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Long-term weight loss

Long-Term Weight Loss: Why So Many Fail

Over fifty years of data have demonstrated that creating energy deficit through the reduction in caloric intake is effective in reducing weight. . . However, it is only for the short term (1, 2).  The biggest challenge physicians face in the treatment of obesity is that calorie restriction fails when it comes to long-term weight loss.

Isn’t Fasting Effective in Long-Term Weight Loss?

With the craze and popularity of intermittent fasting, some have claimed that intermittent fasting is more effective in weight reduction.  Recent results demonstrate that this may also be incorrect.  In the short term evaluation of caloric restriction and intermittent fasting, reduction in 15-20 lbs of weight is effectively seen and the highly publicized Biggest Loser’s losing ~ 120 lbs.  Intermittent fasting and alternate day fasting have been shown to be more effective in lowering insulin levels and other inflammatory markers in the short term.

There is, however, controversy over maintaining weight loss beyond 12 months in the calorie restriction, intermittent and alternate day fasting groups. Forty different studies in a recent literature review, thirty-one of those studies looking at forms of intermittent fasting, demonstrate that the majority of people regain the weight within the first 12 months of attempting to maintain weight loss(3, 5).  This is, also, what I have seen for over 18 years of medical practice.

Is Calorie Restriction the Only Way to Lose Fat?

Numerous “experts” claim that the only way to reduce fat is “caloric deficit.”  Variations through the use of intermittent, long-term or alternate day fasts can be found all over the internet.   In regards to calorie restriction, these “experts” with nothing more than a personal experience and a blog to back their claims preach this louder than the “televangelists” preach religion.  Based on the faith that many place in this dogma, it could be a religion.  What causes belief in this dogma is that weight and fat loss actually does occur with caloric restriction to a point.  The average person will lose 20-25 lbs, however, within 12 months of achieving this goal, most people regain all the weight.  (No one ever mentions the almost universal problem with long-term weight loss, especially those “experts.”)

Prolonged calorie restricted fasts, intermittent fasts, and alternate day fasts are often grouped together into the fasting approach, causing significant confusion among those that I speak to and counsel in my office.  There is great data that alternate day fasts do not have the reduction in resting energy expenditure that prolonged fasting, intermittent fasting and calorie restriction cause.  However, none of these approaches appears to solve the problem of weight re-gain after long-term (12-24 months into maintenance) weight loss (3).  And, a recent study of 100 men participating in alternate day fasting showed that there was a 38% dropout rate, implying that without close supervision and direction, maintenance of this lifestyle is not feasible for over 1/3rd of those attempting it.

Long-Term Weight Loss Failure Brings Tears

Failure on calorie restricted diets, low fat diets, and intermittent fasting diets with weight regain at twelve to twenty-four months is the most common reason people end up in my office in tears.  They’ve fasted, starved themselves, calorie restricted, tried every form of exercise, and still regained the weight.  Trainers, coaches and “experts” have belittled them for “cheating” or just not keeping to the diet.  Yet, we know that calorie restriction and intermittent fasting cause a rebound in leptin, amilyn, peptid YY, cholecystikinin, insulin, ghrelin, gastric inhibitory peptide and pancreatic poly peptide by twelve months causing ineffective long-term weight loss (6).  The dramatic rise in these hormones stimulates tremendous hunger, especially from ghrelin and leptin.

Hormones after weight loss
N Eng J Med 27 Oct 2011. Mean (±SE) Fasting and Postprandial Levels of Ghrelin, Peptide YY, Amylin, and Cholecystokinin (CCK) at Baseline, 10 Weeks, and 62 Weeks.

Although less problematic in alternate day fasting, these calorie restricted approaches also cause dramatic slowing of the metabolism at the twelve month mark.  In many cases, the metabolic rate never actually returns to baseline, creating even more difficulty in losing further weight or even maintaining weight (6).

Weight rebound after loss
N Engl J Med 27 Oct 2011. Mean changes is weight from 0 – 62 weeks.

Is Gastric Bypass or Gastric Sleeve the Solution?

Gastric bypass and the gastric sleeve procedures have been touted as the solution to this problem, as they decrease ghrelin, however, 5-10 years later, these patients are also back in my office.  They find that 5-10 years after these procedures the weight returns, cholesterol and blood pressure rise, and diabetes returns.  These hormones kick into high gear, stimulating hunger in the face of a slowed metabolism, that to date, has been the driver for weight regain in the majority of people.  People find it nearly impossible to overcome the hunger. You may have experienced this, I know I have.

It’s the Hormones, Baby!

So, what is the answer?  It’s the hormones.  (WARNING – You’ll hear that when your wife is pregnant, too, gentlemen).  We are hormonal beings, both in weight gain, and in pregnancy.  Trying to preach calorie control to a hormonal being is like showing up at the brothel to baptize the staff. You might get them into the water, but you’re probably not getting them returning weekly to church or pay a tithe.

Respect My HormonesSo, how do you manipulate the hormones in a way to control the rebounding hunger and suppression of metabolism?  This is where we put a bit of twist on the knowledge we’ve gained from alternate day fasting.  Recent research shows that “mild” energy deficit in a pulsatile manner, that has the ability to mimicking the body’s normal bio-rhythm’s is dramatically effective in reducing weight and maintaining normal hormonal function without cause of rebound metabolic slowing (4).

Pulsed Mild Energy Restriction

What does this mean in layman’s terms?  It means that if we provide a diet that maintains satiety hormones while providing a period of baseline total energy expenditure needs and a period of mildly reduce caloric intake in a pulsed or cyclic manner, greater weight loss occurs and there is no rebound of weight 1-2 years later.

The main reason I’ve not jumped on the intermittent fasting band wagon is the shift in leptin, amylin, ghrelin and GLP-1 signaling that regularly occurs at the 6-12 month mark.  The rebound of these hormones causes weight re-gain and is what prevents successful long-term weight loss.  A number of people come to my office and tell me they couldn’t follow a ketogenic diet, so they’re doing intermittent fasting and it works . . . for a while.  Then, they end up in my office having hit a plateau or fallen off the wagon and regained all the weight.  They are completely confused and don’t understand what happned.  Most of them are convinced it’s their thyroid or cortisol and they’ve seen every naturopath and functional medicine doctor in town.

What people really need is a simple approach to long-term weight loss without having to spend the night in the physiology lab every two weeks sleeping under a ventilated hood system.

The Ketogenic Lifestyle is a Pulsed Energy Lifestyle

  • First, it is essential to turn off the insulin load. Insulin is the master hormone.  This is done by a ketogenic lifestyle that restricts carbohydrates.
  • Second, providing adequate protein to supply maintenance of muscle and testosterone is key.
  • Third, providing adequate fat is the simple way to maintain leptin, ghrelin, amylin, GLP-1 (among the others) and long-term weight loss.  Can you eat too much fat?  Of course you can.  But, because each of us have differing levels of stress and activity each day, this fat intake becomes the lever for hunger control.
  • Fourth, the use of exogenous ketones ensures easily accessible ketone (short chain fatty acids) to modulate adipose (white fat) signaling of the liver without large caloric intake through the portal vein by first pass of liver metabolism.  The ketones also help stabilize the gut bacteria.  The combination of hormone balance between the liver and fat cells and improvement of gut bacteria suppresses key hunger hormones and aids glucose regulation between the fatty tissues and the liver.  Ketones, both endogenous and exogenous, suppress production of TNF-alpha, IL-6, resistin, and stabilize production of adiponectin and leptin from the adipose cells (7, 8, 9).

In my office, once we calculate the basic protein needs daily, we start with a 1:1 ratio of protein to fat.  Then, the fat is adjusted up or down based on hunger. Remember, hunger occurs, because your body produces hormones.  The addition of fat to a diet that is not stimulating large amounts of insulin resets the hormone patterns back to normal without causing weight gain.

Give Obese People Fat Ad Libitum?

“Sure, Dr. Nally, but what about those people who don’t know if they are hungry, bored, stressed or just have a bacon fixation?  You can’t just give them all the fat they want?!”

Why not?  Implying that people aren’t smart enough to know when they are full is a bit of a fascist philosophy, don’t you think?

Do people over eat?  Sure they do.  But, I’ve found that when you give people an antidote to hunger (using fat intake in the presence of stabilized insulin levels) over a few months, people begin to recognize true hunger from other forms of cravings.  This is especially true when they keep a diet journal.  This gives people the ability to begin listening to their own bodies, responding accordingly and governing their stress, eating, exercise and activity.  Keeping a diet journal is key to long-term weight loss.  And, isn’t helping people use their own agency to improve their health really what we’re trying to do?

Interestingly, doing this over the years seems to line up with the findings of this year’s MATADOR study in the International Journal of Obesity.  They found that mild intermittent energy restriction of about 30-33% for two weeks, then interrupting this with two weeks of a diet that was energy balanced for needs improved both short and long-term weight loss efficiency (4).  In looking at my, and my patient’s diet journals, this energy restriction of about 1/3 of needed calories cyclically seems to happens naturally with a ketogenic lifestyle, without even counting calories.  (Calories are a swear-word in my office).

What does the correct long-term wight loss program look like in a diet or meal plan?  Well, you’ll have to join the Ketogenic Lifestyle 101 Course to see what that really means to you individually.  I look forward to seeing you there.

Want to find out more about the Ketogenic Lifestyle 101 course?  CLICK HERE.

 

Have you read my book The Keto Cure?  Get a signed copy from me by clicking HERE.

References:

  1. Bronson FH, Marsteller FA. “Effect of short-term food deprivation on reproduction in female mice.” Biol Reprod. Oct 1985; 33(3): 660-7. https://www.ncbi.nlm.nih.gov/pubmed/4052528?dopt=Abstract&holding=npg
  2. Connors JM, DeVito WJ, Hedge GA. “Effects of food deprivation on the feedback regulation of the hypothalamic-pituitary-thyroid axis of the rat.” Endocrinology. Sep 1985. 117(3): 900-6. https://www.ncbi.nlm.nih.gov/pubmed/3926471?dopt=Abstract&holding=npg
  3. Seimon RV, Roekenes JA, Zibellini J, Zhu B, Gibson AA, Hills AP, Wood RE, King NA, Byrne NM, Sainsbury A. “Do intermittent diets provide physiological beneftis over continuous diets for weight loss? A systematic review of clinical trials.” Mol Cell Endo. 15 Dec 2015. 418(2): 153-172. https://www.sciencedirect.com/science/article/pii/S0303720715300800
  4. Byrne NM, Sainsbury A, King NA, Hills AP, Wood RE. “Intermittent energy restriction improves weight loss efficiency in obese men: the MATADOR study.” Int J Obes. 2018. 42:129-138.  https://www.nature.com/articles/ijo2017206
  5. Trepanowski JF, Kroeger CM, Barnosky A. “Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults.” JAMA Intern Med. Jul 2017. 177(7): 930-938. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2623528?redirect=true
  6. Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, Proietto J. “Long-term persistence of hormonal adaptations to weight loss.” N Engl J Med. 27 Oct 2011. 365: 1597-1604. http://www.nejm.org/doi/full/10.1056/NEJMoa1105816
  7. Asrih M et al., “Ketogenic diet impairs FGF21 signaling and promotes differential inflammatory responses in the liver and white adipose tissue.” PlosOne. 14 May 2015. Open Access. https://doi.org/10.1371/journal.pone.0126364
  8. Veniant MM et al. “FGF21 promotes metabolic homeostasis via white adipose and leptin in mice.” PlosOne.  Jul 2012. Open access. https://doi.org/10.1371/journal.pone.0040164
  9. Whittle AJ, “FGF21 conducts a metabolic orchestra and fat is a key player.” Endocrinology. 1 May 2016. 157(5): 1722-1724.

Tuesday’s Rumination

Eating whole grains to get more fiber is like eating carrot cake to get more vegetables.

CarrotCake

 

So, in early medieval Britain, when sugar was hard to come by, they were smart enough to know that one carrot was almost the equivalent of 1 tsp of sugar. The sly baker’s, knowing that they could substitute high starch vegetables as a replacement for sugar, convinced us over the years that this was “healthy” because of the fiber.

Yea, right. . .  I’m seeing a heart-attack-on-a-plate.

Those that tell you to eat more vegetables, because you need the fiber, deserve to step on a Lego late this evening on their way to the commode.

Either way, the following table should deter you from looking for fiber in the land of starch:

  • 1 cup of beets – 4 tsp sugar
  • 1 cup or one medium ear of corn – 3 tsp sugar
  • 1 medium (1/2 cup) sweet potato – 2 tsp sugar
  • 1 cup peas – 2.4 tsp sugar
  • 1/2 sweet onion – 2 tsp sugar
  • 1 medium carrot – 1 tsp sugar
  • 1 medium bell pepper – 1.2 tsp sugar
  • 1 cup green beans – 1.1 tsp sugar
  • 1 medium tomato – 0.8 tsp sugar

Do you want to find more important ketogenic lifestyle training that is easy to access, in a way that is simple and painless to remember?  Are you confused by all the contradictory information about a ketogenic lifestyle on the “interwebby?”  Are you tired of people claiming street smarts, when they’re really just Sesame Street smart?

Come join me on my membership site and take the Ketogenic Lifestyle 101 Course.

You’ll thank me later. . .  Seriously, what are you waiting for?

 

Did you join yet?!

Dr. Nally’s Twenty Two Tough Truth’s

Sunday’s are my day of rest, . .  . if a physician ever really rests? I’m sitting out under the stars very late on this Sunday evening, into the wee hours of Monday morning.  (It’s our turn for flood irrigation at 2 o’clock in the morning).  But, I appreciate these times of solitude.  It is on Sunday’s that I’ve been able to work on twenty two life lessons (tough truths) that make life better. I do my best to treat Sundays as a “sacred” or “holy day,” a day of rest from my temporal labor, to contemplate the word of God, to pray & meditate, to participate in public worship and focus on where I am at in my personal spiritual development.

Yes, I know.  I’m a physician; and yet, I believe in God.

No, it is not a contradiction.  (I can already see my in-box filling up with agnostic castigation.)  Friends of mine claim atheism or agnosticism.  Yet in the day to day trenches of life, I find there is no real atheism. There is no such thing as not worshiping.  When it comes down to it, we all worship something.  We each have the choice of what we worship.  Worship being defined as giving adoration, reverence or homage to someone or something.

We have the choice of worshiping the God, a god (however you may define god), spiritualism, truth, ethical principles, nature, football, money, your body, someone else’s body, power, fame, etc.  You and I know this on a basic level, we just have to come to grips with what it is we hold on a pedestal, and to which we “pay homage.”

There comes a point, when one deals with life and death on a daily basis, that a person must question the very existence of God, and come to terms with who or what we actually pay homage.  I’ve sincerely asked that question . . . I’ll leave that story for another time.

It’s during my Sunday afternoons, that I’ve been able to contemplate and attempt to re-apply the “tough truths” of life that seem to challenge me.  So, instead of sharing some bacon with you this evening, I thought I’d share twenty two of the truths that I am working on improving in my life. (Though . . . they’re almost as good as bacon!)

Twenty Two Tough Truth’s that I’ve Learned & Had to Re-Learn in Life:

  1. There is much about life over which we have absolutely no control. You cannot control everything that happens in life, but you can control how you respond.  Your response is your greatest power.  “The joy we feel has little to do with the circumstances of our lives, and everything to do with the focus of our lives.” (Russel Nelson)
  2. It’s not about the cards you’ve been dealt, it’s about how you play the hand. (Randy Pausch)
  3. W. C. Fields said, “Smile first thing in the morning and get it over with.”  My expectations often make me utterly unhappy.  Happiness is letting go of what you assume your life is supposed to be like right now, and sincerely appreciating it for everything that it actually is. 
  4. In mortality, we will always be incredibly imperfect.  If you wait until you’re perfect before you share your stories, ideas, talents and gifts with the world, no one will ever hear from you.
  5. A moment spent worrying is a moment wasted. Worrying will NEVER change the outcome.  Do more, worry less. Train your mind to see the lesson in EVERY situation, and then make the very best of it.  Liberating ourselves from our fears, automatically gives people the ability to do the same around you.  
  6. The best lessons often come from the very hardest days.  If you are having a hard day, stand strong, there is a lesson here.  Sometimes you have to experience a low point in life to learn a good lesson you couldn’t have learned any other way. 
  7. Success easily gets to our heads, and failure easily gets to our hearts.  Our true character is usually revealed at our highs and lows.  Be humble at the mountain top, steadfast in the valley’s and faithful in between. 
  8. We often confuse being busy with being productive.  What you pay attention to grows.  So, focus on what truly matters and let go of what does not. “You are the average of the five people you spend the most time with.” (Jim Rohn)
  9. More money left un-managed just creates more problem.  Yes, we need money to live.  Earn it. Save it. Invest it. But, avoid spending money you haven’t earned, to buy things you don’t need, to impress folks you don’t even know. Manage your money so it doesn’t end up managing you. 
  10. Most of us don’t need more to be happy – we need less.  When things aren’t adding up in life, begin subtracting.  Life gets much simpler when you clear away the physical and mental clutter that makes it complicated. 
  11. Our fancy gadgets (phones, computers, tablets, radios, etc.) often get in our way and dehumanize us.  We all need to learn to be more human again.  Don’t avoid eye contact.  Don’t hide behind the gadgets.  Smile often.  Ask about people’s stories . . . And, then, listen.
  12. We don’t always get what we give.  You will end up sadly disappointed if you expect people will always do for you as you do for them.  Not everyone has the same heart you do. 
  13. Most arguments we have with one another are pointless.  Be selective in your battles. Peace in this moment may be better than being right. You actually don’t need to attend every argument into which you’ve been invited. “You will never reach your destination if you stop and throw stones at every barking dog.” (Winston Churchill)
  14. I’ve never met a strong and confident person with an easy past. Be grateful for your scars.  Be thankful for the emotional muscle and physical strength you gain from standing against the winds of life.
  15. The only way to completely avoid pissing people off is to do nothing of importance. 
  16. The true definition of “Hell” is to meet the person you could have become on your last day on earth. 
  17. Just because you fell off the ketogenic wagon today, doesn’t give you license to drag it into the woods, set it on fire and use the insurance money to buy Twinkies. 
  18. “You only live once, but if you do it right, once is enough.” (Mae West)
  19. Ignoring your passion in life creates anxiety.  Ignoring the anxiety, creates panic and hopelessness. Never ignore what moves you. Mold your work around the lifestyle that brings you passion, don’t mold your passion around your career. 
  20. The human body tends to move more or less in the direction of your expectations.  This is why it is so important to know that the attitudes of confidence and determination you feel and hold are just as much a part of your treatment program as medical science and technology.
  21. The hottest places in Hell are reserved for those, who in times of great moral crises, maintained their neutrality. (paraphrased from Dante Alighieri)
  22. A man would do well to carry a pencil in his pocket, and write down the thoughts of the moment.  Those thoughts that come unsought after in the moment are commonly the most valuable, and should be secured by recording them, . . . because they seldom return.  (Brigham Young)

Over the years, I’ve carried a leatherbound little notebook with me and I write down thoughts or quotes I hear into that little note book.  Among these thoughts and quotes I’ve collected, I’ve found that on Sundays, I can let my mind chew on them.

One of the things that I’ve learned over the years is that observing a weekly “day of rest,” or “holy day,” is that this behavior is one of the most important safeguards to health and wellness.  I’ve learned this from my personal experiences during periods when I didn’t observe the “day of rest” and periods where I have closely guarded that “day of rest.”  I’ve found that observing the Sabbath has truly become a “delight” as spoken of by the Old Testament prophet, Isaiah.

Science Demonstrates Importance of Day of Rest

What is fascinating, is that science has recently demonstrated how this works.  In early 2000, Marcus Raichle from Washington University demonstrated that the human brain demands 20 percent of the body’s energy and uses only 5-10 percent more when solving calculus problems, reading a book (or this blog post, for that matter) or writing a letter.  However, they noticed that some areas of the brain became notably less active when concentrating on a mental challenge, but fired synchronously when laying flat in an MRI scanner, allowing their thoughts to wander (1).

This was confirmed by a number of other researchers who noted that there was a coordinated communication between diverse areas of the brain when people were “resting.” This mysterious coordination between different parts of the brain during “daydreaming” has become known as the default mode network (DMN).  In the last few years, we’ve learned there are actually five different “resting state networks” that coordinate vision, hearing, movement, attention & memory. However, the DMN is the most researched and appears to be the most important.

Dr. Immordino-Yang reviewed the research on the DMN and found that downtime is an opportunity for the brain to make sense of what it has recently learned. It is during this “day of rest” that the mind coordinates unresolved tensions, conversations we had earlier in the week, re-writing verbal blunders, and practicing standing up to those that intimidate us.  Our minds shuffle through the neglected to-do lists and post-it notes on the mental refrigerator of our brain, searching for solutions and answers.  It moves back and forth through childhood scenes and futuristic adult hopes and dreams. It is during this time that our brain looks at the moral connotations of our performance with others (3).

Other research demonstrates that the mind solves very tough problems during this period of rest and day-dreaming.  You may have experienced something like this when you solve a problem while in the shower.  (I hate to admit it, but many of my problems get solved in the shower.)  When the mind isn’t actively working or learning something new, it can accumulate, memorize and rehearse recently learned skills, actually transcribing them onto new brain matter (4).  Recent research demonstrates that this recording of new memory and skill, called “sharp-wave ripples” actually occurs more often during “rest periods” than during sleep (5).

Meditation and the Day of Rest

Meditation and/or prayer have been shown to strengthen connections between regions of the DMN.  Those that observe a day of rest with meditation develop a more intricate wrinkled cortex, the outer layer of the brain that gives us the ability to perform abstract thought and introspection.  Meditation appears to increased both the volume and density of the hippocampus, the area of the brain essential for memory storage and the frontal cortex that allows us to control or rein in emotions.  Fascinatingly, meditation and observance of a “day of rest” slows the natural “wilting” of the brain regions required for sustained attention that normally withers as we age (6, 7, 8, 9).

How soon does observing a rest day or “keeping the Sabbath” become effective?  A number of studies show that noticeable changes occur within a couple of weeks.  More importantly, daily meditation has been show to be more effective in the long run than the total hours of meditation over one’s lifetime (10,11).

As a physician and a clinical hypnotherapist, I personally use and recommend daily meditation.  If you want a free copy of my self-guided meditation program for relaxation and weight loss, CLICK HERE.

Now, what I want to know, is does bacon intake during the rest day have any effect on the hippocampus, frontal cortex or wrinkle cortex?  I guess we’ll have to wait for that research to be completed.  In the mean time, check out my membership page to see what we do know about the use of fat and cholesterol does to help attention and energy.

References:

1. Raichle ME, MacLeod AM, Snyder AZ, Powers WJ, Gusnard DA, Shulman GL. “The maturing architecture of the brains default network.”  Proc Natl Acad Sci U S A. 2001 Jan 16; 98(2):676-82.
2. Moussa MN, Steen MR, Laurienti PJ, Hayasaka S.  “Consistency of Network Modules in Resting-State fMRI Connectome Data” PLOSone. 31 Aug, 2012. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0044428.
3. Immordino-Yang MH, Christodoulou JA, Singh V. “Implications of the Brain’s Default Mode for Human Development and Education.” Perspectives on Psychological Science. 29 Jun, 2012. 7(4): 352-364.
4. Payne, JD. “Learning, Memory, and Sleep in Humans.” Sleep Medicine Clinics. Mar 2011. 6(1):15-30.  https://www.sciencedirect.com/science/article/pii/S1556407X10001220.
5. Perlow LA, Porter JL. “Making Time Off Predictable – and Required.” Harvard Business Review. Oct 2009. https://hbr.org/2009/10/making-time-off-predictable-and-required.
6. Zeidan F, Johnson SK, Diamond BJ, David Z, Goolkasian P. Mindfulness meditation improves cognition: Evidence of brief mental training.” Consciousness and Cognition. Jun 2010. 19(2): 597-605. https://www.sciencedirect.com/science/article/pii/S1053810010000681#]
7. Luders E, Kurth R, Mayer EA, Toga AW, Narr KL, Gaser C. “The unique brain anatomy of medication practitioners: alterations in cortical gyrification.” Front Hum Neurosci. 29 Feb, 2012. online. https://www.frontiersin.org/articles/10.3389/fnhum.2012.00034/full
8. Pagnoni G, Cekic M. “Age effects on gray matter volume and attentional performance in Zen meditation.” Neurobiology of Aging. 28(10): 1623-1627. https://www.sciencedirect.com/science/article/pii/S0197458007002436
9. Luders E, Toga AW, Lepore N, Gaser C. “The underlying anatomical correlates of long-term meditation: Larger hippocampal and frontal volumes of gray matter.” Neuroimage. 15 Apr 2009. 45(3) 672-678. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3184843/
10. Chiesa A, Clati R, Serretti A. “Does mindfulness training improve cognitive abilities? A systematic review of neurpsychological findings.” Clinical Psychology Review. 1 Dec 2010. 31: 449-464.  http://psy.fgu.edu.tw/web/wlchou/perceptual_psychology/class_pdf/Advanced%20Perceptual/2011/2011week15_HaoChen_paper.pdf
11. Chan D, Woollacott M. “Effects of level of meditation on experience on attentional focus: is the efficiency of executive or orientation networks improved?” J Altern Complement Med. 2007. Jul-Aug. 13(6): 651-657. https://www.ncbi.nlm.nih.gov/pubmed/17718648.
Salt #DocMuscles #KetonianKing DocMuscles.com

What If Salt Actually Improves Blood Pressure & Blood Sugar?

What if increasing your salt intake actually improved your diabetic blood sugar?

What if increasing salt intake actually lowered your blood pressure?  Could it be that easy?

Just about every patient that I see has significant worry about salt intake.  Some greater than others. In fact, some people are so salt phobic that when I encouraged its use, they called me a “quack” and left my practice.  But does salt restriction really work, or is it doing more damage than we think?

That was the question that was asked by Dr. Ames in the American Journal of Hypertension 17 years ago.  However, his answer never got a mention.  In fact, I’ve been in practice for almost 18 years, and incidentally stumbled upon this article when it was mentioned by a colleague of mine.   Granted, it is a small sample of people, only 21 in the study.  However, the results are profound.

21 patients with hypertension were randomized to periods of no salt (placebo) and periods of 2 grams (2000 mg) of sodium chloride four times a day (a total of 8 grams of salt per day).  Glucose tolerance tests were completed with insulin levels at the end of each intervention period.

Insulin Resistance and Hypertension Improve by Adding Salt

What was noteworthy was that those with insulin resistance and diabetes had improvement in their glucose levels while on sodium supplementation.  Those with hypertension had improvement in their blood pressure while on the sodium supplementation.   Lastly, those with insulin resistance had a lowering of their insulin levels during the period of increased sodium intake.  These findings fly in the face of the dogma that’s been drilled into our heads that “salt is bad!”

“But, you can’t base your findings on a small group of 21 people,” the experts say.

Yes, it is a small study group. However, these findings are what I, also, have seen clinically in my practice for over 13 years.

We know that the average human needs 3 grams of sodium per day and 3 grams of potassium per day.  If you’re eating the standard American diet (SAD diet) including processed foods, you’re getting 2-3 grams per day of sodium.  In fact, the CDC claims the worst meals for you are:

  • Bread
  • Processed chicken dinners
  • Pizza
  • Pasta

However, if your following a low-carbohydrate or ketogenic lifestyle, you won’t be eating the meals above and you’re probably not getting near enough salt.  This is the cause of the keto-flu I wrote about a few weeks ago.  And, according to the study above, it is a potential driver of our persisting insulin resistance, diabetes and hypertension.

How Much Salt Should I Use?

In my office, I encourage use of 3-4 grams of sodium and 3-4 grams of potassium daily when using a ketogenic lifestyle.  That’s approximately 1 1/2 – 2 teaspoons of salt per day.  I like Redmond’s RealSalt or if you can’t find it, Himalayan Pink Salt, because the pink sea salts contain sodium, potassium, magnesium and zinc.

Could it be that salt restrictions are making our insulin resistance and blood pressure worse?  That’s what the clinical evidences are pointing toward. However, more research is still needed.

Want to know more about a ketogenic life-style?  Click the link on KetoLife above to get some basics.  If you’re already following a ketogenic lifestyle, then let me help you navigate the bumps and turns by going to the Supplement section above and checking out the products I recommend to jump-start ketosis DocMuscles style!

Until then, I’ll have another piece of bacon, please . . . and, oh, pass the salt!

The Keto-Flu

So, you have the keto-flu.  No, you’re not contagious.  No, you can’t pass it on to someone else, or catch it when your friend who follows a ketogenic lifestyle sneezes.

Actually, congratulations are in order. You’ve just experienced the amazing metabolic shift that jump-starts the healing process in your body.  You’re shifting to a metabolism that optimizes the use of fat in the form of ketones.  During this transition, usually within the first week, people can experience a series of symptoms that have been dubbed the “keto-flu.”

Symptoms

What are the common symptoms of the keto-flu?

  • Fatigue
  • Headache
  • Brain Fog
  • Dizziness
  • Nausea
  • Irritability
  • Light-Headedness
  • Leg Cramps

These symptoms can last 3-5 days, in some people I’ve seen it last as long as two weeks.   But, if you weren’t expecting it, and you don’t know what it is, it can be kind of discouraging.  Don’t despair, however, if you know what it is, you can usually do a couple simple things to prevent it, or at least cause the symptoms to dramatically improve.

Cause

The keto-flu is usually caused by a shift in your body’s use of water and salt. Insulin causes the kidneys to retain sodium. When you change to a ketogenic lifestyle, your insulin levels fall to baseline and your body is able to use the sodium and potassium to remove the excess water production in each cell from fat burning. (If it didn’t, you’d swell up like beached whale.) This isn’t a bad thing, it just means that you need to add these electrolytes back into your diet in a greater degree.

The average adult human needs 3-4 grams of sodium each day and 3-4 grams of potassium each day to balance out water use and make all the cells happy.  So, what’cha wait’n for? Make your cells happy.

How To Treat It

I find that putting 1/2 teaspoon of salt (I like the Himalayan Pink sea salt because it contains sodium, potassium, magnesium and zinc) in a glass of water cures the symptoms very rapidly, sometimes within minutes. It’s amazing how fast you suddenly feel the brain fog lift and your energy returns.

Another option is using a bouillon or bone broth with your meal. This adds to the overall enjoyment of the meal and replaces these needed electrolytes in a very tasty way.

If the salt replacement doesn’t do the trick, then your keto-flu may be related to the need for more fat. Often, people who start a ketogenic lifestyle cut out the carbs, but don’t put enough fat back into the system.

On the traditional American (or insert your own country of residence here) diet the body uses carbohydrate as its primary fuel and protein for building blocks. When you cut out the carbs, your body will continue to use the protein for building muscle, skin and connective tissue. However, if you don’t give it enough fat to replace the carbohydrate you removed, it’s like running your car on fumes.

You’re body will run for a while, but not very well.  And, in some cases, you’ll feel like you were left on the side of the road with a body that doesn’t want to go anywhere.  You’ll feel like the gas tank is empty.

If you’re not used to a diet higher in fat, your body also has to “fat-adapt,” sometimes called keto-adaptation.  This is the process of your gut and cells up-regulating MCT receptors (fat channels or doorways for fat) to enter more efficiently.  This can take a few weeks, and for some a few months.  Not giving yourself enough fat in a ketogenic lifestyle can slow this adaptation process and also give you keto-flu-like symptoms.

What If It Doesn’t Improve?

If the leg cramps haven’t improved with the replacement of the salts and fat, you might consider yellow mustard.  Mustard contains sinapoline that when metabolized through the acid of the stomach in the body has a byproduct that is similar effect to that of quinine.   Patients, and myself included find that dipping summer sausage or your favorite hard cheese in some yellow mustard before bed does wonders in prevention of muscle cramps or spasm.

If the nausea turns to vomiting, or if the headache or fatigue worsens with added weakness, then it’s time to call your doctor and get checked out.  Vomiting, weakness and worsening fatigue are signs of something more serious.  If this happens, call your doctor.

What About Exogenous Ketones?

Lastly, the addition of exogenous ketones (ketones bonded to a salt) are also very helpful in this transition period.  Drinking exogenous ketones provides added ketones, rapidly absorbed into the blood stream, and second they provide some of the sodium, potassium or magnesium needed as a replacement.  You can check out my Ketogenic Kick-Start packages here.  Or, you can go to Dr. Nally’s favorite ketone store at DocMusclesKetones.com and order them directly.

Either way, I hope you find this helpful as you transition to your Ketogenic Lifestyle.