in general.
First, if I ever decide to buy a toilet paper roll company, I’ve already made the executive decision that each piece of paper on the roll needs the opportunity to express itself in a random way. One piece would say, “Nice fingernail polish.” Another would say, “Wow, you have a nice bottom.” A third would say, “Please don’t apologize, brown is my favorite color.” A fourth might say, “You know, you really should see your doctor about that . . . ”
Second, if I live until I’m 70 years old, I will have spent 10 of those years on Monday. This calls for sausage and eggs for breakfast every Monday morning. Wait, I’m already doing that . . . no wonder I like Mondays. It also means that if I set my clock to wake up earlier on the weekend, then Monday morning I will start the week off “sleeping in.” It is amazing to me that even under ideal conditions people have trouble locating their car keys in a pocket, finding their cell phone, and even pinning the tail on the donkey . . . but I’d bet everyone of us can find & push the SNOOZE button from 3 feet away, in about 1.7 seconds, eyes closed, first time, every time…
Third, with all of this randomness . . . someone needs to invent the “Sarcasm Font.” There are some things that shouldn’t be written in “Times New Roman.”
Fourth, Can I take back all those times I didn’t want to take a nap when I was younger? I am quite convinced that a significant number of my obesity patient’s would be so much more successful with an afternoon nap.
Fifth, in the age of computers, voice recognition, iPhones and electronic medical records, I really want to meet the person that invented cursive and ask, “Was that really necessary?”
Sixth, in this new era of reality everything, I think that print newspapers would still be fascinatingly successful if the obituary column told you how the person died.
Seventh, with all the high fat, moderate protein I recommend, the freezer has become an important appliance in the ketogenic world . . .yet no one can answer me this question: “Why is there still no freezer light?”
Last, bad decisions often make for the best stories. . . .
It’s been cold this winter and as I was lighting a fire in the fireplace, a thought crossed my mind.
Why is it that only one match seems to start a forest fire, but it takes the whole box to start a campfire?
So, thinking back to my Boy Scout days, I began walking through the process of what it takes to get a good warm fire going. As a Boy Scout while camping in the snow, we used to have contests to see who could, using a single match, start the fastest camp fire. (We would use our most “MacGyver-like” skills). It occurred to me that the same timeless principles that allow one to ignite a fire with a single match are the same principles necessary for “fat burning.”
Maintaining ketosis is much like starting a campfire. There are some basic principles you need to understand. First, too much fuel keeps the fire from starting and too much carbohydrate or too much protein keeps the body from shifting into ketosis. Starting a campfire with a single match requires very fine thin strands of tinder to get started. If the peices are too big, the fire is smothered and cannot get started. It is the same with ketosis. Too much carbohydrate or protein smothers ketosis. You can get a copy of my ketogenic diet through registration on my membership site, by seeing me a patient face to face in the office or through a Tele-Medicine visit.
Second, oxygen is essential. For a fire to start, the flame needs a very small piece of fuel (wood or dryer lint) and large amounts of oxygen to burn. In ketosis, you have to provide the fat. If you’ve removed the carbohydrates and moderated the protein, but not provided enough fat to ignite the ketones, the body thinks it is starving, produces stress and shifts into making it’s own form of glucose for fuel through the process of glyconeogenesis (see my articles on why chicken salad makes you fat, and why your oatmeal is killing your libido).
Third, campfires often don’t have enough heat to get started. You have to get the temperature up before the wood can catch fire. This can be done in the camp fire by making a “cabin” the tinder can sit on and then building the “cabin” around the tinder as the fire builds and the heat increases. The increased heat and oxygen from under the tinder allows the larger pieces of wood to ignite and stay lit. In a ketogenic diet, the use of real food is similar to the cabin. Providing real food sources, instead of processed shakes and bars, allows for all the natural vitamins and minerals to let the ketosis start and ramp the metabolism up. Providing the correct vitamins also allows for the metabolism to have the ability to ramp up ketosis. I designed the KetoEssentials Vitamin specifically for this reason.
So, there you have it, the Paradoxical Effect of Fire and of Fat.
You can see today’s Periscope discussion on this topic below:
“But I don’t understand why I still feel this way . . .”
I hear this every day.
Sometimes we have to dig deep for the answer, sometimes it’s just the act of listening that helps us find the answer and sometimes it’s the nail staring us right in the face. We often don’t want to recognized patterns in our lives that adversely affect us because we’ve become comfortable with those patterns.
Is that piece of toast, that piece of fruit, that creamer in your coffee, that bowl of cereal or is it really the nail?
Sometimes, you don’t need to be fixed . . . you just need to be heard.
On this evenings PeriScope video we talked about cholesterol. And, and you can see an updated, in depth discussion about cholesterol on my YouTube channel here. Please go check it out and if you find it helpful, please follow me here and on YouTube. The is the burning question on everyone’s mind who starts a Low-Carb, High Fat or Ketogenic Diet: “What will happen to my cholesterol if I lower my carbohydrates and eat more fat?”
The answer . . . it will improve!
How do I know this? I’m an obesity specialist. I specialize in FAT or lipids (to put it kinder scientific terms). To specialize in fat, one must know where it came from, what it’s made of and where it is going. And, this has been the case with every single patient I have used this dietary change with for the last ten years, myself included.
Lets start with the contents of the standard cholesterol or “Lipid Panel”:
The first problem with this panel is that it makes you believe that there are four different forms of cholesterol. NOT TRUE! Actually cholesterol is cholesterol, but it comes in different sizes based on what it’s function is at that moment in time. Think of cholesterol as a bus. There are bigger busses and smaller busses. Second, triglyceride is actually the passenger inside the HDL and the LDL busses. And third, Total Cholesterol is the sum of the HDL, LDL, as well as ILDL & VLDL which aren’t reported in the “Lipid Panel” above.
The fourth thing that this panel doesn’t tell you is that HDL & LDL are actually made up of sub-types or sub-particles and are further differentiated by weight and size.
For our conversation, we need to know that the number of LDL particles (LDL-P) can actually be measured in four different ways and these measurements have identifed that there are three sub-types: “Big fluffy” large dense LDL, medium dense LDL, and small-dense LDL. Research has identified that increased numbers of small-dense LDL correlates closely with risk for inflammation, heart disease and vascular disease (1).
If you’ve been a follower of my blog for a while, you’ve seen this picture before. This picture illustrates why an LDL-C (the bad cholesterol measurement) can be misleading. Both sides of the scale reflect an LDL-C of 130 mg./dl. However, the LEFT side is made up of only a few large fluffy LDL particles (this is the person with reduced risk for heart disease) called Pattern A or a LDL healthy cholesterol level. Even though the LDL-C is elevate above the recommended level of 100 mg/dl, the patient on the left has much less risk for vascular disease (this is why you CAN’T trust LDL-C as a risk factor).
The RIGHT side of the scale shows that the same 130 mg/dl of LDL-C is made up of man more small dense LDL particles (called “sd LDL-P”) with a Pattern B type that is as increased risk for heart or vascular disease. This is where the standard Lipid Panel above, fails to identify heart disease and it’s progression.
Research tells us that the small dense LDL particle levels increase as the triglycerides increase. And we know that Triglyceride levels increase in the presence of higher levels of insulin leading to a cascade of inflammatory changes. Insulin is directly increased by the ingestion of simple and complex carbohydrates. Insulin also increases with the ingestion of too much protein. So, that chicken salad or the oatmeal you ate, thinking it was good for you, actually just raised your cholesterol. If you are insulin resistant, your cholesterol just increased by 2-10 times the normal level (see my article here on how insulin resistance causes this.)
“Ok, but Dr. Nally, there are four different companies out in the market measuring these fractional forms of cholesterol. Which one should I choose?”
There are actually five different ways you can check your risk.
In regards to screening for cardiovascular risk, the use of all five approaches are more effective than the standard lipid panel. However, I have found that clinically the NMR Lipo-profile or the Cardio I-Q Ion-Mobility tests are the most useful in additionally monitoring insulin resistance, inflammation, and disease progression.
It is was the use of these tests that demonstrated to me the profound effect of carbohydrate restriction and ketogenic lifestyles on vascular and metabolic risk. We talk more about these tests on my YouTube video .
Hope this helps.
References:
We have been taught for over 50 years that the minimum carbohydrate intake necessary to maintain health is 130 grams per day, with the average diet of 2000 calories per day containing around 300 grams per day based on 1977 recommendations that 55-60% of are dietary intake should come from carbohydrates. This value was initially established during World War II by a committee of scientists tasked with determining dietary changes that might effect national defense (1). These “guidelines,” originally called the Recommended Daily Allowances (RDA) and accepted by many as the gospel truth, have been modified every ten years and in 1997 changed to the Dietary Reference Intake (DRI). However, the recommended carbohydrate values have not changed other than “avoiding added sugars” in the most recent 2015 recommendations.
In light of the fact that there are NO actual diseases caused by lack of carbohydrate intake, most dietitians and physicians still preach the carbohydrate dogma originally outlined by the RDA. I say dogma, because these recommendations are based on a diet that vilifies fat, particularly animal fat like red meat. Say the words “red meat” around a dietician these days you’d think Voldemort (“He Who Shall Not Be Named”) had returned.
I bring up the carbohydrate quandary because it is a question that I am asked every single day. The question that seems to be asked of me, more and more, is what exactly is a carbohydrate?
Let’s make it simple. There are really only three types of carbohydrates:
Let’s start with Sugar. The simple form of carbohydrates, and the form that spikes your blood sugar and insulin rapidly, are called mono-saccharides (glucose, galactose, fructose & xylose). When two of these mono-saccharides are bound together they form disaccharides like sucrose, also known as “table sugar” (glucose + fructose), lactose found in milk (glucose + galactose), and maltose found in cereals and sweet potatoes (glucose + glucose).
The simple monosaccharides or disaccharides are easy broken into their mono-saccharide form in the blood stream and require the body to produce insulin to be used. The person with insulin resistance, impaired fasting glucose or type II diabetes often produces 2-10 times the normal amount of insulin to correctly use these mono-saccharides (see why this is a problem in: The Dreaded Seven: Seven Detrimental Things Caused By High Insulin Levels). Remember, fruit is also simple sugar containing the mono-saccharide fructose . . . which we call “natures candy” in my office.
“Yea, I know sugar is bad for me, but Dr. Nally, I just eat the good starches.”
If I had a nickel for every time I’ve herd that phrase . . .
We’ve become comfortable with shunning fat and “simple sugar,” but in the process we’ve been eating more “good starch.” But the “good starches” are also saccharides – just in longer chains of more than three glucose molecules bound together. Our gut easily breaks the bonds between the glucose links and turns these starches into mono-saccharides to be used as fuel. It takes a bit longer than the simple sugars above, so the release of insulin is slower (which is why it has a better glycemic index score), but whether you produce the insulin in the first hour or the second hour after eating it, insulin is still insulin. In the case of insulin resistance, the damage is still done.
These good starches make up “comfort food” like bread, rice, pasta, potatoes, corn, grains & oats. To the patient with insulin resistance, impaired fasting glucose or type II diabetes, the higher insulin response stimulates increased weight gain, rise in cholesterol, shift in hormone function and progression of atherosclerosis (vascular and heart disease). See the recent article on Why Your Oatmeal is Killing Your Libedo.
What about “resistance starches?” These are still starches and I am finding clinically that they still cause a rise in insulin and push people out of ketosis (See Common Ketosis Killers).
Finally, Fiber. Fiber is a carbohydrate, however, it is the indigestible part of the plant. Fiber has double bonds between the saccharides that human gastrointestinal tracts cannot digest. In most cases, fiber passes right through the intestines without being digested. It actually acts like a broom for your colon, helping the intestines to move nutrients through the system. This is why I recommend 1-2 leafy green salads a day for most patient’s following ketogenic diet. Fiber does help to promote bowel function.
Fruit, non-green vegetables, pasta, grains and breads do contain good sources of fiber, however, these foods also have absorbable starches making them problematic as noted above.
The take home message is this, the use of starch or simple carbohydrate will be problematic for weight loss, cholesterol control, blood sugar control or blood pressure control in a patient with insulin resistance.
Therefore, the ketogenic lifestyle truly begins at the end of your comfort zone.
I thought that over the next few weeks I’d address a number of Ketogenic Lifestyle Rules that I have adopted. These seem to help and bring a little clarity to one following a Ketogenic Lifestyle or someone on the road to becoming a true “Ketonian.”
The first of these rules is that there should ALWAYS be bacon in the fridge!
We address this rule and some interesting facts around having bacon in the fridge in this evening’s Persicope below. We also address the benefits of journaling, how to help stop binge eating, what are your real protein needs, and red-meat fear-mongering. We even discuss whether or not pigs like bacon. Enjoy!
Links referenced in this video:
Red & Processed Meats: Bacon Fear-Mongering
Calculating Your Protein Needs from Ideal Body Weight
(Just a note: I love Katch.me’s service; however, due to the contract language allowing Katch.me to have unlimited rights to my Periscope Videos, I have withdrawn from Katch and my videos are no longer available on this medium until the contract usage can be modified.)
Watch this weekend’s Periscope conversation about why weight loss is slow and why anything that is worthwhile takes time.
You can watch the Periscope Video below:
I am frequently asked about the sweeteners that can be used with a low carbohydrate diet. There are a number of sweeteners available that are used in “LowCarb” pre-processed foods like shakes or bars, or in cooking as alternatives to sugar; however, many of them raise insulin levels without raising blood sugar and are not appropriate for use with a true low-carbohydrate/ketogenic diet. You can see and print the article I published clarifying which sweeteners you can use and which ones to avoid in the menu bar above “Sour Truth About Sweeteners” and you can watch last night’s periscope below:
Enjoy!!
It has long been understood that tumor cells of any kind require high levels of glucose to grow and spread (1,2). It is also recognized that higher levels of insulin, commonly found in patients with insulin resistance or type II diabetes, are 2.4 times more likely to stimulate the development of breast cancer (3). A diet low in glucose has thereby been theorized to be an adjunct to cancer treatment.
Ketogenic diets have been demonstrated to be therapeutically useful in the treatments of epilepsy and cardiovascular disease (4). A ketogenic diet is one in which carbohydrate levels are kept below 50 grams per day and fat intake is increased to the point that the body shifts its metabolism to use triglycerides, and the ketones derived from triglycerides, as the primary fuel source for the majority of the cells within the body. With this understanding in mind, the application of a ketogenic diet, one high in fat and protein with limited carbohydrate or glucose has been suggested as a adjunct to cancer treatments (5).
A recent study (6) in the Oncology Letters evaluated the benefits of a ketogenic diet in 78 cancer patients in clinical practice. A novel marker measuring the tumor cells use of glucose called transketolase-like-1 (TKTL1) was closely monitored, as was each of the 78 patients adherence to a ketogenic diet. Increased TKTL1 was noted in more aggressively active and growing tumors (7,8).
Among the 43 males and 35 females, 7 patients agree to and followed a fully ketogenic diet and 6 of them followed a partially ketogenic diet. Ketogenic meals were provided by a German company called Tavarlin that would prepare and mail ketogenic meals including oil, fat, snacks, bread, protein and energy drinks. Dietary journals were reviewed every three months over a period of about 10 months.
40 % of these patients experienced a halting of the tumor progression and 60% experienced improvement noted by normalization of TKTL1 or reduction in TKTL1, respectively. Those on a ketogenic diet demonstrated an average reduction of TKTL1 by approximately 50%.
This is the first study of its kind and has significant potential. Could dietary carbohydrate restriction be an effective cancer treatment or adjunct to cancer treatment?
Because the food diaries were based on reporting only, the sample study was very small, and patients treated in the outpatient setting have the possibility of variability in the standard oncologic treatments, the results must be interpreted with caution. However, the data is very promising. This study is one in which I have great interest as I have seen similar results in my clinic on a case by case basis.
Based on the limitations noted above, rigorous randomized control studies are needed, but this is an exciting an promising first step. Additionally, the presence of a marker for tumor growth that correlates with diet is remarkable. And, it provides the ketogenic specialist a possible measurement tool that could be used clinically.
References:
Multiple Sclerosis (MS) is a neurological disease caused by demyelination or breakdown of the myelin coating around the nerve cells (1). This is referred to as a neurodegeneration where the physical structure of the nerve is compromised, much like the coating around an electrical wire being chipped or stripped away. Common symptoms of MS are sensory symptoms in the extremities or face, unilateral visual loss, acute or subacute motor weakness of the muslces, diplopia (double vision), gait disturbance and balance problems, Lhermitte sign (electric shock-like sensations that run down the back and/or limbs upon flexion of the neck), vertigo, bladder problems, loss of control of a limb, and pain.
Initially, and for many years, the degeneration seen in multiple sclerosis (MS) was thought to occur because of an acute inflammatory attack on the cells by dis-regulated immune cells crossing the blood brain barrier. However, treatments focused on modulating the inflammatory attack seem to have no effect on the degeneration and demyelination. Thus, the actual definitive cause of this demyelination and neuro-degeneration has eluded us since 1868, when Jean-Martin Charcot first described it.
Recent studies point to evidence that this demyelation may be due to degeneration or breakdown of the nerve cell’s ability to use glucose as a primary fuel (2, 3). It is now theorized that MS may be due to a combination of degeneration and localized inflammation related to poor glucose uptake causing the demyelination which is seen in a number of MS cases (4, 5, 6).
With this dual concept in mind, ketogenic diets have demonstrated some promising results when used with neurological diseases including MS. Ketogenic diets have been used in the treatment of epilepsy since 500 B.C. and in the treatment of obesity since 1860. It is now becoming apparent that ketogenic diets may play a very significant role in the treatment of neurological disease because of two-fold effects that arise when ketones become the primary fuel for the body.
First, when a person becomes keto-adapted and ketones are used as the primary fuel, instead of glucose, the body up-regulates mitochondria to use the ketones for fuel. As the ketone level rises, the need for glucose diminishes. This provides the nerve cell an alternative fuel source if glucose metabolism is impaired. It also decreases the need and production of insulin, a known hormone heavily involved in stimulating inflammation and inflammatory responses.
The second effect of a ketogenic diet is this favorable effect on inflammation. It has been demonstrated that a ketogenic diet decreases reactive oxygen species, increased production of superoxide dismutase and catalayse, all of which notably decrease the inflammatory effects of oxidative stress (9,10, 11). A ketogenic diet also is well known to raise glutithione levels, another anti-oxidant that decreases inflammation and oxidative stress (12-16). This same anti-inflammatory and keto-adaptation effect can be obtained from intermittent fasting.
To date, studies in patients with neurologic diseases like MS, Alzheimer’s disease using ketogenic diets have had positive results in memory, cognition and diminished inflammation with evidence of halting or reversing the chronic demyelination (17,18, 19). Still somewhat theoretical, the evidence points to effective dietary treatment and prevention for multiple sclerosis and other degenerative neurological diseases like Alzheimer’s Disease.
References:
Join Dr. Nally on this evening’s Periscope as we talk about your biggest weight loss struggles in rapid fire style. We cover topics this evening from the effects of cheating on a ketogenic diet to how to overcome a weight loss stall . . . join us to hear the whole conversation.
Catch up with Dr. Nally and his amazingly beautiful and talented wife, Tiffini, as he Periscopes about two of his favorite Low-Carb snacks:
Enjoy!
The image above has nine dots within a square. Your task, using only four lines is to connect ALL nine dots WITHOUT ever raising your pen, pencil or finger (Please don’t use a sharpie on your computer screen . . . it doesn’t come off).
You may have seen this puzzle previously . . . it’s made its rounds in corporate training circles. But the underlying principle remains true. The solution requires you to expand your thinking or to “think outside the box.”
Whenever you find yourself on the side of the majority, it is time to pause and reflect. (Mark Twain)
Why should we limit ourselves to thinking outside the box. Can’t we just get rid of the box?
True discovery consists in seeing what everyone has seen . . . then, thinking what no one has thought.
The answer can be found when those four lines are used beyond the box our mind creates:
What good has the box done us? People were burned at the stake because they refused to believe the Earth was not the center of the universe. People were beheaded because they had a sneaking suspicion that the world was not flat.
Why is it so very hard to accept that our weight gain and diabetes are driven by a hormonal signal, and not by gluttony or caloric intake of fat? The definition of insanity is doing the same thing repetitively and expecting a different outcome. How long have you been restricting calories and fat with only minimal or no improvement in your weight, blood sugar, cholesterol or general feeling of health?
The main problem with the current thought model, or dogma, on the obesity’s cause is that it does not account for metabolic syndrome. Metabolic syndrome is insulin resistance. It is an over production of insulin in the presence of ANY form of carbohydrate (sugar or starch).
In the practice of medicine over the last 15 years, I noticed that a very interesting pattern emerged. There was always a spike in fasting and postprandial insulin levels 5-10 years prior to the first abnormal fasting and postprandial blood sugars. These patients were exercising regularly and eating a diet low in fat. But they saw continued weight gain and progressed down the path of metabolic syndrome. 10-15 years later, they fall into the classification of type II diabetes. What I now lovingly refer to as stage IV insulin resistance.
The only thing that seems to halt this progressive process with any degree of success is carbohydrate restriction. Fasting insulin levels return to normal, weight falls off, and the diseases of civilizations seem to disappear as insidiously as they arose.
So you tell me, is the world flat? Is the Earth the center of the universe?
What is a low carbohydrate or ketogenic diet? 15 years of practical in the trenches experience have helped me develop a very simple program to help you lose and maintain your weight. Access to this program, video help and access to blog articles at your fingertips are offered through my online membership site.
You can also hear me each week a I discuss low carbohydrate, paleolithic and ketogenic diets with the Legendary Jimmy Moore on KetoTalk.com
Our very own, Jenna Lightfoot, PA-C, made it into the Cohost Contest Final Round for Jimmy Moore’s Low Carb Conversations. Listen to this intriguing review of the recent headlines and vote for your favorite candidate here.
At Nally Family Practice, where Jenna is one of our in-house Paleo/Low Carb experts, we thought that they all did a fantastic job. However, we’re a little preferential on who won this final round.
But, you should be the judge. So, click the link here, or down load the podcast from iTunes and make sure you vote ASAP!
Good morning from Arizona. I’ve had a few people ask about how gut health relates to a ketogenic diet. This is a great question and one that I think can be answered best by taking a closer look at my natural koi pond and learning a little about pond scum.
So, sit back and look at the similaries between your gut and how nature balances a pond system: Katch.me
Or you can watch the video below:
The four tenets of health that we touch on above that are essential to understand before you can understand gut health:
Keys to gut health and pond balancing that we touch on:
Hope this gives you a starting point for your New Year!!
It’s Here! KetoTalk with Jimmy Moore and the Doc premiers today. You can link to it here: http://ketotalk.com/2015/12/0-keto-talk-with-jimmy-moore-the-doc-debuts/ or click on the menu bar above to take you to KetoTalk.com.
The show has been picked up by iTunes, but it takes anywhere from 3-7 days to appear in their search menus, so be patient and while iTunes assimilates it, you can always hear it or download it from KetoTalk.com.
We want to hear your feed back so please tell us what you think and rate us on iTunes when it is available.
Have a Happy New Year!!!
A few of my patients have recently asked me, “Dr. Nally, why to you post pictures of your horse, koi and farm animals on instagram?”
Let me answer that question with the following questions:
If you can answer “yes” to any of the questions above, then I highly recommend prescription strength nature . . .
All parody and humor aside, full strength prescription nature is one of the very best treatments for stress.
I find that sitting outside with my animals, watching the birds, dogs, horses and ducks dramatically helps with lowering my stress levels and helps me re-focus. You can see my favorite place to sit on my farm and watch nature . . . here on Katch.me
You may find the following posts very insightful in explaining how stress wreaks havoc on your weight loss, mood & emotions and how to go about fixing it:
For someone like me, who spends 14-18 hours a day taking care of illness and sickness, I have found that spending time in nature is often more therapeutic than any pill available in the pharmacy. So, this afternoon, if your looking for me, I’ll be taking my own medicine, a prescription of Nature Rx on my horse.
KetoTalk with Jimmy & the Doc (the legendary podcaster Jimmy Moore from Livin’ La Vita Low Carb and his newest co-host, your’s truly, Dr. Adam Nally) makes its debut this Thursday, December 31st, 2015 on iTunes. You can see the show notes at KetoTalk.com (will be up and live on January 1st, 2016).
Throughout the exciting month of January, we will be airing a brand new episode of this 20-minute show each Thursday and a special bonus episode available on Sundays just to wet your ketogenic appetite and to kick off the podcast in its first month. Then, in February we’ll settle in to our regular Thursday time slot each week.
New podcasts can take a few days to assimilate into #iTunes, so don’t get discouraged if you don’t immediately see it up on iTunes. However, you can always find them at KetoTalk.com. Jimmy and I look forward to being your go-to, Ketogenic Lifestyle source for the latest and greatest in treating the diseases of civilization!
Get a sneak peek of our new show on tomorrow’s (Wednesday, December 30th) episode of “The Livin’ La Vida Low-Carb Show” where you can hear my interview with Jimmy as a preview what is sure to be a big hit in the #keto community. Thanks in advance for supporting our new podcast!
Sitting around the dinner table this evening we began discussing personality types. As a fun exercise, we each took the Jung Typology Test based on Jung and Myers-Briggs findings about personality. If you haven’t taken this personality test, you might find it quite interesting and the topic of hours of conversation around the dinner table . . . as we did this evening. The test is free on-line and takes about 10 minutes.
The actual Myers-Briggs Type Indicator costs about $50.00 and includes an interpretation by someone trained in giving the test. It differs slightly in its questions and the way the testing is interpreted.
Both tests provide an interesting insight into your individual psychological preferences regarding four categories. According to Carl G. Jung’s theory of psychological types published in 1971, people can be characterized, first, by their preference or general attitude about the source of and how they express their energy:
The second preference is one of the two functions of perception, or related to how they perceive information coming from either the external or internal world:
and the third preference relates to how one processes the information that they have received, acting as one of the two functions of thought or judgement:
Isabel Briggs Myers, a researcher and practitioner of Jung’s theory, proposed that the fourth preference related to how one applies or implements the information that he or she processed above. She proposed a judging-perceiving relationship as the fourth dichotomy influencing personality type in 1980:
Each of these dichotomies represents an opposite pole of preference and each of us have a dominant pole toward which we gravitate.
Based upon your dominant traits, a personality type index is assigned.
Kim and Lee studied these personality preferences and how they relate to diet, health and propensity toward obesity. Their findings were interesting in that expression, perception and judgement did not seem to have any bearing on health or obesity. However, the application of judgement vs perception did play a role in health. Judging (J) means that a person organizes all of his or her life events and, as a rule, sticks to those plans. Perceiving (P) means that he or she is inclined to improvise and explore alternative options.
Significantly better dietary and health behaviors were identified in those preferring Judging (J) versus those preferring Perceiving (P) traits. Those preferring the Judging (J) behaviors included eating breakfast, regularly eating three meals a day, smoking less, exercising more and having a lower tendency to nocturnal eating.
The findings show that the use of Jung Type or Myers-Briggs Type Indicator may be helpful in identifying and index those with a Perceiving (P) trait that would benefit from dietary and exercise education, nutritional counseling and/or behavior modification programs.
It has been my experience that those with a “P” type dichotomy preference would benefit greatly from daily food planning and journaling.
So, what is your Jung/Myers-Briggs type?
Just for fun, and because my kids were very curious about what each personality type would appear as in character, I’ve included the Jung/Myers-Briggs Disney typing.
I’m an ENFJ, just in case you’re curious.
References:
May God’s choicest blessings be yours today and through the New Year. May you experience the restoring Grace that emanates from the child born in a humble manger and through whom this world receives access to light, truth and eternal life.
Thank you, each, for your friendship, service, love, kindness, and for helping me to nobly live in the present while looking to the future.
Merry Christmas!
Have you been cutting your calories and reducing fat and exercising your brains out and still not seeing the needle on the scale move that much? Persistently and repetitively performing an action that doesn’t produce the desired result is insanity. Cutting calories and reducing fat while expecting weight loss is akin to pouring water in the gas tank of your car and expecting it to run smoothly. Why do we do it? Are the 53, 000, 000 people with health club and gym memberships this year really insane?
This evening on PeriScope we touch on fat phobic insanity and the limiting step that actually turns weight gain on or off. (We knew about this in the 1960’s, we just ignored it.)
You can see tonight’s PeriScope with the rolling chat-box questions here at Katch.me/docmuscles. Or, you can watch the video stream below:
The only way to successfully loose weight is to modify or turn off the mechanisms that stimulate fat storage. For years we have been told that this was just a problem of thermodynamics, meaning the more calories you eat, the more calories you store. The solution was, thereby, eat less calories or exercise more, or both. We are taught in school that a 1 gram of carbohydrate contains 4 kcal, 1 gram of protein contains 4 kcal, and 1 gram of fat contains 9 kcal.
If you ascribe to the dogma that weight gain or loss is due to thermodynamics, then it’s easy to see that cutting out fat (the largest calorie containing macro-nutrient) would be the best way limit calories. For the last 65 years, we as a society have been doing just that, cutting out fat, exercising more (with the idea of burning off more calories) and eating fewer calories.
What has this dogma done for us? It’s actually made us fatter! (1)
Some may argue that we really aren’t eating fewer calories and exercising more. But most people I have seen in my office have tried and tried and tried and failed and failed and failed to loose weight with this methodology. In fact, the majority of my patients attempt caloric restriction, exercise and dieting multiple times each year with no success. The definition of insanity is “doing the same thing over and over and expecting a different result.”
Most of my patients are not insane, they recognize this and stop exercising and stop restricting calories . . . ’cause they realized, like I have, that it just doesn’t work!
If you’re one that is still preaching caloric restriction and cutting out fat, I refer you to the figure above and the definition of insanity . . . your straight-jacket is in the mail.
So, if reducing the calories in our diet and exercising more is not the mechanism for turning on and off the storage of fat, then what is?
Before I can explain this, it is very important that you appreciate the difference between triglycerides and free fatty acids. These are the two forms of fat found in the human body, but they have dramatically different functions. They are tied to how fat is oxidized and stored, and how carbohydrates are regulated.
Fat stored in the adipose cells (fat cells) 
as well as the fat that is found in our food is found in the form of triglycerides. Each triglyceride molecule is made of a “glyceride” (glycerol backbone) and three fatty acids (hence the “tri”) that look like tails. Some of the fat in our adipose cells come from the food we eat, but interestingly, the rest comes from carbohydrates
(“What! Fat comes from sugar?! How can this be?!!“)
We all know that glucose derived from sugar is taken up by the cells from the blood stream and used for fuel, however, when too much glucose is in the blood stream or the blood sugar increases above the body’s comfort zone (60-100 ng/dl), the body stores the excess. The process is called de novo lipogenesis, occurring in the liver and in the fat cells themselves, fancy Latin words for “new fat.” It occurs with up to 30% (possibly more if you just came from Krispy Kream) of the of the carbohydrates that we eat with each meal. De novo lipogenesis speeds up as we increased the carbohydrate in our meal and slows down as we decrease the carbohydrate in our meal. We’ve known this for over 50 years, since it was published by Dr. Werthemier in the 1965 edition of the Handbook of Physiology (2).
While we know that fat from our diet and fat from our food is stored as triglyceride, it has to enter and exit the fat cell in the form of fatty acids. They are called “free fatty acids” when they aren’t stuck together in a triglyceride. In their unbound state, they can be burned as fuel for the body within the cells. I like to think of the free fatty acids as the body’s “diesel fuel” and of glucose as the body’s version of “unleaded fuel.” The free fatty acids can easily slip in and out of the fat cell, but within the adipose cell, they are locked up as triglycerides and are too big to pass through the cell membranes. Lipolysis is essentially unlocking the glycerol from the free fatty acids and allowing the free fatty acids to pass out of the fat cell. Triglycerides in the blood stream must also be broken down into fatty acids 
before they can be taken up into the fat cells. The reconstitution of the fatty acids with glycerol is called esterification. Interestingly, the process of lipolysis and esterification is going on continuously, and a ceaseless stream of free fatty acids are flowing in and out of the fat cells. However, the flow of fatty acids in and out of the fat cells depends upon the level of glucose and insulin available. As glucose is burned for fuel (oxidized) in the liver or the fat cell, it produces glycerol phosphate. Glycerol phosphate provides the molecule necessary to bind the glycerol back to the free fatty acids. As carbohydrates are being used as fuel, it stimulates increased triglyceride formation both in the fat cell and in the liver, and the insulin produced by the pancreas stimulates the lipoprotein lipase molecule to increased uptake of the fatty acids into the fat cells (3).
So when carbohydrates increase in the diet, the flow of fat into the fat cell increases, and when carbohydrates are limited in the diet, the flow of fat out of the fat cells increases.
Summarizing the control mechanism for fat entering the fat cell:
These two mechanisms ensure that there is always unleaded (glucose) or diesel fuel (free fatty acids) available for every one of the cells in the body. This provides the flexibility to use glucose in times of plenty, like summer time, and free fatty acids in times of famine or winter when external sources of glucose are unavailable.
The regulation of fat storage, then, is hormonal, not thermodynamic. Unfortunately, we’ve know this for over 65 years and ignored it.
We’ve ignored it for political reasons, but that’s for another blog post . . .
References:
1. James, W. J Intern Med, 2008, 263(4): 336-352
2. Wertheimer, E. “Introduction: A Perspective.” Handbook of Physiology. Renold & Cahill. 1965.
3. Taubs, G. “The Carbohydrate Hypothesis, II” Good Calorie, Bad Calorie. Random House, Inc. 2007, p 376-403.
Today in the office I had the calorie conversation again . . . three times. We have an entire society with a very influential health and fitness industry built around the almighty calorie. Has it helped? Looking at our 5 year obesity outcomes. It hasn’t helped a bit. In fact, it is worse. In 1985 only 19% of U.S. adults were obese.
In 2014, 34.5% of U.S. adults were obese. The numbers this year are approaching 35.6% You can see the dramatic increase in obesity by 1-3% every year for the last 5 years in the CDC images above.
For over 50 years we have been told that caloric restriction and fat restriction is the solution. But by the numbers above, the 58 million people in the U.S. utilize a gym or health club to burn off those calories aren’t seeing the success that they should be expecting.
Why? Because the calorie is NOT king. What do I mean by that? We don’t gain weight because of the thermogenic dogma we’ve been taught for the last 50 years. Our weight gain is driven by a hormone response to food. Hear more about why the calorie is NOT king on tonight’s PeriScope. You can Katch it here with all the live stream comments and hearts at Katch.me/docmuscles.
Or you can watch the video without the comments here:
This morning in my meal preparation I was thinking about when my schedule would allow me to see the newest release of Star Wars.
I noticed that my bacon was a little chewy . . . coincidence or not?
Today’s Periscope was an exciting one. Do you really need a pre- or post-workout shake or meal? How much protein do you need? What’s the difference between ketosis and ketoacidosis? Is Dr. Nally a ketogenic cheerleader? Get your answers to these and many more questions asked by some wonderful viewers this evening on today’s PeriScope.
https://katch.me/embed/v/5def6bce-4f67-363a-b5f9-3bbec8a8aea2?sync=1
Be sure to check out Dr. Nally’s new podcast called “KetoTalk with Jimmy and the Doc” with the veteran podcaster Jimmy Moore on KetoTalk.com. The first podcast will be available on December 31, 2015. KetoTalk with Jimmy and the Doc will be available for download for free on iTunes.
Stay tuned . . . !
