I am always impressed by good pictures, great recipes and and scrumptious food. My wife knows this. Finding great ketogenic recipes is essential. The reason, is that to loose weight and remain in ketosis, it is often essential to increase fat intake to at least 50% of your total calories. Fat Bombs are a great snack idea that helps one accomplish this task. Increasing fat to that level can be challenging for some. Maria Emmerich has posted another tasty and tantalizing high fat, low carbohydrate snack. Check out her recipe for the Crispy Fat Bomb. This is one of those great high fat, low carb tools to keep you in ketosis.
On of my patient’s was just asking about another good Fat Bomb Recipe. So, thanks, Maria!! And, my patient’s thank you too. Try this one out. Please let me know what you think of the crispy versus Tiffini’s Fat Bombs.
Found this info-graphic while surfing Banner Health’s information pages. Many of my patients get a very confused look on their face when I ask them to restrict carbohydrates. Sugar is the most prevalent form of carbohydrate in the Standard American Diet or SAD diet. Sugar comes by more than one name. This info-graphic is actually very helpful. All of these names are synonymous with weight gain and cholesterol formation.
This aquaponics stuff is amazing! Came home today to crystal clear water. Even with 9 ducks and 11 fish in the pond, the two lightly planted grow beds and the bogs have cleared up the water with amazing speed. The algae has disappeared even in direct sunlight and temperatures in the 112-114 degree range over the last week.
So, in celebration of nature attaining pond water clarity in just two weeks, I added three more beautiful Koi.
It is fascinating how very calming it is to my soul to sit by the pond and watch the ducks & fish. It appears that a nearby hive of bees is using the pond for a water supply as there is always at lease 5-10 little honey bees driking at the water’s edge. I’ve seen dragon flies come by daily. What amazes me is that I’ve now seen more hummingbirds, cardinals and wrens in the last week than I’ve seen all year. My dogs love it and in the 114 degree weather, wading your feet in the water is so very refreshing.
You can see the progress of this pond over the last 9 months here at The Doc & The Horse.
Now to begin planting my leafy green veggies . . .
To the many friends, family and patients who served, spilled their blood and lost their lives in defense of this great nation. In all humility, I thank you!
It is not foolish and wrong to mourn the men and women who have died, but it is so much more important that we thank God that such men and women have lived.
May your day be full of happiness and joy because of the great sacrifice that so many willingly offered.
3. Good health is merely the slowest possible rate at which one can die.
4. Give a person a fish and you feed them for a day. Teach that person to use the Internet and they won’t bother you for weeks, months or even years.
5. Health nuts are going to feel a little sheepish someday, just lying on a hospital bed, dying of nothing.
6. All of us could take a lesson from the weather. It pays absolutely no attention to criticism.
7. In the 60’s, people took acid to make the world feel weird. Now, the world is weird, and people take Prozac to make it feel normal.
8. Life is essentially carbohydrate induced. . . This all started because someone was tempted into eating an apple.
9. Don’t worry too much about old age; it doesn’t last that long.
What is the “Fountain Of Youth” as We Know It Today?
A ketogenic or carnivorous diet placing one into ketosis regularly slows aging and reducing the risk of dementia dramatically (1, 2).
Berberine Plus 500mg twice a day if you are at all insulin resistant has been shown to stop progression to diabetes and insulin resistant, improve weight loss, reverse symptoms of PCOS and has notable research demonstrating anti-inflammatory properties (3) all of which are know to slow aging.
Check out my recent video talking about this an answering over 100 of your ketogenic related questions:
References:
Veech RL, 2004, “The therapeutic implications of ketone bodies…,”Prostaglandins LeukotEssent Fatty Acids, 2004 Mar;70(3):309-19.70
Ott A, Stolk RP, Hofman A, van Harskamp F, Grobbee DE, Breteler MM. Association of diabetes mellitus and dementia: the Rotterdam Study. Diabetologia. 1996 Nov;39(11):1392-7. doi: 10.1007/s001250050588. PMID: 8933010.
Yin J et al., Efficacy of Berberine in Type II DM, Metabolism, May 2008
Gallagher JC. Vitamin D and aging. Endocrinol Metab Clin North Am. 2013 Jun;42(2):319-32. doi: 10.1016/j.ecl.2013.02.004. Epub 2013 Apr 9. PMID: 23702404; PMCID: PMC3782116.
Scott, S.B., Graham-Engeland, J.E., Engeland, C.G. et al. The Effects of Stress on Cognitive Aging, Physiology and Emotion (ESCAPE) Project. BMC Psychiatry15, 146 (2015). https://doi.org/10.1186/s12888-015-0497-7
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.
People were burned at the stake because they refused to believe the Earth was not the center of the universe. They were beheaded because they had a sneaking suspicion that the world was not flat.
Is it really that hard to accept that our weight gain and diabetes is driven by a hormonal signal, and not by gluttony or caloric intake of fat?
The challenge with the current thought model on the cause of obesity is that it does not account for metabolic syndrome. In the practice of medicine over the last 15 years, an interesting pattern has emerged. I noticed that there was 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.
The only thing that seems to halt this process in these patients is carbohydrate restriction. Fasting insulin levels return to normal, weight falls off, and the diseases of civilizations disappear as insidiously as they arose.
So you tell me, is the world flat? Is the Earth the center of the universe?
I recently read a blog post decrying anyone that would recommend a low carbohydrate / ketogenic diet to their patients.
What?!
In fact, this particular blog outlined a number of “adverse reactions” to a ketogenic diet, and based upon these perceived reactions, the writer advised severe caution with its use in just about anyone. It is important to note at the outset that most of the data this blogger quotes are from older studies completed in children for the treatment of epilepsy with specific liquid ketogenic dietary meal replacements. (Not what you’d expect in a low-carb / ketogenic diet for the average obese adult today.)
Diet Confusion
Thanks to recent misinformation by a number of medical professionals, including the person writing the blog referenced above, a poor understanding of fatty acid metabolism by the general community, and a distinct lack of understanding of human adaptability recorded over the last 5,000-6,000 years, there is still significant confusion about ketogenic diets.
It is important to recognize the crucial fact that the human body is designed to function quite well when supplied any of three macronutrients: carbohydrates, proteins or fats. It does so through an amazing series of enzymatic reactions referred to as the Krebs (tricarboxylic acid) cycle, producing needed ATP (adenosine triphosphate) required for our muscles to contract, our heart to beat and our diaphragm to expand our lungs. What’s even more amazing that that the body was designed to recognize the season we are in based up on the food we eat. That is, until we invented refrigerators in 1913. (Now our bodies think it’s year round summer time . . . wait . . . I live in Arizona where it is year round summer time.)
No, this is not a post about unplugging your refrigerator, living on solar, getting off the grid and saving energy.
Our bodies recognize the seasons we are in based upon inherent hormone release. The key hormone is insulin. Insulin can be looked at as the seasonal indicator to our bodies. Insulin production rises and falls based on our intake of carbohydrates (sugar, starches, some fibers). Insulin, essentially, tells our bodies when it is a “time of plenty” and when it was a “time of famine.” Why? You ask. We didn’t have refrigerators 100 years ago and you were lucky if you had a root cellar. The body needs to know when to store for the famine (the winter) that was around the corner. Insulin is that signal.
During the summer, potatoes, carrots, corn and other fruits are readily available. These are all starchy carbohydrates and they all require the body to stimulate an insulin response so that they can be absorbed. Insulin stimulates fat storage (J Clin Invest. 2000;106(4):473-481. doi:10.1172/JCI10842). Just like bears, our bodies were designed to store for the winter.
If you think back in history, your grandparents probably used stored meats & cheeses that could be salted or smoked for preserving during this time of year. Those crossing the plains were commonly found with pemmican, a concentration of fat and protein used as a portable nutrition source in the absence of other food. (Chapter VIII. Narrative of the Life of David Crockett, of The State of Tennessee, Written by Himself, Sixth Edition [E.L. Carey and A. Hart:Philadelphia] 1834, 1837; Marcy, The Prairie Traveler, p. 31.) Think about conversations you may have had with your grandmother when she told you that for Christmas, she received an orange. A single orange for a gift?! Many of my patients drink 12-15 of them in a glass every morning. The winter diets of our grandparents were very low in starches and carbohydrates. When carbohydrate intake is low, little insulin is produced.
Again, insulin is the hormone that tells you that you’re in “a time of plenty” and stimulates weight gain and cholesterol production to prepare for winter. Those prescribing the use of ketogenic diets understand this innate human adaptive trait, and use it to effect changes in weight, cholesterol and other desired metabolic changes.
Three types of ketones. Uptodate.com, May 2015
Now, let’s define the difference between ketosis and keto-acidosis and try to clarify the misinformation that is being spread around the blogosphere.
A ketone is a molecule the body produces from the breakdown of fat and some proteins (amino acids). There are specifically three types of ketones: beta-hydroxybutyric acid, acetoacetic acid and acetone. If ketosis was “bad,” then why would our bodies produce these molecules? They are not bad, and in fact, multiple studies show that the body is often more efficient and effective when it functions on ketones rather than glucose as its primary fuel source. The body can only supply a limited amount of sugar or glucose for fuel. If you talk to runners, marathoners or triathletes, they will tell you that after about 45-90 minutes of continuous endurance exercise the glucose supply runs out and they will experience what is termed a “bonk” (have a low-blood sugar or hypoglycemic episode). Unfortunately, our bodies can only store about 18-24 hours of glucose.
Metobolic Changes of Ketogenic Diet (American Journal of Physiology – Endocrinology and Metabolism Published 1 June 2007 Vol. 292 no. 6, E1724-E1739 DOI: 10.1152/ajpendo.00717.2006)
However, the body can store days upon days of fat in the form of triglyceride in the fat cells. Triglyceride is broken down into ketones. If glucose is the “unleaded” fuel, you can think of ketones as the “diesel fuel” that is easier to store and runs longer.
The average body functioning on ketones as the primary fuel will have a ketone level measured in the blood somewhere between 0.4 and 4 mmol/L. Because of a balance that is created by the use of ketones and a feedback mechanism that kicks in when the ketone level rises, the body will maintain a pH of around 7.4.
Ketoacidosis is dramatically different. If you are a type I diabetic, you don’t produce any insulin. The feedback mechanism regulating ketone use is broken and the ketone levels and triglyceride breakdown speeds up because the body can’t access glucose and can’t produce insulin. The ketone levels spike and the level can rise to > 25 mmol/L. In the presence of a high blood sugar and high ketone level, the acid level in the blood shifts to a pH of less than 7.3. This is referred to as metabolic acidosis and can be life threatening as the low pH shuts down the bodies’ enzymatic processes and a person becomes critically ill and without treatment, can die. (Kitabchi AE et al., Clinical features and diagnosis of diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults. www.uptodate.com, May 2015.)
If you’re not a type I diabetic, you have nothing to worry about. Regardless of what the “ketogenic nay-sayers” blog about, your liver makes approximately 240g of glucose per day, this stimulates a basal release of insulin which keeps the pH in check. It’s also what keeps weight loss at a consistent pace of around 2-10 lbs per month.
If you are a type I diabetic, don’t fret. Carbohydrate restriction can still be used very effectively. It just takes some balancing and understanding of your individual metabolism. Talk to your physician and/or medical bariatrician about how to follow a carbohydrate restricted diet while using insulin.
What about all the other “adverse effects” the blogosphere and other so-called experts claim about ketogenic diets?
Let’s take them on one by one. Are you ready?
Gastrointestinal (GI) disturbances – Yes. Any time you change your diet you may experience diarrhea, constipation or gassiness. Most of the time, this is because you are either 1) not eating enough leafy greens (fiber) or 2) you’re using a supplement that contains an artificial sweetener. Most of the studies on ketogenic diets did not incorporate fiber and the studies used to make this point were on children who used a ketogenic fat supplement shake or liquid preparations containing these artificial sweeteners to make them palatable. If you have spoken to any bariatrician, they will tell you, the best way to follow a ketogenic diet is to eat real food. If you want to read about the anecdotal GI effects of sweeteners, read the comment section in Amazon about the Haribo Sugar Free Gummy Bears.
Inflammation Risk – In every patient that I have placed on a ketogenic diet in the last 8 years, all inflammatory markers including CRP, Sedimentation Rate and Uric Acid have all decreased. Inflammation gets better on an appropriately formulated ketogenic diet. The older studies of ketogenic diets in children contain most of their fat from Omega-6 fatty acids from vegetable oil which will increase inflammation and oxidative stress, spike the cortisol levels and have the secondary effect of actually raising the triglycerides. (Simopoulos AP,The importance of the ratio of omega-6/omega-3 essential fatty acids, Biomed Pharmacother., 2002 Oct;56(8):365-79.)
Muscle Cramps/Weakness – The process of weight loss occurs by burning fat into CO2 and water. We breathe the CO2 out, but the water produced has to follow salts out through the kidneys. Hence, we lose salts. This can cause weakness and muscle cramps. The solution? Stop restricting salt on a low carbohydrate diet. We are the only mammal that restricts salt and we do it because low-fat diets cause us to retain water. Low carbohydrate diets do the opposite. Use sea salt or sip beef or chicken bouillon broth with your dinner. The use of yellow mustard also helps (the small amount of quinine in yellow mustard stops the cramping). If you have congestive heart failure, talk to your doctor about monitoring your salt intake in balance with your diuretic or water pill.
Hypoglycemia – If you read the ketogenic diet research, most of it was done on epileptic children. The diets called for a period of starvation, then the use of a ketogenic liquid based on the John’s Hopkin’s protocol. It is a well-known fact in medicine that starvation in children can frequently cause hypoglycemia, especially in children with other genetic or congenital defects leading to forms of epilepsy. In clinical practice, with ketogenic diet use in adults, hypoglycemia is rare.
Low Platelet Count (Thrombocytopenia) – Again, this was seen in the epileptic children who were placed into starvation first, then introduced a liquid fat replacement shake to stop intractable seizures. These liquids or shakes were often nutrient deficient in other essentials. Folic acid, B12 and copper deficiency can occur when not eating “real food.” Low platelet counts are rarely seen on ketogenic diets based around “real food.” Many children in the ketogenic studies had been on or were concomitantly on valproic acid for their seizures. Valproic acid is commonly known to cause thrombocytopenia (Barry-Kravis E et al, Bruising and the ketogenic diet: evidence for diet-induced changes in platelet function. Ann Neurol. 2001 Jan;49(1):98-103.; Kraut E, Easy Bruising, http://www.uptodate.com, May 2015.)
Easy Bruising – This is usually due to inadequate protein supplementation as was the case in much of the ketogenic literature where protein levels were also restricted. (Kraut E, Easy Bruising, http://www.uptodate.com, May 2015.)
Pancreatitis – Patients who are insulin resistant or have impaired fasting glucose commonly have high triglycerides. Elevation in triglycerides itself is a cause of pancreatitis. Ketogenic diets lower the triglycerides. However, if a patient has not been following their diet as directed, spikes in the triglycerides can occur placing the person at risk for pancreatitis.
Long QT Intervals/Heart Arrhythmias – The list of things causing Long QT intervals and abnormal heart rhythms is long and variable (Acquired Long QT Syndrome. Berul C et al. www.uptodate.com, May 2015). It is well know that starvation, rapid weight loss and liquid protein diets can cause a delay in the conduction signal in the heart. Anyone wishing to start any diet should have an electrocardiogram (EKG) through their doctor to ensure that the diet (of any type) doesn’t exacerbate a prolonged QT interval.
Three year weight loss and metabolic improvement in a patient on a Low-Carb / Ketogenic diet. Note: Patient admits to not following ketogenic diet during holidays from Nov 2013 – Feb 2014 (see the dramatic changes to the body when cheating happens)
Cardiomyopathy – Prolonged QT intervals have been associated with cardiomyopathy and the former can stimulate the later. Any diet that has the potential to prolong a QT interval has the potential to cause cardiomyopathy. Hence the need for regular EKG monitoring on any diet (Acquired Long QT Syndrome. Berul C et al. www.uptodate.com, May 2015).
Lipid/Cholesterol Changes – In the 8 years I have been applying ketogenic diets to patients, I have seen dramatic improvement in the triglycerides and HDL levels. The only time triglycerides rise over 100 is if the patient is using artificial sweeteners or is cheating on the carbohydrate restriction. Total cholesterol commonly rises, however, this is indicative of the fact that there is a shift in the LDL particle size and this affects the calculation of both total cholesterol and LDL-C. In light of this, most of my patients have dramatic improvement in triglycerides and small dense LDL particle number. I’ve included the common cholesterol changes I seen in my office as a few case reports to demonstrate the effectiveness of a ketogenic diet:
2 year ketogenic dietary labs and weight loss
Myocardial Infarction – It is interesting that one blogger includes this on the list of adverse reactions, however, when you actually read the study, the author of the paper make an “assumption” that there was potential for heart attack due to an elevated total cholesterol, however, a correlation was never made. Again, in the 8 years I have been using ketogenic diets, I have seen dramatic improvement in cholesterol profiles, inflammatory markers, atherosclerosis and carotid intimal studies (Shai I et al, Circulation 2010; 121:1200-1208).
Three year metabolic history of a Low-Carbohydrate / Ketogenic diet
Menstrual Irregularities / Amenorrhea – It is well known that any diet causing protein or other nutritional deficiency will affect the menstrual cycle first and growth second. The only time menstrual irregularities occur with a ketogenic or Low-Carb diet is when a patient is not taking in enough protein or is not eating real food. What amazes me is that a properly applied ketogenic diet causes normalization of the menstrual cycle, and in my practice, I’ve had a number of women successfully be able to conceive after making a ketogenic dietary change.
For more details on the nutrient content of a ketogenic diet, see the recent article by a friend of mine, Maria Emmerich. She’s been creating ketogenic diets for years and has a number of fantastic books my wife and I have been using in our home over the last nine years. She is one among many that can give you some direction on how to devise a healthy, real food based ketogenic diet. See the page on my website here that will give you some direction in formulating your Ketogenic Lifestyle.
Nally Family Low-Carb / Ketogenic Cheese Cake
So, to celebrate Mother’s Day, today, with my family, I am going to indulge in some Low-Carb / Ketogenic Cheese Cake!! Happy Mother’s Day, to all of you and especially to all you mothers out there making a healthy difference in the lives of your families! (You can find the recipe for this delicious cheese cake here)
In the words of Sir William Ostler, “If it were not for the great variability among individuals, medicine might well be a science and not an art.”
Tattoo removal used to take 12-20 treatments with a laser and was a pretty painful process. With the PicoSure laser 4-6 treatments often does the job, and with minimal pain. One of my patients was here to follow up on a tattoo removal. He was very impressed and wanted me to be sure I posted it for other patients. Look how impressive the PicoSure is after just the first treatment.
Red is the hardest color to treat, but as you can see, It is starting to fade. This is just after the 1st treatment. We’ll see how it has done in 6 weeks after the 2nd treatment.
Do you still have that tattoo of “Jane” on your shoulder that your wife, Jenny, is tired of seeing? Were you unaware at the time that tattoos are the exception to the mantra, “What happens in Vegas, stays in Vegas?”
Are those age or sun spots becoming more prominent and unsightly?
Do you have scarring from acne from years ago that you’d like to remove?
Have you begun developing “crows feet” with each passing year?
As you have been losing weight with your dietary changes, is it time to address those skin changes you’ve been noticing?
Not to worry. We offer the fastest and most advanced laser technology in the world right inside our office.
Dr. Nally uses the PicoSure Laser which delivers ultra-short bursts of specific energy to the skin allowing him to selectively shatter the ink in tattoos with faster recovery time, fewer treatments and amazing results.
Because of the selectivity of the this laser, and the rapid burst of energy, facial rejuvenation and wrinkle treatments with “no down time” are now available.
The amazing technology now available with this laser allows Dr. Nally to improve and treat acne scarring that was previously very difficult to treat.
Even those pesky sun spots that worsen with age are no longer a challenge.
Give us a call and let us set up your next treatment with the worlds most impressive and most advanced laser treatment system.
This post isn’t going to win me any friends . . . in fact, mentioning this topic a few days ago has already angered a number of them and resulted in an online tongue lashing by a few others. However, I can’t resist. And, based on some very persuasive data and personal experience, I don’t care.
Truth is truth . . . it doesn’t change no matter how you spin it, or attempt to fit it into your paradigm. The problem is what we have accepted in the last 40-50 years as “the scientific truth about getting healthy” is far from truth. By getting healthy, I’m implying the application of main-stream methods accepted to lose weight, reduce cholesterol, improve blood pressure and reduce your risk of heart disease and diabetes.
For the last 40 years we’ve been told that the only way to get and live healthy is to restrict our calories. This main-streamed advise continues even today in our USDA 2010 Dietary Guidelines. And, if you ascribe to this futile dogma propagated since the 1970’s, then you’ll know that the “only acceptable way” to do this is to “eat less fat” (because fat is the most caloric dense of the macro-nutrients, right?) and to “exercise more” (because that’s how we burn calories, right?!) Well, that’s what I thought, too. And that is the health prescription I doled out to my-self and to all of my patients for the first 8 years of my practice.
Interestingly, most of them, including myself, took that prescription of a caloric restricted diet of 1200-1500 calories per day and exercise 3-6 days a week for 30-60 minutes and ran with it. Personally, I restricted calories to 1200-1500 per day and began running triathlons. I performed cardiac monitored running, swimming and cycling for an hour a day during the week and 2 hours on the weekend. I lifted weights 2-3 days per week as well. Guess what it got me? Fat.
It raised my triglycerides by 100 points, elevated my LDL-C and increased my waistline by 3 inches. Yes, I gained weight. But, hey, my doctor was happy because my HDL-C went up by 4 points.
I saw this identical pattern with 3/4ths the patients in my office. A fourth of my patient’s (the group without any genetic insulin resistance) saw weight loss and improvement in their cholesterol profiles, but the rest didn’t. I had the exciting opportunity to introduce the saddened and discouraged 3/4ths of my patients to STATIN drugs and blood pressure medications. My average patient’s gained 2-3% of their body fat each year. Those that exercised like fiends were lucky if their weigh gain just stabilized.
What I saw in my office over a period of eight years was that exercise and caloric restriction didn’t work. But I couldn’t say that, because that goes against everything your 8th grade health teacher taught you. It contradicted your neighborhood dietitian, and it spat in the face of the food pyramid and the USDA Guidelines. The Government wrong? Never. . . . Speaking contradictory of the calorie-in/calorie-out exercise dogma was heresy, right? Contradict, Dr. Ornish, wouldn’t be heard of?!!
If I’ve learned one thing in my medical career, it is this: “Don’t be afraid to question everything” – even Dr. Dean Ornish, the USDA and the American Heart Association. And, fascinatingly, I’m not the only on that did.
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Three Massive Studies did just that . . . question whether this exercise and caloric restriction dogma really works. This is what applying exercise and caloric cutting did for almost 67,000 people between 1972 and 2010 – little to nothing.
WHAT?!! Nothing?! You can’t be serous?
The first of these trials was the MRFIT (Multiple Risk Factor Intervention) Trial. It started in 1972, looking at 12,866 men with high risk for heart disease and followed them over seven years. All of them were placed on caloric restricted low fat diets and encouraged to exercise. It demonstrated that low fat diets and exercise FAILED to reduce weight or stop coronary artery disease in 100% of the cases. Don’t believe me? Read it for yourself (JAMA. 1982; 248 (12):1465-1477).
The second of these trials was the Women’s Health Initiative (WHI). This study started in 1991 and followed 48,835 women (yes, that’s a small city of women) for eight years. They didn’t believe the MRFIT results apparently, so they had a low fat (caloric restricted) arm and a control arm [the SAD diet (Standard American Diet)]. The women on the low fat arm lost a whooping 0.4 kg over the 8 year period (JAMA. 2006 Jan 4;295(1):39-49). 0.4 kg, really!?? That’s almost an entire pound of weight loss over 8 years. Quick, call Barnes & Noble so we can package that diet and sell it on Opra!! (Oh, wait, the news media was a little embarrassed by the findings and never really mentioned them.)
Lastly, if research on 60,000 men and women wasn’t enough to demonstrate what most primary care physicians seen in their offices daily, we had to do the Look AHEAD Study(Action for Health in Diabetes). This study started in 2001 and was supposed to run for 13.5 years. It studied 5,145 Type II diabetic patients with intensive lifestyle intervention. These patients were placed on intensive caloric and fat restriction of 1200-1800 calories per day with exercise and behavioral counseling. It was so unsuccessful, that they stopped the trial at 9.6 years – cause it wasn’t working.
The patients did lose some weight through Look AHEAD . . . an average of 6% of their body fat (That means you would have lost 15.6 lbs over 9 years if you weighed 260 lbs. Successful? . . . NOT). What made this trial worse is that it didn’t improve risk for coronary artery disease and people didn’t live longer (N Engl J Med 2013; 369:145-154). They just got the exciting chance to eat cardboard for 9 years of their lives. Sad. Very sad.
So, what does all this mean? Exercising your brains out at an expensive gym every morning won’t do much more than help you loose 1% of your body fat. It won’t increased your life span and it won’t decrease your risk of heart disease, despite what Dr. Ornish said. If you like spending $40 per month just to stare at sweaty fat bodies jumping up and down in spandex, by all means, please keep going to the gym. But I’d much rather spend that $40 on a nice rib eye steak at a restaurant staring at my wife. But, the benefits of saturated fat . . . that’s for another post.
Don’t get me wrong. I love lifting weights. I love riding my horse. I truly enjoy working in my yard. I even enjoy riding my bicycle. But I do these things now because they bring me peace, decrease my stress, and allow me to connect with nature. Believe me, there’s nothing natural about a 250 pound man in spandex staring at himself in a mirror repetitively lifting 30 pound bars of iron. But, we won’t go there.
My friends, and a few of my patients, get their knickers in a wad trying to decry the fact that I’m giving people a reason not to go running. Maybe I am. To be honest, there’s really only one reason I want to run, . . . and that’s when I’m being chased by a bear. But what good does it do to guilt a person into participation in an activity that isn’t really benefiting their health or help them lose weight, unless they really truly enjoy the activity for the sake of the activity?
Our health is not based upon a caloric scale of inputs and outputs. We are hormonal machines. We gain or lose weight and we gain or lose muscle based on powerful hormone signals, specifically insulin. Simple carbohydrate restriction has profound effects upon our weight, blood pressure, cholesterol and inflammatory states. Until we each come to grips with the fact that the food we eat triggers hormone responses in our bodies, we will continue down the path of diseases of civilization. Hippocrates summed it up when he said, “Let food be thy medicine, and let medicine be thy food.”
We just got a sample pack of Lily’s Chocolate. This is a Stevia and erythritol sweetened chocolate that has no aftertaste and doesn’t cause the stomach upset that many experience with chicory root based products. I am always looking for good low carbohydrate alternatives for snacks, as rescue foods, or to assist in baking.
My wife found this chocolate in a recipe that Carolyn Ketchum had posted on her website, All Day I Dream About Food. It is quite tastey!! Thanks, Caroyln!! (By the way, I dream about food all day long, too.)
I scanned a copy of the wrapper for the Salted Almond & Milk Flavor. I have to admit, I ate half the bar. It was that good!!
For those looking for an alternative chocolate for a snack or to use in a recipe, this may be the answer. You can find their whole line of chocolates here.
Have you noticed that there are a large number of advertisements in the media about checking your testosterone or “Low T” Syndrome? It seems like this is the new advertising trend on the radio and late night TV.
Suddenly, everyone’s testosterone is low and men are complaining about their libido, . . . or are they?
Benefits of Testosterone Optimization. (Image Credit: ArtOfManliness.com)
If you practice medicine long enough, you’ll see a trend that seems to have arisen as our waistlines have expanded. About half of the men in my office with insulin resistance, pre-diabetes or diabetes have low testosterone levels. But this shouldn’t be a surprise. Type II diabetes, metabolic syndrome and insulin resistance are all driven by an over production in insulin in response to a carbohydrate load in the meal. Patients with these conditions produce between two to ten times the normal insulin in response to a starchy meal. A number of studies both in animal and human models demonstrate that insulin has a direct correlation on testosterone suppression in the blood. This has been demonstrated in both men and women. In fact, glucose intake has been shown to suppress testosterone and LH in healthy men by suppressing the gonadal hormone axis and more predominant testosterone suppression is seen in patient with insulin resistance or metabolic syndrome.
In fact, to put it simply, insulin increases the conversion (aromitization) of testosterone to estrogen in men (it does the opposite in women). Interestingly, Leptin resistance has a similar effect. I tend to see the worst lowering of testosterone in men with both insulin and leptin resistance.
How to you improve your testosterone? Supplemental testosterone has been shown to help, but it comes with some risks, including prostate enlargement and stimulating growth of prostate cancer. The most natural way to improve your testosterone is to change your diet.
A low carbohydrate or ketogenic diet turns down the insulin production and allows the testosterone to be available for use by the body. A ketogenic diet has the effect of reducing leptin resistance as well through weight loss. A simple dietary change of this type is frequently seen in my office to increase testosterone by 100-150 points.
KetoOS – Drinkable Exogenous Ketones
What is a ketogenic diet? It is a diet that restricts carbohydrates to less than 50 grams per day, thereby causing the body to use ketones as the primary fuel source. So, for breakfast tomorrow morning, hold the oatmeal (1/2 cup of Quaker Instant Oatmeal is 31 grams of carbohydrates) and have the bacon and eggs. And, rather than have the cheesecake for desert this evening, have an extra slice of steak butter on your rib-eye and hold the potato.
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 are not appropriate for use with a true low-carbohydrate/ketogenic diet. You can see and print an article I published about these sweeteners here:
I have multiple patients that come to my office that we follow and treat for weight loss and metabolic syndrome. They are discouraged that their weight loss has stopped or is very, very slow. The most frequent problem I find when they bring in their food journals is the “healthy chicken salad.”
“What?! But, Doc, Chicken Salad is healthy?! RIGHT?”
The chicken salad shows up on their journal almost daily. Somehow, we’ve been indoctrinated that the chicken salad is good for us. I want you to look closely at the image that was recently shared on the internet below. How is the nutrient value of your chicken salad any different than the Big Mac?
Why is this unhealthy? The carbohydrate content greater than 20-30 grams will cause a spike in insulin. When insulin spikes, the body is told to store fat (and it will store fat for up to 12 hours) . . . Yes, the 24 grams of fat in the salad now become dangerous in the presence of an insulin spike. In my patients with metabolic syndrome, they will produce between two and ten times the insulin and store two to ten times the fat. (Ten Big Macs would have tasted better . . . )
There is actually more carbohydrate in your salad than in the big mac. Why not add a strawberry shake just to finish putting the nail in the coffin? And we wonder why we are having trouble with weight loss?
The other issue, and probably of even greater importance, is that chicken breast has the second highest content of lysine & argenine (two of the 10 essential amino acids) count of all the poultry family. This is second only to turkey breast, which also contains a large amount of tryptophan (a third essential amino acid that spikes insulin). Why is this a problem? Because argenine, tryptophan and lysine all stimulate an insulin response on their own, separate from glucose. We need these amino acids, however, when our meals contain a predominance of these amino acids, it rasies insulin significantly in those who are insulin resistant (pre-diabetic).
Those 43 carbohydrates, plus the stimulus from a meat high in argenine, lysine and tryptophan, spike your insulin, kick you out of nutritional ketosis and slow weight loss for up to 48 hours.
Please, if you are following a low-carb or ketogenic diet, get rid of the chicken salad.
The Food Stamp program is administered by the UDSA (Department of Agriculture) and proudly displays that they distribute free meals and food stamps to over 46 million people annually.
Meanwhile, the National Park Service, operated by the Department of the Interior states, in no uncertain terms, “Please DO NOT Feed the Animals . . .” Their policy and reasoning for this statement is . . .
“The animals will grow dependent upon the handouts, and they will never learn to take care for themselves.”
A number of patients come in to the office struggling with loosing weight. When I review their dietary journals with them, I notice that many of them never stop eating fruit (because, fruit is good for you, right?!). Well, lets put it this way:
One banana for breakfast is equal to . . .
. . . just over seven (7) teaspoons of sugar.
Count them . . . seven (7) teaspoons.
If your eating a banana for breakfast, it is halting your weight loss for up to 12 hours. Give the banana’s to the monkeys and cook up some sausage and eggs for breakfast tomorrow.
A friend posted this image and I couldn’t help but think about this little cartoon throughout the day. In the 15 years that I have been in medical practice, it was re-emphasized to me that my definition of cure and the patient’s definition of cure may at times be notably different or even in opposition.
I am reminded of a sweet a patient in her early nineties that was brought in by her three well meaning and very caring daughters. This patient was a type II diabetic and, for the most part, her blood sugar was in pretty good control. To put it in medical terms, her morning blood sugars were in the 120 range and her Hemoglobin A1c (HbA1c) was a 6.4%. She was obese by the standards of her body mass index (BMI) and her cholesterol was elevated.
The concern of her three daughters, “there to rat her out,” as the patient put it, was that she was eating donuts for breakfast each morning for the last few months. I noted that her HbA1c had gone up from 5.9% at the last visit. We discussed the fact that the change in her dietary intake appeared to have caused the rise in her blood sugar and her cholesterol.
With my affirmation of the cause as ammunition, the patient’s daughters began to individually take shots at her choice of meals over the last year. They did it, I could see because they loved and cared for heir mother. But I noticed the patient’s demeanor change suddenly, and a bit of trust between me and my patient began to slip.
This sweet centenarian turned and looked at me, square in the eye, and then proceeded to give me an education.
“Dr. Nally, do you know how old I am?” she asked.
“Why, yes, you are 93 years old,” I replied.
“And do you know how much longer I am going to be alive on this earth?” she inquired.
“Well, no. I do not know how much longer you will be alive, but I can tell you that you have out lived most of your peers and the average age of most Americans.”
“Then, why the hell are you, and my daughters, worried about me eating a damn do-nut?” she yelled. “My blood sugar is still pretty good and I figure that if I have to be around on this earth any longer, then by stars, I am going to enjoy my favorite breakfast. If it kills me, then so be it. I am going to enjoy it.”
Well, that was that. The cure was to enjoy her last few years upon this earth.
The world, generally divides men into those two general classifications, but the world is often wrong. There are men and women who win the admiration and respect of their fellowmen. They are profoundly worth while individuals. Dreaming is just another name for thinking, planning, devising – another way of saying that a man or woman exercises his or her soul. A steadfast soul, holding steadily to an ideal that first sprouted as a dream, plus a sturdy will determined to succeed in any venture, can make any dream come true. Use your mind and use your will. The two work together for you beautifully if you’ll only give them a chance.
BuzzFeed’s Christine Byrne has a great article on 31 ideas for Low-Carb breakfasts . . . I’m going to have to try some of these. The “Eggs in a Cloud” looks fantastic . . .
A few of my patient’s have fallen off the carbohydrate restriction waggon this last year. In celebration of restarting your low-carb lifestyle and resolutions to improve your health, I propose the following celebration.
1) Go home right at 5pm
2) Pull out your favorite skillet (mine is a well used Lodge Cast Iron pan)
3) Remove your favorite full fat sausage from the freezer.
4) Look up your favorite cream cheese waffle recipe.
5) Make your self a Sausage Sanctuary, a Bacon Bungalow or a Low-Carb Cabin (whatever tickles your fancy) in celebration of restarting your carbohydrate restriction and removing the carbage from your life.
I suggest you use a Low-Carb cream cheese waffle you can find here for the roof.
There are a number of recipes for “Fat Bombs” on the internet, but this one is my wife’s version. These have been a lifesaver for starting and maintaining a Low-Carbohydrate or Ketogenic diet over the last few years. They are fantastic mid-meal or anytime Low-Carb snacks, full of satiating fat, that really help during the holidays. I mentioned Fat Bombs to my patients in my Low-Carb Group Visit Class today and I promised to post them here:
Fat Bombs:
1 stick of real Butter softened
1 cup Coconut Oil
1/2-2/3 cup Erythritol
1 tsp liquid Stevia
1/3 cup Cocoa Powder
1 cup Peanut Butter or Almond Butter
2 cups chopped Macadamia Nuts or slivered Almonds
1-2 cups of Coconut
Mix together and place 1-2 table spoon sized scoops in small muffin tin or on wax paper. Must be kept refrigerated to remain firm.
Fat.
