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Libraries and Laboratories

I am a fan boy of D.T. Sheffler.

I am a fan boy for three reasons . . .

First, because he is a fantastic writer.

Second, he is a superb philosopher in medieval, religious, ethical and political competencies.

And, third, he is a former Navy Seal.

The dude is smart, witty . . . and deadly.

I was reminded while reading one of his recent essays that society, to our detriment, has separated our libraries from our laboratories.

My education occurred in the modern STEM group of subjects.  STEM stands for Science, Technology, Engineering and Mathematics.  I appreciate my education, and I am very grateful for it.

However, in the process of homeschooling my children . . .

(The Beautiful One actually did all the schooling, I just watched, listened and cheered her on . . . )

I realized that I missed out greatly on a Classical education.

Classically educated students and educators (the Beautiful One is essential a Classical Educator) tend to be a bookish lot.

They love Cicero and Shakespeare and George MacDonald.

The get all giddy when they see a musty bookstore, gothic arches and castles . . .

And, they love imagining the Trinity College Library in Dublin, Ireland.

In fact, a few of them have saved it as their desktop background.

They speak in code to one another frequently using metaphors from The Lord of the Rings and Narnia, and they may even use Elven script when writing.

This is very different and antithetical to the creatures like me that emerge from the math and science schools of the modern era.

We love aviation, science museums and biology.

We wear Star Wars and NASA t-shirts, and many of us may be caught wearing white knee-high tube socks with Birkenstocks.

We loved marine biology in the eighth-grade, dissecting frogs in 10th grade and won science fairs and physics contests in high school. I actually built a bridge out of balsa wood that held 1300 lbs., winning a cash prize from a nearby college.

Many of us will have telescopic images of constellations on all four of our computers monitors and get all giddy hearing the sound of the clicking of our Model-M keyboards.

And, yes, my lot actually enjoyed doing their calculus homework.

This dramatic difference between the STEM educated and the Classical educated would look very strange to any pre-modern world scholar.

Before the hyper-specialization of today’s modern research universities in the nineteenth and twentieth centuries, mathematics and poetry, physics and philosophy, were all required together to be an educated person. They came together as a unified package.

A scholarly gentleman often housed his laboratory equipment and his fencing gear in the same room as his library.

In fact, Sheffler states that “Plato inscribed above the entrance to his Academy the words: ‘Let no one ignorant of geometry enter here.’ More certainly, in Plato’s Republic, Socrates insists that an extensive education in geometrical reasoning is necessary before a student can embark on the study of philosophy.’”

Aristotle combined his extensive writing and philosophy with works on meteorology, rhetoric and physics. He actually made a number of discoveries in marine biology through dissection and he knew a great deal about astronomy from close observation of the sky.

Most people are aware that Leonardo da Vinci was profoundly competent in multiple fields.

Yet, few know that Isaac Newton, the man who formulated the laws of motion, the theory of universal gravity, and built the first reflecting telescope, spent the last years of his career obsessed with the textual analysis of scripture.

Most are aware that Benjamin Franklin was a very wise statesman and diplomat, but few know his involvement in the discovery of electricity.

Johann Wolfgang von Goethe is known as one of the most influential German writers of all time. Yet, he was also a polymath and had profoundly insightful scientific contributions in botany and color theory.

Education throughout your entire life should consist of the education of a single mind, yours, both knowledgeable and flexible, capable of handling deductive thinking and interpretation of nuance.

I have come to learn that scientific education stocks your mind with facts about the concrete world. It teaches you how to reason carefully about probabilistic causal inferences.

Poetic education teaches the mind to see the analogy between things and create metaphor.

Mathematical education trains the mind to carefully work through a difficult chain of deductive, quantitative reasoning.

Philosophical education incites the mind to ask fundamental questions and then, to reason toward sound answers to those questions.

Literary education civilizes your mind with a very cultivated imagination. It teaches you to make both judgement about and emotional response to what you have imagined.

Educating comprehensively in this way educates the single mind, yours, not a bunch of separate little independent minds.

Extensive scientific knowledge of the physical world with its very complex system of natural causes makes you a better novelist or writer.

The ability to see the analogy within the subtlety of a good joke makes a person a better scientist. (I know a bunch of really boring scientists who have no sense of humor and it affects their research).

A deficiency in one area will lead to incompetence in others, this includes physical exercise and athleticism.

I cannot tell you how many times I’ve hear people say, “I’m no good at math.” You’ve likely heard people say, “I’m more of a creative, artsy type,” or they excuse their horrible spelling by saying, “I’m a math and science guy.”

People and students will have different interests that lead to different specializations.  That is understandable and expected.  However, I’ve seen it in my education and I’ve had multiple professors tell me that a student who is unable to discipline his or her mind to work carefully through a math problem is likely to have difficulty in carefully reading a story.

The student who interprets everything literally and cannot craft a metaphor is also likely to have difficulty with designing an experiment.

The student or professor that is an arm-chair rationalist failing to go out and apply his skill in the real concrete world will never fully comprehend natural phenomena.

Just because you specialized in one area of learning, do not let other areas drop.

This is why I took up sword fighting and fencing at the age of 50 years old.

I now comprehend what it means when one says that “you must be alive to philosophize.”

Without an educational balance in science and humanity, you will never truly understand the need for opposites in the world. You cannot understand life until you experience opposites in all things, happiness and sadness, joy and misery, pleasure and pain, life and death.

This requires strength, courage, mastery and honor as the true virtues of men and women all around the world.

Without a comprehensive education in all areas, the virtues that make civilization possible will disappear.

To Your Health & Longevity,

Adam Nally, DO

Financial Crisis in Medicine

For the last three weeks, a supposed cyberattack on Change Healthcare, a unit of the United Healthcare & Optum organization, has dramatically disrupted the business of health care providers across the United States.

Medicare and all commercial insurances have stopped reimbursing medical offices, including ours, for nearly four weeks.

In asking these health plans for clarification, all we’ve heard is crickets.

When you or I call our insurance companies about this, we get told “there is nothing wrong” and “payments are being made.”

There is either a major breakdown in the communication in these health plans or they are lying.

Change Healthcare is a juggernaut in the health-care world, processing 15 billion claims totaling more than $1.5 trillion a year, the company says [1]. It operates the largest electronic “clearinghouse” in the business, acting as a pipeline that connects health-care providers with insurance companies who pay for their services and determine what patients owe. It supported tens of thousands of physicians, dentists, pharmacies and hospitals, handling 50 percent of all medical claims in the United States, the Justice Department wrote in a 2022 lawsuit that unsuccessfully tried to block UnitedHealth from acquiring the company [2].

Because of this financial fiasco, small and medium sized clinics are scrambling to stay open.

Today many have closed their doors, because of financial payment and reimbursement coming to a screeching halt.

This has dramatically exposed the fragility of the insurance and billing systems that underpin American health care.

Our office, for example in the last four weeks, has only been paid 10% of what we’ve billed out.

It is not possible to pay staff and keep the lights on in a medical office when you don’t actually get paid.  Most small offices have about a 1-2 week cushion before they are forced to close the doors.

Who really knows if this actually was a cyber-attack?

Because EVERY insurance company including Medicare and hospital systems, have stopped paying in the last three weeks.

Sadly, insurance companies have said nothing directly to us as providers, until today.  As of today, they are claiming payment will start up by the end of the month.

All the information I have gained about this has come directly through the media. They claim that this has prevented insurance payments from processing, leaving many care providers and pharmacies to float the bill up front and hoping to get reimbursed.

After 25 years of medical practice, and dealing with problems like this year after year (Medicare frequently just stops paying in January for no reason), this is the last straw.  My office will no longer be accepting any insurance as of May 1, 2024.

We convert to a cash/fee for service/concierge practice.

Because insurance has still not reimbursed us, our office is requiring a $150 retainer which is for services rendered on the day of service between now and May 1, 2024, or until insurance companies compensate us for the services we’ve rendered and the billing we are due. This retainer is refundable upon receipt of your insurance payment or can be added as a credit on your account toward your deductible.

You can pay this retainer and we are happy to see you, or you can reschedule with us and call your insurance company and find out why they are not paying.

We are sorry for the inconvenience that this is causing.

As of today, you have other alternatives.  They are:

Begin our yearly concierge service – $4500 per year – all medical services in the office including quarterly labs are covered (this does not include spa services).

For Visits with Dr. Nally, you can pay cash or card at the time of service at the rates below:

Establish Patients                                            New Patients

10 minutes – $90.00                                        10 minutes – $140.00

20 minutes – $130.00                                       20 minutes – $180.00

30 minutes – $190.00                                       30 minutes – $240.00

40 minutes – $250.00                                       40 minutes – $290.00

60 minutes – $350.00                                       60 minutes – $450.00

Visits with our nurse practitioner are billed at 75% of the rates above.

Additional fee for service pricing can be seen in the office.

I realized this will dramatically change our practice.  However, this is the only way our office will be able to continue to provide solid and effective medical care.

To your health & longevity,

Adam Nally, DO

References:

  1. https://community.changehealthcare.com/developers/eligibilityandclaims
  2. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.justice.gov/atr/case-document/file/1476901/download

Mask Wearing Has No Scientific Evidence Based Justification

Nearly three years after the start of COVID-19 in early 2020, people are still showing up in my clinic wearing single and double masks, with tremendous fear of getting an infection with COVID-19 or Influenza.  As of the end of 2022, some “so called” experts started telling people in the public to wear masks again, and patients in droves are showing up masked to their medical appointments in the last four weeks.

Before the COVID-19 pandemic, the existing available data about respiratory viruses including influenza and various types of coronavirus showed no evidence or justification for wearing masks to prevent the spread of infection of a respiratory virus.  The legitimate reason for use of a mask is during surgery to lend protection from blood and body fluid splatter between patient and providers or with specific types of filtration masks designed to specifically protect from certain types of bacterial infections.  

Review of the Medical Literature:

Here are key anchor points to the extensive scientific literature that establishes that wearing surgical masks and respirators (e.g., “N95”) does not reduce the risk of contracting a verified illness:

  • Jacobs, J. L. et al. (2009) “Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: A randomized controlled trial,” American Journal of Infection Control, Volume 37, Issue 5, 417 – 419. https://www.ncbi.nlm.nih.gov/pubmed/19216002. N95-masked health-care workers (HCW) were significantly more likely to experience headaches. Face mask use in HCW was not demonstrated to provide benefit in terms of cold symptoms or getting colds.
  • Cowling, B. et al. (2010) “Face masks to prevent transmission of influenza virus: A systematic review,” Epidemiology and Infection, 138(4), 449-456. https://www.cambridge.org/core/journals/epidemiology-and-infection/article/face-masks-to-prevent-transmission-of-influenza-virus-a-systematic- review/64D368496EBDE0AFCC6639CCC9D8BC05. None of the studies reviewed showed a benefit from wearing a mask, in either health care worker or community members in households (H). See summary Tables 1 and 2 therein.
  • bin-Reza et al. (2012) “The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence,” Influenza and Other Respiratory Viruses 6(4), 257–267. https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1750-2659.2011.00307.x “There were 17 eligible studies. … None of the studies established a conclusive relationship between mask/respirator use and protection against influenza infection.”
  • Smith, J.D. et al. (2016) “Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis,” CMAJ Mar 2016 https://www.cmaj.ca/content/188/8/567 “We identified six clinical studies . . . In the meta-analysis of the clinical studies, we found no significant difference between N95 respirators and surgical masks in associated risk of (a) laboratory-confirmed respiratory infection, (b) influenza-like illness, or (c) reported work-place absenteeism.”
  • Offeddu, V. et al. (2017) “Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis,” Clinical Infectious Diseases, Volume 65, Issue 11, 1 December 2017, Pages 1934–1942, https://academic.oup.com/cid/article/65/11/1934/4068747 “Self-reported assessment of clinical outcomes was prone to bias. Evidence of a protective effect of masks or respirators against verified respiratory infection (VRI) was not statistically significant.”
  • Radonovich, L.J. et al. (2019) “N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial,” JAMA. 2019; 322(9): 824–833. https://jamanetwork.com/journals/jama/fullarticle/2749214 “Among 2862 randomized participants, 2371 completed the study and accounted for 5180 HCW-seasons. … Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza.”
  • Long, Y. et al. (2020) “Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis,” J Evid Based Med. 2020; 1- 9. https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12381 “A total of six RCTs involving 9,171 participants were included. There were no statistically significant differences in preventing laboratory-confirmed influenza, laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection, and influenza-like illness using N95 respirators and surgical masks. Meta-analysis indicated a protective effect of N95 respirators against laboratory-confirmed bacterial colonization (RR = 0.58, 95% CI 0.43-0.78). The use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory-confirmed influenza.”

Conclusion: Masks Do Not Work

No randomized controlled (RCT) study with verified outcome shows a benefit for health care workers or community members in households to wearing a mask or respirator. There is no such study in existence.

Likewise, no study exists that shows a benefit from a broad policy to wear masks in public.

If there were any benefit to wearing a mask, because of the blocking power against droplets and aerosol particles, then there should be more benefit from wearing a respirator (N95) compared to a surgical mask, yet several large meta-analyses, and all the RCT, prove that there is no such relative benefit.

No Evidence or Justification for Mask Wearing

Despite the news media with all their hype, all of the scientific studies done in the world up until 2020 demonstrated that there was absolutely no justification for mask wearing to prevent spread of respiratory illness including influenza and corona-viruses.  The guidelines of the World Health Organization (WHO) and the US Center for Disease Control and Prevention (CDC) also showed that there was no need for wearing masks in the general public. The practice of wearing masks did not, and to this day, have any professional justification.  

In 2020, the recommendation around the world for wearing masks suddenly changed without any new professional support to confirm their effectiveness against respiratory infection.   The vast majority of studies during the pandemic suffered from very low quality and many biases.  

Only Two High Quality Mask Studies Exist

Since the start of the pandemic only two high-quality studies have been completed, one looking at a population of over 3000 people in Denmark, and the other with over 342,000 adults completed in Bangladesh.  The study in Bangladesh found some marginal benefit for people over age 50 years old, but overall both studies show that there is no significant benefit for wearing masks to prevent infection with influenza or the corona-virus specifically.

In fact, the results of both of these studies demonstrate that the wearing of masks actually may do more harm than good.   In addition to these studies, several observational studies demonstrated that wearing a mask can cause headaches, concentration difficulty, shortness of breath, decrease in blood oxygen levels, increase in the level of carbon dioxide, bacterial contamination from the mask itself and the existence of substances suspected being carcinogenic as result of lack of regulations and the production of masks.

Wearing a mask for a prolonged period of time can become problematic because of the accumulation of carbon dioxide levels that may exceed permitted standards, might cause tiredness, blurriness, sleepiness and deficiency in judgment, as well as thinking.  

Masks Adversely Affect Social, Mental and Emotional Health

An additional issue I personally found to be a problem in my office, masks create communication difficulty with people who have impaired hearing and need to read lips is a major factor.  Additional studies demonstrated the negative effect of wearing masks on communication and especially with children’s mental and emotional development.

There are a few particular situations in which wearing masks is justified.  In the context of medical treatment when a patient with a respiratory disease is closely examined by medical staff who will be spending prolonged periods of time with that patient, and certainly in the cases of active infectious COVID-19 there is justification for wearing a mask by both the therapist and the patient. However, research still demonstrates the spread to be very low if the contact is less than three hours in length.

As a physician who has practiced medicine for over 20 years, when the patient comes to me with leg pain there is no reason for him or for me to wear a mask.  If a patient comes in with anemia, there is also no reason to wear a mask.    In the medical encounter, the relationship that exist between the doctor and the patient has great significance.  Masks interfere with that relationship and the empathy that should exist between them.  Mask wearing when none is justified creates a subconscious barrier and changes the social and emotional dynamics between the patient and doctor.  Currently, there is a directive for mask-wearing in medical, health and welfare facilities around the world in a number of countries and in a number of hospitals which actually has no scientific justification.

Untrustworthy Medical Journals and Bias

The medical profession and providers within this profession rely heavily on articles published in high-quality journals to provide evidence based guidance and direction for our decisions and actions.  However, in the last three years, bias in these publications has been very significant and misleading in these leading journals.  It has essentially made them untrustworthy.  

Because of this, doctors have passed through a kind of brainwashing by the medical establishment.  They have been receiving inaccurate, misleading and contradictory information from previously trusted sources now swayed by bias, political, governmental and monetary influence, so doctors themselves struggle to know what is right and what is not.

Perhaps most worrisome is the continued refusal to have open professional discussion, and the disdain for different positions backed by poor quality research and data not consistent with the norms of medicine and science.  This has had long-term negative consequences for the medical profession and consequences that every doctor in the world should be concerned about.

As I mentioned above, no study exists that shows a benefit from any broad policy to wear masks in public. There is good reason for this. It would be impossible to obtain unambiguous and bias-free results because:

  • Any benefit from mask-wearing has only a very small effect, since undetected in controlled experiments, which would be swamped by the larger effects, notably the large effect from changing atmospheric humidity.
  • Mask compliance and mask adjustment habits would be unknown and impossible to account for.
  • Mask-wearing is associated (correlated) with several other health behaviors; see Wada (2012).
  • The results would not be transferable, because of differing cultural habits.
  • Compliance is achieved by fear, and individuals can habituate to fear-based propaganda, and can have fundamentally different basic responses.
  • Monitoring and compliance measurement are near-impossible, and subject to large errors.
  • Self-reporting (such as in surveys) is notoriously biased, because individuals have the self-interested belief that their efforts are useful.
  • Progression of the epidemic is not verified with reliable tests on large population samples, and generally relies on non-representative hospital visits or admissions.
  • Several different viruses and strains of viruses causing respiratory illness generally act together, in the same population and/or in individuals, and are not resolved, while having different epidemiological characteristics.

Unless you’re going in to perform surgery, please, for your health and mine, stop wearing a mask.

Cracks in the Armor of Primary Care Medicine

Primary care medicine and the physician’s and providers that provide it are at the breaking point. I’ve provided some of the key points identified in a survey of primary care physicians completed March 1, 2022.

  • 46% of physicians said that primary care is crumbling.
  • 41% said they are mentally and financially fragile.
  • 33% said they have been denied or are over-due serious payment from insurers and health plans.
  • Only 21% of primary care offices are fully staffed.
  • 60% of patient visits take longer due to worsening health of population and exacerbated concerns with delay on access to care during the pandemic.
  • 25% of doctors plan to leave primary care in the next 3 years.
  • 28% of doctors had to limit use of telehealth due to insufficient payment. 
  • Computer literacy is a significant obstacle for 20% of the patients trying to use telehealth.
  • Broadband speed is a significant issue for 20% of patients trying to use telehealth.
  • 36% of physicians state that their burnout is at an all-time high.
  • 53% say that their ability to bounce back and recover from this adversity and burden is severely limited.

“Primary care continues to face a policy emergency regardless of when the COVID-19 public health emergency is rescinded. The findings above continue the ongoing narrative captured in over 35,000 responses to this survey since March 2020. ”

Policymakers, health plans, hospitals and patients alike must respond or watch primary care collapse on their watch.

What Collagen Supplement Should I Use?

Many people are looking for natural sources of collagen.  Every day in my clinic, I get asked about which collagen supplement I recommend using.  People have been convinced over the years by great sales and marketing that they must have some form of supplemental collagen.  

This is an important question, because there are many benefits to collagen.  As the most abundant protein in our body, collagen is essential for:

·         Fighting signs of aging like wrinkles

·         Improving joint health and osteoarthritis

·         Healing Irritable Bowel & Leaky Gut Syndrome

·         Boosting metabolism

·         Improving mental health

·         Reducing the appearance of cellulite

·         Strengthening hair & nails

·         Great looking skin

WHAT IS COLLAGEN?

In the body, collagen is mostly found in the skin, bones, and joints.  It also is found in the lining of the gut. We’ve known for years that gut health is incredibly important for overall health!

Collagen in the body is made up of amino acids which wrap together to make a triple-helix structure.  The helix structure is why collagen is so strong.

The amino acids which make up collagen are:

·         Glycine: Makes up about 33% of collagen

·         Proline: Makes up about 10% of collagen

·         Hydroxyproline: Makes up about 10% of collagen

·         Hydroxylysine: Makes up about 1% of collagen

The 5 most common types are Type I, II, III, IV and V.

·        Type I Collagen is the most abundant in our body (over 90%)  and stronger than steel by weight. It is found in skin, hair, nails, muscle, joints and organs.

·        Type II Collagen makes up movable joints.

·        Type III (the so-called ‘baby collagen’) is the second most abundant collagen in human tissue.

·        Type IV forms basal lamina, the epithelium-secreted layer of the basement membrane.

·        Type V is present in cell surfaces, hair and placenta.

WHY YOU NEED COLLAGEN

Our bodies make collagen out of amino acids we consume through food.  However, as we age, our bodies ability to make collagen declines. Thus, around the age of 30, collagen production begins to diminish by about 1% to 2% yearly.  By the age of 40, you and I lose 10% to 20% of our collagen!

UV rays, cigarette smoke, pollution, poor diet lacking in the necessary amino acids causes our skin’s structural integrity to be compromised. 

Our dermis is made up of more than 80% Type I Collagen and 15% Type III Collagen, along with Elastin and Hyaluronic Acid, and specialized cells called ‘Fibroblasts’ (the essential ‘collagen factories’ that synthesize new collagen).  

Together they are the key components for the extracellular matrix which gives our skin its structure, elasticity and firmness.

 Collagen is the key foundational protein for healthy, youthful-looking skin.

To produce collagen, our bodies first need to have amino acids as the building blocks for collagen. Millions of people around the world were indoctrinated in the low-fat diet dogma taught in grade school since the 1970’s. If you’ve been eating a low fat, vegetarian or vegan diet, which is lacking in those crucial amino acids, your body won’t be able to produce enough collagen!

Why? Because those amino acids above are found in animal proteins and animal fats, specifically from the connective tissues of cows and pigs (amazing how bacon is necessary for everything, right?!)

To make things worse, naturally-occurring enzymes in our bodies also break down collagen.  Environmental factors like pollution, free radicals, and excessive sun exposure can also break down collagen.

THE #1 SOURCE OF COLLAGEN: Natrual GELATIN

When it comes to sources of collagen, you won’t find anything better than gelatin.  Why? Because gelatin IS collagen.  As mentioned above, gelatin comes from the connective tissue of cows, pigs and is found in whites and yolks of eggs. You can also get some types of collagen from fish.

Slow cooking or smoking beef and pork liquifies the connective tissues in these meats and creates the moistness that is so very delicious.

The great thing about gelatin is that it is easy for the body to digest and absorb.  But, don’t expect your wrinkles or joint pain to disappear overnight.

Yes, you can buy expensive collagen powders or gelatins and help pay for supplement company CEO’s boat. And, some of these have been shown to be effective in helping the skin.  However, most of the stuff you find in the supermarket is so highly processed that it isn’t likely to deliver any benefits.

Many collagen supplements found in powders can also cause diarrhea, bloating, a sensation of heaviness in the gut and stomachache.

Instead, save your money. Consume slow cooked beef & pork, eggs, fish and/or cook with bone broth.  It will do wonders for your hair, skin and nails and it tastes great.

Sources:

1.    https://www.ncbi.nlm.nih.gov/books/NBK21582/

2.    https://www.jmnn.org/article.asp?issn=2278-1870;year=2015;volume=4;issue=1;spage=47;epage=53;aulast=Borumand

3.    https://pubmed.ncbi.nlm.nih.gov/23949208/

 

The Habits of Happiness

Recent research reveals that those who are the happiest have three daily habits that they are consistent in following:

  1. Think of three new things you are thankful for each day and write them down.
  2. E-mail a two minute positive note or send a card to someone new every morning to praise them or thank them.
  3. Spend a few minutes each day writing about the most meaningful moments of the past 24 hours.

You will be amazed at how powerful these three simple habits are in bringing joy and happiness to your life.

The Nation Has Changed – Overnight

The world we lived in last Tuesday, is not he same world we live in today.  Historic changes have occurred.  We live today in a United States in name only.   There are now two distinct countries inside one nation the Leftist Nation and the Conservative Nation.  One of those “country’s” economies is under attack. The Leftist Nation has declared economic warfare on the rest of us.
The capital riots have given the Leftist Nation the ability to declare war on 75 million Americans.  Every word that any of us speak is going to be monitored, scrutinized and twisted.  How will each of us maintain a voice that can be heard by those needing to hear it?  Conspiracy theories have flourished because we have no media actually doing their job.
Parlor was officially de-platformed by Amazon Web Services.  Amazon, Apple, Facebook and Google did this in a coordinated effort.  The power structure of these companies has created a need of government and government needs hi-tech.  This is why they have aligned.
We have come to the point that Kathy Griffin, again, re-posted the gruesome bloody head of Trump in her hand on twitter last week – not a soul said a word. When Pornhub is purchased by Disney and Apple, Google and Amazon shut down conservative voices, ask yourself who the real enemy is?
Anything that Twitter, Facebook, Instagram, Google and Amazon will attack anyone with an opposing voice. Rational Americans recognize very clearly the hypocrisy of these actions.
I will never stop standing for liberty, for freedom of speech, for freedom of expression, and the right to bear arms. I will never stop supporting the entire Bill of Rights.
This will more profoundly effect every aspect of our lives, including health care.
The Leftist Nation has dismissed on a daily basis the concerns of 75 million people for four years. Then this powerful group of elites removed the only person that was supportive to this group of 75 million by de-platforming President Trump’s voice.  We are the United States in name only today, we are a house divided.
What will you and I do about it?

Fork In The Road

I woke today seeing a large fork in the road of life.  It was more prominent that other forks I’ve seen in my 50 years of navigating life’s highways.

Everyone eventually comes upon this fork. Yet, this morning, because of the crisis created in life, it loomed bigger and beckoned prompt decision.

The road separated to the left and to the right.

The road to the left was paved in the color of dole.  People followed neatly in line.  They donned their masks.  They carried their subsidy checks in freshly hand sanitized hands.  Neatly packaged rations of toilet paper, and chicken under their arms.  The path was smooth, well-trodden, the evidence of thousands passing down this fork.  The road sign pointing to the left said “Victim.”

The road to the right was not nearly as smooth.  It was rocky, and in some areas, not well marked.  A small sign, barely visible, hidden in the shadows of overgrowth pointed to the right and said “Victor.”

When you look back on your life, and you remember today and the decision before you at the fork in the road, will you have merely survived?  Or will you have thrived?

Has the experience of the first few months of 2020 softened you or hardened you?  Have you even noticed?  Did you even see the signs at the fork in the road?

The road you chose is up to you and you alone.

When you feel stuck, when your life is stagnating, it takes courage to turn down a different path.  It takes effort and resolve to break free and walk a different path.   Traveling a different road gives you a new perspective, an interlude to the mundane, and forces you to be alert and to learn.

Stop waiting for the instructions.  You already know what to do.

I know you want to hear it.  I know you need to hear it.  But, no one is going to tell you it’s finally “safe.”  It will never be completely safe. That’s the whole point of life.  Growth does not occur in restraints.  When you’re not feeling safe, remember, you’re growing.

Many voices can be heard beckoning you down the well beaten path of ease.  Sure, you could live out your life on the couch.  It’s softer and safer there, quarantined upon your familiar couch.

Stop waiting for someone to re-train you, re-hire you or even reassure you.  Reassurance is only momentary.  Stop waiting for the next “expert” to change your life with an enlightened YouTube video.  The herd will never be immunized.   That’s why you were given you own immune system.  Stop waiting for a vaccine, a magic pill, or the sound of “all clear.”  It will never be all clear.  Lean into the challenge.

Stop waiting for someone to re-open your life.  No one is coming to save you.  The sad but honest truth is no one really cares.  So, stand up, step out, work a bit harder.

It’s up to you to protect, provide and steer your carriage down the road.  Do not give up that greatest of all your gifts, your ability to chose.  Yes, you must chose.  If your ability to chose is taken, you’ll never see it again in your lifetime.

The road will never be the same, it never is.  The road you chose today determines the level to which you just survive or thrive.  Chose to thrive.

Let me help you thrive.  My membership program and concierge program is designed just for that purpose.

 

What Can You & I Do To Prevent Viral Infections?

The following general measures are recommended to reduce transmission of infection:

  • Diligent hand washing, particularly after touching surfaces in public. Use of hand sanitizer that contains at least 60 percent alcohol is a reasonable alternative if the hands are not visibly dirty.
  • Respiratory hygiene (for example – covering the cough or sneeze).
  • Avoiding touching the face (in particular eyes, nose, and mouth).
  • Avoiding crowds (particularly in poorly ventilated spaces) if possible and avoiding close contact with ill individuals.
  • Cleaning and disinfecting objects and surfaces that are frequently touched. The CDC has issued guidance on disinfection in the home setting; a list of EPA-registered products can be found here.

Dr. Nally talks about each of these in his latest YouTube video below:

YouTube player

“Keep the carbs low and the fat high.”

—————————————————————-

For more information about any of the things mention above and in other videos, you can find the links below:

#JustKeepEsterifying #LeadFolloworGetOutOrMyWay.
#Ketogenic #Keto #KetogenicLifestyle #Carnivore #DrAdamNally #DocMuscles #DocMusclesLive #DocTalk #DocsWhoLift #LiftRunShoot #DocMusclesLife YouTube.com/drnally/.
Dr Nallys Lasers: #PicoSure #Icon #SculpSure #TempSure
Help Dr. Nally have time to make more great videos:  https://www.patreon.com/docmuscles
YouTube Channel: http://youtube.com/DrNally/
Book: The KetoCure  https://amzn.to/2PmkPoO
Twitter: https://www.twitter.com/DocMuscles/ or @DocMuscles
Weight Management & Concierge Medicine: https://www.DocMuscles.com/membership/
Direct Primary Care Programs:  https://www.docmuscles.com/direct-primary-care/
Exogenous Ketone Manufacturers:

Should You Be Wearing A Face Mask To Prevent Coronavirus?

Should You Wear A Mask?

Source: @jperla (Twitter)

Should you and your family members be wearing a mask to slow the spread of coronavirus (COVID-19)?   This is a hotly debated topic and one that may not soon be agreed upon by everyone.  Over the last few weeks, a number of voices are saying “Yes.”

I am, also, one of those proponents of dawning a mask.  And, that’s no April Fool’s joke.

Dr. Nally in the office

The head of the Chinese Center for Disease Control and Prevention, Dr. George Gao, is also one who has been very vocal about using a mask.  “The big mistake in the US and Europe, in my opinion, is that people aren’t wearing masks. This virus is transmitted by droplets and close contact. Droplets play a very important role — you’ve got to wear a mask, because when you speak, there are always droplets coming out of your mouth.” Gao said in his interview in Science.

Because coronavirus is a droplet based infection, and not an aerosolized infection, wearing a face mask can more effectively prevent the droplets that carry the virus from escaping and infecting other people.  However, I don’t recommend using the medical grade masks. Save those for those that must have face to face contact with COVID-19 positive patients and persons with direct exposures.  For the lay person in the grocery store who must get essentials and may have brief contact, I recommend using a specially designed homemade mask.

Masks Actually Help

Recent research shows that some people infected with the COVID-19 virus who don’t have any acute symptoms can still spread the virus.  This means that the person in line with you to buy toilet paper, might just be infected and not know it.  Research also shows that even wearing a proper homemade mask can reduce silent transmissions of bacteria and viruses in these situations.

In fact, this has been the recent topic of discussion at the CDC, and the use of homemade masks were reviewed in great detail in yesterday’s Washington Post article here.

Homemade Masks Make a Dent in Viral Spread

Wearing a homemade mask has become the norm in Czechia.  The government of Czechia mandated the wearing of masks on March 18th, 2020.   Jeremy Howard of #Masks4all has collected and summarized 40 published scientific research papers that show wearing masks actually does work.  One 2011 meta-analysis shows, when coupled with strict hand washing, masks have the greatest impact on reducing virus spread.

Mr. Howard states that this action of the Czechian government has flattened the curve of the pandemic in his country.  You can read the article in Prague Morning.

What Kind of Mask Should I Wear?

So, what kind of mask should I wear?  The what, where and how of homemade masks that I am recommending to my patients can by found in my youtube video below.

YouTube player

The source for the pattern that I am wearing and recommend using can be found here:  http://tianascloset.com/index.php/2020/02/06/face-mask-against-the-coronavirus-epidemic/

How can you avoid contaminating the mask and yourself?

The main objection of the mask naysayers is that the mask itself becomes contaminated.  Carelessly using the mask and not cleaning it can become of source of viral transmission.  The benefit of a homemade mask is that it is cheap, washable and re-usable.

Here are some steps to follow to ensure that you and your family remain healthy while using a homemade mask:

  • Wash with soap and water, or sanitize your hands well, before making any mask.
  • Wash and sanitize your hands before putting the mask on.
  • When removing the mask, do not touch the front of the mask with your hands; take it off by the ties or elastics. Then wash your hands.
  • Immediately after use, do not put the mask on any surface. Put the mask into the washing machine or a sink of hot soapy water and clean well.  Some data shows that you can also bake fabric masks. However, the temperature must reach 180F° (82C°) for 20 minutes to cleans it.
  • If you have made a disposable mask out of paper towels or coffee filters, throw it out into a plastic-lined waste bin with a lid.
  • After discarding, or sanitizing the mask, sanitize your hands again.
  • Any time you are wearing a mask, do not touch the mask, your face or rub your eyes.

Wearing any mask over the next 3-4 weeks will help protect you from passing the virus on to others at greater risk.  It may also decrease your risk of someone else passing the virus on to you.

This will help reduce the number of infected people from overwhelming our healthcare system, first responders, and healthcare workers.

Check out my dedicated coronavirus page that is regularly updated for further information about this virus at https://www.docmuscles.com/coronavirus/.

Overcoming a Weight Loss Stall On a Ketogenic Diet

What do you do when you hit a weight loss stall while living a ketogenic lifestyle?  Find out below. Dr. Nally goes into detail on the multiple causes of stalling while following a low-carbohydrate or ketogenic lifestyle. He dispels the myths around counting calories and macros.  And,  he discussed the basics of overcoming a stall.

Help Dr. Nally have time to make more great videos: https://www.patreon.com/docmuscles

All About Fat on a Ketogenic Diet (Can You Eat Too Much Fat?)

Catch my new video. I go into depth regarding why the type of fat you eat is very important on a ketogenic lifestyle. I reviews the effects of short, medium and long chain fats and how they are absorbed and used. We talk about starting a ketogenic diet and answer multiple viewer questions. Check it out!

 

The Shovel will Fail You in Obesity, Finances & Life

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.

  1. Pick one small debt and begin to pick at it by applying just a little extra each month until it is gone.
  2. Cancel your extra cable, sell the motorcycle and payoff the 21% interest credit card.
  3. 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.

  1. Kiss your wife every time you leave, even if it’s just for a ten minutes to run to the convenience store.
  2. Hold her for five seconds longer every time you hug.
  3. Find a gift you can give her once a week, just because.
  4. 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.
  5. 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.

  1. Start with one meal and make some substitutions.  My dietary plan can help you with this.
  2. 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.
  3. Add a quality vitamin to your morning routine.
  4. Take ten minutes and do 20 push-ups and 20 sit-ups, then take a 10-minute walk.
  5. Simply remove the “white stuff” from your meals. You will be amazed at the results.
  6. 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.

If you’re looking for a program that teaches you how to do this, check out my membership site.

Two Most Common Elements in the Universe: Hydrogen & Moronium . . . Maybe, Not In That Order

Over the last few months, I’ve found myself amid the center of vehement nutritional arguments about fat, carbohydrates, calories and diet.  I have found it fascinating that very intelligent men and women, over the last 50 years, have accepted, without reservation, a dogma taught them by their eighth grade nutrition teachers.  This dogma is interlaced and interwoven throughout the textbooks, manuals, and college cafeterias throughout the world.

Low-carb is bad

Very few souls have questioned this dogma, and even in light of it’s utter failure to improve one’s health, it becomes the fall back point upon which millions have accepted nutritional disease and defeat.  It makes no sense that a dogma of this nature, without anything more than a scientific corellation in the 1960’s, could sway the minds of intelligent researchers, physicians and scholars for over 50 years.

It is a well known fact, however, that hydrogen is the most common element in the universe and is used as a basic building block for most molecular structures.  What many don’t realize is there exists another element yet to be added to the periodic table that is almost as prevalent called moronium (pending symbol approval  – Mu).  It fills the blank space on the table of elements between Hydrogen and Helium.   I, and those who have been able to identify this element, suspect that moronium is a gas at room temperature and has some affinity to binding the white matter of the brain responsible for catechol-O-methyltransferase (COMT) gene regulation of the prefrontal cortex.  It is suspected by some that when it is inhaled by a person of low intellect, it has only a mild effect. However, when combined with either oxygen (O), hydrogen (H) or Helium (He)  and inhaled by those of higher intelligence, it has a much wider, more potent and even stupefying diffusion effect, that is quite surprising to witness.

PeriodicTableBoilingPoint

Moronium reacts adversely when diffused into blood with a higher alcohol concentration and seems to spontaneously combust when it is exposed to old paper and libraries. Moronium is very difficult and very expensive to isolate.  Moronium seems to be more prevalent during the summer and winter solstices, which may be why moronium intoxication seems to appear around holidays.  Recent attempts in a nearby lab to synthetically create even small crystals of moronium cause an explosion, physically and psychologically stupefying all of the researchers involved and inducing them to leave the study of science and pursue individual careers as drummers.

The presence of moronium seems to be higher in those that do not read, or have an aversion to reading.  There is some correlation that moronium drops in proportion to listening to iTunes podcasts, however, follow-up reading does appear to have a potential lowering affect on the moronium levels within the brain.

Why do I bring this up?

I suspect that this little known element may be responsible for intelligent men and women introducing questionable theoretical science as incontrovertible truth.  Those with suppressed COMT regulation seem to have a propensity to accept theoretical science because it sounds good,  even when there’s really no way to actually prove the theory at the time, or when colleagues have accepted the theory in a peer-pressure instead of peer-review situation.

The stupefying effect of moronium bound COMT produces dogma like:

The amazing thing about science is that it is self-correcting (at least it used to be). A scientist makes a set of observations about nature, and then identifies a plausible theory within the laws of nature to fit those observations. Then, researchers take that theory and test it in as many ways as possible, attempting to disprove the theory and isolate the cause of the observation.  If the theory withstands scrutiny it becomes widely accepted.

At any given point in the future, if contradicting evidence emerges, the original theory is discarded and a new theory is then identified.  In essence, this is the simple scientific method, however, in modern day application, it has become a great deal more messy than you’d think.

This approach (application of “the scientific method”) was skirted during the 1960’s and 1970’s regarding the “fat causes heart disease” theoretical proposition.  Interestingly, there was also a notable increase in the number drummers and musicians during the 1980’s Hair Bands era.   This begs the questions, which I wholly agree needs further study: Does moronium exist? and . . . . Did levels of moronium actually increase between 1960 and 1990 causing a surge in the presence and popularity of Hair Bands?

HairBandsmontage

It only took us 20 years to get past the Era of the HairBands, hopefully we can turn the nutritional ship around and recognize the real culprit causing the Diseases of Civilization.

 

 

KetoOSKanv21
Ketosis in 60 minutes . . .

 

KetoEnhance3bottles
The Multi-Vitamin Dr. Nally Personally Uses

(Author’s Note: For those who may possibly be under the influence of moronium toxicity, the post above is written in sarcastic jest, and to be clear, there IS NOT an element currently under investigation called moronium!)

Random Thoughts from the Toilet Paper Roll

Random-Thought-Notebook

I am a family physician.  Each door I open holds another challenge, another question or another puzzle. You never know what will be behind door number 2 or number 3.  This leads to becoming very adept at understanding and thinking about the random.  Door #1 one holds the rash. Door #2 holds the patient with diabetes.  Door #3 . . . rectal bleeding.  Yes, my morning often starts out just that way.

While randomly thinking about the randomness that my career choice brought to my life, I’ve made a few random decisions that relate to our health in general.

Smedbo CS3414 Cabin Euro-Style Toilet Roll With Lid Toilet Roll

First, if I ever decide to buy a toilet paper roll company, I’ve already made the executive decision that each piece of paper on the roll needs the opportunity to express itself in a random way. One piece would say, “Nice fingernail polish.” Another would say, “Wow, you have a nice bottom.”  A third would say, “Please don’t apologize, brown is my favorite color.” A fourth might say, “You know, you really should see your doctor about that . . . ”

If I Get Hit By a Bus Tomorrow, Here's How to Replace the Toilet Paper Roll

Second, if I live until I’m 70 years old, I will have spent 10 of those years on Monday.  This calls for sausage and eggs for breakfast every Monday morning.  Wait, I’m already doing that . . . no wonder I like Mondays.  It also means that if I set my clock to wake up earlier on the weekend, then Monday morning I will start the week off “sleeping in.” It is amazing to me that even under ideal conditions people have trouble locating their car keys in a pocket, finding their cell phone, and even pinning the tail on the donkey . . . but I’d bet everyone of us can find & push the SNOOZE button from 3 feet away, in about 1.7 seconds, eyes closed, first time, every time…

Dok CR32 4 Port Smart Phone Charger with Speaker, Alarm, Clock & FM Radio

Third, with all of this randomness . . . someone needs to invent the “Sarcasm Font.” There are some things that shouldn’t be written in “Times New Roman.”

Fourth, Can I take back all those times I didn’t want to take a nap when I was younger?  I am quite convinced that a significant number of my obesity patient’s would be so much more successful with an afternoon nap.

Fifth, in the age of computers, voice recognition, iPhones and electronic medical records, I really want to meet the person that invented cursive and ask, “Was that really necessary?”

Sixth, in this new era of reality everything, I think that print newspapers would still be fascinatingly successful if the obituary column told you how the person died.

KetoOS
KetoOS – Drinkable Exogenous Ketones

Seventh, with all the high fat, moderate protein I recommend, the freezer has become an important appliance in the ketogenic world . . .yet no one can answer me this question: “Why is there still no freezer light?”

Are the Keys in the Freezer?

Last, bad decisions often make for the best stories. . . .

 

The Low-Carb Restaurant

Ketogenic Lifestyle Rule #3: Be BOLD or Be Italic, but never be Regular: Why Size Matters with Cholesterol


On this evenings PeriScope video we talked about cholesterol.  And, and you can see an updated, in depth discussion about cholesterol on my YouTube channel here.  Please go check it out and if you find it helpful, please follow me here and on YouTube.   The is the burning question on everyone’s mind who starts a Low-Carb, High Fat or Ketogenic Diet: “What will happen to my cholesterol if I lower my carbohydrates and eat more fat?”

The answer . . . it will improve!

How do I know this?  I’m an obesity specialist.  I specialize in FAT or lipids (to put it kinder scientific terms).  To specialize in fat, one must know where it came from, what it’s made of and where it is going. And,  this has been the case with every single patient I have used this dietary change with for the last ten years, myself included.

Lets start with the contents of the standard cholesterol or “Lipid Panel”:

  • Total Cholesterol
  • HDL-C (the calculated number for “good” cholesterol)
  • LDL-C (the calculated number for “bad” cholesterol).
  • Triglycerides

The first problem with this panel is that it makes you believe that there are four different forms of cholesterol.  NOT TRUE!  Actually cholesterol is cholesterol, but it comes in different sizes based on what it’s function is at that moment in time.   Think of cholesterol as a bus.  There are bigger busses and smaller busses.   Second, triglyceride is actually the passenger inside the HDL and the LDL busses.  And third, Total Cholesterol is the sum of the HDL, LDL, as well as ILDL & VLDL which aren’t reported in the “Lipid Panel” above.

The fourth thing that this panel doesn’t tell you is that HDL & LDL are actually made up of sub-types or sub-particles and are further differentiated by weight and size.

Cholesterol Size

For our conversation, we need to know that the number of LDL particles (LDL-P) can actually be measured in four different ways and these measurements have identifed that there are three sub-types: “Big fluffy” large dense LDL, medium dense LDL, and small-dense LDL.  Research has identified that increased numbers of small-dense LDL correlates closely with risk for inflammation, heart disease and vascular disease (1).

Microsoft PowerPoint - ADA Otvos LDL size talk_modified.ppt [Com

If you’ve been a follower of my blog for a while, you’ve seen this picture before. This picture illustrates why an LDL-C (the bad cholesterol measurement) can be misleading. Both sides of the scale reflect an LDL-C of 130 mg./dl. However, the LEFT side is made up of only a few large fluffy LDL particles (this is the person with reduced risk for heart disease) called Pattern A  or a LDL healthy cholesterol level.  Even though the LDL-C is elevate above the recommended level of 100 mg/dl, the patient on the left has much less risk for vascular disease (this is why you CAN’T trust LDL-C as a risk factor).

The RIGHT side of the scale shows that the same 130 mg/dl of LDL-C is made up of man more small dense LDL particles (called “sd LDL-P”) with a Pattern B type that is as increased risk for heart or vascular disease.  This is where the standard Lipid Panel above, fails to identify heart disease and it’s progression.

Research tells us that the small dense LDL particle levels increase as the triglycerides increase.  And we know that Triglyceride levels increase in the presence of higher levels of insulin leading to a cascade of inflammatory changes.  Insulin is directly increased by the ingestion of simple and complex carbohydrates.  Insulin also increases with the ingestion of too much protein.  So, that chicken salad or the oatmeal you ate, thinking it was good for you, actually just raised your cholesterol.   If you are insulin resistant, your cholesterol just increased by 2-10 times the normal level (see my article here on how insulin resistance causes this.)

Adapt Your Life

“Ok, but Dr. Nally, there are four different companies out in the market measuring these fractional forms of cholesterol. Which one should I choose?”

There are actually five different ways you can check your risk.

  1. Apolipoprotein levels.  This can be done through most labs; however, this test doesn’t give you additional information on insulin resistance that the other tests can.
  2. Berkley Heart Lab’s Gradient Gel Electrophoresis – This test gives a differentiation based on particle estimation between Pattern A and Pattern B
  3. Vertical Auto Profile (VAP-II) test by Arthrotec – This test determines predominant LDL size but does not give a quantifiable lipoprotein particle number which I find very useful in monitoring progression of insulin resistance and inflammation.
  4. NMR Spectroscopy from LipoScience – This test measures actual lipoprotein particle number as well as insulin resistance scores and will add the Lp(a) if requested.  I find the NMR to be the most user friendly test and useful clinically in monitoring cholesterol, vascular risk, insulin resistance progression and control of the inflammation caused by diabetes.  This test has the least variation based on collection methods if frozen storage is used.
  5. Ion-Mobility from Quest – This test also measures lipoprotein particle number but does not include insulin resistance risk or scoring.  Because the test is done through a gas-phase electric differential, the reference ranges for normal are slightly different from the NMR.

In regards to screening for cardiovascular risk, the use of all five approaches are more effective than the standard lipid panel.  However, I have found that clinically the NMR Lipo-profile or the Cardio I-Q Ion-Mobility tests are the most useful in additionally monitoring insulin resistance, inflammation, and disease progression.

It is was the use of these tests that demonstrated to me the profound effect of carbohydrate restriction and ketogenic lifestyles on vascular and metabolic risk.  We talk more about these tests on my YouTube video .

Hope this helps.

KetoOS Image

References:

  1. Williams PT, et al. Comparison of four methods of analysis of lipoprotein particle subfractions for their association with angiographic progression of coronary artery disease. Atherosclerosis. 2014 April; 233(2): 713-720.

Ketogenic Lifestyle Rule #1: There should ALWAYS be bacon in the fridge

BaCoN Fridge

I thought that over the next few weeks I’d address a number of Ketogenic Lifestyle Rules that I have adopted.  These seem to help and bring a little clarity to one following a Ketogenic Lifestyle or someone on the road to becoming a true “Ketonian.”

The first of these rules is that there should ALWAYS be bacon in the fridge!
Adapt Your Life

We address this rule and some interesting facts around having bacon in the fridge in this evening’s Persicope below.  We also address the benefits of journaling, how to help stop binge eating, what are your real protein needs, and red-meat fear-mongering. We even discuss whether or not pigs like bacon.  Enjoy!

 

Links referenced in this video:

Red & Processed Meats: Bacon Fear-Mongering

Calculating Your Protein Needs from Ideal Body Weight

The Power of a Good Vitamin

 

(Just a note: I love Katch.me’s service; however, due to the contract language allowing Katch.me to have unlimited rights to my Periscope Videos, I have withdrawn from Katch and my videos are no longer available on this medium until the contract usage can be modified.)

Patience: Why Weight Loss is a Slow Process?

tortoise_&_hare_1

Watch this weekend’s Periscope conversation about why weight loss is slow and why anything that is worthwhile takes time.

You can watch the Periscope Video below:

Ketogenic Diet Halts Tumor Growth

 

Prostate Cancer Cell Replication
Prostate Cancer Cell Replication

It has long been understood that tumor cells of any kind require high levels of glucose to grow and spread (1,2).  It is also recognized that higher levels of insulin, commonly found in patients with insulin resistance or type II diabetes, are 2.4 times more likely to stimulate the development of breast cancer (3). A diet low in glucose has thereby been theorized to be an adjunct to cancer treatment.

Ketogenic diets have been demonstrated to be therapeutically useful in the treatments of epilepsy and cardiovascular disease (4). A ketogenic diet is one in which carbohydrate levels are kept below 50 grams per day and fat intake is increased to the point that the body shifts its metabolism to use triglycerides, and the ketones derived from triglycerides, as the primary fuel source for the majority of the cells within the body.  With this understanding in mind, the application of a ketogenic diet, one high in fat and protein with limited carbohydrate or glucose has been suggested as a adjunct to cancer treatments (5).

KetoOS
KetoOS – Drinkable Exogenous Ketones

A recent study (6) in the Oncology Letters evaluated the benefits of a ketogenic diet in 78 cancer patients in clinical practice.  A novel marker measuring the tumor cells use of glucose called transketolase-like-1 (TKTL1) was closely monitored, as was each of the 78 patients adherence to a ketogenic diet.  Increased TKTL1 was noted in more aggressively active and growing tumors (7,8).

Among the 43 males and 35 females, 7 patients agree to and followed a fully ketogenic diet and 6 of them followed a partially ketogenic diet.  Ketogenic meals were provided by a German company called Tavarlin that would prepare and mail ketogenic meals including oil, fat, snacks, bread, protein and energy drinks.  Dietary journals were reviewed every three months over a period of about 10 months.

40 % of these patients experienced a halting of the tumor progression and 60% experienced improvement noted by normalization of TKTL1 or reduction in TKTL1, respectively.  Those on a ketogenic diet demonstrated an average reduction of TKTL1 by approximately 50%.

This is the first study of its kind and has significant potential.  Could dietary carbohydrate restriction be an effective cancer treatment or adjunct to cancer treatment?

Because the food diaries were based on reporting only, the sample study was very small, and patients treated in the outpatient setting have the possibility of variability in the standard oncologic treatments,  the results must be interpreted with caution.  However, the data is very promising.   This study is one in which I have great interest as I have seen similar results in my clinic on a case by case basis.

Based on the limitations noted above, rigorous randomized control studies are needed, but this is an exciting an promising first step.  Additionally, the presence of a marker for tumor growth that correlates with diet is remarkable.  And, it provides the ketogenic specialist a possible measurement tool that could be used clinically.

 

References: 

  1. Klement RJ and Kämmerer U: Is there a role for carbohydrate restriction in the treatment and prevention of cancer? Nutr Metab (Lond) 8: 75, 2011
  2. Vaughn AE and Deshmukh M: Glucose metabolism inhibits apoptosis in neurons and cancer cells by redox inactivation of cytochrome c. Nat Cell Biol 10: 1477-1483, 2008.
  3. Gunter MJ, Hoover DR, Yu H, Wassertheil-Smoller S, Rohan TE, Manson JE, Li J, Ho GY, Xue X, Anderson GL, et al: Insulin, insulin-like growth factor-I, and risk of breast cancer in postmenopausal women. J Natl Cancer Inst 101: 48-60, 2009.
  4. Paoli A, Rubini A, Volek JS and GrimaldiKA: Beyond weight loss: A review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr 67: 789-796, 2013.
  5. Ruskin DN and Masino SA: The nervous system and metabolic dysregulation: Emerging evidence converges on ketogenic diet therapy. Front Neurosci 6: 33, 2012.
  6. Jansen, N., Walach, H.”The development of tumours under a ketogenic diet in association with the novel tumour marker TKTL1: A case series in general practice”. Oncology Letters 11.1 (2016): 584-592.
  7. . Schwaab J, Horisberger K, Ströbel P, Bohn B, Gencer D, Kähler G, Kienle P, Post S, Wenz F, Hofmann WK, et al: Expression of Transketolase like gene 1 (TKTL1) predicts disease-free survival in patients with locally advanced rectal cancer receiving neoadjuvant chemoradiotherapy. BMC Cancer 11: 363, 2011.
  8. Zhang S, Yang JH, Guo CK and Cai PC: Gene silencing of TKTL1 by RNAi inhibits cell proliferation in human hepatoma cells. Cancer Lett 253: 108-114, 2007

The Ketogenic Diet & Multiple Sclerosis

Multiple Sclerosis (MS) is a neurological disease caused by demyelination or breakdown of the myelin coating around the nerve cells (1).   This is referred to as a neurodegeneration where the physical structure of the nerve is compromised, much like the coating around an electrical wire being chipped or stripped away. Common symptoms of MS are sensory symptoms in the extremities or face, unilateral visual loss, acute or subacute motor weakness of the muslces, diplopia (double vision), gait disturbance and balance problems, Lhermitte sign (electric shock-like sensations that run down the back and/or limbs upon flexion of the neck), vertigo, bladder problems, loss of control of a limb,  and pain.

 

Effects of Ketosis on Multiple Sclerosis

Initially, and for many years, the degeneration seen in multiple sclerosis (MS) was thought to occur because of an acute inflammatory attack on the cells by dis-regulated immune cells crossing the blood brain barrier.  However, treatments focused on modulating the inflammatory attack seem to have no effect on the degeneration and demyelination.  Thus, the actual definitive cause of this demyelination and neuro-degeneration has eluded us since 1868, when Jean-Martin Charcot first described it.

Recent studies point to evidence that this demyelation may be due to degeneration or breakdown of the nerve cell’s ability to use glucose as a primary fuel (2, 3).  It is now theorized that MS may be due to a combination of degeneration and localized inflammation related to poor glucose uptake causing the demyelination which is seen in a number of MS cases (4, 5, 6).

Demyelination of Nerve
A. Normal nerve cell with intact myelin sheath around the axon. B. Demyelinated axion nerve losing its ionic charge due to escape of potassium. C. Radio-labled tracer allowing visualization of demyelination on PET Scan

With this dual concept in mind, ketogenic diets have demonstrated some promising results when used with neurological diseases including MS.  Ketogenic diets have been used in the treatment of epilepsy since 500 B.C. and in the treatment of obesity since 1860.  It is now becoming apparent that ketogenic diets may play a very significant role in the treatment of neurological disease because of two-fold effects that arise when ketones become the primary fuel for the body.

First, when a person becomes keto-adapted and ketones are used as the primary fuel, instead of glucose, the body up-regulates mitochondria to use the ketones for fuel. As the ketone level rises,  the need for glucose diminishes.   This provides the nerve cell an alternative fuel source if glucose metabolism is impaired. It also decreases the need and production of insulin, a known hormone heavily involved in stimulating inflammation and inflammatory responses.

The second effect of a ketogenic diet is this favorable effect on inflammation.  It has been demonstrated that a ketogenic diet decreases reactive oxygen species, increased production of superoxide dismutase and catalayse, all of which notably decrease the inflammatory effects of oxidative stress (9,10, 11).  A ketogenic diet also is well known to raise glutithione levels, another anti-oxidant that decreases inflammation and oxidative stress (12-16).  This same anti-inflammatory and keto-adaptation effect can be obtained from intermittent fasting.

To date, studies in patients with neurologic diseases like MS, Alzheimer’s disease using ketogenic diets have had positive results in memory, cognition and diminished inflammation with evidence of halting or reversing the chronic demyelination (17,18, 19).  Still somewhat theoretical, the evidence points to effective dietary treatment and prevention for multiple sclerosis and other degenerative neurological diseases like Alzheimer’s Disease.

KetoOS

References:

  1. J. M. Pearce, “Historical descriptions of multiple sclerosis,” European Neurology, vol. 1, no. 1, pp. 49–53, 2005.
  2. C.-A. Castellano, S. Nugent, N. Paquet et al., “Lower brain 18F-fluorodeoxyglucose uptake but normal 11C-acetoacetate metabolism in mild Alzheimer’s disease dementia,” Journal of Alzheimer’s Disease, vol. 43, no. 4, pp. 1343–1353, 2014.
  3. S. Nugent, S. Tremblay, K. W. Chen et al., “Brain glucose and acetoacetate metabolism: a comparison of young and older adults,” Neurobiology of Aging, vol. 35, no. 6, pp. 1386–1395, 2014.
  4. H. Lassmann, W. Brück, and C. F. Lucchinetti, “The immunopathology of multiple sclerosis: an overview,” Brain Pathology, vol. 17, no. 2, pp. 210–218, 2007.
  5. C. Confavreux and S. Vukusic, “Natural history of multiple sclerosis: a unifying concept,” Brain, vol. 129, no. 3, pp. 606–616, 2006.
  6. P. K. Stys, G. W. Zamponi, J. van Minnen, and J. J. G. Geurts, “Will the real multiple sclerosis please stand up?” Nature Reviews Neuroscience, vol. 13, no. 7, pp. 507–514, 2012.
  7. P. G. Nijland, I. Michailidou, M. E. Witte et al., “Cellular distribution of glucose and monocarboxylate transporters in human brain white matter and multiple sclerosis lesions,” Glia, vol. 62, no. 7, pp. 1125–1141, 2014.
  8. L. C. Costantini, L. J. Barr, J. L. Vogel, and S. T. Henderson, “Hypometabolism as a therapeutic target in Alzheimer’s disease,” BMC Neuroscience, vol. 9, supplement 2, article S16, 2008.
  9. P. G. Sullivan, J. E. Springer, E. D. Hall, and S. W. Scheff, “Mitochondrial uncoupling as a therapeutic target following neuronal injury,” Journal of Bioenergetics and Biomembranes, vol. 36, no. 4, pp. 353–356, 2004.
  10. P. G. Sullivan, N. A. Rippy, K. Dorenbos, R. C. Concepcion, A. K. Agarwal, and J. M. Rho, “The ketogenic diet increases mitochondrial uncoupling protein levels and activity,” Annals of Neurology, vol. 55, no. 4, pp. 576–580, 2004.
  11. T. Shimazu, M. D. Hirschey, J. Newman et al., “Suppression of oxidative stress by β-hydroxybutyrate, an endogenous histone deacetylase inhibitor,” Science, vol. 339, no. 6116, pp. 211–214, 2013.
  12. S. G. Jarrett, J. B. Milder, L.-P. Liang, and M. Patel, “The ketogenic diet increases mitochondrial glutathione levels,” Journal of Neurochemistry, vol. 106, no. 3, pp. 1044–1051, 2008.
  13. J. B. Milder, L.-P. Liang, and M. Patel, “Acute oxidative stress and systemic Nrf2 activation by the ketogenic diet,” Neurobiology of Disease, vol. 40, no. 1, pp. 238–244, 2010.
  14. N. Dupuis, N. Curatolo, J. F. Benoist, and S. Auvin, “Ketogenic diet exhibits anti-inflammatory properties,” Epilepsia, vol. 56, no. 7, pp. e95–e98, 2015.
  15. D. Y. Kim, J. Hao, R. Liu, G. Turner, F.-D. Shi, and J. M. Rho, “Inflammation-mediated memory dysfunction and effects of a ketogenic diet in a murine model of multiple sclerosis,” PLoS ONE, vol. 7, no. 5, Article ID e35476, 2012.
  16. Y.-H. Youm, K. Y. Nguyen, R. W. Grant et al., “The ketone metabolite β-hydroxybutyrate blocks NLRP3 inflammasome—mediated inflammatory disease,” Nature Medicine, vol. 21, no. 3, pp. 263–269, 2015.
  17. A. Ramm-Pettersen, K. O. Nakken, I. M. Skogseid et al., “Good outcome in patients with early dietary treatment of GLUT-1 deficiency syndrome: results from a retrospective Norwegian study,”Developmental Medicine and Child Neurology, vol. 55, no. 5, pp. 440–447, 2013.
  18. Y. Ito, H. Oguni, S. Ito, M. Oguni, and M. Osawa, “A modified Atkins diet is promising as a treatment for glucose transporter type 1 deficiency syndrome,” Developmental Medicine and Child Neurology, vol. 53, no. 7, pp. 658–663, 2011.
  19. M. Storoni and GT Plant, “The Therapeutic Potential of the Ketogenic Diet in Treating Progressive Multiple Sclerosis,” Multiple Sclerosis International, vol. 2015, Article ID 681289, 9 pages, 2015.

Thinking Outside of the Box

Nine dots

The image above has nine dots within a square.  Your task, using only four lines is to connect ALL nine dots WITHOUT ever raising your pen, pencil or finger (Please don’t use a sharpie on your computer screen . . . it doesn’t come off).

You may have seen this puzzle previously . . . it’s made its rounds in corporate training circles. But the underlying principle remains true.  The solution requires you to expand your thinking or to “think outside the box.”out-of-the-box

Whenever you find yourself on the side of the majority, it is time to pause and reflect. (Mark Twain)

Why should we limit ourselves to thinking outside the box.  Can’t we just get rid of the box?

True discovery consists in seeing what everyone has seen . . . then, thinking what no one has thought.

The answer can be found when those four lines are used beyond the box our mind creates:

Nine dots solution

What good has the box done us?  People were burned at the stake because they refused to believe the Earth was not the center of the universe. People were beheaded because they had a sneaking suspicion that the world was not flat.

Why is it so very hard to accept that our weight gain and diabetes are driven by a hormonal signal, and not by gluttony or caloric intake of fat?  The definition of insanity is doing the same thing repetitively and expecting a different outcome.  How long have you been restricting calories and fat with only minimal or no improvement in your weight, blood sugar, cholesterol or general feeling of health?diabetes global warming

The main problem with the current thought model, or dogma, on the obesity’s cause is that it does not account for metabolic syndrome.  Metabolic syndrome is insulin resistance.  It is an over production of insulin in the presence of ANY form of carbohydrate (sugar or starch).

In the practice of medicine over the last 15 years, I noticed that a very interesting pattern emerged.  There was always a spike in fasting and postprandial insulin levels 5-10 years prior to the first abnormal fasting and postprandial blood sugars.  These patients were exercising regularly and eating a diet low in fat.  But they saw continued weight gain and progressed down the path of metabolic syndrome.  10-15 years later, they fall into the classification of type II diabetes.  What I now lovingly refer to as stage IV insulin resistance.

The only thing that seems to halt this progressive process with any degree of success is carbohydrate restriction.  Fasting insulin levels return to normal, weight falls off, and the diseases of civilizations seem to disappear as insidiously as they arose.

So you tell me, is the world flat?  Is the Earth the center of the universe?

Low-carb is bad

What is a low carbohydrate or ketogenic diet?  15 years of practical in the trenches experience have helped me develop a very simple program to help you lose and maintain your weight.  Access to this program, video help and access to blog articles at your fingertips are offered through my online membership site.

You can also hear me each week a I discuss low carbohydrate, paleolithic and ketogenic diets with the Legendary Jimmy Moore on KetoTalk.com

PeriScope: Weight Loss, Gut Health & Pond Scum…In The New Year

Good morning from Arizona.  I’ve had a few people ask about how gut health relates to a ketogenic diet.  This is a great question and one that I think can be answered best by taking a closer look at my natural koi pond and learning a little about pond scum.

So, sit back and look at the similaries between your gut and how nature balances a pond system: Katch.me

Or you can watch the video below:

The four tenets of health that we touch on above that are essential to understand before you can understand gut health:

  1. The body is a unit and works as such with all parts enhancing the whole
  2. The body is capable of self-regulation, self-healing, and health-maintenance
  3. Structure & function are reciprocally interrelated
  4. Rational treatment of the body must be based upon understanding the principles above and assisting or augmenting those principles

Keys to gut health and pond balancing that we touch on:

  1. Remove the toxins from entering the system like:
    • Antibiotic overuse
    • Caffeine
    • Artificial Fat
    • Artificial Sweeteners
  2. Repair the system and it’s ability to balance the system
    • Takes time
    • Provide structure for the bacteria to which it can bind
    • Provide essential vitamins and minerals like KetoEnhance & Omega-3 fatty acids
    • Periodic Fasting
  3. Restore the bacteria or flora of the system
    • Prebiotics (fermented foods like sauerkraut, kimchi, Japanese natto, etc.)
    • Probiotics like Dietary KetoBalance (can be purchased in the office)
  4. Replace the salts and pH balance where necessary
    • Replace electrolytes
    • Limit things that shift the pH balance

Hope this gives you a starting point for your New Year!!

Why the Calorie is NOT King

Today in the office I had the calorie conversation again . . . three times.  We have an entire society with a very influential health and fitness industry built around the almighty calorie.  Has it helped? Looking at our 5 year obesity outcomes.  It hasn’t helped a bit.  In fact, it is worse.  In 1985 only 19% of U.S. adults were obese.

Obesity 2011
U.S. Obesity Adult 2011

Obesity 2014
U.S. Adult Obesity 2014

In 2014, 34.5% of U.S. adults were obese.  The numbers this year are approaching 35.6%   You can see the dramatic increase in obesity by 1-3% every year for the last 5 years in the CDC images above.

For over 50 years we have been told that caloric restriction and fat restriction is the solution.  But by the numbers above, the 58 million people in the U.S. utilize a gym or health club to burn off those calories aren’t seeing the success that they should be expecting.

Why?  Because the calorie is NOT king.  What do I mean by that?  We don’t gain weight because of the thermogenic dogma we’ve been taught for the last 50 years.  Our weight gain is driven by a hormone response to food.   Hear more about why the calorie is NOT king on tonight’s PeriScope.  You can Katch it here with all the live stream comments and hearts at Katch.me/docmuscles.

Or you can watch the video without the comments here:

The 3 Weight Loss Necessities to Weathering the Holidays

What are the three things you need to successfully weather the holidays with your ketosis lifestyle? What does a raindeer on a motorcycle look like? How does insulin resistance effect kidney stones and gout? How do you get back on track if you fall off the ketosis wagon? These and many more questions are answered by Dr. Adam Nally on tonight’s PeriScope.

You can see the video stream including the comment roll here at katch.me/docmuscles.  Or you can watch the video below:

Caffeine . . . Weight Loss Wonder Boy or Sneaky Scoundrel?

I’ve been looking for the answer for quite some time. . . what role does caffeine play in your and my weight management journey?  The answer gave me a headache. . . literally and figuratively.

As many of you, including my office staff, know, I love my Diet Dr. Pepper (and my bacon).  I found that being able to sip on a little soda throughout the day significantly helped the carbohydrate cravings and munchies during a busy and stressful day at the office.   Diet Dr. Pepper contains caffeine, however, I wasn’t really worried.  Caffeine has been well know to have a thermogenic effect which increases your metabolism and has been thought for many years to help with weight loss among the weight loss community.

Diet Dr. Pepper is, also, one of only four diet sodas on the grocery store shelves that doesn’t contain acesulfame potassium (click here to see why most artificial sweeteners cause weight gain).  The four diet sodas that I have been comfortable with my patients using are Diet Dr. Pepper, Diet Coke, Diet Mug Root-beer and Diet A&W Cream Soda.  These are the last four hold out diet sodas that still use NutraSweet (aspartame) as the sweetener.  Most of the soda companies have switched the sweetener in their diet sodas to the insulinogenic acesulfame potassium because it tastes more natural and aspartame has been given a media black eye of late.  However, NutraSweet (aspartame) is the only sweetener that doesn’t spike your insulin or raise blood sugar (click here to find out why that is important).

Yes, I know.  The ingestion of 600 times the approved amount of aspartame causes blindness in lab rats (but we’re not lab rats, and . . . have you ever met someone that drinks 600 Diet Dr. Peppers in a day?  The lethal dose of bananas, which are high in potassium that will stop your heart, is 400).  Aspartame can also exacerbate headaches in some (about 5% of people) and I’ve had a few patients with amplified fibromyalgia symptoms when they use aspartame.   But for most of us, its a useful sweetener that doesn’t spike your insulin response, halting or causing weight gain.

But, over the last few years, I’ve noticed that increased amounts of Diet Dr. Pepper & Diet Coke seem to cause plateauing of weight and decreasing the ability to shift into ketosis, especially mine.  I’ve also noticed (in my personal n=1 experimentation) that my ability to fast after using caffeine regularly seems to be less tolerable, causing headaches and fatigue 8-10 hours into the fast, symptoms that don’t seem to let up until eating. Through the process of elimination, caffeine seems to be the culprit.

Red Bull in caffeineAfter mulling through the last 10 years of caffeine research, most of which were small studies, had mixed results, used coffee as the caffeine delivery system (coffee has over 50 trace minerals that has the potential to skew the results based on the brand) and never seemed to ask the right questions, the ink from a study in the August 2004 Diabetes Care Journal screamed for my attention.

It appears that caffeine actually stimulates a glucose and insulin response through a secondary mechanism.   The insulin surge and glucose response is dramatically amplified in patients who are insulin resistant.  Caffeine doesn’t effect glucose or insulin if taken while fasting; however, when taken with a meal, glucose responses are 21% higher than normal, and insulin responses are 48% higher in the insulin resistant patient. Caffeine seems to only effect the postprandial (2 hours after a meal) glucose and insulin levels.  The literature shows mixed responses in patients when caffeine is in coffee or tea, probably due to the effect of other organic compounds (1).

Caffeine Effect on glucose insulin
Caffeine effect on plasma glucose and plasma insulin compared to placebo (1).

Caffeine also diminishes insulin sensitivity and impairs glucose tolerance in normal and already insulin resistant and/or obese patients.  This is seen most prominently in patients with diabetes mellitus type II (stage IV insulin resistance).  Caffeine causes alterations in glucose homeostasis by decreasing glucose uptake into skeletal muscle, thereby causing elevations in blood glucose concentration and causing an insulin release (2-6).

Studies show that caffeine causes a five fold increase in epinephrine and a smaller, but significant, norepinephrine release.  The diminished insulin sensitivity and exaggerated insulin response appears to be mediated by a catacholamine (epinephrine, norepinephrine & dopamine)  induced stress response (5).  Caffeine has a half life of about 6 hours, that means the caffeine in your system could cause a catacholamine response for up to 72 hours depending upon the amount of caffeine you ingest (7).

The reason for my, and other patient’s, headaches and fatigue after a short fast was due to the exaggerated stress hormone response.  Increased levels of insulin were induced by a catacholamine cascade after caffeine ingestion with a meal, dramatically more amplified in a person like me with insulin resistance. The caffeine with the last meal cause hypoglycemia 5-7 hours into the fasting, leading to headaches and fatigue that are only alleviated by eating.

Even when not fasting, the caffeine induced catacholamine cascade causes up to 48% more insulin release with a meal, halting weight loss and in some cases, causing weight gain.

Caffeine is not the “Wonder-Boy” we thought it was.

How much caffeine will cause these symptoms? 50 mg or more per day can have these effects.

caffeine-content-of-popular-drinks

Ingestion of caffeine has the following effects:

  • 20-40 mg – increased mental clarity for 2-6 hours
  • 50-100 mg – decreased mental clarity, confusion, catacholamine response
  • 250-700 mg – anxiety, nervousness, hypertension & insomnia
  • 500 mg – relaxation of internal anal sphincter tone (yes . . . you begin to soil yourself)
  • 1000 mg – tachycardia, heart palpitations, insomnia, tinnitus, cognitive difficulty.
  • 10,000 mg (10 grams) – lethal dose (Yes, 25 cups of Starbucks Coffee can kill you)

The equivalent of 100 mg of in a human was given to a spider, you can see the very interesting effect on productivity.  How often does the productivity of the day feel like the image below?

Spider Normal
Normal Spider (9)

Spider Caffeine
Spider on caffeine (9)

Beware that caffeine is now being added to a number of skin care products including wrinkle creams and makeup.  Yes, caffeine is absorbed through the skin, so check the ingredients on your skin care products.

Diet Dr. Pepper, my caffeine delivery system of choice, has slightly less caffeine (39 mg per 12 oz can or 3.25 mg per oz) than regular Dr. Pepper.  I found myself drinking 2-3 liters of Diet Dr. Pepper per day (long 16-18 hour work days in the office).  After doing my research, I realized that my caffeine tolerance had built up to quite a significant level (230-350 grams per day).

So, a few weeks ago, I quit . . . cold turkey.

Did I mention the 15 withdrawal symptoms of caffeine? (8)

  • Headache – behind the eyes to the back of the head
  • Sleepiness – can’t keep your eyes open kind of sleepiness
  • Irritability – everyone around you thinks you’ve become a bear
  • Lethargy – feels like your wearing a 70 lb lead vest
  • Constipation – do I really need to explain this one?
  • Depression – you may actually feel like giving up on life
  • Muscle Pain, Stiffness, Cramping – feel like you were run over by a train
  • Lack of Concentration – don’t plan on studying, doing your taxes or performing brain surgery during this period
  • Flu Like Illness – sinus pressure and stuffiness that just won’t clear
  • Insomnia – you feel sleepy, but you can’t sleep
  • Nausea & Vomiting – You may loose your appetite
  • Anxiety – amplified panic attacks or feeling like the sky is falling
  • Brain Fog – can’t hold coherent thoughts or difficulty with common tasks
  • Dizziness – your sense of equilibrium may be off
  • Low Blood Pressure & Heart Palpitations – low pressure and abnormal heart rhythm

I experienced 13 of the 15 that lasted for 4 days.   I do not recommend quitting cold turkey unless you have a week off and someone to hold your hand, cook your meals and dose your Tylenol or Motrin.  My wife thought I was dying. . . I thought I was dying on day two.  I actually had a nightmare about buying and getting into my own coffin.  It can take up to three weeks to completely recover from caffeine withdrawal.

The other way to quit is to decrease your caffeine intake by 50 mg every two days.   That means decrease caffeine by:

  • 1 can of soda every two days
  • 1/4 cup of coffee every day
  • 1/2 can of Energy Drinks every two days
  • 1 cup of tea every two days

The benefit of this method is that withdrawal symptoms are much less severe without the caffeine headache and the ability to remain productive.  It will take longer, but quitting cold turkey is not a pretty picture.  Been there . . . done that, . . . and I’m not going back. I actually lost another half inch off my waistline by day 5 of caffeine discontinuation.

What is the take home message here?  If you have any degree of insulin resistance, caffeine makes it worse and will amplify your weight gain as well as decrease the productivity of your day.

References:

  1. Lane JD, Barkauskas CE Surwit RS, Feinglos MN, Caffeine Impairs Glucose Metabolism in Type II Diabetes, Diabetes Care August 2004 vol. 27 no. 8 2047-2048; doi:10.2337/diacare.27.8.204
  2. Jankelson OM, Beaser SB, Howard FM, Mayer J: Effect of coffee on glucose tolerance and circulating insulin in men with maturity-onset diabetes. Lancet 1: 527–529, 1967
  3. Graham TE, Sathasivam P, Rowland M, Marko N, Greer F, Battram D: Caffeine ingestion elevates plasma insulin response in humans during an oral glucose tolerance test. Can J Physiol Pharmacol 79:559–565, 2001
  4. Greer F, Hudson R, Ross R, Graham T: Caffeine ingestion decreases glucose disposal during a hyperinsulinemic-euglycemic clamp in sedentary humans.Diabetes 50:2349–2354, 2001
  5. Keijzers GB, De Galan BE, Tack CJ, Smits P: Caffeine can decrease insulin sensitivity in humans. Diabetes Care 25:364–369, 2002
  6. Petrie HJ, et al. Caffeine ingestion increases the insulin response to an oral-glucose-tolerance test in obese men before and after weight loss. American Society for Clinical Nutrition. 80:22-28, 2004
  7. Statland BE, Demas TJ, Serum caffeine half-lives. Healthy subjects vs. patients having alcoholic hepatic disease, Am J Clin Pathol 1980 Mar;73(3):390-393
  8. Evans SM, Griffiths RR, Caffeine Withdrawal: A Parametric Analysis of Caffeine Dosing Conditions, JPET April 1, 1999 vol. 289no. 1 285-294
  9. Noever R, Cronise J, Relwani RA. Using spider-web patterns to determine toxicity. NASA Tech Briefs April 29,1995. 19(4):82. Published in New Scientist magazine, 29 April 1995

Common Ketosis Killers

“I’ve tried your low-carb diet, Dr. Nally, and it didn’t work.”

“Hmm . . . really?”  If you’re mumbling this to yourself, or you’ve said it to me in my office, then lets have a little talk.  You’ve probably been subjected to the common ketosis killers.

Scale HelpI’ve heard this statement before.  It’s not a new statement, but it’s a statement that tells me we need to address a number of items.  If you’ve failed a low carbohydrate diet, I’d suspect you are pretty severely insulin resistant or hyperinsulinemic.  You probably never really reached true ketosis.   I’d want to have you checked out by your doctor to rule out underlying disease like hypothyroidism, diabetes, other hormone imbalance, etc.

Nutritional Ketosis is Most Effective as a Lifestyle Change

Next, switching to a low-carbohydrate lifestyle is literally a “lifestyle change.”  It requires that you understand a few basic ketosis principles.  And, it takes the average person 3-6 months to really wrap their head around what this lifestyle means . . .  and, some people, up to a year before they are really comfortable with how to eat and function in any situation.

I assume, if you are reading this article, that you’ve already read about ketosis and understand the science behind it.  If not, please start your reading with my article The Principle Based Ketogenic Lifestyle – Part I and Ketogenic Principles – Part II.  If this is the case, then please proceed forward, “full steam ahead!”

There are usually a few areas that are inadvertently inhibiting your body transformation, so let’s get a little personal.

Nutritional Ketosis is a Very Low Carbohydrate Diet

First, this is a low carbohydrate diet.  For weight loss, I usually ask people to lower their carbohydrate intake to less than 2o grams per day. How do you do that?  (A copy of my diet is accessible through my membership site HERE.)  You’ve got to begin by restricting all carbohydrates to less than 20 grams per day.  Any more than 20 to 30 grams per day will cause an insulin release from the pancreas and stimulate fat storage of both carbohydrate and fat for the next 10-12 hours, commonly killing ketosis.  Keep a dietary journal to record your progress, your cravings, your successes and failures.  I’m going to want to see it and review it with you if you see me.

No, I don’t believe in “Net Carbs.”  Net Carbs are a sales gimmick to get you to buy “artificial food” that keeps you coming back for “artificial food” and halts your weight loss (you’ll see why shortly).   You’re going to lose the most weight and feel your best when you eat real food. I do allow for the subtraction of real fiber, specifically non-cooked, non-blended, non-juiced leafy greens (If you cook, blend or juice a leafy green, it activates more carbohydrate availability).  Leafy greens are real fiber.  You can subtract them.  In fact, I recommend eating 1-3 cups of leafy greens per day to help bowel function & provide necessary folic acid, but, everything else is “carbage.”  Avoid it.

Yes, cottage cheese and yogurt contain carbohydrates.  Be very cautious with them.

No, oatmeal and Cream of Wheat™ are not helpful. See my article on Why Your Oatmeal is Killing Your Libedo.Alcohol

Alcohol also halts your weight loss.  It’s not the sugar in the alcohol I’m worried about, the distilling process changes the sugar to alcohol, however, alcohol stimulates an insulin response after the alcohol is metabolized in the liver with a SIMILAR RESPONSE to regular sugar.

 

To Effectively Maintain Nutritional Ketosis, You MUST get adequate Protein

Second, this is a low carbohydrate, moderate protein, high fat lifestyle.  N0 . . . it is NOT a high protein diet! However, so many of my patients don’t eat enough protein that they feel like it is a “high protein diet.”

Protein is essential for the building and maintaining of muscle, connective tissue and a number of other enzymatic reactions in your body.  However, in patients who are morbidly obese [people with a body mass index (BMI) over 50], excess protein intake can cause fat to be stored by producing an excessive insulin response.  In these patients we initially moderate protein.  Excess sugars and a number of proteins, in the presence of a high insulin response, are converted to triglyceride (the soft squishy stuff inside the fat cells that make them plump) and stocked away inside your adipose tissue.  Excessive protein, especially the amino acids argenine, leucine and tryptophan are common ketosis killers, not because they are converted to sugar, but because they stimulate and insulin response all by themselves.

If you don’t fall into the morbidly obese category (BMI over 50). Then, I encourage you to use the protein levels below.

Initially, I ask my patients to focus on lowering their carbohydrate intake and I don’t really worry about protein.  (It is often hard enough to figure out what the difference between a carbohydrate and a protein in the first month or two if you’ve never had any nutrition background.)  Most people begin losing weight just by lowering carbohydrates over the first few months.  Once you figure out how to lower your carbohydrates, if your weight loss is not moving and your pants are not getting looser, then you’re probably eating too much protein.

How much protein do you need?  It’s pretty easy to calculate and is based on your height and gender.  Your basic protein needs to maintain muscle, skin and hair growth are as follows:

  • 70 grams or higher for women per day
  • 120 grams or higher for men per day.

However, these levels are WAY TOO LOW for weight loss and maintaining good health.  Because we now know that protein acts as a hormone in a number of ways, in my office I recommend women get 80-90 grams of protein per day, and men should get > 150 grams of protein per day.

ProteinIf you’re still a little confused about protein, read my article on Why Your Chicken Salad Stops Your Weight Loss.

This also goes for protein powders and protein shakes.  Many of these have 25-40 grams of protein in them per serving, so be careful with their use.

Nutritional Ketosis is a High Fat Diet

Third, this is a high fat lifestyle.  Yes, I want you to INCREASE your fat intake.  I’m going to repeat that, again, just for clarity, . . . . INCREASE your fat intake.  Increase it to around 50% of your total calories, . . . 70% of your total calories if you can do it.  Not enough fat is a common ketosis killer.

“What?! Won’t that cause heart disease and stroke and make my cholesterol worse?!!!”

I know, take a big deep breath . . . (you may even need to breath into a paper bag for a minute if you begin hyperventilating).

No, it will not raise your cholesterol, cause heart disease, or cause a stroke.  If you have lowered your carbohydrate intake to less than 20 grams per day, then there is NO hormonal signal for you to make more bad cholesterol, worsen heart disease, or cause a stroke.  In fact, there is great data showing that increasing your fat and lowering your carbohydrates reverses the blockage in the arteries.  I see this reversal every single day in my clinic through the application of ketogenic diets.

If we remove carbohydrate as your primary fuel, you must replace it with something else.Food Pyramid WrongThat something else should be fat.  Protein must be moderated, as it will also be stored as fat if you eat too much.  So, if the carbohydrates are kept low, fat intake can be increased and the body will pick the fat it wants and essentially throw the rest out without raising cholesterol, causing weight gain or causing heart disease.  This is why we want you to use good natural animal fats like butter, hard cheese, olive oil, coconut oil, avocado, etc.  Look for fats highest in omega-3 fatty acids as these decrease inflammation and improved weight loss.  Look for meats highest in fat like red meat (55% fat) and pork (45% fat).  Take the food pyramid and flip it over.

Check Your Sweeteners At the Door

The fourth common ketosis killer and culprit in halting your weight loss is  artificial sweeteners.  There are quite a few of them.  Most of them WILL cause an insulin response (exactly what we don’t want for weight loss) with minimal to no rise in blood sugar.  Raising blood sugar doesn’t matter, if the insulin is being stimulated  . . . “you’re gonna gain weight for the next 10-12 hours.”  I wrote an article for you to print off and hang on your fridge, upload it to your iPhone or carry it with you in your purse to the grocery store. (If you’re a man and you’re carrying a purse, please don’t tell me about it.)  You can find the article here: The Skinny About Sweeteners.  The short list of those sweeteners that are OK to use and cook with, and do not increase insulin response, can be found here in my Amazon Store.

Don’t Even Start with Coffee Creamers

CoffeeCreamersFifth on my list is coffee creamer.  Coffee creamer contains corn syrup solids (another very special name for  . . . SUGAR!!) and/or maltodextrin (SUGAR’s married name!).  If you must put something in your coffee, then use real heavy cream (pure tasty fat) or real butter.   It will taste much better (I’m told – I don’t drink coffee personally) and you won’t get an insulin spike 2-3 hours later and begin craving more coffee and donuts.

Yes, “Half & Half” is half fat and half sugar. . .  avoid it too!!

Ketosis Killing Medications

The sixth culprit in halting weight loss is medications.  Please talk to your doctor before making ANY changes in your medications as suddently stopping them can be hazardous to your health.  Those highest on my list for stopping your weight loss are Glyburide (glipizide), insulin, & steroids like prednisone.  A more complete list of medications that will halt your weight loss can be found on my on my ketogenic diet plan.  If you are on any prescription medications, please talk to your doctor or to a physician board certified in obesity medicine treatment about how to adjust or wean these medications in a way that is safe and appropriate for your individual needs.

Estrogen

The seventh common culprit in halting weight loss is a lack of estrogen in menopausal or post-menopausal women.  About menopause-cartoon-02420% of women that I see in my practice who are over 55 years old, need some degree of estrogen replacement before they are able to lose weight.  Estrogen plays a very large role in regulation of the metabolism and when deficient, causes weight retention or weight gain.  Talk to your doctor about the risks and benefits of estrogen for you individually in this situation.

Stress

The eighth reason for shifting out of ketosis is stress.  Acute and chronic stress can be caused by a number of issues. The most common is lack of sleep.  You can read about stress and ways to address it in two of my articles: How Does Stress Cause Weight Gain? and Adrenal Insufficiency, Adrenal Fatigue and PseudoCushing’s Syndrome – Oh My!

For many years, we’ve thought that caffeine was great for weight loss.  However, we are finding, clinically, that too much caffeine can also cause a stress response by raising cortisol, releasing glycogen, thereby stimulating an insulin response and bringing your weight loss to a screeching halt.  How much caffeine? . . . The jury is still out . . . and remains to be determined.  But, I am currently under going an n=1 experiment on myself (as many of you know, I loved Diet Dr. Pepper.  But I had to give it up).  I’ll keep you posted . . .

Look closely at these eight issues.  Correcting them usually solves most plateaus with weight loss and improves blood pressure, blood sugar and cholesterol control dramatically.

Adrenal Insufficiency, Adrenal Fatigue, PseudoCushing’s Syndrome – Oh My!

Adrenal Fatigue? Adrenal Insufficiency?  Cortisol? PseudoCushing’s Syndrome?  What do these terms mean and why are they all over the internet these days? And, what do they have to do with your weight loss?

This was our topic this evening on PeriScope.  Katch Dr. Nally speak about this topic with rolling comments at Katch.me/docmuscles.  Or you can watch the video below:

If you’re not sure about what this is, you’re not alone. I think I’ve heard the term “Adrenal Fatigue” at lease four times a day for the last three months.  If you ask your doctor, they’ll probably scratch their heads too.  The funny thing is that “Adrenal Fatigue” isn’t a real diagnosis, but it is all over the internet and it shows up in the titles of magazines in the grocery store every day.  There’s even and “Adrenal Fatigue For Dummies” so it must be real, right?!  Adrenal Fatigue for Dummies

No.  It isn’t a real diagnosis.  It is a conglomeration of symptoms including fatigue, difficulty getting out of bed in the morning, and “brain fog” that have been lumped together to sell an “adrenal supplement.” (Sorry, but that’s really what it is all about.)  Do a Google search and the first five or six sites describing adrenal fatigue claim the solution is taking their “special adrenal supplement.”

I know what you’re thinking, “Your just a main stream, Western Medicine doctor, Dr. Nally, you wouldn’t understand.”  Actually, I do understand.

Adrenal fatigue has risen in popularity as a “lay diagnosis” because many patients show up at their doctors office with significant symptoms that actually interfere with their ability to function, and after all the testing comes back negative for any significant illness, they are told that they are normal.  But the patient still has the symptoms and no answer or treatment has been offered.  It’s discouraging. . . very discouraging.

That’s because the symptoms are actually the body’s response to chronic long term stress.  Many of my patients, myself included, have found themselves “stuck” in their weight loss progression, feeling fatigued, struggling to face the day, with a number of symptoms including cold intolerance, memory decline, difficulty concentrating, depression, anxiety, dry skin, hair loss, and even infertility in some cases.  Is it poor functioning adrenal glands? No, your feeling this way because the adrenal glands are actually doing their job!!

If the adrenal glands weren’t working you’d experience darkening of the skin, weight loss, gastric distress, significant weakness, anorexia, low blood pressure, and low blood sugar.  The symptoms are actually called Addison’s disease and it is actually fairly rare (1 in 100,000 chance to be exact).  So what is causing the symptoms you ask?

There are a number of reasons, but one that I am seeing more and more frequently is “Pseudo-Cushings’s Syndrome.” Pseudo-Cushing’s Syndrome is a physiologic hypercortisolism (over production of cortisol) that can be caused by five common issues:

  1. Chronic Physical Stress
  2. Severe Bacterial or Fungal Infections that Go Untreated
  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 an increased corsiol secretion. Chronic stress induces hyperactivity of the hypothalamic-pituitary-adrenal axis causing a daily, cyclic over production of cortisol and then normalization of cortisol after resolution of the stressor.  This cortisol response is not high enough to lead to a true Cushing’s Syndrome, but has the effect of the symptoms listed above and begins with limiting ones ability to loose weight.

I’m convinced that this is becoming more and 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 into the blood stream 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 or proteins into glucose) for fuel. Cortisol, also, shifts the storage of fats into the deeper abdominal tissues (by stimulating insulin production) and turns on the maturation process of adipocytes (it makes your fat cells age – nothing like having old fat cells, right?!)  In the process, cortisol suppresses the immune system through an inhibitory effect designed to decrease inflammation during times of stress (7,8,9).  If this was only occurring once in a while, this cascade of hormones acts as an important process.  However, when cortisol production is chronically turned up, it leads to abnormal deposition of fat (weight gain), increased risk of infection, impotence, abnormal blood sugars, brain fog, head
aches, hypertension, depression, anxiety, hair loss, dry skin and ankle edema, to name a few.

The chronic elevation in cortisol directly stimulates increased insulin formation by increasing the production of glucose in the body, and cortisol actually blunts or block-aids the thyroid function 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 and cause weight gain (10-11).

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

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.  Pseudo-Cushing syndrome will demonstrate a slightly elevated morning cortisol that doesn’t meet the criteria for true Cushing’s type syndrome or disease.

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.  Find a hobby that you enjoy and participate in it once or twice a week.  Preferably, a hobby that requires some physical activity. The activity will actually help the sleep wake cycles to improve.

Fifth, follow a low carbohydrate or ketogenic diet.  Ketogenic diets decrease insulin and reverse the effect of long term cortisol production.  Ketogenic diets a have also been shown to decrease or mitigate inflammation by reducing hyperinsulinemia commonly present in these patients (13).

So, the take home message is . . . take your adrenal glands off of overdrive.

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.
  13. Fishel MA et al., Hyperinsulinemia Provokes Synchronous Increases in Central Inflammation and β-Amyloid in Normal Adults. Arch Neurol. 2005;62(10):1539-1544. doi:10.1001/archneur.62.10.noc50112.

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