Sugar with your Salt?

Now you have to watch your salt ingredients too.  Store bought salts are starting to add dextrose for flavor.  Dextrose is just another word for SUGAR!!  Aaarrrrhhhhh!!  Why do you need to add sugar to your salt?  You don’t.  Throw out any salt that contains dextrose.  It will raise your cholesterol and cause weight gain.

Salt with Sugar

Never noticed this until it was pointed out by Maria Emmerich.  Thanks, Maria.

Stevia . . . the plant

Many of you have already seen my article about sweeteners, which ones work well and which ones make you fat.  If not click here for the article.  Stevia is one of those sweeteners that doesn’t spike your insulin as long as it isn’t crystallized with dextrose or maltodextrin. I actually found the stevia plant at one of my nearby nurseries, thanks Moon Valley Nursery.

Here is the plant after two weeks in my aquaponics garden.

The leaf can be dried, crushed then used to sweeten food or drink.  Can’t wait to try it.

Stevia Plant

Don't Fear Fat

Dont Fear Fat

 

Don’t fear the fat.  If you haven’t seen the movie Cereal Killers, you should watch it by clicking here.   D.J. O’Neill ditches wheat and sugar in a food plan consisting of 70% fat – under the guidance of legendary South African Sports Scientist Prof. Tim Noakes.

Respiratory Illness Surge Due to Enterovirus D68

I have been seeing a large number of respiratory infections in my office over the last 3 weeks. These appear to be viral infections cause by Enterovirus D68 and have some significant respiratory consequences, especially in children with other lung problems.

Enterovirus Electron Micrograph
Enterovirus Electron Micrograph

EV-D68 is one of more than 100 types of enteroviruses. It was first identified in California in 1962. Since then, EV-D68 infections has not been commonly reported in the United States. There have been very few reports of this virus in the last few years, however, the circulation of specific types of enteroviruses is often quite unpredictable, and different types of enteroviruses can be common in different years with no particular pattern. Most enterovirus infections in the United States tend to occur in the summer and fall. EV-D68, similar to other enteroviruses, is known to cause infections primarily in children but has been known to infect adults.

EV-D68 can shed from an infected person’s respiratory secretions, such as saliva, nasal mucus, or sputum. The virus likely spreads from person to person when an infected person coughs, sneezes, or touches another surface. EV-D68 can cause mild to severe respiratory illness. Most of the children who have become very ill with EV-D68 infection in Missouri and Illinois had difficulty breathing, and some had wheezing. Many of these children had asthma or a history of wheezing.

Although there are no vaccines to prevent EV-D68 infections, clinicians should encourage their patients to follow these prevention steps:

• Wash hands often with soap and water for 20 seconds;

• Avoid touching eyes, nose, and mouth with unwashed hands;

• Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick; and

• Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.

Enterovirus SymptomsEnsure that patients with asthma regularly take prescribed medications and follow guidance to maintain control of their illness. They should also take advantage of influenza vaccine when available, because people with asthma have a difficult time with respiratory illnesses.

Hopefully, you and your family won’t have a problem with this virus this year. Follow the steps above to help prevent its spread and see your doctor if you begin to show signs of serious illness like fever, shortness of breath, persisting cough or worsening flu-like illness that is not improving.

Hypertension and Insulin Resistance

Blood Pressure SurpriseHypertension (elevated blood pressure) is one of the triad symptoms of metabolic syndrome.  I see this to some degree a very large majority of the people seen in my office.  Many people are so used to having borderline or elevated blood pressure, and not successfully controlling it through caloric restriction, they are told it is a “genetic problem,” placed on blood pressure medication and sent on their way.  The problem is that most of these people will have a progressive elevation in blood pressure over time and these medications are continually raised until the person is on four or five different blood pressure medications at maximal doses.  Again, their genetics are blamed and that is the end of it.  Or is it?!

When I first started treating the insulin resistance problem in the human, rather than the blood pressure problem, I began to see immediate reductions in blood pressure within one to two weeks.  So much of a reduction that if I didn’t warn the patient that they should begin to back down their medications, they would experience symptoms of dizziness, light-headedness, headache and a few patient’s nearly passing out.  I often wondered why applying a ketogenic diet had such a profound effect on blood pressure so quickly.  Dr. Robert Lustig helped answer that question for me.

In order to understand how the Standard American Diet (we call it the SAD diet in my office) raises your blood pressure, it is important to understand how the body processes the basic sugar molecule.  Sugar is one glucose molecule bound to a fructose molecule.  This is broken down in the body and 20% of the glucose is metabolized in the liver, the other 80% is sent on to be used as fuel throughout the body. Fructose, however, is where the problems arise.  100% of the fructose is metabolized in the liver, and the by product of fructose metabolism is increasing the liver’s production of MORE glucose and the byproduct of uric acid. Uric acid is produced and this inhibits the production of nitric oxide. The diminished nitric oxide in the presence of an increased level of glucose (stimulating increased insulin production) constricts the blood vessels and raises blood pressure.   Yes, that donut you just ate raised your blood pressure for the next 12 hours.

All of this can be seen in the really complex diagram found in Dr. Lustig’s 2010 article:

Metabolism of Fructose
Lustig R. J Am Diet Assoc. 2010

So, how do you lower your blood pressure through diet?  First, cut out all the simple sugars. These include anything with table sugar, high fructose corn syrup and corn syrup.

Second, limit your overall intake of other sources of carbohydrates including any type of bread, rice, pasta, tortilla, potato, corn and carrots.  Realize that fruit is fructose, and when taken with other forms of glucose can have the same effect as table sugar.

Third, if you are taking blood pressure medications, see your doctor about close monitoring of your blood pressure as it can drop within 1-2 weeks of making these dietary changes.

The Gateway Called Death

The life of a close friend and patient was recently taken. This has been weighing upon my mind of late, as a similar event occurred in the life of my sister a few years ago.  I looked over the words and passages I wrote a few years ago, and for some reason, felt strongly that I should include them here.  I write this blog to help those struggling with weight, diabetes and the diseases of civilization.  One of those diseases frequently affecting weight is the depression and fear that accompanies the death of a loved one.  Often, the answers science offers are not enough and we are required to rely upon our faith.  I share some of that with you here.

I have spent the majority of my professional life in the acquisition of knowledge and its application in the relief of significant illness.  My greatest foes have been ignorance, disease, distress, disability and, ultimately, death.  I come in contact almost daily with seriously ill patients facing the very real prospect of death.  Of necessity, I have come to look upon death as a formidable foe to be fought.  For all conscientious doctors, death’s gateway from life threatens us as the prospect of individual defeat.

The famed scientist Madame Marie Curie returned to her home the night of the funeral of her husband, Pierre Curie, who was killed in an accident in the streets of Paris.  She made this entry in her diary:

“They filled the grave and put sheaves of flowers on it. Everything is over. Pierre is sleeping his last sleep beneath the earth. It is the end of everything, everything, everything.”

GatewayBUT IS IT?

What is this thing that men call death,
This quiet passing in the night?
Tis not the end, But Genesis
Of better worlds and greater light.
O God, touch though my aching heart,
And calm my troubled, haunting fears.
Let hope and faith, transcendent pure,
Give strength and peace beyond my tears.
There is not death, but only change
With recompense for won;
The gift of Him who loved all men,
The Son of God, the Holy One.
(G. B. Hinckley)

However, every patient of every doctor, if followed long enough will pass away. The first rule of surgery is that “all bleeding stops eventually.” The inescapable rule of life is that no matter how good your treatments are, all patient’s will meet the undertaker, eventually.
When this happens, and it happens to all of us, a sense of sadness naturally prevails regardless of the age or nature of the deceased.

If death is to happen to all of us, then why do we feel sadness at the death of a friend or loved one?

This sadness is caused by the feeling of loss tied to three age-old unanswered questions:

  1. Did you and I exist before we were born, and if so, where were we?
  2. Why are we here together and what is the purpose of this life?
  3. Where do we go when we die?

Are there answers to these questions?

When science does not have the answers, I have found great hope and answers in hidden within the teachings of my faith. I share them with you, not to preach or offend, but in hopes that you might find peace and solace in your life as I have in mine.

The spiritual leader Wilford Woodruff said “that if the people knew what was behind the veil, they would try by every means . . . that they might get there, but the Lord in his wisdom has implanted the fear of death in every person that they might cling to life and thus accomplish the designs of their creator.” (The Gateway We Call Death, Russell M. Nelson, p.96)

The Lord explained to Moses, “For this is my work and my glory, to bring to pass the immortality and eternal life of man.” (Moses 1:39)

This work and glory is referred to by a number of names including The Plan of Salvation, The Plan of Redemption, The Plan of Eternal Progression, The Plan of Happiness and others.

I often speak with people that say to me, “I just want to be happy.” Or they question me asking, “Will I ever really be happy?”

Happiness is the object and design of our existence . . . and well be the end thereof if we pursue the path that leads to it.  Along this path lies virtue, uprightness, faithfulness, holiness and keeping the commands of our Creator.  So how does this help us find happiness in the face of the death of a friend or loved one?

The answers are found in contemplation of the the three age-old questions.  First, where were we before we were born?

The Old Testament prophet Job, one of the more ancient writers of the Bible, gives us some insight. The Lord asked him the same question: “Who is this that darkeneth counsel by words without knowledge? Gird up now thy loins like a man; for I will demand of thee, and answer thou me. Where was thou when I laid the foundation of the earth . . . when the morning stars sang together, and all the sons of God shouted for joy?” (Job 38:2-7)

You and I must have been somewhere – the Lord asked us where we were. And, who were all the “sons of God shouting for joy?” Why were they shouting? Where were they?

The apostle, Luke, in the New Testament answers those questions years later as he lays out the genealogy of the human family.  He starts at Christ and then names each subsequent father leading up to ” . . . Enos, which is the son of Seth, which was the son of Adam, which was the son of God.” (Luke 3:38)

The apostle, John, must have had some idea of a pre-mortal existence because of the way they phrased the question to Jesus Christ about the man who was born blind, “Master, who did sin, this man or his parents, that he was born blind?” (John 9:2) The question was not “could he have sinned before he was born?” but instead, “who did sin?” Christ’s answer implied that both were possible, but neither was the case in this situation.

Paul writes to the Hebrews, “Furthermore, we have had fathers of our flesh which corrected us, and we gave them reverence; shall we not much rather be in subjection to the Father of our Spirits, and live?” (Hebrews 12:9) We are also given instruction to open our prayers with a phrase like, “Our Father in Heaven.” Hence, He is the Father of our Spirits, our Heavenly Father, our spiritual Father.

We then are brothers & sisters in the spiritual sense, and Jesus Christ is our elder brother, being the firstborn spirit child of God.  If this is the case, then all of us, including you and I, were among the sons and daughters of God who shouted for joy along with Adam.

The Lord explained to Moses, “I have created all things, of which I have spoken, spiritually before they were naturally upon the face of the earth . . . for in heaven created I them.” (Moses 3:5) In addition to this, we learn from Moses that a council was held in heaven in which you and I were present. At this grand council, the plan to create this earth, including the fall of Adam, and the Atonement of Jesus Christ was presented and accepted.

There was, however, someone who opposed this plan. Lucifer rebelled and was cast out of heaven with those who chose to follow him.

If all this is true, then it means you and I accepted this plan and here we are. Accepting this plan as described by the prophet Abraham is defined as accepting our First Estate.

So, the first question is where did we come from? We came from the presence of God, the pre-mortal spirit world, in the company of all our spirit brothers and sisters.

Second question, why are we here? Trying to wrap the whole of this question into a nutshell gives us the following answer.

First, on the eternal perspective, progression requires that we each have our own physical mortal body that has the capacity of becoming refined, immortalized or glorified through the process of death and subsequently resurrection.

Second, we had to be sent somewhere outside of the presence and powerful righteous influence of God our Father to prove ourselves, to exercise our own agency, and determine in this life the nature of our life to come – the life after death. One of the prophets, Jacob, tells us that Adam & Eve were expelled out of the Garden of Eden into a “lone and dreary world” and on a probation of sorts, where a person could chose from a myriad of different things that were either good or evil. It is necessary for man to taste the bitter to enable him to appreciate the good, is one way to explain it.

The ancient prophet Alma calls this a probationary state, a time to repent, to grow, to learn responsibility, and to prepare for the next life. (Alma 12:24, 42:4)

Said the Lord, “And thus did I, the Lord God, appoint unto man in the days of his probation – that by his natural death he might be raised in immortality unto eternal life, even as many as would believe.” (Doctrine & Covenants 29:43)

Obtain a Body . . . Prove Ourselves . . . Get Experience . . . this is your first estate.

Some of us live 80 years, some of us live 50 years, some of us live 39 years, and some live only a brief few years on this earth. Will you and I be given as much time? There are laws to be learned and lived, ordinances to experience, and covenants to be made and kept, and faith and obedience to demonstrate in this life.

Third, where do we go from here? Where will I go when I die? Where have friends and family that have passed on gone to?

The penitent thief on the cross being crucified with the Savior, Jesus Christ, asked the Him the same question. The Savior responded with this answer, “Today shalt thou be with me in paradise.” (Luke 23:43)

Christ died in the literal sense that you and I will die. He underwent a physical dissolution by which His immortal spirit was separated from His body of flesh and bones, and that body was actually dead. While the corpse lay in Joseph’s rock-hewn tomb, the living Christ existed as a disembodied Spirit. Where was He?  We naturally assume that he went where spirits of the dead ordinarily go. He was in the disembodied state a Spirit among spirits. He went to the Spirit world.

We know that the spirit world is not heaven, as the Savior, on the third day after his crucifixion, met the weeping Mary Magdalene and said: “I am not yet ascended to my Father.” He had gone to Paradise as he told the penitent thief, but not to the place where God dwells. Sprit Paradise, therefore, is not Heaven, or the place where God the Eternal Father and his celestialized children dwell and make their abode. Spirit Paradise is a place where dwell
righteous and repentant disembodied spirits between bodily death and resurrection. Another division of the spirit world is reserved for those disembodied beings who have lived lives of wickedness and who remain impenitent even after death.

The ancient prophet Alma explained to his son Corianton who was confused on this matter, “Now there is must needs be a space betwixt the time of death and the time of resurrection.” (Alma 40:6) “Now concerning this state of the soul between the death and the resurrection, behold it has been made know unto me by an angel that the spirits of all men, as soon as they are departed from this mortal body, yea, the spirits of all men, whether they be good or evil, are taken home to God who gave them life. And then shall it come to pass, that the spirits of those who are righteous are received into a state of happens, which is called Paradise, a state of rest from all their troubles and from all care and sorrow.”
“And the spirits of the wicked, yea, who are evil – for behold they have no part nor portion of the Spirit of the Lord; for behold they chose evil works rather than the good; therefore, the spirit of the devil did enter into them, and take possession of their house – this is the state of the souls of the wicked, yea, in darkness, and as a state of awful, fearful looking for the fiery indignation of the wrath of God upon them; thus they remain in this state, as well as the righteous in paradise, until the time of their resurrection.” (Alma 40:11-14)

The Spirit World is therefore quite a unique place.

Another apostle and scriptural historian, Bruce R. McConkie, explains from the Savior’s parable of the rich man and Lazarus, “The spirit world is divided into two parts: Paradise which is the abode of the righteous, and hell which is the abode of the wicked. Until the death of Christ, these two spirit abodes were separated by a great gulf, with the intermingling of their respective inhabitants strictly forbidden.” (Luke 16:19-31)  We know that Christ visited this spirit world because the apostle Peter’s biblical account tells us the following: “For Christ also hath once suffered for sins, the just for the unjust, that he might bring us to God, being put to death in the flesh, but quickened by the Spirit: by which also he went and preached unto the spirits in prison; Which sometime were disobedient, when once the long-suffering of God waited in the days of Noah, while the ark was a preparing, wherein few, that is, eight souls were saved by water.” (1 Peter 3:18-20)

When Christ visited the Spirit world, he also organized the affairs of this kingdom such that the righteous spirits began teaching the His gospel to those who had not heard it and those who were disobedient or wicked.  Although, there are two spheres within the one spirit world, there is now some intermingling of the righteous and the wicked that inhabit those spheres; and when the wicked spirits repent, they leave their prison-hell and join the righteous in spirit paradise. Hence Joseph Smith said, “Hades, Sheol, paradise, spirit prison are all one: it is a world of spirits. The righteous and the wicked all go to the same world of spirits until the resurrection.” (Teachings, p. 310).

Life, work and activity all continue in the spirit world. Men and women have the same talents and intelligence there which they had in this life. They possess the same attitudes, inclinations, and feelings there which they had in this life. They believe the same things, as far as eternal truths are concerned: they continue in effect, to walk in the same path they were following in this life. (Mormon Doctrine, Spirit World, McConkie) The prophet Amulek said, “That same spirit which doth possess your bodies at the time that ye go out of this life, that same spirit will have power to possess your body in the eternal world.” (Alma 34:34) Thus, if a man has the spirit of charity and the love of truth in his heart in this life, that same spirit will possess him in the spirit world.
Family and friends who have passed away with the spirit of joviality and happiness will find it will carry them forward in the gospel and in the teaching of the gospel to many others on the other side.

When I leave this frail existence,
When I lay this mortal by,
Father, Mother, may I meet you
In your royal courts on high?
Then at length, when I’ve completed
All you sent me forth to do,
With your mutual approbation
Let me come and dwell with you.
(Eliza R. Snow, “O My Father,” Hymns, #292)

This post mortal world is a place to await resurrection. All will be resurrected. The Atonement of Jesus Christ ensures a universal resurrection. “For as in Adam all die, even so in Christ shall all be made alive.” (1 Cor 15:22) Judgment will then, after the resurrection, be passed on all according to individual works and obedience while in mortality. The great prophet Nephi says, “For by grace are they saved after all they can do.” (2 Nephi 25:23) Said the Savior to His disciples, “Yet a little while, and the world seeth me no more, but ye see me because I live and ye shall live also.” (John 14:19)

Inheriting the glory that Christ has been resurrected into is conditional and is based upon the laws by which individuals choose to govern their mortal lives.
Said the prophet Alma, “The plan of restoration is requisite with the justice of God; for it is requisite that all things should be restored to their proper order. Behold, it is requisite and just, according to the power and resurrection of Christ, that the soul of man should be restored to its body, and that every part of the body should be restored to itself.
“And it is requisite with the justice of God that men should be judged according to their works; and if their works were good in this life, and the desires of their hearts were good, that they should also as the last day, be restored unto that which is good.” (Alma 41:2-3)

The righteous who understand and live the truth will be resurrected to receive a glory in heaven referred to as Celestial and Paul refers to this as comparable to the glory of the Sun. In this celestial kingdom also known as the Kingdom of God, marriages and eternal family relationships are secured, eternal progress and progression is uninterrupted forever and ever.

The less valiant who choose the lesser law will be resurrected to receive a glory Terrestrial that Paul compares to the glory of the moon. They chose not to enjoy that which they could have enjoyed. These would not accept the words of the prophets in this life and died in their sins, but accepted afterwards.
And to the undisciplined, wicked, liars, sorcerers, adulterers, whoremongers, and the unrepentant who are shut out in spirit prison until the Savior finishes his work (D&C 76:85), they will be resurrected to a glory Telestial or that equivalent, as Paul puts it, to the “glory of the stars, for one star differeth from another star in glory.” (1 Corinthians 15:40-44)  The remainder will become attached to Perdition, those who refuse any part of the Atonement of Christ – those that are cast off forever, as the scriptures say, into outer darkness.
What of those that have taken their lives prematurely when the Lord has said, “Thou shalt not kill”? Are they consigned to spirit prison and later a telestial glory?

Another of the Lord’s modern day apostles, M. Russell Ballard, recently stated that there are “some things we know, and some we do not . . . [the] judgment for sin is not always as cut and dried as some of use seem to think. . . the Lord recognizes differences in intent and circumstances: Was the person who took his life mentally ill? Was he or she so deeply depressed as to be unbalanced or otherwise emotionally disturbed? Was the suicide a tragic, pitiful call for help that went unheeded too long or progressed faster than the victim intended? Did he or she somehow not understand the seriousness of the act? Was he or she suffering from a chemical imbalance in their system that led to despair and a loss of self control? Obviously, we do not know the full circumstances surrounding every suicide. Only the Lord knows the details, and he it is who will judge our actions here on earth.” (Liahona, March 1988, Suicide: Some Things We Know, and Some We Do Not)

Said the prophet Joseph Smith: “While one portion of the human race is judging and condemning the other without mercy, the Great Parent of the universe looks upon the whole of the human family with a fatherly care and paternal regard . . . He is a wise Lawgiver, and will judge all men, not according to the narrow contracted notions of men, but ‘according to the deeds done in the body whether they be good or evil,’ . . . We need not doubt the wisdom and intelligence of the Great Jehovah; He will award judgment or mercy to all nations according to their several deserts, their means of obtaining intelligence, the laws by which they are governed, the facilities afforded them of obtaining correct information, and His inscrutable designs in relations to the human family; and when the designs of God shall be made manifest, and the curtain of futurity be withdrawn, we shall all of us eventually have to confess that the Judge of all the earth has done right.” (Teachings of the Prophet Joseph Smith, Salt Lake City, Deseret Book, 1938, p218)

When we are judged, the Lord will take all things into consideration: our genetic and chemical makeup, our mental state, our intellectual capacity, the teachings we have received the traditions of our fathers, our health, and so forth.

That is the plan. Those are the answers. Death, then, is a gateway.

Upon the cross he meekly died
For all mankind to see
That death unlocks the passageway
Into eternity.
(Hymns, #184 – “Upon the Cross of Calvary”)

“The keeper of the gate is the Holy One of Israel; and he employeth no servant there; and there is none other way save it be by the gate; for he cannot be deceived, for the Lord God is his name.” (2 Nephi 9:41)

To live, to love, and to be loved are the essence of what is important in this life.  Those we have known and passed on have lived great lives, they were loved and are still loved.

Mourning and tears are normal – in fact, they are a healthy reaction. Mourning is one of the purest expressions of deep love. It is a natural response in accord with divine commandment: “Thou shalt live together in love, insomuch that thou shalt weep for the loss of them that die.” (D&C 42:45)

By mortal standard time, it’ll be much longer than we like till we see our loved ones again. By eternal standard time – “We’ll see you soon.”

Until then watch. There are another set of hands you should look for, pierced at the palms and at the wrists. You will recognize His hands when you see them. You will recognize Him when you see Him. His hands are always open. The brightness of His eyes and smile will warm the darkest recesses of your soul. When you meet Him, touch his hands, feel the mark in his side, and bow at His feet. He knows you by name. He knows each of us by name. He will offer you the peace, the rest and the love that you seek.

“To everything there is a season, and a time to every purpose under heaven: A time to be born and a time to die . . . A time to weep, and a time to laugh, at time to mourn, and a time to dance . . . a time to get and a time to loose . . . a time to embrace . . . and a time to love.” (Ecclesiastes 3:1-8)

This death of which I speak eventually comes to all. It comes to some in childhood, to some in ripe old age, and to others in the prime of life. To some it comes by natural means, anticipated and expected, to others it comes without warning, unannounced. It may come quietly in the peace of the night, or it may come violently in the confusion of an instant, but assuredly, it comes to all.

To you my beloved friends, patients and family, remember His invitation.  “Come unto me, all ye that labor and are heavy laden, and I will give you rest. Take my yoke upon you, and learn of me; for I am meek and lowly in heart; and ye shall find rest unto your souls. For my yoke is easy, and my burden is light.” (Matthew 11:28-30)

This yoke is a conviction, a way of life; it is called the Gospel of Jesus Christ. It does not take away challenges, disappointments, frustrations, pain or sorrow. But, when lived, it lifts burdens, lightens loads, and makes life bearable. It empowers you with light and strength from on high to learn and grow from experiences in spite of whatever life brings.

This is my conviction. This I know to be true. It is what brings hope in the battle against the inevitable foe, death. May it bring you the warmth of heart and the solace of soul that it brings to me as I ponder its meaning in my life and the lives of my family. May the knowledge of the Plan of Salvation bring you comfort in knowing that those we care about have passed through the gateway we call death to look forward upon immortality and the Glory of the Savior Jesus Christ.

Learning

CowboySunsetThe challenge with learning is that it is impossible for a man to learn what he thinks he already knows. It’s what we think we already know that often prevents us from learning. The mind is much like a parachute, it works very best when it is open. It helps to recognize that the problems we face today cannot be solved with the same thinking that created them. And, the secret to fixing the problems is to not focus all of your energies on the old, but to build upon the new.

The Perfect BLT

Perfect BLTA few of my patients have come in struggling with their weight this week, following what they assumed to be a low carbohydrate diet. They were eating yogurt for breakfast, a chicken salad for lunch, and chicken and vegetables for dinner. A true low carbohydrate diet is ketogenic (it derives fuel from ketones) and is the byproduct of fatty acid metabolism.  That means your fuel is coming from fat, not protein or carbohydrate.  The presence of glucose, fructose, lactose or other sugars (or many sugar alcohols) shut fatty acid metabolism down and halt the process of weight loss and frequently increase weight gain.  Too much protein does the same thing.  A chicken salad is not ketogenic.  It may be low carb, but without adequate fat, the absence of glucose drives the body to use protein as it’s primary fuel source.  It is essential to maintain ketosis that a low carbohydrate diet moderate the protein and increase the fats to upwards of 60-70% of the total caloric intake.

Bacon is a 50/50 food. (I’m not talking about turkey bacon . . . that’s not real bacon).  Each slice of real bacon is at a minimum 3 grams (50%) fat, and 3 grams (50%) protein.  No carbs there, either.

So, if you’re struggling with your weight loss on a low carb diet . . . your first step should be “BLT” it!

The Fire Within

I recently read this counsel given at the Northland College by Principal John Tapene in 1959.  It still applies to us today. It is a state of mind that applies to life and to all that we do, including our approach to weight loss.  I paraphrase it below.

We frequently hear the cry from our teenagers and young adults, “what can we do, where can we go?”

My answer to them and to you is this: Go home, mow the lawn, wash the windows, learn to cook, build a raft, get a job, visit the sick, study your lessons and after you’ve finished, read a book. Your city or town doesn’t owe you recreational facilities and your parents don’t owe you fun. The world does not owe you a living.

Fire WithinOn the contrary, you owe the world something.  You owe it your time, talent and energy so that no one will be at war, in sickness and in loneliness as we have been in the past.  In other words, grow up, stop being a crybaby, get out of your dream world and develop a backbone and not a wishbone. Motivation is a fire from within.  If someone else tries to light that fire under you, chances are, it will only burn very briefly.  Start behaving like a responsible person.  You are important and you are needed.  It’s too late to sit around and wait for somebody to do something someday.  Someday is now, and that somebody is you.

 

Fat Phobia . . . The Religion

Low Carb Communication Challenges“You want me to eat WHAT?!  But that’s . . . ,it’s . . . FAT, really?”

” Yes, it is.”

Every day, instruction to my patients is initially seen as Food Pyramid heresy and My Plate iconoclasm. Yes, I want you to flip the Food Pyramid on its head, and push everything off My  Plate and fill it with fat. . . Really. . . Yes, I do.

I was counseled by many school professors over the years that there are two things you should avoid talking about: Religion & Politics. The ketogenic or low carbohydrate dietary conversation involves both.  “Fat Phobia” is a Religion.  We have demonized fat and sainted the treadmill.  You see, fat got a bad wrap when the bomb calorimeter was invented.  We realized that there was twice as much energy found in fat that there was in carbohydrate or protein.  Early nutritionists, understanding that heat is a form of energy, and realizing that energy is conserved, found that food substrates contain a set amount of energy that can be measured in a closed environment.  Naturally,  the Law of Thermodynamics got applied to lend understanding in how people gain or loose weight. We coined the term “you are what you eat” based upon our understanding of the Laws of Thermodynamics. The calorie became “king.”

  • 1 gram of carbohydrate = 4 kcal
  • 1 gram of protein = 4 kcal
  • 1 gram of fat = 9 kcal

For the last sixty years (an entire generation of humans) we have based our diet around the calorimetry of food and have labeled them as good or bad based upon calories. To loose weight, we are taught, you either have to eat food containing fewer calories (fat has the most calories per volume so it must be bad!) or burn it off faster than you take it in (did you go exercise at that new gym next door), right?  Wrong.

First, you and I are not bomb calorimeters.  We are not closed systems. We harbor variable levels of symbiotic bacteria (these also burn fuel at variable rates) and our body temperatures fluctuate to regulate other enzymatic and hormonal processes.

Second, bomb calorimetery functions on the premise that volumes are also held at a constant. Human volume and density change daily.  Simple chemistry tells us that volume = mass / density. The average human mass fluctuates by 5lbs every day and our density changes based upon our hydration status (the amount of water we drink). Because these two variables are not constant in a human being, it is impossible to correctly apply the Laws of Thermodynamics to the human body and accurately predict weight gain or loss.

Third, hormones!  (Anyone married to a pregnant female understands that nothing is as it seems when hormones are involved.) We have a plethora of hormones that change the rate in which fuels are burned or stored in the human body. Our GI flora (symbiotic bacteria in the human gastrointestinal tract) are also affected by hormones and do not have set rates of fuel use or breakdown.  What this means is that you and I process food at different rates and derive different levels of energy and fuel from the same donut.  Genetics plays a leading role in how these hormones are used and turned on and off.  Fat is burned or stored in the body based on a hormonal mechanism I described in a previous post you can read here.

Asking patients to reduce carbohydrate intake to less than 20 grams per day and increasing fat intake to up to 70% of total caloric intake is essentially 20th century nutritional apostasy.

The dietary concepts from the Food Pyramid and My Plate have been embraced by our country for over sixty years.  Changing our views on these as a country will be for many like changing religions.  For those of us “with eyes to see and ears to hear” our work is cut out for us.

Your Work

Low-Carb Protein Shake

A number of my patients have asked what I use personally as a protein supplement and whether I use protein shakes.  I’ve struggled to find a great tasting protein shake that does not contain any artificial sweeteners (see my article The Skinny On Sweeteners) that raise the insulin levels.  Most of the pre-prepared shakes (including the Adkins, EAS, Muscle Milk, and many others) will significantly slow weight loss and knock you out of ketosis due to an insulin response stimulated by drinking them.

My sweet wife just perfected our family’s favorite high fat, low carbohydrate protein shake.  Oh, it’s good and  it’s filling.  You’ll love it and you won’t be hungry for at least 3-4 hours after savoring this sweet taste-bud sensation.

This is a great shake for a mid-meal snack or a quick meal on the go.

Dr. Nally’s Low Carb High Fat Protein Shake:

[One serving (~ 2 cups) is 4.5 grams of carbohydrate]

Blend to preferred texture. . . (may add more heavy whipping cream if it is still too thick).
Enjoy!!

Burnout

Ask yourself the following questions:

  • Does your job limit interaction with people and/or do you spend most of your time with a computer screen?
  • Have you become cynical or critical at work?
  • Do you drag yourself to work and have trouble getting started once you arrive?
  • Have you become irritable or impatient with co-workers, customers or clients?
  • Do you lack the energy to be consistently productive?
  • Do you lack satisfaction from your achievements?
  • Do you feel disillusioned about your job?
  • Are you using food, drugs or alcohol to feel better or to simply not feel?
  • Have your sleep habits or appetite changed?
  • Are you troubled by unexplained headaches, backaches or other physical complaints?

burn outThese are the ten most common signs of “burnout.”  46% of respondents in surveys indicate at least one of the above symptoms of burnout. Two or more of these imply that you are suffering from some degree of “burnout.” The classic triad of burnout is:

  1. Exhaustion
  2. Cynicism
  3. Questioning the quality of your work, or questioning whether you are making a difference in the world any longer

What is burnout? It is defined by “Mr. Webster” as “physical or mental collapse caused by overwork or stress.” But, that definition doesn’t seem to do it justice, and many people experiencing burnout don’t actually “collapse.”  They do, however, become significantly less productive, depressed, and loose the enjoyment of life.  Work begins to feel like slavery, exercise becomes a chore, food begins to have associations with guilt, friendships are seen as obligations and love looses its luster and looks more like a social construct.

Burnout is often likened to discontent, however, these are two very different emotional feelings.  Discontent can be defined as dissatisfaction with ones circumstances. There are two kinds of discontent in this world: the discontent that works and the discontent that wrings its hands.  The first kind often gets what it wants and the second looses what it has.

Burnout differs from discontent, in that continued work toward a goal brings on the triad of emotional exhaustion, depersonalization and the feeling of reduced personal accomplishment. Burnout is, in reality, the sum total of hundreds of thousands of tiny betrayals of purpose.

Burnout can occur in any field of work, however, a study published in the 2012 issue of JAMA reveals that over 40% of the ~800,000 U.S. physicians are experiencing burnout and are more prone to burnout than any other worker in the United States.  The journal Academic Medicine recently reported that medical students, when compared to age-matched fellow college graduates, reported significantly higher rates of burnout.

So, how do you overcome burnout?

I’m an Osteopath.  I see disease in the context and inter-relationship of the mind, body & spirit.  Overcoming burnout requires one to restore balance in these three areas.  I am impressed by the work of Charlie Hoehn in his book, Play it away: A workaholic’s cure for anxiety.  Charlie does a wonderful job of describing the broken inter-relationship of the mind, body and spirit in a person experiencing burnout.

The first step to repairing the broken inter-relationship is to recognize and remove those anchors keeping you tethered to the feelings of burnout.  The anchors are the stressors that cause you to worry on a daily and weekly basis.  Journaling these stressors, writing them down in 3-5 word sentences is the start.  Identify which of these stressors is the biggest or causes the most angst, then write out the following question.  “How can I eliminate [stressor] from my life?  Do this with the largest two or three stressors. Then write out a solution that is small and uncomplicated to each stressor.  Put the solution to work immediately. If your solution has not improved your feelings of stress and anxiety within a week, then drop the first and try to find a second stressor, or otherwise switch to a second solution. Journaling these thoughts, questions, feelings and answers allows your mind to change from a self-centered focus to an action based focus.  It clears the mind to move into action. Nothing is more important in reducing burnout, than nourishing the imagination. Using a journal helps stimulate thought and the imagination.

The second technique is scheduling some real play. Write down the five most fun activity involved with play that you did as a child. Then, set aside dedicated time for your favorite activity of play.  It is essential that you actually schedule this play time into your daily activities.  There are a couple of rules associated with play time.

  1. Disconnect from all social media
  2. Harmony of the playtime is more important than winning
  3. Have some serious fun
  4. Shoot for 30 minutes of play time per day
  5. This should ideally be done outside in the fresh air and sunlight

“A lack of play should be treated like malnutrition: it’s a health risk to your body and your mind.”  (Stuart Brown)

“Play is the highest form of research.” (Albert Einstein)

Technique number three is related to sleep.  It is essential that you have a consistent bedtime and give yourself the opportunity to take an afternoon nap.  You can optimize your sleep by turning off electronics before getting into bed, going to bed at the same time each night, decreasing the room temperature to 68-70 degrees Fahrenheit, draw the curtains to make the room dark, and use a relaxing loop of quite background sound like ocean waves, or the sound of a trickling stream to ease your mind (can be found on a number of apps).

It may take up to a week for your body to unwind and get used to this schedule.  Also, schedule a 20 minute afternoon nap.

Meditation and/or prayer is the fourth technique.  Sit or kneel, close your eyes and observe the thoughts that enter your mind for 10-15 minutes. Listen to and keep your breathing calm and deep. Pay attention to the rhythm of your breathing.  Reading can also be a form of meditation and has become an important refreshing part of alleviating burnout.  We can only be as good as the books that we read.  Read, ponder over and talk about good books.

Fifth, eat healthy meals with healthy friends.  Decrease the carbohydrates and increase the good omega 3 fats in your diet.  The insulin response to carbohydrates stimulates the inflammatory and parasympathetic nervous system making you more fatigued and tired. Reduce the bread, rice, pasta, potatoes, carrots and corn intake in your diet.

Increasing the good fat in your diet (like Kerrygold Irish Butter, Coconut Oil, Olive Oil, and real animal fats) actually increases your bodies access to essential B vitamins and improves the use of Vitamin D.  Making dietary changes become a habit is often easier when it is done with a friend.  Schedule opportunities to eat healthy meals with family or friends attempting to do the same thing.  You will help support each other and be more likely to succeed.

The last recommendation is spend time in nature.  One weekend a month spend at least two hours out in nature. Take a hike, go on a nature walk, go camping, swim in the river, etc. Give yourself permission to unplug during these times.  Then, pay close attention to how you feel when your in different environments.

In the words of Shakespeare, “Self-love, my liege, is not so vile a sin/As self-neglecting” (King Henry V, Act 2, scene 4).

I conclude with the rhetorical question, “If you work for a living, why do you kill yourself working?” (The Good, The Bad, and the Ugly)

 

Relapse

FallOffWaggonDid you fall off the low-carbohydrate wagon this week?  Did those donuts just call out your name as you walked by the bakery in the grocery store? Maybe you feel like you were shot out of the carbohydrate cannon, landing in the nearby Potato County? If so, you probably had a relapse.  You were doing so well, then all the sudden, your will-power caved.

Relapse is not uncommon when making a dietary lifestyle change. What causes relapse? I often see people relapse back to the Standard American Diet, the SAD diet, because of a number of reasons.

Neurohormones of Hunger
Neuro-hormones of Hunger

First, it is important to recognize that there are a milieu of neuro-hormones that drive hunger cravings or suppression. Anything that triggers a change in these hormone levels can cause the carbohydrate cravings to kick in . . . and you find yourself stuffing yourself with “carbage.”

Second, is boredom.  Many people find an increased nervousness when they get bored.  They find that eating, with it’s calming parasympathetic nervous system effect,  diminish the nervousness that arises out of boredom.  They often create a near Pavlov’s type trigger to eat when they experience boredom and it is quickly interpreted as hunger. There is actually a release of endorphin associated with eating and chewing that suppresses stress and or anxiety.  Reduction of stress, exercise, and journal writing have been found to help patient’s reduce the food cravings associated with boredom.  It is important to have “rescue foods” like string cheese, a handful of almonds, beef jerky, or “fat bombs” available that can be used when you experience these symptoms.

Following the line of triggers, Pavlov demonstrated that repeated actions associated with rewarding consequences will form a physiologic trigger.  Frequently. our desire to eat carbohydrates (“carb cravings”) are often tied to triggers. For example, growing up in my home as a child, our family frequently would relax by watching prime-time television while eating a large bowl of popcorn and a Pepsi.  To this day, whenever I turn on the television in the evening, I get cravings for carbohydrates.  It is important to look at what you were doing or what was going on around you at the time the craving occurred. Substitution of foods has helped to solve these cravings by replacing the popcorn and Pepsi with pork rinds and Diet Dr. Pepper. (Don’t cringe, pork rinds and guacamole tastes fantastic and is a very low carbohydrate substitute that works for me.)

Lastly, many patients fall off the wagon when they visit or have a meal with family. They are often made to feel guilty if they don’t eat Aunt Velda’s homemade chocolate chip cookies.  They are afraid of offending their relatives if they don’t partake of those tasty cookies.  The challenge is that cheating by eating the cookies causes an insulin spike and leads to 24-72 hours of carbohydrate cravings thereafter. Are those cookies worth 72 hours of carbohydrate cravings?  Maybe. But it is important to consider helping Aunt Velda to understand what those cookies will do to you, and that you still care for Aunt Velda even if you don’t eat her chocolate chip cookies.

In many families, food is often associated with love.  “If you don’t eat the food I made for you, you don’t really love me” is an underlying tone that can be found in many family dynamics that I see in my office.  Some times bringing your own low-carb chocolate chip cookies, and offering one to Aunt Velda, will stimulate a conversation about your dietary changes and diffuse the guilt and offence that might arise.

Often, knowing what will cause you to fall off the wagon, helps to keep you on the wagon.  What challenges have you had staying on the wagon?

Stress . . . . The Weight Loss Killer

Has your weight loss plateaued? Are you struggling to meet your weight loss goals? Have you struggled to lose weight in spite of doing everything “correctly?” Are you still struggling with those last few pounds?

You’re not alone. Many of my patients, myself included, have found themselves “stuck” in their weight loss progression.  There are a number of reasons you may not be loosing weight, but one that I am seeing more and more frequently is “Pseudo-Cushings’s Syndrome.” Pseudo-Cushing’s Syndrome is a physiologic
hypercortisolism (high level of cortisol) that can be caused by a number of problems:

  1. Physical stress
  2. Severe bacterial or fungal infection
  3. Malnutrition or Intense chronic exercise
  4. Psychological stress – including untreated or under-treated depression, anxiety, post-traumatic stress, or dysthymia (chronic melancholy)
  5. Alcoholism

The psychiatric literature suggest that up to 80% of people with depressive disorders have increased cortisol secretion (1,2,3).  HPA Stress responsePeople with significant stressors in their life have been show to have a raised cortisol secretion. Chronic stress induces hyperactivity of the hypothalamic-pituitary-adrenal axis causing an over production of cortisol and normalization of their cortisol levels occurs after resolution of the stressor.  This cortisol response is not high enough to lead to a true Cushing’s Syndrome, but effects ones ability to loose weight.

I suspect this is becoming more prevalent due to the high paced, high-stress, always on, plugged in, 24 hour information overload lives we live.

What is cortisol? It is a steroid hormone made naturally in the body by the adrenal cortex (outer portion of the adrenal gland). Cortisol is normally stimulated by a number of daily activities including fasting, awakening from sleep, exercise, and normal stresses upon the body. Cortisol release is highest in the morning, helping to wake us up, and tapers into the afternoon. Cortisol plays a very important role in helping our bodies to regulate the correct type (carbohydrate, fat, or protein) and amount of fuel to meet the bodies physiologic demands that are placed upon it at a given time (4,5,6).

HPAThyroidUnder a stress response, cortisol turns on gluconeogensis in the liver (the conversion of amino acids into glucose) for fuel. Cortisol, also, shifts the storage of fats into the deeper abdominal tissues and turns on the maturation process of adipocytes (fat cells). In the process, it suppresses the immune system to decrease inflammation during times of stress (7,8,9).  In the short run, this is an important process, however, when cortisol production is chronically turned up, it leads to abnormal deposition of fat, increased risk of infection, impotence, abnormal blood sugars, head
aches, hypertension and ankle edema, to name a few.

The chronic elevation in cortisol directly stimulates an increase in insulin by increasing the production of glucose in the body, and cortisol blockaids the thyroid axis. Both of these actions halt the ability to loose weight, and drive weight gain.
Cortisol also increases appetite (10).  That’s why many people get significant food cravings when they are under stress (“stress eaters”). Cortisol also indirectly affects the other neuro-hormones of the brain including CRH (corticotrophin releasing hormone), leptin, and neuropeptide Y (NPY). High levels of NPY and CRH and reduced levels of leptin have also been shown to stimulate appetite (10-11).

How do you test for Pseudo-Cushing’s Disease?  

Testing can be done by your doctor with a simple morning blood test for cortisol. If your cortisol is found to be elevated, it needs to be repeated with an additional 24 hour urine cortisol measurement to confirm the diagnosis. If Cushing’s Syndrome is suspected, some additional blood testing and diagnostic imaging will be necessary.

How do you treat it?

First, the stressor must be identified and removed.  Are you getting enough sleep?  Is there an underlying infection? Is there untreated anxiety or depression present?  Are you over-exercising? These things must be addressed.

Second, underlying depression or anxiety can be treated with counseling, a variety of weight neutral anti-depressant medications or a combination of both.  Many of my patients find that meditation, prayer, and journaling are tremendous helps to overcoming much of the anxiety and depression they experience.

Third, adequate sleep is essential.  Remove the television, computer, cell phone, iPad or other electronic distraction from the bedroom.  Go to bed at the same time and get up at the same time each day. Give yourself time each day away from being plugged in, logged in or on-line.

Fourth, mild intensity (40% of your maximal exertion level) exercise 2-3 days a week was found to lower cortisol; however, moderate intensity (60% of your maximal exertion level) to high intensity (80% of your maximal exertion level) exercise was found to raise it (12).  A simple 20 minute walk, 2-3 times per week is very effective.

So, the take home message . . . It’s not the stress that’s killing us, it’s our reaction to it.

References:

  1. Pfohl B, Sherman B, Schlechte J, Winokur G. Differences in plasma ACTH and cortisol between depressed patients and normal controls. Biol Psychiatry 1985; 20:1055.
  2. Pfohl B, Sherman B, Schlechte J, Stone R. Pituitary-adrenal axis rhythm disturbances in psychiatric depression. Arch Gen Psychiatry 1985; 42:897.
  3. Gold PW, Loriaux DL, Roy A, et al. Responses to corticotropin-releasing hormone in the hypercortisolism of depression and Cushing’s disease. Pathophysiologic and diagnostic implications. N Engl J Med 1986; 314:1329.
  4. Ely, D.L. Organization of cardiovascular and neurohumoral responses to stress: implications for health and disease. Annals of the New York Academy of Sciences (Reprinted from Stress) 771:594-608, 1995.
  5. McEwen, B.S. The brain as a target of endocrine hormones. In Neuroendocrinology. Krieger and Hughs, Eds.: 33-42. Sinauer Association, Inc., Massachusetts, 1980.
  6. Vicennati, V., L. Ceroni, L. Gagliardi, et al. Response of the hypothalamic- pituitary-adrenocortical axis to high-protein/fat and high carbohydrate meals in women with different obesity phenotypes. The Journal of Clinical Endocrinology and Metabolism 87(8) 3984-3988, 2002.
  7. Wallerius, S., R. Rosmond, T. Ljung, et al. Rise in morning saliva cortisol is associated with abdominal obesity in men: a preliminary report. Journal of Endocrinology Investigation 26: 616-619, 2003.
  8. Epel, E.S., B. McEwen, T. Seeman, et al. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat.
    Psychosomatic Medicine 62:623-632, 2000.
  9. Tomlinson, J.W. & P.M. Stewart. The functional consequences of 11_- hydroxysteroid dehydrogenase expression in adipose tissue. Hormone and Metabolism Research 34: 746-751, 2002.
  10. Epel, E., R. Lapidus, B. McEwen, et al. Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior.Psychoneuroendocrinology 26: 37-49, 2001.
  11. Cavagnini, F., M. Croci, P. Putignano, et al. Glucocorticoids and neuroendocrine function. International Journal of Obesity 24: S77-S79, 2000.
  12. Hill EE, Zack E, Battaglini C, Viru M, Vuru A, Hackney AC. Exercise and circulating cortisol levels: the intensity threshold effect. J Endocrinol Invest. 2008. Jul;31(7):587-91.