I’ve been told that many of you have nominated me. Thank you!!!
Every year Ketogenic.com hosts the Keto Awards with Metabolic Health Summit to highlight some of the best and brightest in our community.
There are five unique categories in which you can nominate and it would be an honor to me for you to add your vote: Top Keto Educator Top Keto Book Top Keto Podcast Top Keto Researcher Making Positivity Louder
I’ll be sure to let you know who is selected. Please take a minute to cast your vote for me. Vote Here:
I have been very vocal this week about the new narrative for racism that permeates every air-wave and smartphone across the country, “The criminal justice system is to blame.” The logic states that Black men are being rounded up for little reason by a White-run criminal justice system dedicated to the eradication of a burgeoning minority middle class. If it weren’t for the dastardly system, all would be well. All is to blame on “white privilege” they claim. And, the narrative is being driving by the organization called Black Lives Matters.
Phoenix, Arizona May 31, 2020 – CNN
A significant number of the ketogenic and carnivore world “elites” have significant buy in to this narrative and have come down hard on my position during the last week. I’ve been called a white racial supremacist, a bigot, a fanatic, and I’ve even had a few death threats arise in my “in-box” because I disagree with the agenda of this organization. But those of you who know me, know that I don’t make statements lightly. Any time I take a position, it will be based in scientific fact.
All of this has occurred as protests, riots, looting and murder have flooded the news, social media feeds and airwaves of the world. Anger that justice has not been served was the initial outcry. True it is that any life unjustly taken deserves restitution. Yet, in the attempt to make things right, I refuse to join with a movement that stands for nearly everything wrong and evil in this world.
As of today, more innocent lives have been taken (20 as of today’s count) since these violent protests began over the horrible death of George Floyd. But what about the other black lives that have been lost in the chaos. What about the Black business owners that lost their businesses? What about the families of those that lost fathers and mothers to this violence in response to violence?
Minneapolis Minnesota, May 31, 2020 – FoxNews.com
“Dr. Nally, you don’t have to agree with everything. Just because it’s on their website, doesn’t make them bad. Just agree with the good things this movement is doing. Just drop to a knee with your sign and show your support for the good parts,” I’ve been told by quite a few people I used to admire.
Let’s apply that logic to other examples. Would you hold your church social on the lawn of the Playboy Mansion because Hugh Hefner was a Methodist who believed in God and had a copy of “The Purpose Driven Life” on his nightstand table?
I am not a racist. Just because I disagree with your position on social justice does not make me a racist either. The definition of racism is the belief that race is the primary determinant of human traits and capacities, and that racial differences produce an inherent prejudicial superiority of a particular race. I do not view, interact with or treat anyone of a different skin color any differently than I would treat my own family.
This may offend you, but according to scientific evidence, “white privilege” isn’t real. If it were a real issue, you would not see statistical success of the Asian populations in the United States. Just look at the graph of ethnic incomes below.
And, it’s not just income. Asian students score higher on educational testing like the SAT. How does the argument of “white privilege” explain this anomaly? It doesn’t. If race provided privilege, then these graphs would be notably different.
Those of us that have been raised to abide the law, pay our taxes, set aside our instinctual urge to provide justice by allowing for due process in the civilization we’ve contributed to, act with civility toward leadership, give honor to the experience of our parents and our elders, follow basic civil instructions, provide for our families, protect them and serve our neighbor are horrified that someone would claim we are “subconsciously racist.” This is an attack on and an attempt to verbally disarm the good men and women of this country by creating guilt, claiming that because of your heritage, a part of you is unwilling to protect your neighbor.
Because of this, I cannot sit idly by and watch this country spiral down the drain without making my position loud and clear. Based upon additional thoughts I contemplated after reading Ryan Bomberger’s article in TownHall this morning, here are:
Ten Reasons I Will Never Support #BlackLivesMatters (BLM)
Their Premise Isn’t True. I despise racism. It is never appropriate. It is even worse when racism is used as a political weapon like is has been this week. According to the FBI’s latest homicide statistics, a black man is 11 times more likely to be killed by another black man than by a white man. The comprehensive 2019 study by PNAS, “White officers are not more likely to shoot minority civilians than non-White officers.” Even the Washington Post’s database on police-involved deaths put this into perspective. In 2020, among those killed by police officers (all male):
2 Native Americans
9 Asians
46 Hispanics
76 Blacks (Incidentally only 9 of those 76 Blacks were unarmed)
149 unlabeled individuals
149 Whites (whose deaths are never reported by national mainstream media.)
“White Privilege” – @AmyDC – (Satire Image)
2. Goals for Forgiveness or Reconciliation are not Present. On none of the Black Lives Matters websites are there any mention of healing wounds, forgiveness or moving forward. You cannot talk about the sins of distant past and expect to move forward if there is no intention of forgiveness. Ask any counselor, psychiatrist or physician, when your spouse brings up old wounds or grievances with every argument, does the marriage get better? Absolutely not. They’ve never forgiven you and neither will Black Lives Matters. Their paradigm is not centered in any gospel of forgiveness. It is a prejudicial oppressor/oppressed race theory paradigm that is completely flawed. This seems strange when the majority of Blacks in the U.S. are Christian (79%) and profess a belief in Jesus Christ.
Most Christians believe that we are individually responsible for our own actions and, not Adam’s transgression from the fall (that was the whole point of the atonement of Christ). Yet, belief that white people living today are responsible for the slavery their for-bearers participated in is diametrically opposed to Judaeo-Christian philosophy. I am not responsible for my father’s transgressions and neither are you. You can’t stand on both sides of the fence.
What is the solution? Whether you are a believer or not, Jesus Christ taught an inspired model that leads to peace and harmony — to love God first, and then to love our neighbors as ourselves. I don’t pretend that either of these pursuits is easy, but in the 50 years I have been upon this earth, it is the only action that yields the promised fruit.
3. The Focus is 100% Black Power. That’s all you’ll ever see on their websites at M4BL and BLM. Both of these organizations focus on “organizing and building Black power across the country.” This is not what Martin Luther King promoted. He promoted “God’s power and human power.” That’s dramatically different. I agree with Dr. Martin Luther King, Jr.’s statement, that “hate cannot drive out hate. Only love can do that.” Only this kind of love and empathy can inspire us to do the rigorous work of rebuilding bridges of cooperation instead of walls of segregation and alienation. I will happily stand and march with the principles outlined by Dr. King.
5. Black Lives Matters Intentionally Ignores and Suppresses the Importance of Fatherhood. From their own website: “We disrupt the Western-prescribed nuclear family structure requirement by supporting each other as extended families and ‘villages’ that collectively care for one another, especially our children, to the degree that mothers, parents, and children are comfortable.” Notice “fathers” is intentionally missing from that statement. We know from years of research that every “village” that has fatherless families is a village that suffers higher crime rates, higher drug usage, higher abortion rates, higher drop-out rates, higher poverty rates, and so much more.
Prejudice, hate and discrimination are learned behaviors. We are not born with them. This is why parents, family members, and teachers must be the first line of defense. Teaching children to love all, and find the good in others, is more crucial than ever. Oneness is not sameness in America. We must all learn to value the differences.
How does the absence of a father play a role in this? Isn’t it interesting that the ethnicity that is the most successful at income and education is also the group that has the lowest number of fatherless homes.
6. They Demand Reparations. On the same BLM website above, they demand, “Reparations for . . . full and free access for all Black people (including undocumented and currently and formerly incarcerated people) to lifetime education . . . retroactive forgiveness of student loans, and support for lifetime learning programs.”
Ummmm, question? What about the mixed racial peoples? Will the white half of their bodies have to pay the Black half of themselves?
7. Complete Abolition of Police Forces. These people assert that complete abolition of prisons, police and any other institution related to civil safety is their goal. Across 30 cities this week you’ve heard the cry, “Defund the police!” This would leave total anarchy in any community. Yet, police chief’s and commissioners around the county have begun to stand with these groups at the behest of their officers. Reforming department codes to control use of force, continued training in use of aggressive force and monitoring systems that identify officers who abuse these policies have been show to be effective and are essential, but abolishing police forces is utter insanity.
To paraphrase Winston Churchill, people who buy this mindset are guilty “Of not understanding the difference between the fire department and the fire.”
8. BLM IS Anti-Capitalistic. They declare “We are anti-capitalist. We believe and understand that Black people will never achieve liberation under the current global racialized capitalist system.” The video and recordings that identify incidences of police brutality and misuse of force are captured on phones and body-cameras that were made possible by capitalism. We have known for over 100 years that the best way to raise people out of poverty is capitalism. Capitalism is what makes the United States of America the most charitable nation on the earth and the nation with the most freedom.
9. Collin Kaepernick Supports It. I want nothing to do with a man who idolizes Fidel Castro and Che Guevara and worships Malcom X (check out his social media feeds and you see all the proof you need). Malcom X was an anti-integration, pro-violence member of the Nation of Islam (virulently racist). Interesting that this #SocialJusticeWarrior is absolutely silent about the fact that he makes millions from Nike whose entire Executive Leadership Team is White, and according to Kaepernick makes its shoes in the most “murderous regime in the world.”
Colin Kaepernick – NYTimes.com
10. Not All Black Lives “Really” Matter. The pro-abortion Black Lives Matter further declares: “We deserve and thus we demand reproductive justice [aka abortion] that gives us autonomy over our bodies and our identities while ensuring that our children and families are supported, safe, and able to thrive.” Aborted children don’t thrive.
Many even argue that Planned Parenthood’s founder Margaret Sanger, a strong believer in eugenics, intentionally used abortion to lower the Black birth rate. Something is amiss when over one-third of all abortions occur in Black mothers.
BLM has claimed solidarity with “reproductive justice” groups since February 2015 and have been officially adopted into the Democratic National Convention platform since August 2015. Sorry folks, you cannot simultaneously fight violence while all the while celebrating it by destroying lives before they take their first breath.
Will I be ostracized from the keto/carnivore community for my position? Probably, but my conscience is clear, and I can sleep at night.
The keto misconceptions abound and this week is no different. A popular health website recently published an article warning people about the “dangers” of a ketogenic diet, including the keto-flu, kidney disease, gut bacteria, nutritional deficiency, bone health and low blood sugar. They claimed these dangers are “evidence based.” Dr. Nally very quickly debunks these dangers, explains how the naysayers “spin” the science and talks about why these misconceptions are false.
One of the common complaints that I see in my office is chronic numbness and tingling of the hands, fingers, feet & toes. There are multiple causes of these symptoms, but by far the most common cause in my practice is polyneuropathy caused by insulin resistance (hyperinsulinemia).
Before we dive into this particular type of nephropathy, it is important that we define a few terms. The terms “polyneuropathy,” “peripheral neuropathy,” and “neuropathy” are frequently used interchangeably, and although they can be easily confused, they are distinctly different.
Definitions
Polyneuropathy is a specific term that refers to a generalized sensation of tingling or numbness that uniformly affects many nerves at the peripheral sites (ends of the extremities like hands, fingers, lower legs, feet and toes).
Peripheral neuropathy is a less precise term. It is frequently used synonymously with polyneuropathy, but can also refer to any disorder of the peripheral nervous system. However, this term includes pain or numbness that radiates from nerve roots like “sciatica” of the leg and “brachial plexopathy” causing symptoms in one hand and/or arm (mononeuropathies).
Neuropathy, which again is frequently used interchangeably with peripheral neuropathy and/or polyneuropathy, can refer even more generally to disorders of the central (brain & spinal cord) and peripheral nervous system (nerves of the arms and legs) and their connections to sensory organs, such as the eye and ear, and to other organs of the body, muscles, blood vessels, and glands.
Why spend time defining all this? Because, neuropathy can be very confusing, even for the experienced physician. And, because I am seeing, more and more frequently, cases of insulin resistance induced polyneuropathy. The polyneuropathies must be distinguished from other diseases of the peripheral nervous system, including the mononeuropathies and mononeuropathy multiplex (multifocal neuropathy), and from disorders of the central nervous system.
Mononeuropathy refers to focused involvement of a single nerve, usually due to a localized trauma, compression, or nerve entrapment. Carpal tunnel syndrome is a common example of a mononeuropathy. Sciatica due to a lumbar disc bulge is another form of mononeuropathy.
Mononeuropathy multiplex refers to simultaneous involvement of non-adjoining sections of nerve trunks. Used loosely, this term can refer to multiple compressive mononeuropathies. However, in its more specific meaning, it identifies trauma, infection, auto-immunity or damage to multiple nerves outside the central nervous system. This is often due to lack of blood supply due to disease based inflammation of blood vessels supplying blood to these peripheral nerves.
Diseases of the central nervous system such as a brain tumor, stroke, or spinal cord lesion occasionally present with symptoms that are difficult to distinguish from polyneuropathy.
Insulin Resistance and Neuropathy
Insulin resistance, or better defined hyperinsulinemia, begins 10-15 years before a person is considered “pre-diabetic” and 20 years before the onset of type II diabetes. This “over production of insulin” in response to carbohydrates, starches and sugars causes a subtle and progressive form of inflammation. This excessive production of insulin will damage the smallest arteries (capillaries) carrying oxygen and fuel to the back of the eyes, the kidneys and the peripheral nerves of the hands, fingers, lower legs, feet and toes.
Often not identified until a person is actually diabetic, the mechanism underlying the development of this type of neuropathy is extremely complex. It is driven by years of subtle and progressive damage to the blood vessels, and inability of the nerves to use essential B vitamins damaging the genetics of the cell. This leads to inflammatory, metabolic, and ischemic effects causing the nerves to function poorly over time.
What Causes Polyneuropathy?
The mechanism of polyneuropathy damage in the patient with hyperinsulinemia three-fold.
The presence of high insulin stimulates increased fat storage. As fat cells begin to get filled, they begin to over-produce a number of inflammatory hormones including TNF-alpha, IL-6, IL-1, Adiponectin, Leptin and Resistin. These inflammatory hormones turn on auto-immunities and abnormal immune system function.
At the same time, the high insulin levels suppress appropriate testosterone and estrogen production causing microscopic damage to the lining of the smallest arteries and capillaries of the body (found predominantly at the extremities, kidneys and back of the eyes).
65% of patients with insulin resistance (hyperinsulinemia) have a malformation of one or both genes that encode the MTHFR enzyme (methylenetetrahydrofolate reductase) that uses folic acid (Vitamin B9) inside the cells of the body. Because this is genetic and is a process occurring inside the cell, it has been difficult to identify until recent advances in measuring genetic SNPs. Single nucleotide polymorphisms, frequently called SNPs (pronounced “snips”), are the most common type of genetic variation among people.
Interestingly, MTHFR deficiencies are also strongly correlated with depression, anxiety and other forms of mental illness. MTHFR is a SNP that can easily be tested through a simple blood sample at your local lab or doctors office. And, nerve testing can be done through a simple sudomotor function test in the doctors office. In fact, Medicare encourages this testing yearly through part of the Annual Wellness Exam.
The polyneuropathy that I see most commonly in my office can and will improve. In fact, polyneuropathy will completely resolve if you catch it early enough. We treat it in two ways.
What Can I Do To Treat Polyneuropathy?
First, restrict carbohydrate intake. A ketogenic or carnivore diet is the perfect approach to this. If you don’t have a copy of my book, The KetoCure, please pick one up on my website or on Amazon. if you are just looking to fine tune the nuts and bolts of your diet, you can get a copy of my diet recommendations here. Carbohydrate restriction corrects the high insulin levels. Within a few weeks, people start seeing improvement in inflammation, testosterone, estrogen and leptin resistance.
Second, get your MTHFR SNPs tested. This can be ordered through a simple blood test through your doctor or nearby lab. If you have one or both MTHFR mutations, treatment is simple. A mutation of the MTHFR SNP directly causes polyneuropathy, anxiety, depression and in severe cases, schizophrenia. It can also cause significant problems with homocysteine metabolism and is a significant risk factor in heart disease.
Third, use the correct form of folic acid. If you have the MTHFR mutation, regular folic acid is ineffective. Instead of using regular folic acid (Vitamin B9), 1000-5000mcg per day of L-methyl folate (premethylated Vitamin B9) solves the problem. Within 90 days, over 50% of my patients feel dramatic improvement in their neuropathy and many have compete resolution of the numbness and tingling. I see this so frequently, that a few years ago I had my multivitamins designed to include L-methyl folate instead of regular folic acid. You can find them here at Ketoliving. com. If you want more information on why I designed my own vitamin supplement a few years ago, you can read about them here.
So, restrict your carbs, use the appropriate form of folic acid for you, and pass the bacon!
If you are interested in getting more help on this issue, schedule an appointment with me in my office. Or, consider one of my membership options if seeing me in my office isn’t convenient for you. Sign up today!
References:
Yigit, Serbulent et al. “Association of MTHFR gene C677T mutation with diabetic peripheral neuropathy and diabetic retinopathy.” Molecular vision 19 1626-30. 25 Jul. 2013.
Wan, Lin et al. “Methylenetetrahydrofolate reductase and psychiatric diseases.” Translational psychiatry 8,1 242. 5 Nov. 2018, doi:10.1038/s41398-018-0276-6.
Shelton, Richard C et al. “Assessing Effects of l-Methylfolate in Depression Management: Results of a Real-World Patient Experience Trial.” The primary care companion for CNS disorders 15,4 (2013): PCC.13m01520. doi:10.4088/PCC.13m01520.
Hughes R. Investigation of peripheral neuropathy. BMJ 2010; 341:c6100.
Morrison B, Chaudhry V. Medication, toxic, and vitamin-related neuropathies. Continuum (Minneap Minn) 2012; 18:139.
Pareyson D, Piscosquito G, Moroni I, et al. Peripheral neuropathy in mitochondrial disorders. Lancet Neurol 2013; 12:1011.
Rutkove SB, et al., Overview of Polyneuropathy. UpToDate.com. Online Jan 2020, https://www.uptodate.com/contents/overview-of-polyneuropathy?search=neuropathy&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
Our celebration of Independence Day is a deception.
Laying beneath the fireworks, barbecue and fun is the hard to swallow truth . . . It’s all a sham.
Are you and I really independent anymore? No. Not anymore.
243 years ago, the British oppression was a threat. It was singular, visible and involuntary.
Now, the threat we face daily is an entirely new form of tyranny, infinitely more complex.
The scary thing is that oppression is now:
Fractionated
Invisible
Voluntary
Fractionality of Our Millennial Tyranny
Slavery has changed. The oppressor previously owned the slave individually. However, with time we learned that when there are multiple owners, the burden of ownership is lessened. Joint ownership became the norm. Now we have joint ownership of our condos, boats, and jets. The burden of slave ownership was the risk of revolt and revolution.
If ownership of debt can be spread among the masses, the individual risk is mitigated.
Our fractional oppression is spread throughout the legion, and the tyranny is masked as a principle of the great “free market.”
BIG FOOD sells cancer, diabetes, heart disease and fatigue through the FOMO of fake food.
BIG MEDIA sprinkles us with malaise, despair, anxiety and post-traumatic stress with lurid half-truths, click-bait shock value, and salty emotion all with the intent to sell us more advertisement.
BIG PHARMA peddles side-effects, addiction and false hope convincing the feeble mind, created by BIG FOOD, that a pill is necessary to prevent us from experiencing the pain, emotion and struggle of life – that same life that BIG MEDIA keeps ever present in the palms of our hands. In bed with BIG GOVERNMENT, their evangelism recommends medicating instead the more difficult learning from struggle and failure.
BIG GOVERNMENT covers us with red tape to stop the financial bleeding and hemorrhaging of the tumor’s growth it stimulates, through greed and invasion of individual inalienable right.
BIG MONEY circles us on wings of dread and fear singing a song of doom, all the while sampling emotional cookies and Danishes of immediate gratification, while slipping the “plastic card with a security chip” shackles over the wrists of the enslaved.
BIG EDUCATION preys upon our children with glib platitudes, group-think, and participation trophies. It teaches the weakened minds to prize test-taking, rote memorization, and fact regurgitation above problem-solving, creative thinking, and learning from failure. They prepare our children to work as drones on the factory floor of cyberspace instead of art and enterprise.
And, that’s just the beginning.
Look no further than your bank statement to see how the oppression is itemized. Each line item takes it’s pound of flesh round the clock each month.
Invisibility of Oppression
“None are more hopelessly enslaved than those who falsely believe that they are free.” -Goethe-
200 years ago, the shackles were visible.
Today the shackles are disguised. Independence is a deception.
We are smarter than an outright shackle. So, they were re-tooled, re-imagined, re-formed, and hidden like landmines in cyberspace:
0% APR
Matching contributions
Free Miles
Free Samples
No Money Down
84 Month Installments
These are just grease on the slaughterhouse chute.
It Can’t Be Oppression if You & I Now Volunteer?
Forced slavery is no longer acceptable in our “free society.” The dark genius of modern oppression is the creation of cultural norms, rituals and addiction that invite us to PUT ON OUR OWN CHAINS.
Modern slavery is now VOLUNTARY.
“No one put a gun to your head or forced you to buy our product or service,” is the mantra of the oppressor while billions are spent on engineering conditions that make the shackles look like icing on your cyberspace cake.
But there is an escape . . .
Massive in scale, fractional, and nearly invisible, there is still a choice.
CHOICE IS THE ESCAPE
So, this evening, as the cardboard tubes of fireworks lay discarded in the park grass, and the toy flags lay rolled up on top of the fridge, awaiting their return to the attic for storage, let your Independence Day celebration be much deeper. Choose.
Let your Independence Day stir the same indignation for oppression that our fore-fathers felt.
Cultivate within yourself the desire to fight and win a second Independence Day.
You will need every ounce of resolve and strength you can muster.
Today, there are no chains, hangman’s noose or firing squads, there is but chemistry, habit, choice and instinct. The Oppressor will attempt to use it against you. You can still see it if you look. You can still choose.
Have the courage to flip them the bird of indignation as they present you the “standard American prepackaged life.”
Reject What Isn’t Real
Reject the drama and depletion of paycheck-to-paycheck living . . . instead, create wealth. Save a few dollars each day.
Reject the cardboard food in the grocery store and eat real food: bloody, fresh and wild. It will re-energize you.
Reject the FOMO of the dutiful consumer and become a CREATOR. Create the world you dream of by small and simple daily choices.
Reject the fake new, fake government, fake food, fake medicine, fake success, fake friendships, and fake happiness that encircles us. Create a life that is REAL. You’ll know it’s real because you can feel it, beyond the pain of trial and error and failure, REAL encompasses heart, mind, body and soul at the same time.
Take off the blinders so that you may see the leeches and parasites sticking to you. Rip them from your body and warm yourself as you burn them in the fire.
Only then will you escape the clutches of the modern tyrant.
Only then will you be free.
[Adapted from Bryan Ward and his “Third Way Man” series]
Adam S. Nally, D.O. (aka DocMuscles)
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Rice is rice. Potato is a carbohydrate that will halt your weight loss and please do not bring me a bagle.
And, NO, I did not just give you permission to go eat a jelly donut!!
You’d be amazed at how many people don’t realized the carbohydrate content (sugar equivalents) of various foods that we’ve been told are “good for us.” Check out my youtube.com video here on eight steps to getting started with a ketogenic lifestyle.
Over fifty years of data have demonstrated that creating energy deficit through the reduction in caloric intake is effective in reducing weight. . . However, it is only for the short term (1, 2). The biggest challenge physicians face in the treatment of obesity is that calorie restriction fails when it comes to long-term weight loss.
Isn’t Fasting Effective in Long-Term Weight Loss?
With the craze and popularity of intermittent fasting, some have claimed that intermittent fasting is more effective in weight reduction. Recent results demonstrate that this may also be incorrect. In the short term evaluation of caloric restriction and intermittent fasting, reduction in 15-20 lbs of weight is effectively seen and the highly publicized Biggest Loser’s losing ~ 120 lbs. Intermittent fasting and alternate day fasting have been shown to be more effective in lowering insulin levels and other inflammatory markers in the short term.
There is, however, controversy over maintaining weight loss beyond 12 months in the calorie restriction, intermittent and alternate day fasting groups. Forty different studies in a recent literature review, thirty-one of those studies looking at forms of intermittent fasting, demonstrate that the majority of people regain the weight within the first 12 months of attempting to maintain weight loss(3, 5). This is, also, what I have seen for over 18 years of medical practice.
Is Calorie Restriction the Only Way to Lose Fat?
Numerous “experts” claim that the only way to reduce fat is “caloric deficit.” Variations through the use of intermittent, long-term or alternate day fasts can be found all over the internet. In regards to calorie restriction, these “experts” with nothing more than a personal experience and a blog to back their claims preach this louder than the “televangelists” preach religion. Based on the faith that many place in this dogma, it could be a religion. What causes belief in this dogma is that weight and fat loss actually does occur with caloric restriction to a point. The average person will lose 20-25 lbs, however, within 12 months of achieving this goal, most people regain all the weight. (No one ever mentions the almost universal problem with long-term weight loss, especially those “experts.”)
Prolonged calorie restricted fasts, intermittent fasts, and alternate day fasts are often grouped together into the fasting approach, causing significant confusion among those that I speak to and counsel in my office. There is great data that alternate day fasts do not have the reduction in resting energy expenditure that prolonged fasting, intermittent fasting and calorie restriction cause. However, none of these approaches appears to solve the problem of weight re-gain after long-term (12-24 months into maintenance) weight loss (3). And, a recent study of 100 men participating in alternate day fasting showed that there was a 38% dropout rate, implying that without close supervision and direction, maintenance of this lifestyle is not feasible for over 1/3rd of those attempting it.
Long-Term Weight Loss Failure Brings Tears
Failure on calorie restricted diets, low fat diets, and intermittent fasting diets with weight regain at twelve to twenty-four months is the most common reason people end up in my office in tears. They’ve fasted, starved themselves, calorie restricted, tried every form of exercise, and still regained the weight. Trainers, coaches and “experts” have belittled them for “cheating” or just not keeping to the diet. Yet, we know that calorie restriction and intermittent fasting cause a rebound in leptin, amilyn, peptid YY, cholecystikinin, insulin, ghrelin, gastric inhibitory peptide and pancreatic poly peptide by twelve months causing ineffective long-term weight loss (6). The dramatic rise in these hormones stimulates tremendous hunger, especially from ghrelin and leptin.
N Eng J Med 27 Oct 2011. Mean (±SE) Fasting and Postprandial Levels of Ghrelin, Peptide YY, Amylin, and Cholecystokinin (CCK) at Baseline, 10 Weeks, and 62 Weeks.
Although less problematic in alternate day fasting, these calorie restricted approaches also cause dramatic slowing of the metabolism at the twelve month mark. In many cases, the metabolic rate never actually returns to baseline, creating even more difficulty in losing further weight or even maintaining weight (6).
N Engl J Med 27 Oct 2011. Mean changes is weight from 0 – 62 weeks.
Is Gastric Bypass or Gastric Sleeve the Solution?
Gastric bypass and the gastric sleeve procedures have been touted as the solution to this problem, as they decrease ghrelin, however, 5-10 years later, these patients are also back in my office. They find that 5-10 years after these procedures the weight returns, cholesterol and blood pressure rise, and diabetes returns. These hormones kick into high gear, stimulating hunger in the face of a slowed metabolism, that to date, has been the driver for weight regain in the majority of people. People find it nearly impossible to overcome the hunger. You may have experienced this, I know I have.
It’s the Hormones, Baby!
So, what is the answer? It’s the hormones. (WARNING – You’ll hear that when your wife is pregnant, too, gentlemen). We are hormonal beings, both in weight gain, and in pregnancy. Trying to preach calorie control to a hormonal being is like showing up at the brothel to baptize the staff. You might get them into the water, but you’re probably not getting them returning weekly to church or pay a tithe.
So, how do you manipulate the hormones in a way to control the rebounding hunger and suppression of metabolism? This is where we put a bit of twist on the knowledge we’ve gained from alternate day fasting. Recent research shows that “mild” energy deficit in a pulsatile manner, that has the ability to mimicking the body’s normal bio-rhythm’s is dramatically effective in reducing weight and maintaining normal hormonal function without cause of rebound metabolic slowing (4).
Pulsed Mild Energy Restriction
What does this mean in layman’s terms? It means that if we provide a diet that maintains satiety hormones while providing a period of baseline total energy expenditure needs and a period of mildly reduce caloric intake in a pulsed or cyclic manner, greater weight loss occurs and there is no rebound of weight 1-2 years later.
The main reason I’ve not jumped on the intermittent fasting band wagon is the shift in leptin, amylin, ghrelin and GLP-1 signaling that regularly occurs at the 6-12 month mark. The rebound of these hormones causes weight re-gain and is what prevents successful long-term weight loss. A number of people come to my office and tell me they couldn’t follow a ketogenic diet, so they’re doing intermittent fasting and it works . . . for a while. Then, they end up in my office having hit a plateau or fallen off the wagon and regained all the weight. They are completely confused and don’t understand what happned. Most of them are convinced it’s their thyroid or cortisol and they’ve seen every naturopath and functional medicine doctor in town.
What people really need is a simple approach to long-term weight loss without having to spend the night in the physiology lab every two weeks sleeping under a ventilated hood system.
The Ketogenic Lifestyle is a Pulsed Energy Lifestyle
Third, providing adequate fat is the simple way to maintain leptin, ghrelin, amylin, GLP-1 (among the others) and long-term weight loss. Can you eat too much fat? Of course you can. But, because each of us have differing levels of stress and activity each day, this fat intake becomes the lever for hunger control.
Fourth, the use of exogenous ketones ensures easily accessible ketone (short chain fatty acids) to modulate adipose (white fat) signaling of the liver without large caloric intake through the portal vein by first pass of liver metabolism. The ketones also help stabilize the gut bacteria. The combination of hormone balance between the liver and fat cells and improvement of gut bacteria suppresses key hunger hormones and aids glucose regulation between the fatty tissues and the liver. Ketones, both endogenous and exogenous, suppress production of TNF-alpha, IL-6, resistin, and stabilize production of adiponectin and leptin from the adipose cells (7, 8, 9).
In my office, once we calculate the basic protein needs daily, we start with a 1:1 ratio of protein to fat. Then, the fat is adjusted up or down based on hunger. Remember, hunger occurs, because your body produces hormones. The addition of fat to a diet that is not stimulating large amounts of insulin resets the hormone patterns back to normal without causing weight gain.
Give Obese People Fat Ad Libitum?
“Sure, Dr. Nally, but what about those people who don’t know if they are hungry, bored, stressed or just have a bacon fixation? You can’t just give them all the fat they want?!”
Why not? Implying that people aren’t smart enough to know when they are full is a bit of a fascist philosophy, don’t you think?
Do people over eat? Sure they do. But, I’ve found that when you give people an antidote to hunger (using fat intake in the presence of stabilized insulin levels) over a few months, people begin to recognize true hunger from other forms of cravings. This is especially true when they keep a diet journal. This gives people the ability to begin listening to their own bodies, responding accordingly and governing their stress, eating, exercise and activity. Keeping a diet journal is key to long-term weight loss. And, isn’t helping people use their own agency to improve their health really what we’re trying to do?
Interestingly, doing this over the years seems to line up with the findings of this year’s MATADOR study in the International Journal of Obesity. They found that mild intermittent energy restriction of about 30-33% for two weeks, then interrupting this with two weeks of a diet that was energy balanced for needs improved both short and long-term weight loss efficiency (4). In looking at my, and my patient’s diet journals, this energy restriction of about 1/3 of needed calories cyclically seems to happens naturally with a ketogenic lifestyle, without even counting calories. (Calories are a swear-word in my office).
What does the correct long-term wight loss program look like in a diet or meal plan? Well, you’ll have to join the Ketogenic Lifestyle 101 Course to see what that really means to you individually. I look forward to seeing you there.
Want to find out more about the Ketogenic Lifestyle 101 course? CLICK HERE.
Have you read my book The Keto Cure? Get a signed copy from me by clicking HERE.
References:
Bronson FH, Marsteller FA. “Effect of short-term food deprivation on reproduction in female mice.” Biol Reprod. Oct 1985; 33(3): 660-7. https://www.ncbi.nlm.nih.gov/pubmed/4052528?dopt=Abstract&holding=npg
Connors JM, DeVito WJ, Hedge GA. “Effects of food deprivation on the feedback regulation of the hypothalamic-pituitary-thyroid axis of the rat.” Endocrinology. Sep 1985. 117(3): 900-6. https://www.ncbi.nlm.nih.gov/pubmed/3926471?dopt=Abstract&holding=npg
Seimon RV, Roekenes JA, Zibellini J, Zhu B, Gibson AA, Hills AP, Wood RE, King NA, Byrne NM, Sainsbury A. “Do intermittent diets provide physiological beneftis over continuous diets for weight loss? A systematic review of clinical trials.” Mol Cell Endo. 15 Dec 2015. 418(2): 153-172. https://www.sciencedirect.com/science/article/pii/S0303720715300800
Byrne NM, Sainsbury A, King NA, Hills AP, Wood RE. “Intermittent energy restriction improves weight loss efficiency in obese men: the MATADOR study.” Int J Obes. 2018. 42:129-138. https://www.nature.com/articles/ijo2017206
Trepanowski JF, Kroeger CM, Barnosky A. “Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults.” JAMA Intern Med. Jul 2017. 177(7): 930-938. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2623528?redirect=true
Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, Proietto J. “Long-term persistence of hormonal adaptations to weight loss.” N Engl J Med. 27 Oct 2011. 365: 1597-1604. http://www.nejm.org/doi/full/10.1056/NEJMoa1105816
Asrih M et al., “Ketogenic diet impairs FGF21 signaling and promotes differential inflammatory responses in the liver and white adipose tissue.” PlosOne. 14 May 2015. Open Access. https://doi.org/10.1371/journal.pone.0126364
Veniant MM et al. “FGF21 promotes metabolic homeostasis via white adipose and leptin in mice.” PlosOne. Jul 2012. Open access. https://doi.org/10.1371/journal.pone.0040164
Whittle AJ, “FGF21 conducts a metabolic orchestra and fat is a key player.” Endocrinology. 1 May2016. 157(5): 1722-1724.
In my last blog post about willpower, I described habits being neural impulse channels in our brain stimulated by a cue following a path leading to the same outcome each and every time – without exerting much effort. Researchers call the formation of these impulse channels habit-loop cycles. Much of the original obesity research of the 19th century was conducted by psychiatrists and psychologists recognizing that people had habitual eating patterns. Because of this, gluttony became the perceived influence of obesity. This underlying philosophy still permeates the obesity research, treatment and low-carb dietary world today. Yet, over the last 15 years, I’ve found that the habit-loop cycle is tied to powerful hormone responses. These responses to very subtle and often unknown triggers or cues powerfully drive weight gain, obesity and struggles with willpower. How does the habit-loop cycle effect you? Before we can change these habit-loop cycles, we have to understand what they are, and how they were created.
It’s All About That Basal Ganglia
Meghan Trainor tells us that “It’s all about that bass . . .” However, it’s really all about that basal ganglia. Deep inside our brains, close to the brain stem, at the location where the brain meets the spinal cord, is a little “nub” of neurological tissue called the basal ganglia. This little nubbin of tissues was identified by the really smart scientists at MIT in the 1990’s as the location where habits are formed and executed. The brain is – to take a quote from my favorite ogre, Shrek – “like an onion – it has layers!”
The Brain Is Like an Onion
If you picture the outer layers of the brain tissue, those closest to the hair and scalp, you can create a mental image of where our most complex thoughts occur. When you think up a new invention, create a new way to cook with bacon, laugh at a friend’s joke, or link two complex thoughts about how habits form, you are using these outer layers of the brain.
Like an Onion – It Has Layers! (DreamWork’s Shrek, 2001)
However, our interest today is deeper . . . much, much deeper. Deep within the center of the brain at the basal ganglia is the location where our automatic behavior originates. Swallowing, breathing and the startle responses are housed in this little nubbin of brain tissue. It is this area of the brain that learns to recall and record patterns of neurological thought and stimulating action. This part of the brain has the ability, like the water drops on the mound we discussed last week, to record neural pathways and tracks leading to reduced mental effort and habit. The basal ganglia even has the ability to store habits while the rest of the brain is asleep. It is in this location, the basal ganglia, where the habit-loop cycle occurs.
Habits Created by Chunking
The habit-loop cycle is the process where the brain converts a sequence of actions into an automatic routine. The really smart guys at MIT call this “chunking,” and it is the root of habit formation. There are hundreds of behavioral chunking activities that you and I rely upon every day. Some of these are as simple as the process you use to squirt toothpaste on your toothbrush before brushing your teeth. Others are more complex like getting dressed or making a lunch box for the kids.
The Habit-Loop Cycle in Your Car
A habit-loop cycle is performed by this little nubbin of tissue by millions of people every morning. Take, for example, backing your car out of the garage. When you first learned to do this, it required huge amounts of concentration – and for very good reason. You’re steering 3000-5000 lbs of steel between a 16 foot garage-door opening into oncoming traffic.
Safely backing your car requires you to open the garage door, unlock the car, adjust the seat, insert the key into the ignition, turn it clockwise, move the rear-view mirror and the side mirrors to visualize any obstacles, put your foot on the brake, put the car into reverse, gently remove your foot from the brake, mentally estimate the distance between the garage and the street while keeping the wheels straight and looking over your shoulder, applying a slight pressure between the gas pedal and the brake, and in some cases, slapping your teenagers hand while they fiddle with the radio dial.
But think about it . . . did you actually put any thought into these actions this morning? You and I probably did this once or twice today without any additional thought. It happened because the basal ganglia took over and created a habit-loop out of it. This routine, repeated hundreds of times, became a habit, requiring very little mental effort.
Your Basal Ganglia Makes You Fat
The habit-loop cycle occurs hundreds and maybe thousands of times throughout our day. It is the cycle that drives hundreds of our activities. In fact, it is this same cycle, in combination with 30 different hormones, that drives our weight gain or weight loss. Yes, I said it,your basal ganglia can make you fat.
Habits Make for a Smaller Brain
Your brain will try to turn any regular routine into a habit, because habits allow our minds to slow down and conserve effort, energy and fuel. The efficient brain allows us to stop thinking about basic behaviors like walking, breathing and eating. This effort-saving effect of the brain is a major advantage, otherwise our brains would be huge, requiring heads the size of watermelons, or even the size of a water tower, causing their own weather systems. Your wife will thank you for an efficient brain that is smaller and requires less room. Can you imaging giving birth to a watermelon or a small Chevy? (Did you notice the size of Shrek and the Donkey’s head? Just say’n . . . )
Habits Are The Root of Behavior
What all this leads to is this – habits, as much as memory and reason, are the root of our behavior. We often don’t remember the experiences that create our habits. However, once they are created, they influence our action without our own realization. Charles Duhigg’s book, The Power of Habit is a great resource for further information on how habits drive our behavior.
The Habit-Loop of Obesity
So, how does all this affect obesity and weight gain? Let’s, first, look at the habit-loop cycle. Researcher, Larry Squire, documented the habit-loop through three decades of research. He and others published numerous articles showing that habits have a cue or trigger that stimulates a routine. The routine leads to an outcome or reward. The reward usually satisfies a craving. Cue-> Routine -> Reward. What we learn through our studies in obesity is that the reward often stimulates a hormonal response of 1-30 different hormones in brain and body leading to repeat cues or triggers. The cravings are hormonally driven. I call it the Habit-Loop of Obesity.
The Craving is the Key
Human psychology and emotion is the key behind habit creation. First, there must be a trigger or cue. Second, the trigger is attached to a previously experienced emotion or craving tied to the cue. The key to habit formation is the craving. The craving is what stimulates the physical routine to occur. It is an emotion or craving that drives the brain to create the habit. Third, there must be a clearly defined outcome or reward that satisfy the emotion or the craving. The emotion or craving doesn’t have to be associated with hormones, however, in the relm of obesity, it is usually tied together.
I am all about making things easier. Your brain does it. We all do it. And, I’m all about trying to help you lose fat and get healthy more easily. Let food be your medicine, let medicine be your food. That’s my mantra and that is as easy and natural as it gets. But, in our day and age, we don’t always have access to growing and raising our own food. That’s why my second mantra is – better living through chemistry. So, I created the KetoKart. Over the last 15 years of medical practice, I’ve found products and supplements that aid in letting food be your medicine, changing triggers, modifying hormones, and help to satisfy cravings in a healthy way to make your decisions easier. Go to the KetoKart, see which package works for you and order it. You’ll thank me.
How do we change our obesity habits? Stay tuned for the third part in this series: Fixing the Habit-Loop of Obesity.
So, I want to know . . . which package did you choose?
Pre-order your copy of my new book that will be available on September 26, 2017.
The ketogenic diet isn’t just a great tool for helping people lose weight and feel their best; it’s also an extremely effective method for treating the common “diseases of civilization.” The Keto Cure will give readers the prescription they need to heal their bodies by eating plenty of fat and moderating protein and carbs.
I’ve been advocating a low-carb, high-fat diet in my clinical practice for over fifteen years, helping people address their health problems by making better food choices. I teamed up with bestselling low-carb author and podcaster Jimmy Moore to create a top-50 health podcast espousing the benefits of eating keto. Now, for the first time, I’ve taken my years of clinical experience, put everything down on paper, and create a how-to guide that details all the ways in which the ketogenic diet can help remedy common ailments.
The Keto Cure details the science behind the keto diet’s effectiveness at treating a wide range of diseases, including:
Alzheimer’s
Epilepsy
Fatty liver disease
Hypercholesterolemia
Hypertension
Parkinson’s disease
Thyroiditis
Type 2 diabetes
and many more
The Keto Cure also outlines practical tips gleaned from Dr. Nally’s fifteen-plus years in medical practice, as well as Moore’s ten-plus years as a health and wellness podcaster, on overcoming the common pitfalls that people experience when adapting to a high-fat way of eating, including fatigue and keto flu. This helpful information, combined with a wide variety of delicious keto recipes from international bestselling cookbook author Maria Emmerich, makes The Keto Cure a complete resource for healing oneself with the ketogenic diet.
Listen and watch as we talk about how ketosis, or the absence thereof plays a role in the formation of the Diseases of Civilization (It’s not rocket science, or maybe it is?)
We touch on non-alcoholic fatty liver disease, carbohydrate restriction, the use of protein and even exercise (Did you say “eggs are sides . . .” or exercise?). So pull up a piece of string cheese and spend 20 minutes that may just change your life.
You can find the vitamin supplements that Dr Nally developed and uses himself and with his patients at KetoLiving.com.
You can find exogenous ketones referenced in the video at DynamicKetones.com
How does ketosis help the diseases of civilization? Find out as Dr. Nally answers these and many other pertinent dietary questions this evening.
You can learn more about his multi-vitamin supplement he designed for insulin resistance/diabetic/weight management patients that he mentions in the video here at KetoLiving.com.
You can learn about exogenous ketones that he mentions helps to augment ketosis here at DymaicKetones.com.
What is Insulin Resistance? Dr. Nally talks about the nuts and bolts of this syndrome and how it works. He answers multiple questions regarding diet and insulin resistance. Let me know what you thing and what questions future videos should answer.
Watch as we talk about how insulin stimulates the Na-K-ATPase pump leading to increased leg edema, varicose veins, bloating, hypertension and swelling. I see it all the time. Watch the video to find out why.
Watch further as I, Dr. Nally, answer some of the very common misconceptions and confusing factors about the ketogenic lifestyle, ketosis, supplements and exogenous ketones. Enjoy!!
Ketosis plays a major role in lowering blood glucose, insulin and notably improving memory in those with Mild Cognitive Impairment and risk for Alzheimer’s Disease (1). Watch this short 5 minute segment on how a ketogenic lifestyle helps. You can learn about a Ketogenic Lifestyle by reading my blog post: A Principle Based Ketogenic Lifestyle. And you can ramp up your blood ketones in less than 30 minutes by getting exogenous ketones at DynamicKetones.com.
Enjoy!!
References:
Krikoria R et al. “Dietary ketosis enhances memory in mild cognitive impairment.” Neurobiology of Aging. Feb 2012, Vol 33:2 p 419-425.
Why should you consider using a ketogenic lifestyle? There are many reasons. This is part 8 of a 25 part series and this one focuses on how ketosis improves testosterone in men and estrogen in women.
I had the chance to appear for an interview on Vicki Fitch’s podcast last night: A Fresh Perspective. We talked about bacon, ketogenic diets, hypoglycemia, sweeteners, food cravings, #FitchSlaps, exogenous ketones and we answered a bunch of great questions from the Facebook Live audience. You can see video of the show below:
Had a great time. Let me know what you think. Thanks, Vicki!!
I am frequently asked about the sweeteners that can be used with a low carbohydrate diet. There are a number of sweeteners available that are used in “LowCarb” pre-processed foods like shakes or bars, or in cooking as alternatives to sugar. However, most of them raise insulin levels without raising blood sugar and are not appropriate for use with a true low-carbohydrate/ketogenic diet. You can see and print the article I published clarifying which sweeteners you can use and which ones to avoid here:
Of recent note, I’ve been asked about the insulin response that occurs in the study found here quoted by Dr. Jason Fung in his wonderful book, The Obesity Code.
First, it is essential to note that both the crystalline form of Stevia and the aspartame used in the form of Equal, also a crystal, contain either dextrose or malto-dextrin as the crystallizing agent. Both dextrose and malto-dextrin have a known insulin spike equal to table sugar. You can see that in my article link above. Watch the video and we’ll discuss which forms of Stevia and aspartame don’t raise insulin in myself or my patients.
Aspartame has been effective in appetite suppression in many obesity patients clinically. However, recent studies have demonstrated that aspartame does have a negative effect on gut flora, has potential to cause insulin resistance to persist when used long term (seen in animal studies) and has been shown to damage the mitochondria of brain cells (also animal studies). I now caution my patients with its use. We will keep a very close eye on all these sweeteners.
I am always fascinate when religious or spiritual topics collide with medical evidences and/or disease. I am convinced that “the natural man” has trouble recognizing that all things are spiritual unto God (1 Corinthians 2:14). Unfortunately, training in medicine often attempts to “educate the spirituality out of you.”
However, this week,and in church today, I’ve been reading about “signs of the times.” Of interest, and something that I’ve been pondering, is the statement made in Luke 21:25-26 where the Savior, Jesus Christ, specifically foretells the signs of His Second Coming. Among the perplexities and distress outlined, one statement stands out this week and has been the food of much thought, “Men’s hears failing them for fear,…” (Luke 21:26).
This food for thought is actually what directed me to this verse, as I’ve had a number of people express notable fear and worry over whether their diet is correct, because so much miss-information abounds in society today. Argument, stress and fear over diet, apparently, is not new and was something that even Paul noticed and wrote about in his Epistle to the Romans (Romans 14:1-3).
Stress and fear are two of the biggest hindrances to health and weight loss in my office. The most common non-food cause of failing to maintain ketosis while living a ketogenic lifestyle is stress. Stress is often due to fear. Men, and women alike, become fearful because they seem to:
Forget their Purpose
Forget their Identity
When heartache arise from illness, injury, disability, death, divorce, wayward children and the other innumerable causes, stress and fear abound. Worry about diet and health, in a time when so much contradictory advise is at our fingertips, adds to that fear.
When we forget our purpose and our identity, three symptoms arise both physically and spiritually:
Apathy toward some or all parts of life (“It’s just going to change again so why even care . . ?”)
A mental slumber due to temporal or carnal pacification (“I can just eat and/or drink my problems away”)
Fear of change and the pain or effort it may take to make a change (“I don’t have the will-power to change anymore.”)
The scriptures call this “weak hands & feeble knees” (Isaiah 35:3), and we in medicine refer to this as dysthymia, the first step in progression toward chronic depression and/or anxiety.
These symptoms all increase chronic levels of cortisol and insulin. Amplified “brain fog,” weight gain, and inflammation are physical responses to the mental fear that is chronically unresolved. These symptoms just add to the apathy, mental slumber and fear of pain that was already present.
The problem is that over time, this progressive triad lead down the hormonal path to what we now call atherosclerosis, narrowing of the blood vessels, increasing the risk for heart attack, heart failure and stroke. This was seen in Hippocrates day as “sudden death related to episodes of chest distress” (Leibowitz, 1970). The Italian anatomist Giovanni Morgagni (1682-1771) described it in his day as “the force of the heart decreases so much more in proportion as the greater number of its parts becomes tendonous instead of being fleshy.”
SO, WHAT DOES ONE DO?
First, realize that the problems you are facing have been faced by millions of human beings and you are not alone. But, to paraphrase Irene Dunne, if you don’t stand for something, you will fall for anything.
I no longer believe in coincidence. Whether you have thought about it or not, every interaction you have with others (even our interaction . . . your reading this blog), are not by coincidence. There is a reason. Whether you believe it or not, everything around us testifies that God exists; the Hand of Providence can be seen from the rotation of the earth, planets and stars, the precision of the seasons, the balance of the atmosphere allowing for the perfect pressures and concentration of elements to sustain a life giving breath, to the perfect replication of DNA within billions of cells throughout the body.
I’m not trying to get religious, and, no, I can’t prove this through the scientific method . . . But, that is just the point. Hands are weak because of lack of faith. Faith is the substance of things hoped for, the evidences of which are not yet seen. Even though we do not see the evidences, we can discern the light and that gives hope. Hope is a substance that gives purpose. I can strengthen hands by sharing a little light and stabilize knees through friendship and fellowship (Romans 14:1).
If the Big Bang started the universe, what started the Big Bang? Where did the first atom or molecule or particle of dust come from? I have a very difficult time accepting that you and I are here by accident, by a chaotic explosion that created order. That implies that there must be a plan, and that plan had to have been set in motion by a Creator. You and I have a place in that plan. That also implies that that Creator placed solutions to our challenges, including the diseases of civilization, within our grasp and available to those seeking the solutions upon the earth today.
Second, today’s society teaches the Pleasure Principle. This is the human instinct to seek pleasure and avoid pain, including avoiding painful recollections. We often define ourselves by those things that bring us pleasure. We each go through personal tests, failures and triumphs. Some of us harness all of those experiences for good, others find worsening mental paralysis due to fear of them. We often hide from the painful experiences and attempt to bury or forget them. Food is often involved with many of the experiences of life, and for a significant number of people, the endorphin release from eating a meal, sometimes just the act of chewing, may be the only pleasure one experience in a day, in a week or a in a year. Many people hide from painful recollections behind the simple pleasure produced by the eating of “comfort foods.” Food, and our opportunities to experience pleasure from it’s various flavors, textures and physical stimulus, begin to define us. However, hiding from life’s painful memories with momentary pleasures usually prolongs or makes the problem worse. The ingestion of simple foods containing glucose and fructose, their effect on the liver, and the hedonistic hormonal response is the basis of addiction, and simple carbohydrates provide the perfect fix.
Fascinatingly, when fructose is metabolized in the liver, in the presence of glucose (the basic structure of sugar – one fructose molecule bound to a glucose molecule), the byproduct has a hedonic (pleasure experiencing) effect on the exact same pleasure receptors in the brain that bind to morphine. Yes, that’s why the M&M’s make you forget your troubles and why the Jolly Rancher is so jolly. And, its the same reason you crave another do-nut two hours after you ate the entire baker’s dozen.
Healing can only occur when one is willing to confront and talk about the reasons, the real reasons you’d rather experience the endorphins from the do-nuts with your family instead of acknowledge your weakness, stresses, and fears. Many of us are so afraid of where we might be, we avoid acknowledging where and who we are. It takes courage not to take the easy path. And I will be the first to admit, pizza is the easy path and it’s scenic views are decorated with french fry palms and sunset clouds of apple fritters.
Third, many cultures and most forms of religion or spirituality incorporate the use of fasting to one degree or another. Why fasting? Well, it removes the effect of the pleasure principle for starters.
Fasting is also a simple and inexpensive method of shifting the body’s metabolism to one of ketosis. Spiritual, physical and mental clarity are more prominent in the ketotic state. Finding your identity and purpose are often encouraged while fasting. In fact, a whole chapter in the Old Testament’s Book of Isaiah is dedicated to the powerful effects of fasting and the ketogenic state it produces (Isaiah 58:3-12).
Your life is never without meaning. Keep it real by recognizing that diet alone may not compete your answer for physical health. Having courage and faith allow you to see and embrace the truth that is right in front of you. The Alcoholics Anonymous’ 12 step program only becomes successful when one realistically and courageously applies their faith to align with the truth they have felt all along. For any long-term lifestyle change to take place, one must connect and live the principles before one truly knows they are true. In this way the Ketogenic Lifestyle becomes real and men’s hearts are less likely to fail them. You can start here: The Principle Based KetoDynamic Lifestyle.
“Doc, if I don’t get my testosterone up, I’m just going to die!”
I’ve been hearing that statement from men more and more often lately. And, the answer isn’t what you’d think.
If you’ve watched late night TV recently, you’ve probably seen the many advertisements for testosterone supplements for low testosterone in men or what is now being called “Low T” Syndrome. It seems like this is the new advertising trend so much that patient’s use the term “Low T” as part of their conversations.
Watch the four minute short below about how your testosterone and sense of fatigue is being driven by your oatmeal or breakfast cereal . . .
Is it that men have just stopped making testosterone? Suddenly, everyone’s testosterone is low and men are complaining about fatigue, libido, and erectile dysfunction . . . or are they?
It’s actually the oatmeal . . . and the breakfast cereals. Clinically, when a man cuts the cereals and oatmeal out of his diet, he actually increases testosterone by 50-150 points within 1-2 months.
If you practice medicine long enough, you’ll see a trend that seems to have arisen as our waistlines have expanded. About half of the men in my office with insulin resistance, pre-diabetes or diabetes have low testosterone levels. But this shouldn’t be a surprise. Type II diabetes, metabolic syndrome and insulin resistance are all driven by an over production in insulin in response to a carbohydrate load in the meal. Patients with these conditions produce between two to ten times the normal insulin in response to a starchy meal. A number of studies both in animal and human models demonstrate that insulin has a direct correlation on testosterone suppression in the blood. This has been demonstrated in both men and women. In fact, glucose intake has been shown to suppress testosterone and LH in healthy men by suppressing the gonadal hormone axis and more predominant testosterone suppression is seen in patient with insulin resistance or metabolic syndrome.
In fact, to put it simply, insulin increases the conversion (aromitization) of testosterone to estrogen in men (it does the opposite in women by interacting with the hormone FSH). Interestingly, leptin resistance has a similar effect. I tend to see the worst lowering of testosterone in men with both insulin and leptin resistance.
What that basically means is that your breakfast cereal or oatmeal decreases your ability to maintain testosterone by up to 50% (1), lowers your ability to stabilize muscle (2), increases your risk for heart attack and stroke and makes you fat!
Death by oatmeal . . . really?
Yes.
How to you improve your testosterone? Supplemental testosterone has been shown to help, but it comes with some risks, including prostate enlargement and stimulating growth of prostate cancer. The most natural way to improve your testosterone is to change your diet.
A low carbohydrate or ketogenic diet turns down the insulin production and allows the testosterone to be available for use by the body. A ketogenic diet has the effect of reducing leptin resistance as well through weight loss. A simple dietary change of this type is frequently seen in my office to increase testosterone by 100-150 points.
What is a ketogenic diet? It is a diet that restricts carbohydrates to less than 30 grams per day, thereby causing the body to use ketones as the primary fuel source. So, for breakfast tomorrow morning, hold the oatmeal (1/2 cup of Quaker Instant Oatmeal is 31 grams of carbohydrates) and have the bacon and eggs. And, rather than have the cheesecake for desert this evening, have an extra slice of steak butter on your rib-eye and hold the potato.
Or, you might consider using a high fat shake with exogenous ketones. This is my breakfast each morning:
Exogenous ketones mixed in sparkling water, 2 tablespoonfuls of coconut oil and my multi-vitamin and I’m usually full until after noon.
Either way, get rid of your breakfast cereals or oatmeal . . . it’s killing ya!
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.
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.
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:
Miasmatic Theory of Disease (A noxious poisonous vapor of air called miasma filled with decomposed particles of matter believed to be the cause of cholera and chlamydia or the Black Death)
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?
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.
Ketosis in 60 minutes . . .
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!)
Ok, for those of you who are using Keto/OS (I commend you for your insightful use of the next step in ketogenic metabolism bio-hacking), I have discovered one of my new favorite mixes. (If you’ve already tried this mix, then where have you been and why didn’t you tell me about it?!)
Enter Keto//OS – exogenous ketones that aid in shifting you into ketosis. Yes, they actually do work and usually bump my ketones up 0.5 mmol/L to 1.5 mmol/L when I use them.
So, I mixed my orange flavored Keto//OS version 2.1 with Diet A&W Cream Soda, and voala, Orange Cream that takes me back to childhood memories!! You gotta try this.
As you know, I have no problem with using Diet Dr. Pepper, Diet Coke (NOT Coke Zero!), Diet Mug Rootbeer & Diet A&W Cream Soda. The sweetener that these four sodas use does not kick you out of ketosis, and I am OK with my patients using them on my Ketogenic diet. (Yes, I am OK with most of my patient’s using aspartame. Yes, I’ve actually read the studies . . . have you?! That’s why I’m OK with it’s use.)
If you haven’t tried Keto//OS yet, you can get your sample here.
Alzheimer’s disease puzzle pieces now starting to fit
Alzheimer’s Disease is a progressively devastating, fatal disease that affects 5.2 million Americans and over 44 million people throughout the world. This disease is often more difficult on the families and caregivers, then on the patient’s themselves. With my office located near three of the country’s largest retirement communities, it is a disease that I see and treat every single day.
A paper published in the Journal of Alzheimer’s Disease this week, confirmed suspicions and patterns that I have been seeing for over 15 years. A significant number of my patients with Alzheimer’s dementia (AD) also have insulin resistance, impaired fasting glucose or diabetes mellitus – type II. I have long wondered if there was a tie to these diseases because of the patterns seen in my office. However, much of the research examining the association between type II diabetes and AD have come to differing conclusions about the cause. Some have concluded that insulin resistance is to blame and others have concluded that insulin deficiency may play a role. Other studies have found that a hormone called amylin secreted with insulin is to blame. And, other articles have found that both amylin and amyloid-beta protein form the plaques within the brain common to AD. Lastly, more recent data complied appears to point to the opposite conclusion – that amylin provides neruro-protective effects and may actually reduce the symptoms of AD. So, what are we to make of all of this? How is the doctor in the trenches to interpret and then advise those with or at risk for Alzheimer’s Disease?
The paper referenced above, by Dr. Schilling, takes all of this data into account and with careful attention to research methods and compiling immense amounts of data from all of these studies, it identifies the integration points with insulin and insulin-degrading enzyme (IDE) that have begun to disentangle the research. What it reveals is fascinating information.
First, under normal circumstances, we now know that insulin stimulates the expression of IDE, which subsequently breaks insulin down after it is used. IDE, however, also plays a roll in breaking down amyloid-beta protein and other amyloidogenic peptides. Alzheimer’s disease is caused by a build up of these amyloid based proteins forming plaques within the human brain.
Second, the body’s system for breaking down and removing these plaques can fail or become inefficient in four different ways. What has been confusion for many years to researchers is now much more clear with our clarified understanding of insulin resistance moving through five different stages (see my article on Diabetes Mellitus type II – really the fourth stage of insulin resistance).
What are these four possible points of breakdown?
In the fifth or last stage of insulin resistance (where insulin deficiency occurs due to pancreatic failure and lack of adequate insulin production) or in a type 1 diabetes patient who makes no insulin at all, inadequate IDE can result in accumulation of amyloid-beta in the brain. Poor IDE production may cause amylin and amyloid-beta plaques in the brain.
Diminished IDE production due to any other cause may lead to amylin and amyloid-beta plaque formation leading to AD
Excessive production of insulin, occurring in stages I-IV of insulin resistance, stimulates increased amylin production which competitively inhibit breakdown of amyloid-beta resulting in AD.
Production of more than the typical level of amyloidogenic peptide that outpaces the formation of IDE is the fourth mechanism occurring with insulin resistance and stimulates the formation of amyloid plaque in the brain consistent with AD.
Further study is essential to tease out what the nuts and bolts of the mechanism may be, but with our understanding of stages of insulin resistance, the puzzle pieces are falling into place. This conglomeration of data provides further confirmation that insulin resistance is likely the key player in the progression of Alzheimer’s Disease years before type II diabetes or type I insulin dependence are ever diagnosed in the individual.
What is the take home message today? Impaired fasting glucose, diabetes mellitus and Alzheimer’s disease are later expressions of the underlying problem: insulin resistance. This is where a low carbohydrate and/or ketogenic diet begins to play a huge role in both prevention and treatment of Alzheimer’s Disease.
More to come . . . In the mean time, pass the butter and the Keto//OS.
Be warned, a ketogenic diet may cause pregnancy . . . !
Infertility and poly-cystic ovarian syndrome (PCOS) is a common occurrence in women with insulin resistance, pre-diabetes and diabetes. When treated with a ketogenic lifestyle, these symptoms often improve dramatically, and in fact, I’ve had a number of women in my medical practice, previously unable to conceive due to PCOS, get pregnant after changing to a ketogenic diet.
As I reviewed my website recently, I realized that I have posted lots of science but I’ve never posted any success stories. So, as patient’s are comfortable & willing to share, I will begin posting these experiences here on the blogosphere for the world to witness their successes and the power of the KetoDynamic Antidote.
The first success story is my own. This picture of me and my wife, were taken after I had been following a ketogenic lifestyle for about 4 years. I dropped 60 lbs, normalized my cholesterol and blood sugar also normalized. I couldn’t and wouldn’t recommend these lifestyle changes unless I was willing to follow them for the long haul myself. I call people following a ketogenic lifestyle for longer than a year “Ketonians.”
Not only mine, but hundreds of patient’s having similar successes have become the greatest reward to my career as a physician over the last 15 years. They are truly the “KetoDynamic Moments” that etch themselves into my memory and have made me such an advocate of a ketogenic lifestyle. Therefore, it is with great honor and excitement that I have been allowed to share Michelle’s story below.
Michelle started seeing me in October 2015. She has struggled with weight all her life and, now in her late 40’s, weighed 201 lbs with a waist circumference of almost 36 inches and a body mass index of 32. Her “before” picture was taken just before a Halloween activity in 2015. Her “after” picture was taken in late March 2016.
A simple ketogenic lifestyle change ( <20g of carbohydrates, moderate protein for her ideal body weight & increasing fat to > 60% of total calories) has produced almost 50 lbs of weight loss and 6 inches off her waist in just 5 months. This was with dietary change only (Michelle doesn’t exercise) and she’s still losing weight. What is dramatic, and I see it every day, is that Michelle looks younger by at least 10 years (she actually added 20 years to her life span with this weight loss already). She feels fantastic. Blood sugar and cholesterol are now under control and she has tremendous amounts of energy. Her picture in March is at a body mass index of 29.
Michelle doesn’t calorie restrict. She just eats until she is full. Congratulations, Michelle!!! And, keep up the great work.
If you’d like to share your KetoDynamic successes with me and my audience, please let me know.
A patient recently asked me how bad being in nutritional ketosis was for her. I responded that the worse problem I’ve seen recently is the patient that broke his toe when he slipped on bacon grease. Are there risks with a ketogenic diet? Yes, but these usually only occur when you cheat or fall off the wagon. What problems can arise? Lets talk about them individually.
First, as I stated above, make sure you don’t slip on bacon the grease. It really can be an issue if you’re not used to using increased amounts of fat in your kitchen. So, be prepared for how to cook and use fat. Grandma understood this well, we could learn a great deal from her if you ask her about using bacon grease.
Second, let’s define the difference between ketosis and keto-acidosis and try to clarify the misinformation that is being spread around the blogosphere.
A ketone is a molecule the body produces from the breakdown of fat (specifically triglycerides) and some proteins (amino acids). There are specifically three types of ketones: beta-hydroxybutyric acid, acetoacetic acid and acetone. If ketosis was “bad,” then why would our bodies produce these molecules? They are not bad, and in fact, multiple studies show that the body is often more efficient in weight loss, inflammatory reduction, bowel function, epigenetic influence and maintenance of lean body mass more effectivly when it functions on ketones rather than glucose as its primary fuel source. You can see these studies here, here, here and here.
The body can only supply a limited amount of sugar or glucose for fuel. If you talk to runners, marathoners or triathletes, they will tell you that after about 45-90 minutes of continuous endurance exercise the glucose supply runs out and they will experience what is termed a “bonk” (have a low-blood sugar or hypoglycemic episode). Unfortunately, our bodies can only store about 18-24 hours of glucose.
However, the body can store days upon days of fat in the form of triglyceride in the fat cells. Triglyceride is broken down into ketones. If glucose is the “unleaded” fuel, you can think of ketones as the “diesel fuel” that is easier to store and runs longer.
The average body functioning on ketones as the primary fuel will have a ketone level measured in the blood somewhere between 0.4 and 4 mmol/L. Because of a balance that is created by the use of ketones and a feedback mechanism that kicks in when the ketone level rises, the body will maintain a pH of around 7.4.
Ketoacidosis is dramatically different. If you are a type I diabetic, you don’t produce any insulin. The feedback mechanism regulating ketone use is broken and the ketone levels and triglyceride breakdown speeds up because the body can’t access glucose and can’t produce insulin. The ketone levels spike and the level can rise to > 25 mmol/L. In the presence of a high blood sugar and high ketone level, the acid level in the blood shifts to a pH of less than 7.3. This is referred to as metabolic acidosis and can be life threatening as the low pH shuts down the bodies’ enzymatic processes and a person becomes critically ill and without treatment, can die. Further information on ketoacidosis can be found here.
If you’re not a type I diabetic, you have nothing to worry about. Regardless of what the “ketogenic nay-sayers” blog about, your liver makes approximately 240g of glucose per day, 24 hours a day, 7 days per week, this stimulates a basal release of insulin which keeps the pH in check. It’s also what keeps weight loss at a consistent pace of around 2-10 lbs per month.
If you are a type I diabetic, don’t fret. Carbohydrate restriction can still be used very effectively. It just takes some balancing and understanding of your individual metabolism. It does require close blood sugar and insulin monitoring. If you are a Type I diabetic, please talk to your physician, obesity specialist and/or bariatrician about how to follow a carbohydrate restricted diet while using insulin. It can be done and it can be done very effectively, but monitoring is essential.
What are the other potential problems that can arise when you follow a ketogenic diet?
Gastrointestinal (GI) Disturbances – Yes. Any time you change your diet you may experience diarrhea, constipation or gassiness. Most of the time, this is because you are either 1) not eating enough leafy greens (fiber) or 2) you’re using a supplement that contains an artificial sweetener. Most of the studies on ketogenic diets did not incorporate fiber and the studies used to make this point were on children who used a ketogenic fat supplement shake or liquid preparations containing these artificial sweeteners to make them palatable. If you have spoken to any obesity specialist, they will tell you, the best way to follow a ketogenic diet is to eat real food. If you want to read about the anecdotal GI effects of sweeteners, read the comment section in Amazon about the Haribo Sugar Free Gummy Bears.
Oh, by the way, 65% of patients in my practice following ketogenic diet see improvement in gastroesophageal reflux (GERD) symptoms. This was seen in a 2006 study looking at ketogenic diets and reflux.
Hair Loss/Thinning– Yes. This does happen initially and if you are not eating enough fat. It is important to note that hair loss/thinning can occur with any form of weight loss. You can see data on this here. Hair loss is very common if you are restricting calories, which was occurring in a number of the ketogenic dietary studies previously published. You do not, and should not, need to “restrict calories” if you are following a ketogenic diet correctly, and in fact, most people take in more than 1800 calories on a ketogenic diet.
Inflammation Risk– In every patient that I have placed on a ketogenic diet in the last 10 years, all inflammatory markers including CRP, Sedimentation Rate, Apo B, HOMA-IR and Uric Acid have all decreased. Inflammation gets better on an appropriately formulated ketogenic diet. The older studies of ketogenic diets in children contain most of their fat from Omega-6 fatty acids from vegetable oil which will increase inflammation and oxidative stress, spike the cortisol levels and have the secondary effect of actually raising the triglycerides. You can find more information on this here & here.
Kidney Stones/Gout – These (kidney stones & gout) are both commonly caused by spikes in uric acid. As noted above, I’ve seen multiple cases in my practice where a ketogenic diet lowers uric acid. Only a small clinical trial has been published in the literature (and it wasn’t truely ketogenic), but the results point to the potential for ketogenic diets to lower uric acid. Ketogenic diets also have the capacity to lower the formation of calcium oxalate stones through a secondary mechanism where calcium oxalate formation is driven by uric acid formation. Older small case reports in the pediatric seizure literature identify calcium oxalate stones, however, dehydration (too little fluid/water intake) is the primary cause of kidney stones.
So, are ketogenic dietary patients at risk? Only if you cheat on your carbohydrate restriction and you let yourself get dehydrated. So, I warn patients. Don’t cheat and make sure your drinking adequate amounts of water.
Muscle Cramps/Weakness– The process of weight loss occurs by burning fat into CO2 and water. We breathe the CO2 out, but the water produced has to follow salts out through the kidneys. Hence, we lose water and salts. This can cause weakness and muscle cramps. The solution? Stop restricting salt on a low carbohydrate diet. We are the only mammal that restricts salt and we do it because low-fat diets cause us to retain water. Low carbohydrate diets do the opposite. Use sea salt or sip beef or chicken bouillon broth with your dinner. You may consider adding magnesium to your diet. The use of yellow mustard also helps (the small amount of quinine in yellow mustard stops the cramping). If you have congestive heart failure, talk to your doctor about monitoring your salt intake in balance with your diuretic or water pill.
Hypoglycemia– If you read the ketogenic diet research, most of it was done on epileptic children. The diets called for a period of starvation, and then the introduction of a ketogenic liquid based shake following the John’s Hopkin’s protocol. It is a well-known fact in medicine that starvation in children can frequently cause hypoglycemia, especially in children with other genetic or congenital defects leading to forms of epilepsy. In clinical practice, with ketogenic diet use in adults, hypoglycemia is rare. The only time I see hypoglycemia is when patient’s with significant insulin resistance or diabetes cheat on a large amount of carbohydrate and get a secondary insulin surge leading to hypoglycemia 3-5 hours after cheating.
Low Platelet Count (Thrombocytopenia)– Again, this was seen in epileptic children who were placed into starvation first, then introduced a liquid fat replacement shake to stop intractable seizures. These liquids or shakes were often nutrient deficient in other essentials. Folic acid, B12 and copper deficiency can occur when not eating “real food.” Low platelet counts are rarely seen on ketogenic diets based around “real food.” Many children in the ketogenic studies had been on or were concomitantly on valproic acid for their seizures. Valproic acid is commonly known to cause thrombocytopenia and this is another reason that thrombocytopenia was seen in this population. (Barry-Kravis E et al, Bruising and the ketogenic diet: evidence for diet-induced changes in platelet function. Ann Neurol. 2001 Jan;49(1):98-103.; Kraut E, Easy Bruising, http://www.uptodate.com, May 2015.)
Impaired Concentration/Mood– A number of patients starting carbohydrate restriction will go through 2-4 weeks of carbohydrate withdrawal. This carbohydrate withdrawl can be experienced just as powerfully as morphine withdrawal in some patients. Sugar is a drug and has a powerful effect on the same hedonic receptors that morphine does in the brain. Some patients will experience headache, tremor and decreased concentration while “withdrawing” off of starches and carbohydrates. Studies show that after the 4-8 week period of keto-adaptation, cognitive function dramatically improves.
Easy Bruising – This is usually due to inadequate protein supplementation as was the case in much of the ketogenic literature where protein levels were also restricted. (Kraut E, Easy Bruising, http://www.uptodate.com, May 2015.)
Pancreatitis – Patients who are insulin resistant or have impaired fasting glucose commonly have high triglycerides. Elevation in triglycerides itself is a cause of pancreatitis. Ketogenic diets lower the triglycerides. However, if a patient has not been following their diet as directed, spikes in the triglycerides can occur placing the person at risk for pancreatitis.
Long QT Intervals/Heart Arrhythmias – The list of things causing Long QT intervals and abnormal heart rhythms is long and variable (Acquired Long QT Syndrome. Berul C et al. www.uptodate.com, May 2015). It is well know that starvation, rapid weight loss and liquid protein diets can cause a delay in the conduction signal in the heart. Anyone wishing to start any diet should have an electrocardiogram (EKG) through their doctor to ensure that the diet (of any type) doesn’t exacerbate a prolonged QT interval.
Cardiomyopathy– Prolonged QT intervals have been associated with cardiomyopathy and the former can stimulate the later. Any diet that has the potential to prolong a QT interval has the potential to cause cardiomyopathy. Hence the need for regular EKG monitoring on any diet (Acquired Long QT Syndrome. Berul C et al. www.uptodate.com, May 2015).
Lipid/Cholesterol Changes – In the 10 years I have been prescribing ketogenic diets to patients, I have seen dramatic improvement in the triglycerides, small dense LDL particle and HDL levels. The only time triglycerides rise over 100 is if the patient is using artificial sweeteners, is cheating on the carbohydrate restriction, or is taking in too much protein. Total cholesterol commonly rises, however, this is indicative of the fact that there is a shift in the LDL particle size and this affects the calculation of both total cholesterol and LDL-C. In light of this, most of my patients have dramatic improvement in triglycerides and small dense LDL particle number.
Myocardial Infarction – In older papers, elevated total cholesterol was noted and the authors made the “assumption” that myocardial infarction “could” be a risk. We now recognize that elevated Total Cholesterol is NOT a causitive risk for heart disease.
These previous assumptions have been interpreted by the blogosphere ketogenic “nay-sayers” as actual risk. However, a correlation and causation was never made. Again, in the 10 years I have been using and prescribing ketogenic diets, I have seen dramatic improvement in cholesterol profiles, inflammatory markers, atherosclerosis and carotid intimal studies (Shai I et al, Circulation 2010; 121:1200-1208).
Menstrual Irregularities / Amenorrhea– It is well known that any diet causing protein or other nutritional deficiency will affect the menstrual cycle first and growth in stature second. The only time menstrual irregularities occur with a ketogenic or Low-Carb diet is when a patient is not taking in enough protein and/or fat, and is not eating real food. What amazes me is that a properly applied ketogenic diet actually causes normalization of the menstrual cycle, and in my practice, I’ve had a number of women successfully be able to conceive after making a ketogenic dietary change.
Is a ketogenic diet bad for you? You be the judge.
If you are following a ketogenic diet correctly and with real food, the only thing you really need to worry about is slipping on bacon grease.
In an era where over 70% of us (35.7% obesity & 34% overweight in 2015 according to the CDC) have started to resemble the food pyramid, seeing the effect of a carbohydrate heavy diet should give a clue.
Our bodies were meant to burn ketones. We have a parallel system within us designed to use ketones as an energy source. Ketones are faster and more efficient than the way our bodies use glucose. Ketones give you 38% more energy than you can get from glucose. We as a society are following a deceptive food pyramid.
When we limit or remove carbohydrate from our diet, we are left with ketones as a primary fuel. It is time that we recognize what Dr. Yudkin was trying to tell us in 1970’s, that our carbohydrate and sugar intake is the driver for heart disease, diabetes and the diseases of civilization. (Yudkin, John. Sweet and dangerous: the new facts about the sugar you eat as a cause of heart disease, diabetes, and other killers. PH Wyden, 1972.)
If you are interested in the low-carb, moderate protein, high-fat, ketogenic diet, then this is the podcast for you. We zero in exclusively on all the questions people have about how being in a state of nutritional ketosis and the effects it has on your health. There are a lot of myths about keto floating around out there and our two amazing cohosts are shooting them down one at a time. Keto Talk is cohosted by 10-year veteran health podcaster and international bestselling author Jimmy Moore from “Livin’ La Vida Low-Carb” and Arizona physican and certified bariatric physician Dr. Adam Nally from “Doc Muscles” who thoroughly share from their wealth of experience on the ketogenic lifestyle each and every Thursday. We love hearing from our fabulous Ketonian listeners with new questions–send an email to Jimmy at livinlowcarbman@charter.net. And if you’re not already subscribed to the podcast on iTunes and listened to the past episodes, then you can do that and leave a review HERE. Listen in today as Jimmy and Adam answer more engaging questions about nutritional ketosis from you the listeners today in Episode 17!
I get this question almost daily. Sorry to burst your bubble, but there is NO exercise program that will give you “six-pack” abs.
Really. You can do sit-ups, leg lifts and crunches ’till the cows come home and it will do nothing other than give you abdominal cramps. It will also make you hungry. I don’t care what Men’s Fitness, Bodybuilding.com, Muscle Magazine, Shape or even Doctor Oz said. There are no “6 Best Exercises for Ripped Abs.” There is only one exercise . . . throwing the carbs in the trash (or giving them to the neighbor you don’t like.)
The “12 Step Ab Program” really only has ONE STEP . . . cut the carbs. Let me repeat that. There is only ONE STEP to “six-pack abs,” . . . cut the carbs. Cardiovascular exercise does nothing for amazingly toned abdominal muscles, other than make you hungry. Resistance exercise improves insulin resistance, but doesn’t build the abs. Avoiding the milk, rice, wheat, oatmeal and fruit allows the abs to appear. Yes, I’m serious. What do bears eat? Berries.
When did you last see the a bear with “six-pack abs?”
The only way to see your “six-pack” is to remove the fat covering your “six-pack.” The only way to get rid of fat covering your “six-pack” is to stop drinking it and lower the carbohydrate content to less than 20 grams per day. Seriously . . .
So you’ve done 100 crunches a day for six months? Do you see your “six-pack” now? Exactly.
I’ve said it before and I’ll say it again. Insanity is doing the same thing over and over and expecting a different result.
Staying in ketosis and adding 2-3 days of resistance training will melt 2-5 lbs of abdominal fat away each month. Yes, I know it is slow . . . but that is weight (fat) that will stay off. Use whole foods high in fat, moderate in protein and low in carbohydrate. Use supplements like Keto//OS & Adapt bars to help when you don’t have access to a good meal or as a snack when you are hungry. Look at the list of Low Carb Links above to get great ideas for meal preparation and sweeteners that you can use.
It’s been cold this winter and as I was lighting a fire in the fireplace, a thought crossed my mind.
Why is it that only one match seems to start a forest fire, but it takes the whole box to start a campfire?
So, thinking back to my Boy Scout days, I began walking through the process of what it takes to get a good warm fire going. As a Boy Scout while camping in the snow, we used to have contests to see who could, using a single match, start the fastest camp fire. (We would use our most “MacGyver-like” skills). It occurred to me that the same timeless principles that allow one to ignite a fire with a single match are the same principles necessary for “fat burning.”
Maintaining ketosis is much like starting a campfire. There are some basic principles you need to understand. First, too much fuel keeps the fire from starting and too much carbohydrate or too much protein keeps the body from shifting into ketosis. Starting a campfire with a single match requires very fine thin strands of tinder to get started. If the peices are too big, the fire is smothered and cannot get started. It is the same with ketosis. Too much carbohydrate or protein smothers ketosis. You can get a copy of my ketogenic diet through registration on my membership site, by seeing me a patient face to face in the office or through a Tele-Medicine visit.
Second, oxygen is essential. For a fire to start, the flame needs a very small piece of fuel (wood or dryer lint) and large amounts of oxygen to burn. In ketosis, you have to provide the fat. If you’ve removed the carbohydrates and moderated the protein, but not provided enough fat to ignite the ketones, the body thinks it is starving, produces stress and shifts into making it’s own form of glucose for fuel through the process of glyconeogenesis (see my articles on why chicken salad makes you fat, and why your oatmeal is killing your libido).
Third, campfires often don’t have enough heat to get started. You have to get the temperature up before the wood can catch fire. This can be done in the camp fire by making a “cabin” the tinder can sit on and then building the “cabin” around the tinder as the fire builds and the heat increases. The increased heat and oxygen from under the tinder allows the larger pieces of wood to ignite and stay lit. In a ketogenic diet, the use of real food is similar to the cabin. Providing real food sources, instead of processed shakes and bars, allows for all the natural vitamins and minerals to let the ketosis start and ramp the metabolism up. Providing the correct vitamins also allows for the metabolism to have the ability to ramp up ketosis. I designed the KetoEssentials Vitamin specifically for this reason.
So, there you have it, the Paradoxical Effect of Fire and of Fat.
Don’t use too much fuel: Start with tinder for the fire – Limit the carbohydrates and moderate your protein (see how to balance protein here) to get into ketosis
Provide for increased oxygen for a fire – Provide adequate fat for ketosis
Provide a setting where the heat can build for a fire – Provide real food and appropriate vitamin sources for optimized metabolism in a ketogenic lifestyle.
You can see today’s Periscope discussion on this topic below:
So, how do you manipulate the hormones in a way to control the rebounding hunger and suppression of metabolism? This is where we put a bit of twist on the knowledge we’ve gained from alternate day fasting. Recent research shows that “mild” energy deficit in a pulsatile manner, that has the ability to mimicking the body’s normal bio-rhythm’s is dramatically effective in reducing weight and maintaining normal hormonal function without cause of rebound metabolic slowing (4).
raise insulin levels without raising blood sugar and are not appropriate for use with a true low-carbohydrate/ketogenic diet. You can see and print the article I published clarifying which sweeteners you can use and which ones to avoid here:
When we forget our purpose and our identity, three symptoms arise both physically and spiritually:
insulin. Amplified “brain fog,” weight gain, and inflammation are physical responses to the mental fear that is chronically unresolved. These symptoms just add to the apathy, mental slumber and fear of pain that was already present.
Second, today’s society teaches the Pleasure Principle. This is the human instinct to seek pleasure and avoid pain, including avoiding painful recollections. We often define ourselves by those things that bring us pleasure. We each go through personal tests, failures and triumphs. Some of us harness all of those experiences for good, others find worsening mental paralysis due to fear of them. We often hide from the painful experiences and attempt to bury or forget them. Food is often involved with many of the experiences of life, and for a significant number of people, the endorphin release from eating a meal, sometimes just the act of chewing, may be the only pleasure one experience in a day, in a week or a in a year. Many people hide from painful recollections behind the simple pleasure produced by the eating of “comfort foods.” Food, and our opportunities to experience pleasure from it’s various flavors, textures and physical stimulus, begin to define us. However, hiding from life’s painful memories with momentary pleasures usually prolongs or makes the problem worse. The ingestion of simple foods containing glucose and fructose, their effect on the liver, and the hedonistic hormonal response is the basis of addiction, and simple carbohydrates provide the perfect fix.
If you are interested in the low-carb, moderate protein, high-fat, ketogenic diet, then 
