Over the last 18 years of my practice, I’ve seen tremendous success in helping people improve their health when low-carbohydrate dietary changes are anchored as the foundation of treatment. However, there is still a group of people that struggle with seeing success. Even with the most effective ketogenic dietary control, there are those that see abnormal weight gain, inability to lose weight, poor libido, fatigue, foggy thinking, mood swings, persisting depression, headaches, bloating, breast tenderness, fibro-cystic breast changes, hair loss, and hot flashes. They may not experience all these symptoms, however, many are often present. If you have been following a ketogenic lifestyle and are still experiencing any of these symptoms, you are probably suffering from estrogen dominance.
Estrogen dominance is a condition that elusively effects thousands of women (and men) and your doctor probably doesn’t even know about it. I didn’t know about it. I, like all of my physician colleagues, were trained in school that the symptoms above are related to fluctuations of estrogen as a woman ages (or dropping of testosterone as a man ages). We were, and still are, taught that they are fixed by giving more powerful doses of estrogen or testosterone.
Over the years of my clinical experience, giving more estrogen frequently didn’t work. And, giving men more testosterone didn’t work either. What I found very effective, for many, was changing the diet. And, for about 85% of people, the symptoms list above resolved. However, the cause of the symptoms above in that last 15% of patients I see was still elusive. Examinations, blood tests, and even psychological evaluations never revealed the answer. Giving synthetic estrogen, progestin or testosterone when the blood work showed abnormality partially alleviated some of the symptoms for a few months, but then the patients would end up back in my office with the symptoms having returned.
I’ve found a number of problems following the “standard” medical approach to using synthetic sex hormones.
The first problem is that estrogen, progesterone and testosterone are heavily bound to proteins in the blood. It is only the free component of the three forms of estrogen and progesterone in the body and the free testosterone that acts upon the delicate cells located throughout the body. Blood testing does not account for the levels of free estrogen forms and progesterone effectively. These can only be tested through salivary testing.
The second obstacle is that the synthetic forms of progesterone (progestin), cannot effectively enter the brain. When synthetic forms are used, a person only gets half the benefits of progesterone found in the human body. This is why so many women have depression, anxiety and foggy brain feelings when using the synthetic versions.
The third challenge is that pharmaceutical companies cannot patent a drug that is identical to your human hormones. The chemical structure of the synthetic estrogen, progestin or testosterone must be slightly different. Hormones effectively work on certain aspects of various cells throughout the body, however, progesterone and progestin (the synthetic version found in medroxyProgesterone) DO NOT have the same hormonal effect on each cell. Natural progesterone is broken down by the stomach when ingested. That’s why progestin was invented, however, it doesn’t act the same in the body and only does half the job.
The fourth dilema is that much of our food in the standard American Diet stimulates increased estrogen production or inhibits clearance of estrogen excess through the gut and digestive tract. This happens in men and women. We can get excess estrogen from animals treated with hormones in meats, milk and dairy products. Hydrogenated oils in processed foods change the way estrogen and progesterone are handled in the body. These unstable fats increase the effects of estrogen on the body and amplify the risk for cancers. Excessive omega-6 fatty acids in the diet magnify estrogen receptor response to estrogen.
Estrogen metabolism in the liver and removal in the gut are dependent on vitamins B & E, magnesium and idol-3-carbinol (IC3). Diets without adequate IC3 from glucobrassicin found in leafy green and crucirferous vegetables allow re-uptake of estrogen in the gut leading to high estrogen levels and estrogen dominance. This is where gut health is even more important, and where I see failure in the “carnivore” approach to a ketogenic lifestyle.
The fifth problem is that the more estrogen I give a person, the more estrogen receptors are unregulated to the surfaces of the cells in the body. When that happens, more estrogen is required. Excess estrogen can actually cause many of the same symptoms present in progesterone deficiency including:
Irregular or heavy bleeding
Breast tenderness
Depression
Fatigue
Poor concentration
Fibrocystic breast changes
Decreased libido
Fibroid growth on the uterus
Endometriosis
Water retention and bloating
Fat gain around hips and thighs
Bone mineral loss (osteoporosis)
Hair loss
Skin thinning
Disturbed sleep
Breast and uterine cancer
More estrogen isn’t needed. Balancing natural progesterone with the current estrogen the body is already making is the solution in most cases. This can only be effectively assessed through a salivary hormone test.
In my clinical experience, a ketogenic lifestyle is foundational to balancing these hormones consistently and naturally. Carbohydrate restriction by itself corrects many of the diseases of civilization. I addressed this in my book The Keto Cure. For many, there are few more steps necessary to living a long, happy and healthy life.
The treatment to this issue isn’t difficult. For that reason, much more is to come on this subject. I will address each of the points above in future blogs. However, the first step is get your hormones checked by someone who understand this problem. And, then knows how to interpret it and treat it.
A few years ago, my family and I set out to build a pond.
I have always loved Koi and the serenity of a Koi pond in my own back yard was very enticing. I spent about a year planning my design and the location. I dreamed of a serene evening after a very long, hectic day seeing patients relaxing beside the pond. The sound of trickling water, the occasional splash from fish, the cool breeze passing over the mist from a water-fall would sooth my soul after a busy day in the office.
I envisioned the perfect area. An unused access path, previously worn by the previous owner with truck and trailer traffic, beside my now expanded patio. Twenty feet wide, thirty feet long and four feet deep. . . that seems just perfect.
I pulled out my shovel and set about digging. Eager to begin and filled with the energy of the final product, I set to digging. What could be so hard about digging my own pond? Think of the exercise I will be getting. Thoughts spurred me on.
Minutes later, chest heaving, face glistening with sweat, I stared in dismay at the ground. All I had to show for my wild digging was a small 1/2 inch dent in the dusty Arizona top soil.
Sonoran Clay
Over time, calcium-carbonate, along with other minerals, accumulates and dissolves into the topsoil of the very arid regions of Arizona Sonoran Desert. It forms a two to three-foot layer of soil called “caliche.” Periodic rains carry the calcium as far as three feet down into the soil, then the water rapidly evaporates in the blistering Arizona heat. This often forms two to three feet of soil that is “literally” harder than concrete.
With tremendous zeal, a great deal of sweat and a round of painful blisters, I broke my third shovel on this impenetrable ground. I realized this was much more difficult than I thought. I pulled out the back-hoe attachment for my small farm tractor. After a few hours and few gallons of diesel fuel later, still very little progress occurred.
Multiple weekends and evenings of digging in the Arizona caliche left me with three broken shovels, a ruptured hydrolic line in my tractor, anger that my expensive back-hoe attachment didn’t work, and only a small dent in the ground near my patio. Even the brute force from the tractor would not budge the clay. I wondered if dynamite would be effective? (My wife would have none of this idea).
With my exuberance quashed, I concluded that this would require much more measured exhuming.
Escape From the Prison
We often imagine, with great delight, the removal or destruction of that which enslaves or imprisons us. We dream that just a little sweat, exertion of a few shovel scoops of dirt and the foundation to our prison of obesity, addiction, debt, and depression are exposed. A few extra scoops and we imagine freedom from that prison cell.
If only I had a jack hammer and a bigger, more powerful scoop, I imagine . . . I could make short work of these manacles that bind me.
But, our manacles and prison cells do not so easily give way.
The failings of our sharpened spades and powerful back-hoes form a new, even stronger fetter – the belief that our prison cell is unbreakable, that our challenge is just too great. These failings usually leave a person cured of any further desire to break free. It quashs the dream and solidifying the depression of stagnation.
The in-fecundity of my shovel, no matter the strength and effort put behind it, was not cause to quit. It was life’s lesson that prisons and shackles often only need a simple tool.
Enter the pick-axe. During this process my wife said, “Honey, why don’t you use the pick in the garage?”
“If my shovel and the back-hoe didn’t work, there was no way I was going to break through this clay with a pick axe.” That was absurd, I thought.
Yet when I humbled myself to try, it was simple. The pick-axe was unpretentious. This simple tool allowed for an almost effortless stroke to a small area of weakness in the caliche. A large flake of soil would pop free with each stroke. The process was repeated.
Scale by scale, the dragon’s flank was exposed. Careful work of the pick-axe began to loosen layer after layer, section after section, pellicle after pellicle. Yes, it was slow work. But, each swing was a small victory.
At each little victory, my heart would leap, the dream would become ever clearer.
Working this magic again and again until finally the specter was weakened enough to pull out the shovel. And, further work, allowed for bringing back the powerful back-hoe, in gratifying scoops.
The excavation that I thought would take two months took me fourteen. But, it was gratifying.
I learned a powerful lesson. Wherever life has pinned you, fettered you or barred you in, put down the shovel, and pick up the pick-axe. Second, if you really listen, your spouse may point out the tool you really need. Don’t be afraid to chip away at it a piece at a time.
Finances
Stop waiting for the sharper shovel or the bigger back-hoe to dig yourself out of your harrowing debt, mega mortgage, or your income dwarfing spending. The jackpot or financial windfall won’t come. While others await the jackpot, put down your shovel and shoulder your pick-axe.
Pick one small debt and begin to pick at it by applying just a little extra each month until it is gone.
Cancel your extra cable, sell the motorcycle and payoff the 21% interest credit card.
If you must, pick up a side-hustle for extra to sharpen the pick.
Once you’ve lifted one flake, chip away at the next. Making progress will make it easier to continue. It doesn’t matter how long it takes, just keep at it.
Marriage
You long for resolution of the apathy, progressive resentment and mutual stalemate that permeates your relationship. You look in vain for the bigger shovel that will uncover the treasure that years of apathy have buried. You long to uncover your dreams and needs that have been covered and hardened under the clay of resentment. The shovel and the back-hoe won’t help you here.
Drop the shovel. Shoulder your pick-axe.
Kiss your wife every time you leave, even if it’s just for a ten minutes to run to the convenience store.
Hold her for five seconds longer every time you hug.
Find a gift you can give her once a week, just because.
Put down your phone and look her in the eyes when she talks to you and listen. Really listen and the flakes of hard clay will unveil the beauty of her soul.
Find a way to praise her every day, even if it is through a simple text.
Health
You long to rid yourself of your addiction to sugar, bread, stress, and sleep deprivation. You’ve tried to scoop them out of your life. You even hired a trainer with some muscle to force you to change. You’ve tried in vain to save yourself from yourself.
Trying to use the shovel here is like trying to use the shovel on steel forged walls of your life’s prison fortress. Forget the shovel. Shoulder your pick-axe.
Start with one meal and make some substitutions. My dietary plan can help you with this.
Go to bed an hour earlier. Really, you’ll be surprised that the focus you have will more than compensate for the hour of lost time in the evening.
Take ten minutes and do 20 push-ups and 20 sit-ups, then take a 10-minute walk.
Simply remove the “white stuff” from your meals. You will be amazed at the results.
Put down your phone for 30 minutes and read that book you’ve been meaning to read, instead of surfing Facebook.
Grand-standing with your back-hoe doesn’t help you. Just swing the pick-axe once or twice. Simple daily picking with the sharp point weakens the hardest of ground and the prison walls in our lives. It takes time, so be patient.
Find the weak point, apply the pick. Day by day, little by little you will be free.
I’ve been there. I’m with you. Keep me posted on your journey.
Ketogenic Lifestyle – the Balance of Endocrinology & Psychology
Over the last few weeks, I’ve had the pleasure of talking to a number of patients and friends about what it means to live a ketogenic lifestyle. A low-carbohydrate or ketogenic lifestyle is different from a low-carb diet. It is different because the definition of lifestyle implies the way a person lives their life that reflects specific attitudes and values, not just how they eat. My recent posts, The Principle Based Ketogenic Lifestyle – Part I and Ketogenic Principles – Part II, focus on fundamental principles making the ketogenic lifestyle one in which balance and grounding in all aspects of life can occur. When the mind, the body or the spirit are out of balance or un-grounded, symptoms of metabolic inefficiency, sickness or disease result.
I have been fascinated, as a family practitioner, that the body produces “warning flags,” when there is dysfunction in one of these areas: mind, body & spirit. These warning flags are byproducts of inefficient inter-related functionality between the body’s systems and it is one of the foundation principles of osteopathic medicine. Prior to the advent of many of our diagnostic techniques today like MRI, CT scan, advanced laboratory evaluations, and ultrasound, these were the only indicators of disease that a physician could identify, and upon which diagnosis was made. These flags often show up on the skin, in the hair or nails, in the complexion, or in general appearance or mannerisms.
Skin Tags (fibroepitheial polyps) under the arm
For example,”skin tags” are now recognized as pathognomonic, specifically indicative, of insulin resistance and will often occur up to 20 years before impaired fasting glucose or diabetes is ever recognized.
Exopthalmos (bulging or protruding of the eyes) from hyperthyroidism
Exopthalmos, or protrusion of the eyes, is pathognomonnic for overactive thyroid function (hyperthyroidism), and spider angiomas occur as a somatic flag that cirrhosis of the liver is present.
Alligator Skin (severe dry skin) found in hypothyroidism
Hair loss and dry skin, or “alligator skin,” represents the exact opposite with an under-active thyroid (hypothyroidism).
Spider angioma seen with cirrhosis
When metabolic pathways get “clogged” or flow of blood, lymphatic fluid or hormones do not reach the destinations they were meant to reach, symptoms of accumulation or poor function begin to arise.
The osteopath is also trained to recognize a corollary Chapman’s Reflex Points that act as flags for dysfunction in specific organs or regions of the body. These points relate directly to what causes the pathognomonic flag. I frequently identify abdominal, adrenal, pancreatic and liver Chapman’s points present in those with insulin resistance, inflammatory diseases, pre-diabetes and diabetes. Understanding how to interpret and use these flags comprises four years of medical school and three to four years of residency and often years of clinical application.
Mental or spiritual pathways can often be bloc-aided by poor recognition of, or refusal to acknowledge, individual truths in our lives. Interestingly, the signs or warning flags of spiritual dysfunction are also expressed physically.
“Oh, no?! Dr. Nally are you going to get all religious on us?”
Maybe.
Over the last 15 years of my medical practice, I’ve witnessed the spiritual component of the “mind, body, spirit” unit, or lack thereof, have profound impact on the body’s ability to heal. Every one of us must defeat what Sigmund Freud called the pleasure principle – the human instinct to seek pleasure and avoid pain, including recollections or memories that are painful. Hiding from these memories because of pain is very common and is part of human nature. We often believe that thinking about or re-living the truth may cause us individual overwhelming un-survivable grief. So, we naturally bury the thoughts and emotions and feelings deep down into our subconscious minds.
In fact, we take irrational risks, busy ourselves, use food or drink for short term comfort and move from one distracting or debilitating relationship to another. We lose and then regain gain weight, become workaholics, hide behind thousands of texts, social media posts and emails in order to protect ourselves from the part of ourselves that we don’t want to think about.
However, when we step away from the distractions and courageously look at our individual history, our personal life story, honestly and completely, feelings of sadness, anxiety, regret and anger may often arise. These painful emotions bring with them essential insights into how experiences will help you and I individually grow, become a better people, and help others along the path. It takes faith to trust that these experiences will not destroy us, but were allowed to occur by a loving Father or Creator, understanding that for you and I to grow, we must each be given individual agency to chose. It takes faith to recognize that that Father has your individual best interest in mind. Hiding from these emotions clogs the mental and spiritual systems and fuels disabling depression, anxiety, insomnia and fatigue. These feelings, real as they are, persist when there is no other physical sign of illness. That’s because this illness is not physical. It is spiritual. When we are out of line with the truths that bring peace and balance to our lives, negative, self-limiting patterns of activity and fear stifle growth and development mentally.
It is fascinating to me that on more than one occasion, as an osteopath, when a patient suffering from these symptoms gets a massage or has an osteopathic or chiropractic manipulative treatment, they may suddenly become tearful or have unexpected release of emotion. Physical treatment over the areas of congestion can, and do, cause a reflex triggering of mental, emotional or spiritual release of tensions.
How do I know that it is truth we are hiding from? Take the words of the Buddhist teacher Sogyal Rinpoche found in The Tibetan Book of Living and Dying among many others throughout the ages:
“Saints and mystics throughout history have adorned their realizations with different names and given them different faces and interpretations, but what they are all fundamentally experiencing is the essential nature of the mind. Christians and Jews call it “God”; Hindus call it “the Self,” “Shiva,” “Brahman,” and “Vishnu”; Sufi mystics name it “the Hidden Essence”; and the Buddhists call it “buddha nature.” At the heart of all religions is the certainty that there is a fundamental truth, and that this life is a sacred opportunity to evolve and realize that truth.”
“Wait a minute, what does all this have to do with a ketogenic lifestyle?”
The ketogenic lifestyle is one that is based on values. A patient following a ketogenic diet recognizes that food has just as powerful effect on the hormones of the body as does prescription drugs. Understanding the value of hormone balance and the principles that effect weight, inflammation, blood pressure and cholesterol, the ketogenic lifestyle is one in which carbohydrates are restricted in an individually tailored way to obtain the end goal. How does a ketogenic lifestyle balance mind and spirit?
Step One –
Put down your force-field. This takes courage and it takes faith. Your force-field is any distraction that keeps you from thinking and feeling and identifying truth. These include excessive alcohol, illicit drugs, binge eating, smoking, gambling, working excessively or getting lost in repetitive dramatic romantic relationships .
Believe me, the force-field gets heavier every day. After my father passed away at age 58 from the major complications of diabetes and my sister committed suicide a few years later, I threw myself into work and church service. I worked 16-18 hour days, completed a second board certification in Obesity Management and a fellowship in Health Policy, all while serving as a bishop and counselor in my church. I found that I could raise my force-field of justification to hide from the pain and emotions of family illness and depression.
But the force-field saps your energy and cheats you out of seeing your full potential. I found that as long as I held up my force-field (and some of us care more than one), I couldn’t see the experiences that made me who I am and connect me with those I was trying to serve and help. As long as I was holding up my force-field, I was living in the fear of re-experiencing the pain of loss and the worry of future disease, . . . and people sense that.
You don’t have to drop the force-field all at once. You don’t have to quit work and become a hobbit. You just have to lower the field a little bit, enough to peek over and let the Eternal Truth shine on you. Truth is a funny and powerful thing. The more we overcome our reluctance, face the pain and the fear, the more we realize just how often things begin to go well for us. Living in the presence of great truth and eternal law and being guided by permanent values is what keeps a man patient when the world ignores him, and calm and unspoiled when the world praises him.
Step Two–
Identify emotional or behavioral patterns that you want to change. If you don’t know, ask a trusted friend, your spouse, or your relatives. As I think back over the years, I had a couple trusted friends pull me aside and identify a few of those patterns face to face. I appreciate that, and I’ve never forgotten it.
Make a list of the events in your life that you regret and wish you would have made a different decision.
Go over the list as many times as you need to to identify the pattern or theme that seems to tie the regrets together.
Then actually write down the theme or reason that you identified as the cause. This allows you to identify and remove the corrupted soft-ware of your soul.
This process can take time and is often camouflaged by denial.
Major insight often comes as a knock on the door of denial, so listen carefully to what is being said. Listen to yourself listening. Psychiatrists say that if something said while listening to a patient makes them suddenly feel sad or irritable, then that may be a meaningful theme in the patient’s life. Listen to your gut feelings as you go through the day. Don’t ignore a prompting from your soul.
Step Three –
Realize that today’s negative emotional and behavioral patterns are connected with painful memories and unsolved past conflicts.
Do you get a gut feeling that you want to change the subject when someone brings up a financial setback? Do you want to reply with one liners like, “I’m sure it will all work out?” Are there other topics that make you uncomfortable? Ask yourself why that topic makes you uncomfortable . . . seriously, ask yourself, and then answer yourself. Do you suspect your spouse of cheating when there is no objective evidence to support the suspicions? Recognize these uncomfortable feelings are our subconscious waving flags to make us each aware of unresolved conflicts within our mind and spirit.
Remember, we attract the type of energy we give off.
Step Four–
Pray to whatever higher power you believe in. Meditation, prayer and “ponderizing” brings a reservoir of faith and courage to find and to face the truth. If you have the faith, get on your knees and sincerely ask God for help facing your truth and the challenges, fears and sadness that reflecting upon it may initially bring. I promise you that you will gain the strength to accomplish the task. It will bring the strength to overcome the hidden trauma in your earlier life and will give you the strength to resist the call of ice cream at 3 am.
Following these four simple steps, keeps you vigilant to the physical and spiritual warning flags that may arise on your ketogenic journey and will bring great confidence while modifying your diet to balance your body’s hormonal milieu. Confidence inspires courage. Those with courage and confidence in themselves, and faith that they are on the right path, are unstoppable. Good luck . . . I look forward to seeing you on my journey down the same path.
