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Is Keto For Everyone? Dr. Nally’s Three Principles of Health

Is a Ketogenic Lifestyle What Everyone Needs?

“Do I really need to be doing that ‘Keto Thing’?”

I get asked this question all the time.  And, my answer is that 85% of the people that walk through the doors of my clinic will not be fully successful in weight loss, reversal of diabetes, normalization of blood pressure and reversal of heart disease and/or vascular disease without it.

I am frequently asked, “Is Keto for everyone?”  Does everyone need to follow a ketogenic lifestyle?  The answer is “No.”  15% of the population will be able to maintain great health with calorie restriction and exercise.  However, the principles that provide a successful ketogenic lifestyle are easily understood and incorporated by anyone looking for improved health, energy and weight control.

Principle #1 – Insulin is the Master Hormone

Insulin is the master hormone when it comes to weight loss and the diseases of civilization. Whether you are insulin resistant or not, insulin is essential for life and proper function of the cells of the body, but too much insulin production in response to sugars, starches or complex carbohydrates causes disease.

How do you know if you are insulin resistant (producing too much insulin)?

Skin tags are pathognomonic (a characteristic indicative of the presence of disease) for insulin resistance. If you have skin tags, you may want to focus your diet on increased carbohydrate restriction.

You may not need to completely remove carbohydrate from your diet, however, recognizing that not all carbohydrates are created equal and avoiding those with higher carbohydrate content will help many improve weight and halt the progression of disease. I have many patients that with just partial carbohydrate restriction they are able to lose 20-30 lbs, improve their cholesterol profiles and improve their blood pressure.

There are sixteen different diseases that respond very effectively to carbohydrate restriction.  You can read about them and how the ketogenic lifestyle effectively reverses them in The Keto Cure.

Principle #2 – Saturated Fat & Cholesterol Aren’t the Demons We’ve Made Them Out to Be

Saturated Fat and cholesterol aren’t the demons we’ve made them out to be. Another way to put it is: “Don’t blame the butter for what the bread did.”

Since 1984, nutrition experts treat fat and cholesterol containing foods like the witches of Salem.  Experts castigate their use as if they were the “Avada Kedavra“ curse of the fantasy world.

As an example, eggs, specifically the egg yolk (the part of the egg containing all the cholesterol and saturated fat), have been demonized by just about every health magazine I’ve ever read. (To this day, the chef at every breakfast bar I’ve ever visited asks if I want an ‘egg white only’ omelet.) Interestingly, there is actually no scientific data association between whole egg consumption and heart disease. The science simply does not exist. Seriously, check for yourself.

I personally eat 6-8 eggs a day and my cholesterol is perfect. Back 1000 years ago, only the aristocrats at the chickens.  All laborers and serfs ate the eggs . . . who would be dumb enough to eat your food source? (Don’t answer that.)

For example, the MR-FIT study, the largest cholesterol study ever completed, is incessantly quoted as the study that demonstrates reduction in cholesterol leads to reduction in cardiovascular disease, but this trial was actually a failure and did not demonstrate improved risk by lowering cholesterol. In fact, the Director of the study, Dr. William Castelli stated, “. . . the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol…”

Researchers found that people who ate the most cholesterol, including the most saturated fat, weighed the least. They were also the most physically active. In fact, the British Medical Journal published a 2015 study demonstrating that saturated fat is NOT linked to vascular disease, diabetes or increased mortality (de Souza RJ et al., BMJ 2015,351:h3978).

In my clinic, the basis of appetite suppression is eating adequate protein that includes saturated fat and cholesterol. This is the most powerful tool in my clinical approach to the treatment of weight loss.  I can use foods like red meat, bacon, butter and coconut oil without concern or worry of heart disease as long as you are keeping your carbohydrate intake less than 20 grams per day.

Baseline insulin levels allow for peace of mind about heart disease risk. Heart disease risk goes down when insulin levels are maintained at normal baseline levels. Increasing saturated fat, while at the same time lowering carbohydrate intake has been demonstrated to shift the cholesterol to a more heart protective form (Griffin BA et al., Clin Sci [Lond], 1999 Sep).

Principle #3 – Nutritional Ketosis Has Anti-Inflammatory & Age Slowing Effects On the Body

Ketones in the blood at a nutritional level (0.5-4 mmol/L) have tremendous anti-inflammatory and age slowing effects on the body.  Even having them present intermittently has dramatic improvement on overall inflammatory changes and disease in the body.

Ketones are the usable fuel of the body when the liver breaks down fat for energy. They suppress the NLRP3 inflammasome in every cell in the body. This is important because it allows for more rapid recovery from exercise. It also dramatically decreases pain and fatigue that comes from diseases like arthritis, rheumatoid arthritis, multiple sclerosis and auto-immune disease (Y.H. Youm, et al., Nature Medicine, vol. 21, no. 3, pp. 263–269, 2015.)

If full blown ketosis isn’t for you, partially restrict starch and carbohydrates for a mild to moderate benefit.  Even small amounts of ketones in the blood are helpful.  This provides increased recovery time, and improved inflammation control.

So, even if you don’t follow a strict ketogenic lifestyle, the principles above are powerful.  These three principles make this dietary approach universally effective for weight loss.  They are also very powerful for disease management.  Even partial application of carbohydrate restriction can benefit just about everyone.

You can learn much much more about the Ketogenic Lifestyle as a member of DocMuscles.com.  Click the link and sign up now.

And, don’t forget to get your signed copy of my book, The Keto Cure.

How Do You Know if You’re Insulin Resistant?

How do you know if you're insulin resistant? What questions need to be asked? What should your numbers be? And, many other great ketosis questions. Also, why does Dr. Nally look like he has dirt on his chin? See it here . . .

Read more

The Ketogenic Antidote to Chronic Renal Disease

It is well know that one of the most profound complications of diabetes is damage to the kidney and the very small arteries within the kidney acting as your body’s filtration system.  The kidney begins to lose the ability to adequately filter and retain microscopic protein progressively over time. As the blood sugar and insulin levels continually rise over time in the patient with diabetes or pre-diabetes, damage to the delicate filtering system of the kidneys occur. This very common and progressively damaging problem is called “nephropathy.”

nephropathy kidney
Chronic elevated blood sugar and insulin cause the filtering system to become more and more “leaky” and ineffective.

We knew in 1972 that patients with diabetes had thickening of the basement membrane or endothelium of the small tubles within the kidneys.  In fact, 98.6% of diabetics tested had thickening of this area of endothelium and tubules also called the renal glomeruli (1).  This allows the glomerulus or filtration system of the kidney to become more “leaky” and microscopic protein loss begins to occur through the kidney.  This loss of important proteins in the blood is called “albuminuria” or “micro-albuminuria.”  It is a flag that further damage of the kidney can and will occur without making significant changes to lower the blood sugar and the insulin. As of today, it is not totally clear how the basement membrane is damaged at the microscopic level, however, there is some evidence that elevated insulin has both a physical and immune type effect that stimulates oxidative stress, atherogenesis, immunoglobulins, as well as the formation advanced glycation end products leading to endothelial wall damage (2).

Recent research reveals that a ketogenic diet effectively repairs and/or completely reverses the albuminuria (3).

Evidence in my office of the significant improvement in micro-albumin can be seen in the one of a number of case studies below:

72 year old male with history of diabetes, diabetic nephropathy already treated with full dose statins, ACE inhibtors, metformin, and Januvia.  (Remember, microalbumin should be <30 mg/g)
Date                 Microalbumin      HbA1c
8/12/2010        2264 mg/g              6.4%   Started carb restriction <30 g per day.
10/01/2010        1274 mg/g               5.2%
1/08/2011            1198                          5.8%   Admits to cheating over holidays
12/26/2013         2434 mg/g            6.8%   Returned from 2 yr travel-off diet
2/27/2014          399 mg/g               6.3%  Restarted carb restriction <20g per day
6/20/2014           190 mg/g              7.0%  Traveling – no carb restriction
10/31/2014          280 mg/g              6.9%  Partial carb restriction <10 g/meal
3/14/2015            97 mg/g                6.8%

The patient began following a ketogenic diet in 2010.  After improvement he moved out of town for two years and “fell of the wagon.” Upon returning h restarted his carbohydrate diet and was only partially following it.  As you can see, he also admitted to some cheating on the carbohydrate restriction over the holidays.  In light of this, carbohydrate restriction decreased his albuminuria from 2400 to 97 mg/g within a period of 18 months.

References:

  1. Siperstein MS, Unger RH, Madison LL. “Further Electron Microscopic Studies of Diabetic Microagniopathy.” Early Diabetes: Advances in Metabolic Disorders, sup 1. New York: Academic Press, 1972, p261-271.
  2. Nasr SH, D’Agati VD.  “Nodular glomerulosclerosis in the nondiabetic smoker.”  J Am Soc Nephrol. 2007;18(7):2032.
  3. Poplawski MM, Mastaitis JW, Isoda F, Grosjean F, Zheng F, Mobbs CV (2011) Reversal of Diabetic Nephropathy by a Ketogenic Diet. PLoS ONE 6(4): e18604. doi:10.1371/journal.pone.0018604