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.
Check it out:
I hear this all the time. “I can’t eat keto because. . . ”
What is your excuse?
I am amazed at how tightly people cling to these excuses. They are just that excuses. In the 16 years I’ve been training people how to use these diets to treat disease, I have yet to find one that is not just an excuse that covers up the real reason . . .
Check out my video on this:
I’ve had many of my patients and followers on social media ask about my continued use of the hashtag #JustKeepEsterifying. Well, here is the answer. Check out the short 4 minute video below to get the answer:
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.
Now you know!
The most common complaint that I get in my office when someone has started a ketogenic diet is, “Doc, I feel fatigued. Will this ever go away?”
That feeling of fatigue, some refer to as the “keto-flu,” is usually due to a couple of things. First, you may not be eating enough fat (I recommend a 1 gram to 1 gram ratio of protein to fat when getting started). Second, you’re not taking in enough salt (specifically sodium, potassium, magnesium and/or zinc). These four salts are essential electrolytes our body requires for proper function.
If salt is the problem, the you will be experiencing leg cramps. Cramps during daytime activity are usually due to low sodium or potassium levels. Cramps that wake you up at night are usually due to low magnesium or zinc. Leg cramps can also be due to hypothyroidism or significant blood sugar swings. Dr. Nally will usually check for this during your visit with him.
“But isn’t too much salt bad for you?” I am frequently asked.
Too much salt is only bad for you if you’re eating a “low-fat” diet.
What if increasing salt intake actually lowered your blood pressure?
Did you know that increasing your salt intake can actually improve your diabetic blood sugar if you are following a correct diet? Could it be that easy?
Almost every patient that I see in the office has a significant worry about salt intake, some greater than others. In fact, some people are so fearful about salt that when I initially began encouraging its use, they told me that I was crazy, and they left my practice.
Has restricting salt over the last 50 years really worked, or is it doing more damage than we think?
That was the question that was asked by Dr. Ames in the American Journal of Hypertension 17 years ago. However, his answer never got a mention. In fact, I’ve been in practice for almost 20 years, and incidentally stumbled upon this article when it was mentioned by a colleague of mine. Granted, the study is a small sample size of people, only twenty-one. However, the results are profound.
Twenty-one patients with hypertension were randomized to periods of no salt (placebo) and periods of 2 grams (2000 mg) of sodium chloride four times a day (a total of 8 grams of salt per day). Glucose tolerance tests were completed with insulin levels at the end of each intervention period.
Insulin Resistance and Hypertension Improve by Adding Salt
Three very noteworthy results happened. First, those patients with insulin resistance and diabetes had improvement in their glucose levels while on 2 grams of sodium supplementation.
Second, those with hypertension also, shockingly, showed improvement in their blood pressure while on the 2 grams of sodium supplementation.
Third, those with insulin resistance had a lowering of their insulin levels during the period of increased sodium intake. These findings fly in the face of the dogma that’s been drilled into our heads that “salt is bad!”
“But, Dr. Nally, you can’t base your findings on a small group of 21 people,” the experts say.
Yes, it is a small study group. However, these findings are identical to what I, also, see clinically every day in my practice for over 20 years.
We know that the average human needs at a minimum 3 grams of sodium per day and 3 grams of potassium per day. The standard American diet (SAD diet) including processed foods contains 2-3 grams per day of sodium and potassium. In fact, the CDC claims the worst salt containing meals for you are:
Insulin also stimulates additional retention of sodium at the kidney level. If you are insulin resistant, producing excess insulin in response to starches or sugars, you retain notably larger amounts of salt when eating the standard American diet (SAD diet) or a “low-fat” diet. However, if your following a low-carbohydrate or ketogenic lifestyle, you won’t be eating the meals above and you’re probably not getting near enough salt.
Salts, or electrolytes, are essential in normal cellular function. Low salt in the body is like running your car without oil. It will run, but not very efficiently and over the long term will cause problems. This is the cause of the keto-flu I wrote about previously. And, according to the study above, it is a potential driver of our persisting insulin resistance, diabetes and hypertension.
How Much Salt Should I Use?
In my office, I encourage use of 3-4 grams of sodium and 3-4 grams of potassium daily when using a ketogenic lifestyle. That’s approximately 1 ½ – 2 teaspoons of salt per day. I like the Redmond’s RealSalt or pink Himalayan salt because these products contains all four types of salt (sodium, potassium, magnesium and zinc).
It is probably that your salt restrictions is making your insulin resistance and blood pressure worse. That’s what the clinical evidences are pointing toward, and it is what I see every day in my office.
Want to know more about a ketogenic life-style? Click the KetoLife link to get some basics.
If you’re already following a ketogenic lifestyle, then let me help you navigate the bumps and turns by going to the KetoKart and checking out the products I recommend to jump-start ketosis DocMuscles-style!
Until then, I’ll have another piece of bacon, please . . . and, oh, pass the salt!
“Do I really need to be doing that ‘Keto Thing’?”
I get asked this question all the time. And, my answer is that 85% of the people that walk through the doors of my clinic will not be fully successful in weight loss, reversal of diabetes, normalization of blood pressure and reversal of heart disease and/or vascular disease without it.
I am frequently asked, “Is Keto for everyone?” Does everyone need to follow a ketogenic lifestyle? The answer is “No.” 15% of the population will be able to maintain great health with calorie restriction and exercise. However, the principles that provide a successful ketogenic lifestyle are easily understood and incorporated by anyone looking for improved health, energy and weight control.
Insulin is the master hormone when it comes to weight loss and the diseases of civilization. Whether you are insulin resistant or not, insulin is essential for life and proper function of the cells of the body, but too much insulin production in response to sugars, starches or complex carbohydrates causes disease.
How do you know if you are insulin resistant (producing too much insulin)?
Skin tags are pathognomonic (a characteristic indicative of the presence of disease) for insulin resistance. If you have skin tags, you may want to focus your diet on increased carbohydrate restriction.
You may not need to completely remove carbohydrate from your diet, however, recognizing that not all carbohydrates are created equal and avoiding those with higher carbohydrate content will help many improve weight and halt the progression of disease. I have many patients that with just partial carbohydrate restriction they are able to lose 20-30 lbs, improve their cholesterol profiles and improve their blood pressure.
There are sixteen different diseases that respond very effectively to carbohydrate restriction. You can read about them and how the ketogenic lifestyle effectively reverses them in The Keto Cure.
Saturated Fat and cholesterol aren’t the demons we’ve made them out to be. Another way to put it is: “Don’t blame the butter for what the bread did.”
Since 1984, nutrition experts treat fat and cholesterol containing foods like the witches of Salem. Experts castigate their use as if they were the “Avada Kedavra“ curse of the fantasy world.
As an example, eggs, specifically the egg yolk (the part of the egg containing all the cholesterol and saturated fat), have been demonized by just about every health magazine I’ve ever read. (To this day, the chef at every breakfast bar I’ve ever visited asks if I want an ‘egg white only’ omelet.) Interestingly, there is actually no scientific data association between whole egg consumption and heart disease. The science simply does not exist. Seriously, check for yourself.
I personally eat 6-8 eggs a day and my cholesterol is perfect. Back 1000 years ago, only the aristocrats at the chickens. All laborers and serfs ate the eggs . . . who would be dumb enough to eat your food source? (Don’t answer that.)
For example, the MR-FIT study, the largest cholesterol study ever completed, is incessantly quoted as the study that demonstrates reduction in cholesterol leads to reduction in cardiovascular disease, but this trial was actually a failure and did not demonstrate improved risk by lowering cholesterol. In fact, the Director of the study, Dr. William Castelli stated, “. . . the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol…”
Researchers found that people who ate the most cholesterol, including the most saturated fat, weighed the least. They were also the most physically active. In fact, the British Medical Journal published a 2015 study demonstrating that saturated fat is NOT linked to vascular disease, diabetes or increased mortality (de Souza RJ et al., BMJ 2015,351:h3978).
In my clinic, the basis of appetite suppression is eating adequate protein that includes saturated fat and cholesterol. This is the most powerful tool in my clinical approach to the treatment of weight loss. I can use foods like red meat, bacon, butter and coconut oil without concern or worry of heart disease as long as you are keeping your carbohydrate intake less than 20 grams per day.
Baseline insulin levels allow for peace of mind about heart disease risk. Heart disease risk goes down when insulin levels are maintained at normal baseline levels. Increasing saturated fat, while at the same time lowering carbohydrate intake has been demonstrated to shift the cholesterol to a more heart protective form (Griffin BA et al., Clin Sci [Lond], 1999 Sep).
Ketones in the blood at a nutritional level (0.5-4 mmol/L) have tremendous anti-inflammatory and age slowing effects on the body. Even having them present intermittently has dramatic improvement on overall inflammatory changes and disease in the body.
Ketones are the usable fuel of the body when the liver breaks down fat for energy. They suppress the NLRP3 inflammasome in every cell in the body. This is important because it allows for more rapid recovery from exercise. It also dramatically decreases pain and fatigue that comes from diseases like arthritis, rheumatoid arthritis, multiple sclerosis and auto-immune disease (Y.H. Youm, et al., Nature Medicine, vol. 21, no. 3, pp. 263–269, 2015.)
If full blown ketosis isn’t for you, partially restrict starch and carbohydrates for a mild to moderate benefit. Even small amounts of ketones in the blood are helpful. This provides increased recovery time, and improved inflammation control.
So, even if you don’t follow a strict ketogenic lifestyle, the principles above are powerful. These three principles make this dietary approach universally effective for weight loss. They are also very powerful for disease management. Even partial application of carbohydrate restriction can benefit just about everyone.
You can learn much much more about the Ketogenic Lifestyle as a member of DocMuscles.com. Click the link and sign up now.
And, don’t forget to get your signed copy of my book, The Keto Cure.
So, you’ve started a ketogenic lifestyle and you’re a few months in . . . but, is it really working? How do you know? You should be seeing your waist shrink. But, is all that butter really good for my cholesterol? What about my blood tests?
I commonly get these questions over the last 12-13 years of using a low-carbohydrate or ketogenic lifestyle approach in the treatment of obesity, diabetes, cholesterol and high blood pressure. We can determine the effectiveness of the diet on your metabolism with some simple blood testing.
Watch the video below to find out what tests are right for you:
Why don’t you check all the other inflammatory markers like HS-CRP, Lp(a), etc? Because, I know that these test will be elevated if insulin is > 5 mmol/L and if sdLDL particle is > 500 nmol/L.
Check out our membership site and the benefits that come with it.
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.
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.
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.
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.
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).
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.
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).
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.
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.
“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.
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.
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!”
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.
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.
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.
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.
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.
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 . . . )
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.
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.
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?
Founded by the Secret Society of Happy People in 1999, August 8th was officially named the National Day of Happiness. It was a day created to recognize and express happiness. (I personally think it should involve the sharing of bacon, but some may disagree.) Most people, whether they admit it or not, are searching for happiness. (Most people are searching for bacon, too, . . . but that is for another article.) We hope for happiness, we aim for happiness, and we wish happiness upon our family, friends and neighbors at holidays and birthdays. It appears to be a desired condition of the soul.
In medical school, we learn that the body is almost 80% water. One of my professors 
intelligently quipped, “if you’re unhappy all day, that means you are essentially a cucumber with anxiety.” For many people, happiness is really hard to find. Money is hard to find . . . but, that’s because it gets wasted by people trying to find happiness
What exactly is happiness? It is a transient condition or state of cheerfulness, contentment, satisfaction or pleasure. Many people mistake meaningfulness as happiness. Meaningfulness to one’s life is more enduring. For example, suddenly having a wind-fall of cash may make you happy for the short term. However, what you actually do with that cash over the next few days, months and years is what brings degrees of meaning to your life.
Happiness is based upon your emotional & spiritual vision, and how living your life aligns with the principles you hold most valuable. You can’t control all of the circumstances of your life. Things both good and challenging will happen to you that you never expected. However, you have control of your own happiness. You and I are the architects of it.
In working with a majority of patients who are over 65 years old, I have found that the older we get, the more we look back and realize that external circumstances don’t really matter or determine our happiness. We determine our happiness.
How do we increase our level of happiness? There are 10 Simple Steps to Happiness:
As a doctor, I’m a huge advocate of improving your health which plays a dramatic role in happiness. Losing as little as 10 lbs has been shown to improve energy, decrease your risk for major disease, improve sleep, improve sex life, and decrease inflammation. Improvements in any of those areas will reduce stress and anxiety and increase happiness so you can imagine while improvements in ALL of these areas could dramatically change your life.
As an advocate of the ketogenic lifestyle, I’ve found that the majority of my patients are able to lose 5-15 lbs each month for the first three months using this approach. They average 2-5 lbs pf weight reduction each month there-after while following a ketogenic approach over the long term. Understanding that this is one of the long term keys to success in happiness I want to make sure you know that I’ve developed some custom strategies to help with this and will share them with you below. This lifestyle decreases risk for diabetes by 75%, improves mental clarity, and slows the aging process. (Who wouldn’t want those side effects while eating bacon?)
First, savor the daily experiences. We live our lives at such a high speed, we often neglect to take time to enjoy the experiences around us. A recent trip in down town Amarillo, Texas, brought me to the front doors of a restaurant that served cream-cheese & sausage stuffed, bacon wrapped, jalapenos (try saying that 5 times fast). I had a bit of time and decided to try them. It was the first time in 3-4 days that I actually had the chance to slow down and savor the place around me, the flavors of the food, and the atmosphere of the restaurant.
Just taking a bit of time to savor these things made this experience a very memorable and happy experience that I probably won’t soon forget.
Take 3-5 minutes today to just think about where you are. Savor the smell of a rose, the color of the sky, the shape of the clouds or the sight of a bird. These sensory images can, and will, leave indelible memories and release dopamine and serotonin naturally in the brain. Savoring the daily experiences of life can be part of the process of meditation we will talk about below.
Get involved and volunteer in meaningful activities around your neighborhood, church & community. Research shows that voluntarily giving of time increases happiness in the giver. It also allows one to see, participate with and help those around you who may be less fortunate. Volunteering your time and energy regularly increases your gratitude we will discuss further below.
Expressing gratitude daily has been shown to dramatically increase your sense of well-being and happiness. Expressing gratitude requires awareness. It requires you to take inventory of everything around you (something you will already be doing if you are savoring your daily experiences). Gratitude can be expressed in a journal, through prayer & meditation, or directly to those around you. However, expressing gratitude requires effort.
In the Judaeo-Christian view, expressing gratitude is actually a method of expressing faith. The 17th chapter of Luke holds a biblical example of this concept. When the leper returned to express his thanks to Jesus Christ for being healed, he wasn’t told “Your gratitude made you whole.” Christ told him, “Thy faith hath made thee whole.” He implied that the act of expressing gratitude is a demonstration of faith, a necessary and essential process in human development.
I’m not talking about your bank statement or personal financial statement. I’m talking about recognizing the value of your soul. The only successful non-medication based program to help people overcome addiction is the 12-Step Program through Alcoholics Anonymous. The essential second step of the twelve is recognition that a power greater than ours is involved in our lives. Whether, you believe in God or a greater universal power, recognition of your value is an essential perspective to gaining happiness. This has been demonstrated thousands of times through the 12-Step Programs.
Often, the feeling we have of our personal worth is based on the love and interest we receive from those around us. Yet, this love is sometimes lacking. The love of men is often imperfect, incomplete, or selfish. What if you looked at yourself with the same benevolence, love, and confidence that God does? Imagine the impact it would have on your life to understand your eternal potential as God understands it. If you could view yourself through His eyes, what influence would that have on your life? Recognition of this principle is essential to making any lasting change.
The celebrated Greek poet, Pindar, said, “Become who you are.” Isn’t this a paradox? How does one become who they already are?
Many of my and the younger generations grew up to the sounds and images of The Lion King. You probably remember the scene where Simba receives a visit from his father, Mufasa, the deceased king. After his father died, Simba fled from the kingdom because the guilt he felt about his father’s death. He wanted to escape his responsibility as heir to the throne.
His father appears to him and warns him: “You have forgotten who you are and so have forgotten me. Look inside yourself, Simba. You are more than what you have become. You must take your place in the circle of life.” Then this invitation is repeated several times: “Remember who you are. … Remember who you are.”
Simba, completely shaken by this experience, decides to accept his destiny. He confides in his friend, the shaman monkey, that it “looks like the winds are changing.”
The monkey replies, “Change is good.”
And Simba says: “But it’s not easy. I know what I have to do. But going back means I’ll have to face my past. I’ve been running from it for so long.”
“Where are you going?” the monkey asks him.
“I’m going back!” cries Simba.
(This is also a great movie because of the “bacon references:”)
Admit it. You smiled didn’t you!
Meditation and prayer have been shown to actually change areas of the brain that relate to stress management and mood regulation. People who meditate regularly over long periods of time have better ability to find and maintain positive states like joy and compassion. Richard Davidson and his colleagues found that meditation increases brain activity in areas related to happiness as well.
Happiness has been linked to quality relationships as well. Robert Wallinger, psychiatrist at Harvard University, conducted a 75 year multi-generational study on happiness. He found that the quality of the relationships was powerfully connected to happiness. Lonely people were less happy and had poorer health. People with higher-quality relationship or social ties were the happiest.
However, it wasn’t just having a relationship, but having one with a stable and consistently caring person that made the difference. Having lots of acquaintances or being in a relationship with an unreliable or abusive partner did not make people happier. Amazingly, listening (savoring shared experiences) and complimenting (expressing gratitude) improve the quality of relationships. (Sharing your bacon improves relationships as well.)
A number of studies have demonstrated that a ketogenic diet increases gamma-aminobutyric acid (GABA), a key neuro-hormone signaling satiety and pleasure, in the brain. GABA increases sensations of happiness and euphoria. (Yes, this is why eating bacon makes you and I happier. It’s probably why the thought of bacon in the video above made you smile.) Shifting into a ketogenic state at least periodically has the effect of increasing your sense of happiness throughout the day. It is actually the ketone that does this. Whether you get into ketosis through diet alone, or through the use of exogenous ketones, both methods are effective in aiding you in your quest for happiness.
I know you are probably familiar with the term it is better to give than receive but did you know there is evidence to support the reverse is true too? That happiness also comes from allowing others to help? Think about it. When you are helping others, especially when they appreciate it, you feel happiness or joy. Others experience those same feelings when they are able to help you. Think of a child that wants to make you a meal. No matter what it looks like when it gets to you, you smile and feel happy at the effort, the child smiles back proud at their success. There is happiness in giving and receiving.
So today’s your chance to receive. As a doctor, I find myself shying away from sharing this information with you directly because I never want anyone to feel like my efforts are about me. I’ve spent years learning and understanding the benefits of a Ketogenic lifestyle and spent additional years researching products that work and my local patients are experiencing tremendous results! A friend told me that not sharing this information with people directly was actually being selfish. (Ouch!) “When you know someone has a problem that you can solve, shouldn’t you share it and let them make their own decisions?”
Although that was painful to hear, it helped me commit to being more direct about how I can help all of you to feel better. If you are ready to change the way you feel and want to live a happier, healthier life, the time is NOW. Put these 10 steps in action and enjoy the benefits of a KetoLifestyle. If you want to know more about what I do, keep reading my blog, join my weekly newsletter and watch me Live Stream every week on Facebook Live & Periscope giving you free tips and tricks to stay healthier. If you know you are ready for a change, and you want to see how I can help, check out the variety of Ketogenic programs I offer to help you find the Happiness inside You! Because we all love gifts and they make us Happy, in honor of #NationalHappinessDay, you should see a pop up here for something special! ] Be sure to click here to go to the Keto Kart and cash in on better health!
However you decide to approach your day today, choose to be happy. It really is up to you.
Happy National Cheesecake Day!
Yes, you heard me correctly. It is National Cheesecake Day today. Today you must eat cheesecake – or you could be considered un-American.
“I can’t eat cheese cake, I’m doing a ketogenic diet!” you exclaim.
“Yes. So am I.”
Eating cheesecake is actually good for you, (low-carb cheesecake that is) and it’s also good for your family. This is the perfect day for ketogenic cheesecake . . . like my wife Tiffini’s Low-Carb Key Lime & Blueberry Cheesecake and as my gift to you for #NationalCheesecakeDay, you can get the recipe by filling in that pop up box!
And, “NO – I know what you’re thinking,” you can never have too much heavy whipped cream.
So, why am I so excited about National Cheesecake Day? I love low-carb cheesecake for a number of reasons.
National Cheesecake Day makes me think of testosterone.
I know. Leave it to a man to start with testosterone, but in the big picture, a man really isn’t a man without testosterone, right? I mean, it was during the 5th week of embryonic development that my Y chromosome began signaling the differentiation of male fetal growth in-utero. And like every male, that same hormone, testosterone, continues to differentiate me from the human female counterpart throughout life. (And, boy am I grateful for that.)
The reason testosterone comes to mind is that I see a large number of men with low testosterone. Low testosterone has become a significant issue. 20-30% of the men in my practice suffer from some degree of suppression in testosterone when they first present in my office. In fact, you can’t watch late night TV without being asked if your testosterone is too low (“Do you have Low ‘T’?”).
We know that the primary nutrient shown to affect testosterone to the greatest extent is fat. Studies reveal that diets low in fat and high in carbohydrates are associated with lower testosterone compared to diets high in fat (1, 2). That begs the question, has 50 years of our low-fat high-carb diets made us less manly? I am convinced, but I’ll let you be the judge when you look at the pictures below . . .
When did this become acceptable?
Testosterone is essential in providing energy, muscle mass & growth and actually keeping the waistline down. Adequate testosterone is one of the key components allowing the man to fill the fatherhood rolls of protector and provider.
Interestingly, the female brain is actually subconsciously wired to see the male physique and identify pheromones indicating your testosterone is higher or lower. Most women won’t admit it, because they probably don’t even recognize it, but studies show that men who lack muscle, have lower testosterone and have a beer belly are actually less attractive to the female sex. Men who produce more testosterone produce androstadienone in their sweat at a greater concentration which can be detected by the female improving her mood, focus and sexual response (9). If your diet isn’t helping you stimulate testosterone production, you’re less inclined to perform well in areas requiring its presence and you may be seen as less attractive by the women in the room.
That means that, bacon and eggs you craved this morning improve your manliness and actually give you more sex appeal. And, I’m sorry to say, the bagel and orange juice you had this morning are feminizing, they’re turning you into a woman, especially if you are like 85% of other men who over produce insulin because of insulin resistance.
When insulin is high and being over produced, it suppresses Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH), lowering testosterone production. The high insulin and high fructose of the bagel and orange juice stimulate increased uptake of fat into the fat cells and decreases adiponectin production. This causes increase in Sex Hormone Binding Globulin (SHBG) which further decreases available testosterone. High insulin and low adiponectin puts your “man card” through the wash.
Men need muscles for all sorts of important things. It’s often Dad who carries the child on his shoulders, or lifts you above his head. It takes muscles for that.
We talked about the importance of testosterone in muscle development. That that’s not all. Many men can provide for their families specifically because of their ability to use that muscle. I’m not saying women can’t use muscle, too. In fact, muscle is essential for the female body to be healthy. What I’m saying that there are a number of jobs that make our country function that require men who are fit. Jobs like policemen, firefighters, special-ops military teams, construction workers, life-guards & delivery drivers require the strength and power men bring to these fields. These jobs require muscle, and specifically “manly” muscle from healthy testosterone.
In addition, we know that ketones, the primary fuel in a ketogenic diet, inhibit muscle breakdown by decreasing leucine oxidation and preserving muscle mass (3). Being in ketosis increases testosterone and increases the presence of leucine preserving and allowing for bigger stronger muscles. So, yes, visiting the donut shop actually does make you less manly by allowing the more rapid degradation of your muscles.
“Wasn’t it my muscles that first got your attention when we met and got this whole father thing started in the first place, honey?” I asked my wife in the kitchen.
“What?! No . . .” she responded.
“Oh, . . . never mind.”
Whether you have great muscles or not, you need energy for the muscles you have to fill your role as a man. Work requires energy. As fat is increasingly used as your primary fuel, instead of sugar, the liver converts it into ketone bodies, or ketones. The liver itself, doesn’t use the ketones, so they are taken up by the muscles and brain for fuel. Increased energy, mental clarity and suppression of inflammation are the key findings that are noticed while using fat as your primary fuel. What man couldn’t us a little more of that?
In fact, several studies report that the man in the home has the biggest impact on the overall fitness and on the overall weight of his children. It was found that the father’s, not the mother’s, total and percentage body fat was the best predictor of whether or not the couple’s daughters gained weight as they got older (4). All the more reason to keep your waistline under control, Dad. And, all the more reason to have low-carb cheesecake today.
Another fascinating study showed fathers’ (again, not the mothers’) body mass index is directly related to a child’s activity level (5).
Energy and muscle is essential for “rough-housing” and there is science to prove that “rough-housing” makes your kids awesome! Psychologist Anthony Pellegrini found that the amount of rough-housing children engage in predicts their achievement in first grade better than their kindergarten test scores do (10). What is it about rough and tumble play that makes kids smarter? Well, a couple things.
Rough-housing makes your kids more resilient. Strengthening resilience is a key in developing children’s intelligence. Resilient kids tend to see failure more as a challenge to overcome rather than an event that defines them. Intellectual resilience that comes from energetic fathers helps ensure your children bounce back from bad grades and gives them the grit to keep trying until they’ve mastered a topic.
Neuroscientists studying animal and human brains have found that bouts of rough-and-tumble play increase the brain’s level of a chemical called brain-derived neurotrophic factor (BDNF). BDNF helps increase neuron growth in the parts of the brain responsible for memory, logic, social intelligence and higher learning–skills necessary for academic success. We, also, now know that the brain that uses fat, or ketones, as its primary fuel recovers from injury and makes BDNF more effectively (6,7).
So, remember, that rib-eye with steak butter your kids gave you for dinner and the low-carb cheesecake you had for dinner is actually making you and them smarter and more resilient. You could even say that a diet high in fat and low in carbohydrate gives your family more grit.
The Harvard Grant Study completed in 1934, the longest longitudinal study ever done on the lives of men, found that a man’s father influenced his life in multiple ways exclusive to his relationship with his mother. Loving fathers imparted to their sons:
It should be noted that “it was not the men with poor mothering but the ones with poor fathering who were significantly more likely to have poor marriages over their lifetimes.” Men who lacked a positive relationship with their fathers were also “much more likely to call themselves pessimists and to report having trouble letting others get close” (8).
You, as a testosterone producing man and father, matter. And, being in ketosis makes you an even better father! Seriously.
When all is said and done, a man’s relationship with his father very significantly predicted his overall life satisfaction at age 75 — “a variable not even suggestively associated with the maternal relationship” (8).
So, to circle back, the low-carb key-lime cheese cake just made me more manly. Thanks, Honey! Happy National Cheesecake Day!
Crust:
2 1/2 cups macadamia nut flour (salted tastes better)
1/4 cup sweetener (Swerve)
1/2 cup butter melted
In a medium bowl, whisk together flour and sweetener. Stir in butter until well combined. Press firmly into bottom and up the sides of a pie pan or spring-form pan. Bake at 350 degrees for 8 minutes (watch closely so that the crust does not over-brown)
Filling:
16 oz cream cheese, softened
2 tbsp sour cream
1/4 cup freshly squeezed lime juice with pulp
1 tsp lime zest
3/4 cup sweetener (Swerve or erythritol)
1/2 cup + 2 tbsp heavy whipping cream, divided
1 tbsp gelatin or 1 envelope Knox gelatin
In a large bowl, beat cream cheese, sour cream, lime juice with pulp and zest together until smooth. Beat in the sweetener until well combined. In a small bowl, whisk together 2 tbsp of heavy cream and the gelatin. Stir into the cream cheese until well combined.
In another bowl, beat whipping cream until it forms stiff peaks. Gently fold whipped cream into the cream cheese mixture.
Spread the filling over the cooled prepared crust.
Refrigerate for a few hours until set and ready to serve with blueberries sprinkled on top.
References:
Is bacon grease really healthy? People in my office stress out about getting all the healthy fats and the right amino acids. I am asked all the time, which protein powder they should be taking? Do I prefer fish oil or krill oil? My answer to this is simple.
“Bacon grease.”
I know, I can see it on your face now. . . the blank stare of disbelief.
Yes, I said “bacon grease.”
If you are following a low carbohydrate or ketogenic diet, bacon grease is your essential oil. Let me explain why:
Bacon, and the grease it creates, contains all the essential amino acids. Yes, even the coveted branched chain amino acids (BCAAs). Go ahead, have 3-5 slices for breakfast, but keep the grease and re-use it to cook with. Because your saving yourself from having to buy expensive protein powders and less tasty versions of these essential muscle building blocks.
Bacon grease is a great source of choline, an essential nutrient for stabilizing cell membranes and making the neurotransmitter acetylcholine. Acetylcholine is one of the neurotransmitters absent in memory disorders and muscle disease. Fascinatingly, choline helps in the prevention of fatty liver disease, a disease caused by the standard American diet that often progresses to non-alcoholic liver disease.
Choline has also been shown in a number of studies to help ward off Alzheimer’s Disease.
Bacon fat is a superb source of all of the necessary B vitamins. It is also a superb source of Vitamin D, phosphorus, magnesium and iron. In fact all of the fat soluble vitamins – any vitamin that sounds like a letter of the alphabet: A, B, C, D, etc.- are found in animal fat.
Long-Chain fatty acids are satiating. Bacon grease is a great source of the longer chain fatty acids and has a wonderful effect on suppressing your appetite. That’s why Dr. Nally talks about it so often. Bacon is the duct tape of the culinary world, and acts to suppress the cravings for the pie that might arise 30-60 minutes later.
When have you ever felt a frown after eating bacon? That’s my point . . . you just smiled when that thought crossed your mind. Seriously, don’t deny it . . .
Put a piece of bacon in your mouth, and it doesn’t really matter who the president is, what Kim Kardashian recently posted, or that you’re late for work . . . seriously. Bacon in your mouth reminds you how good life really is. If I die while eating a plate of bacon, my life will be complete.
My wife fries eggs in bacon grease for breakfast when she cooks. I tell you . . . it’s edible love.
Bacon grease also contains a significant amount of medium chain triglycerides (caproic, caprylic, capric, and lauric acids). These medium chain triglycerides (MCTs) are all the rage in helping to maintain a ketogenic diet. MCTs convert rapidly into ketones after absorption into the liver from the gut. Rapid conversion of fat into ketones stimulate more effective contraction of the heart. When the heart contracts more effectively, it releases atrial-naturitic peptide (ANP), that opens the “back door” in the fat cell allowing for more efficient fat burning and maintenance of ketosis.
Many people us essential oils for the aromatic effect they produce on mood and anxiety. Next time you cook bacon, check your mood. Never has there been an aroma that is so inviting and calming. Very few other aromas actually bring people to a dinner table. And for you men out there, bacon grease improves your manhood. Increased presence of ketones, and the appetite suppressing effect of bacon grease helps to stabilize testosterone and leucine. This improves muscle development, enhances libedo, and prevents the progressive decline in testosterone leading to the “girly-man” status that occurs with so many men eating the standard American diet.
Let me leave you with one last question. When is the last time you saw left-over bacon?
Exactly – the same time you saw leprechauns riding unicorns down your street after a rain storm.
So, cook that bacon . . . and save the grease. Use it to cook your eggs or bake with it. You’ll thank me later.
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:
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.
(Click the image above to try your exogenous ketones at a 20% discount.)
For my Canadian Friends click: http://www.docmuscles.shopketo.com/ca
For my Australian Friends click: http://www.docmuscles.shopketo.com/au
What is the Yin & Yang of glucose control? It is Glucagon & Amylin. We talked about glucagon in an earlier post. Today we’ll balance the world of blood sugar with Amylin talk. Don’t go getting hypoglycemic with all the excitement . . . !!
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.
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.
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.
We discuss PCOS, as well as CrossFit, NSAIDs, Toxic Mold, And Calorie Restriction On Keto-Talk this week. Tune in here on you computer or down-load today’s podcast on iTunes for free. You won’t be sorry.
“It’s a snake.”
“It’s a wall.”
“It’s a rope.”
“It’s a fan.”
“It’s a tree.”
“It’s insulin resistance.”
I’ve always been fascinated by those describing a “new finding” in medicine. I am reminded of the story of 5 men who, never having seen an elephant before, were blindfolded and asked to describe what he discovered. However, each man was introduced to a different part of the elephant. Each of them had a dramatically different description of the elephant and each made a conclusion that was very different from the others.
What is fascinating, is that we usually make our “blindfolded comparisons” to those things we have seen or about which we have some descriptive understanding. Observing and describing human physiology is much like examining an elephant while blindfolded for the first time.
This week’s “blind-folded finding” is what has been interpreted by some as “insulin resistance” made worse by a ketogenic diet. Really? This perked my curiosity, because I’ve personally been following a low-carbohydrate/ketogenic diet for years and have thousands of patients doing the same. To this day, I’ve never seen insulin resistance “get worse.” In fact, it gets better. Clinically, it seems to take about 18-24 months to improve, but, it usually gets better.
THE QUESTION –
I’ve had three people from around the world contact me this week and ask why, after being on a ketogenic diet and “in ketosis,” they suddenly get a notably large blood glucose spike when they cheat. By notably large, I mean that their blood sugars rise to over 200 mg/dl within 2 hours of a carbohydrate containing meal. Now, they admit to rapid glucose recovery within an hour or two, and their hemoglobin A1c levels are subjectively normal (less than 5.6%). The worry is “am I becoming diabetic?” They also complain that after having been in ketosis for longer than 3-4 months, they cannot get their fasting blood sugars below 100 mg/dl.
Those asking me the question about this anomalous “physiological insulin resistance” referred to a couple of off-the-cuff blogger’s posts from 2-3 years ago referencing a few small studies (some of which were very poorly designed) [here, here, here & here] in the journals from 10-20 years ago. These articles describe a physiologic response interpreted as worsening “insulin resistance.” However, if you understand what is actually occurring in the Ketonian (yes, I made that term up – there will soon be a whole village of us), I see it as a normal physiologic response. It is misinterpreted by those who’ve never actually seen long term ketogenic physiology, as anomalous, in the average human.
THE ANSWER –
I’ve been seeing this slight elevation in fasting blood sugar with normal or low normal HbA1c in myself and many of my patients for quite some time. However, I never saw it as “insulin resistance” worsening. Clinically, when I tease out the food logs, it usually ends up being protein intake is too high, the person is using a sweetener or creamer causing rebound morning glucose elevation or, in those with low normal HbA1c’s (4.3-5.6%), it is in actuality a protective mechanism of “physiologic glucose sparing” in the keto-adapted individual (1, 2).
It can very easily be explained when one understands how ketones are actually used in the keto-adapted individual. First, a wonderful figure below (Thank you for pointing me to this one, Dr. Peter Attia) found in Dr. Veech et. al.’s paper (3) gives us an overview of how ketones skirt the TCA cycle within the mitochondria of the cell, causing inhibition of pyruvate dehydrogenase leading to glucose sparing by the cells of the brain that still require it’s availability (Oh, by the way, this is how we survived harsh winters and famines).
From the Figure 1 above, you can see that beta-hydroxybuterate [BHB (a ketone)] is converted to acetoacetyl CoA leading to the production of pyruvate, block-aiding additional glycolysis or inhibiting further glucose production at the liver level. Because the muscle tissues become more adept at using BHB, GLUT receptors are down-regulated at the muscle level as a person becomes more keto-adapted. Although we still have much to learn about the keto-adapted state, we know that this occurs more prominently in the muscle tissues than in the gut and brain. This fascinating glucose sparing phenomenon, has been interpreted by some as “worsening insulin resistance.”
Not to worry, glucose sparing is rapidly reversible and transitory within 1-3 days of increasing carbohydrate intake above 100-150 grams per day (1). It is also why those who become keto-adapted get a carbohydrate hangover including headache, stomach cramps, diarrhea, and malaise lasting 8-24 hours after cheating.
Is this bad? Absolutely not! It is NORMAL! (It’s just that most people, physicians included don’t know what the normal physiology of the Ketonian should look like.) Is it going to kill you, cause a stroke or give you a heart attack? Absolutely not. The elevated BHB actually increases production of adiponectin, leucine & glutathione that have antioxidant properties protecting one from transient inflammatory rises in blood sugar, enhancing insulin’s effect on the muscle, and preserving muscle mass while allowing for fat metabolism (4, 5, 6).
THE TAKE-HOME MESSAGE –
First, don’t cheat if you don’t want to see transient rises in blood sugar and experience the wonders of a carbohydrate hangover and some mild reactive hypoglycemia (low blood sugar) after the fact.
Second, if you’ve been in ketosis for longer than 3-4 months, and you absolutely must get another two or three hour oral glucose tolerance test (OGTT), you might want to increase your carbohydrate intake to 50-100 grams per day 1-3 days before the test to avoid an anomalous spike in blood glucose. (One OGTT was enough for me . . . but hey, some of us are gluttons for punishment.)
Third, enjoy your eggs, pass the bacon and stir me up some Keto//OS.
References:
“Doc, how do I get six-pack abs?”
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.
Follow the principles outlined in my past articles like The Principle Based Ketogenic Lifestyle . . . Part I & Ketogenic Principles . . . Part II and make sure you are avoiding Common Ketosis Killers.
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.
We have been taught for over 50 years that the minimum carbohydrate intake necessary to maintain health is 130 grams per day, with the average diet of 2000 calories per day containing around 300 grams per day based on 1977 recommendations that 55-60% of are dietary intake should come from carbohydrates. This value was initially established during World War II by a committee of scientists tasked with determining dietary changes that might effect national defense (1). These “guidelines,” originally called the Recommended Daily Allowances (RDA) and accepted by many as the gospel truth, have been modified every ten years and in 1997 changed to the Dietary Reference Intake (DRI). However, the recommended carbohydrate values have not changed other than “avoiding added sugars” in the most recent 2015 recommendations.
In light of the fact that there are NO actual diseases caused by lack of carbohydrate intake, most dietitians and physicians still preach the carbohydrate dogma originally outlined by the RDA. I say dogma, because these recommendations are based on a diet that vilifies fat, particularly animal fat like red meat. Say the words “red meat” around a dietician these days you’d think Voldemort (“He Who Shall Not Be Named”) had returned.
I bring up the carbohydrate quandary because it is a question that I am asked every single day. The question that seems to be asked of me, more and more, is what exactly is a carbohydrate?
Let’s make it simple. There are really only three types of carbohydrates:
Let’s start with Sugar. The simple form of carbohydrates, and the form that spikes your blood sugar and insulin rapidly, are called mono-saccharides (glucose, galactose, fructose & xylose). When two of these mono-saccharides are bound together they form disaccharides like sucrose, also known as “table sugar” (glucose + fructose), lactose found in milk (glucose + galactose), and maltose found in cereals and sweet potatoes (glucose + glucose).
The simple monosaccharides or disaccharides are easy broken into their mono-saccharide form in the blood stream and require the body to produce insulin to be used. The person with insulin resistance, impaired fasting glucose or type II diabetes often produces 2-10 times the normal amount of insulin to correctly use these mono-saccharides (see why this is a problem in: The Dreaded Seven: Seven Detrimental Things Caused By High Insulin Levels). Remember, fruit is also simple sugar containing the mono-saccharide fructose . . . which we call “natures candy” in my office.
“Yea, I know sugar is bad for me, but Dr. Nally, I just eat the good starches.”
If I had a nickel for every time I’ve herd that phrase . . .
We’ve become comfortable with shunning fat and “simple sugar,” but in the process we’ve been eating more “good starch.” But the “good starches” are also saccharides – just in longer chains of more than three glucose molecules bound together. Our gut easily breaks the bonds between the glucose links and turns these starches into mono-saccharides to be used as fuel. It takes a bit longer than the simple sugars above, so the release of insulin is slower (which is why it has a better glycemic index score), but whether you produce the insulin in the first hour or the second hour after eating it, insulin is still insulin. In the case of insulin resistance, the damage is still done.
These good starches make up “comfort food” like bread, rice, pasta, potatoes, corn, grains & oats. To the patient with insulin resistance, impaired fasting glucose or type II diabetes, the higher insulin response stimulates increased weight gain, rise in cholesterol, shift in hormone function and progression of atherosclerosis (vascular and heart disease). See the recent article on Why Your Oatmeal is Killing Your Libedo.
What about “resistance starches?” These are still starches and I am finding clinically that they still cause a rise in insulin and push people out of ketosis (See Common Ketosis Killers).
Finally, Fiber. Fiber is a carbohydrate, however, it is the indigestible part of the plant. Fiber has double bonds between the saccharides that human gastrointestinal tracts cannot digest. In most cases, fiber passes right through the intestines without being digested. It actually acts like a broom for your colon, helping the intestines to move nutrients through the system. This is why I recommend 1-2 leafy green salads a day for most patient’s following ketogenic diet. Fiber does help to promote bowel function.
Fruit, non-green vegetables, pasta, grains and breads do contain good sources of fiber, however, these foods also have absorbable starches making them problematic as noted above.
The take home message is this, the use of starch or simple carbohydrate will be problematic for weight loss, cholesterol control, blood sugar control or blood pressure control in a patient with insulin resistance.
Therefore, the ketogenic lifestyle truly begins at the end of your comfort zone.
Watch this weekend’s Periscope conversation about why weight loss is slow and why anything that is worthwhile takes time.
You can watch the Periscope Video below:
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, many 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 in the menu bar above “Sour Truth About Sweeteners” and you can watch last night’s periscope below:
Enjoy!!
Catch up with Dr. Nally and his amazingly beautiful and talented wife, Tiffini, as he Periscopes about two of his favorite Low-Carb snacks:
Enjoy!
The image above has nine dots within a square. Your task, using only four lines is to connect ALL nine dots WITHOUT ever raising your pen, pencil or finger (Please don’t use a sharpie on your computer screen . . . it doesn’t come off).
You may have seen this puzzle previously . . . it’s made its rounds in corporate training circles. But the underlying principle remains true. The solution requires you to expand your thinking or to “think outside the box.”
Whenever you find yourself on the side of the majority, it is time to pause and reflect. (Mark Twain)
Why should we limit ourselves to thinking outside the box. Can’t we just get rid of the box?
True discovery consists in seeing what everyone has seen . . . then, thinking what no one has thought.
The answer can be found when those four lines are used beyond the box our mind creates:
What good has the box done us? People were burned at the stake because they refused to believe the Earth was not the center of the universe. People were beheaded because they had a sneaking suspicion that the world was not flat.
Why is it so very hard to accept that our weight gain and diabetes are driven by a hormonal signal, and not by gluttony or caloric intake of fat? The definition of insanity is doing the same thing repetitively and expecting a different outcome. How long have you been restricting calories and fat with only minimal or no improvement in your weight, blood sugar, cholesterol or general feeling of health?
The main problem with the current thought model, or dogma, on the obesity’s cause is that it does not account for metabolic syndrome. Metabolic syndrome is insulin resistance. It is an over production of insulin in the presence of ANY form of carbohydrate (sugar or starch).
In the practice of medicine over the last 15 years, I noticed that a very interesting pattern emerged. There was always a spike in fasting and postprandial insulin levels 5-10 years prior to the first abnormal fasting and postprandial blood sugars. These patients were exercising regularly and eating a diet low in fat. But they saw continued weight gain and progressed down the path of metabolic syndrome. 10-15 years later, they fall into the classification of type II diabetes. What I now lovingly refer to as stage IV insulin resistance.
The only thing that seems to halt this progressive process with any degree of success is carbohydrate restriction. Fasting insulin levels return to normal, weight falls off, and the diseases of civilizations seem to disappear as insidiously as they arose.
So you tell me, is the world flat? Is the Earth the center of the universe?
What is a low carbohydrate or ketogenic diet? 15 years of practical in the trenches experience have helped me develop a very simple program to help you lose and maintain your weight. Access to this program, video help and access to blog articles at your fingertips are offered through my online membership site.
You can also hear me each week a I discuss low carbohydrate, paleolithic and ketogenic diets with the Legendary Jimmy Moore on KetoTalk.com
Have you been cutting your calories and reducing fat and exercising your brains out and still not seeing the needle on the scale move that much? Persistently and repetitively performing an action that doesn’t produce the desired result is insanity. Cutting calories and reducing fat while expecting weight loss is akin to pouring water in the gas tank of your car and expecting it to run smoothly. Why do we do it? Are the 53, 000, 000 people with health club and gym memberships this year really insane?
This evening on PeriScope we touch on fat phobic insanity and the limiting step that actually turns weight gain on or off. (We knew about this in the 1960’s, we just ignored it.)
You can see tonight’s PeriScope with the rolling chat-box questions here at Katch.me/docmuscles. Or, you can watch the video stream below:
The only way to successfully loose weight is to modify or turn off the mechanisms that stimulate fat storage. For years we have been told that this was just a problem of thermodynamics, meaning the more calories you eat, the more calories you store. The solution was, thereby, eat less calories or exercise more, or both. We are taught in school that a 1 gram of carbohydrate contains 4 kcal, 1 gram of protein contains 4 kcal, and 1 gram of fat contains 9 kcal.
If you ascribe to the dogma that weight gain or loss is due to thermodynamics, then it’s easy to see that cutting out fat (the largest calorie containing macro-nutrient) would be the best way limit calories. For the last 65 years, we as a society have been doing just that, cutting out fat, exercising more (with the idea of burning off more calories) and eating fewer calories.
What has this dogma done for us? It’s actually made us fatter! (1)
Some may argue that we really aren’t eating fewer calories and exercising more. But most people I have seen in my office have tried and tried and tried and failed and failed and failed to loose weight with this methodology. In fact, the majority of my patients attempt caloric restriction, exercise and dieting multiple times each year with no success. The definition of insanity is “doing the same thing over and over and expecting a different result.”
Most of my patients are not insane, they recognize this and stop exercising and stop restricting calories . . . ’cause they realized, like I have, that it just doesn’t work!
If you’re one that is still preaching caloric restriction and cutting out fat, I refer you to the figure above and the definition of insanity . . . your straight-jacket is in the mail.
So, if reducing the calories in our diet and exercising more is not the mechanism for turning on and off the storage of fat, then what is?
Before I can explain this, it is very important that you appreciate the difference between triglycerides and free fatty acids. These are the two forms of fat found in the human body, but they have dramatically different functions. They are tied to how fat is oxidized and stored, and how carbohydrates are regulated.
Fat stored in the adipose cells (fat cells) 
as well as the fat that is found in our food is found in the form of triglycerides. Each triglyceride molecule is made of a “glyceride” (glycerol backbone) and three fatty acids (hence the “tri”) that look like tails. Some of the fat in our adipose cells come from the food we eat, but interestingly, the rest comes from carbohydrates
(“What! Fat comes from sugar?! How can this be?!!“)
We all know that glucose derived from sugar is taken up by the cells from the blood stream and used for fuel, however, when too much glucose is in the blood stream or the blood sugar increases above the body’s comfort zone (60-100 ng/dl), the body stores the excess. The process is called de novo lipogenesis, occurring in the liver and in the fat cells themselves, fancy Latin words for “new fat.” It occurs with up to 30% (possibly more if you just came from Krispy Kream) of the of the carbohydrates that we eat with each meal. De novo lipogenesis speeds up as we increased the carbohydrate in our meal and slows down as we decrease the carbohydrate in our meal. We’ve known this for over 50 years, since it was published by Dr. Werthemier in the 1965 edition of the Handbook of Physiology (2).
While we know that fat from our diet and fat from our food is stored as triglyceride, it has to enter and exit the fat cell in the form of fatty acids. They are called “free fatty acids” when they aren’t stuck together in a triglyceride. In their unbound state, they can be burned as fuel for the body within the cells. I like to think of the free fatty acids as the body’s “diesel fuel” and of glucose as the body’s version of “unleaded fuel.” The free fatty acids can easily slip in and out of the fat cell, but within the adipose cell, they are locked up as triglycerides and are too big to pass through the cell membranes. Lipolysis is essentially unlocking the glycerol from the free fatty acids and allowing the free fatty acids to pass out of the fat cell. Triglycerides in the blood stream must also be broken down into fatty acids 
before they can be taken up into the fat cells. The reconstitution of the fatty acids with glycerol is called esterification. Interestingly, the process of lipolysis and esterification is going on continuously, and a ceaseless stream of free fatty acids are flowing in and out of the fat cells. However, the flow of fatty acids in and out of the fat cells depends upon the level of glucose and insulin available. As glucose is burned for fuel (oxidized) in the liver or the fat cell, it produces glycerol phosphate. Glycerol phosphate provides the molecule necessary to bind the glycerol back to the free fatty acids. As carbohydrates are being used as fuel, it stimulates increased triglyceride formation both in the fat cell and in the liver, and the insulin produced by the pancreas stimulates the lipoprotein lipase molecule to increased uptake of the fatty acids into the fat cells (3).
So when carbohydrates increase in the diet, the flow of fat into the fat cell increases, and when carbohydrates are limited in the diet, the flow of fat out of the fat cells increases.
Summarizing the control mechanism for fat entering the fat cell:
These two mechanisms ensure that there is always unleaded (glucose) or diesel fuel (free fatty acids) available for every one of the cells in the body. This provides the flexibility to use glucose in times of plenty, like summer time, and free fatty acids in times of famine or winter when external sources of glucose are unavailable.
The regulation of fat storage, then, is hormonal, not thermodynamic. Unfortunately, we’ve know this for over 65 years and ignored it.
We’ve ignored it for political reasons, but that’s for another blog post . . .
References:
1. James, W. J Intern Med, 2008, 263(4): 336-352
2. Wertheimer, E. “Introduction: A Perspective.” Handbook of Physiology. Renold & Cahill. 1965.
3. Taubs, G. “The Carbohydrate Hypothesis, II” Good Calorie, Bad Calorie. Random House, Inc. 2007, p 376-403.
Today in the office I had the calorie conversation again . . . three times. We have an entire society with a very influential health and fitness industry built around the almighty calorie. Has it helped? Looking at our 5 year obesity outcomes. It hasn’t helped a bit. In fact, it is worse. In 1985 only 19% of U.S. adults were obese.
In 2014, 34.5% of U.S. adults were obese. The numbers this year are approaching 35.6% You can see the dramatic increase in obesity by 1-3% every year for the last 5 years in the CDC images above.
For over 50 years we have been told that caloric restriction and fat restriction is the solution. But by the numbers above, the 58 million people in the U.S. utilize a gym or health club to burn off those calories aren’t seeing the success that they should be expecting.
Why? Because the calorie is NOT king. What do I mean by that? We don’t gain weight because of the thermogenic dogma we’ve been taught for the last 50 years. Our weight gain is driven by a hormone response to food. Hear more about why the calorie is NOT king on tonight’s PeriScope. You can Katch it here with all the live stream comments and hearts at Katch.me/docmuscles.
Or you can watch the video without the comments here:
I’ve been looking for the answer for quite some time. . . what role does caffeine play in your and my weight management journey? The answer gave me a headache. . . literally and figuratively.
As many of you, including my office staff, know, I love my Diet Dr. Pepper (and my bacon). I found that being able to sip on a little soda throughout the day significantly helped the carbohydrate cravings and munchies during a busy and stressful day at the office. Diet Dr. Pepper contains caffeine, however, I wasn’t really worried. Caffeine has been well know to have a thermogenic effect which increases your metabolism and has been thought for many years to help with weight loss among the weight loss community.
Diet Dr. Pepper is, also, one of only four diet sodas on the grocery store shelves that doesn’t contain acesulfame potassium (click here to see why most artificial sweeteners cause weight gain). The four diet sodas that I have been comfortable with my patients using are Diet Dr. Pepper, Diet Coke, Diet Mug Root-beer and Diet A&W Cream Soda. These are the last four hold out diet sodas that still use NutraSweet (aspartame) as the sweetener. Most of the soda companies have switched the sweetener in their diet sodas to the insulinogenic acesulfame potassium because it tastes more natural and aspartame has been given a media black eye of late. However, NutraSweet (aspartame) is the only sweetener that doesn’t spike your insulin or raise blood sugar (click here to find out why that is important).
Yes, I know. The ingestion of 600 times the approved amount of aspartame causes blindness in lab rats (but we’re not lab rats, and . . . have you ever met someone that drinks 600 Diet Dr. Peppers in a day? The lethal dose of bananas, which are high in potassium that will stop your heart, is 400). Aspartame can also exacerbate headaches in some (about 5% of people) and I’ve had a few patients with amplified fibromyalgia symptoms when they use aspartame. But for most of us, its a useful sweetener that doesn’t spike your insulin response, halting or causing weight gain.
But, over the last few years, I’ve noticed that increased amounts of Diet Dr. Pepper & Diet Coke seem to cause plateauing of weight and decreasing the ability to shift into ketosis, especially mine. I’ve also noticed (in my personal n=1 experimentation) that my ability to fast after using caffeine regularly seems to be less tolerable, causing headaches and fatigue 8-10 hours into the fast, symptoms that don’t seem to let up until eating. Through the process of elimination, caffeine seems to be the culprit.
After mulling through the last 10 years of caffeine research, most of which were small studies, had mixed results, used coffee as the caffeine delivery system (coffee has over 50 trace minerals that has the potential to skew the results based on the brand) and never seemed to ask the right questions, the ink from a study in the August 2004 Diabetes Care Journal screamed for my attention.
It appears that caffeine actually stimulates a glucose and insulin response through a secondary mechanism. The insulin surge and glucose response is dramatically amplified in patients who are insulin resistant. Caffeine doesn’t effect glucose or insulin if taken while fasting; however, when taken with a meal, glucose responses are 21% higher than normal, and insulin responses are 48% higher in the insulin resistant patient. Caffeine seems to only effect the postprandial (2 hours after a meal) glucose and insulin levels. The literature shows mixed responses in patients when caffeine is in coffee or tea, probably due to the effect of other organic compounds (1).
Caffeine also diminishes insulin sensitivity and impairs glucose tolerance in normal and already insulin resistant and/or obese patients. This is seen most prominently in patients with diabetes mellitus type II (stage IV insulin resistance). Caffeine causes alterations in glucose homeostasis by decreasing glucose uptake into skeletal muscle, thereby causing elevations in blood glucose concentration and causing an insulin release (2-6).
Studies show that caffeine causes a five fold increase in epinephrine and a smaller, but significant, norepinephrine release. The diminished insulin sensitivity and exaggerated insulin response appears to be mediated by a catacholamine (epinephrine, norepinephrine & dopamine) induced stress response (5). Caffeine has a half life of about 6 hours, that means the caffeine in your system could cause a catacholamine response for up to 72 hours depending upon the amount of caffeine you ingest (7).
The reason for my, and other patient’s, headaches and fatigue after a short fast was due to the exaggerated stress hormone response. Increased levels of insulin were induced by a catacholamine cascade after caffeine ingestion with a meal, dramatically more amplified in a person like me with insulin resistance. The caffeine with the last meal cause hypoglycemia 5-7 hours into the fasting, leading to headaches and fatigue that are only alleviated by eating.
Even when not fasting, the caffeine induced catacholamine cascade causes up to 48% more insulin release with a meal, halting weight loss and in some cases, causing weight gain.
Caffeine is not the “Wonder-Boy” we thought it was.
How much caffeine will cause these symptoms? 50 mg or more per day can have these effects.
Ingestion of caffeine has the following effects:
The equivalent of 100 mg of in a human was given to a spider, you can see the very interesting effect on productivity. How often does the productivity of the day feel like the image below?
Beware that caffeine is now being added to a number of skin care products including wrinkle creams and makeup. Yes, caffeine is absorbed through the skin, so check the ingredients on your skin care products.
Diet Dr. Pepper, my caffeine delivery system of choice, has slightly less caffeine (39 mg per 12 oz can or 3.25 mg per oz) than regular Dr. Pepper. I found myself drinking 2-3 liters of Diet Dr. Pepper per day (long 16-18 hour work days in the office). After doing my research, I realized that my caffeine tolerance had built up to quite a significant level (230-350 grams per day).
So, a few weeks ago, I quit . . . cold turkey.
Did I mention the 15 withdrawal symptoms of caffeine? (8)
I experienced 13 of the 15 that lasted for 4 days. I do not recommend quitting cold turkey unless you have a week off and someone to hold your hand, cook your meals and dose your Tylenol or Motrin. My wife thought I was dying. . . I thought I was dying on day two. I actually had a nightmare about buying and getting into my own coffin. It can take up to three weeks to completely recover from caffeine withdrawal.
The other way to quit is to decrease your caffeine intake by 50 mg every two days. That means decrease caffeine by:
The benefit of this method is that withdrawal symptoms are much less severe without the caffeine headache and the ability to remain productive. It will take longer, but quitting cold turkey is not a pretty picture. Been there . . . done that, . . . and I’m not going back. I actually lost another half inch off my waistline by day 5 of caffeine discontinuation.
What is the take home message here? If you have any degree of insulin resistance, caffeine makes it worse and will amplify your weight gain as well as decrease the productivity of your day.
References:
This evening we covered the 5 myths of weight loss identified through the National Weight Control Registry’s research findings. What causes “wrinkle face” for Dr. Nally? We also talked about & answered 20 minutes of rapid fire questions ranging from the amount of protein you need daily to the likelihood a human could be a bomb calorimeter . . . exciting stuff!!
You can watch the video stream below. Or you can Katch the replay with the rapid stream of exciting comments here at Katch.me/docmuscles.
It is well know that one of the most profound complications of diabetes is damage to the kidney and the very small arteries within the kidney acting as your body’s filtration system. The kidney begins to lose the ability to adequately filter and retain microscopic protein progressively over time. As the blood sugar and insulin levels continually rise over time in the patient with diabetes or pre-diabetes, damage to the delicate filtering system of the kidneys occur. This very common and progressively damaging problem is called “nephropathy.”
We knew in 1972 that patients with diabetes had thickening of the basement membrane or endothelium of the small tubles within the kidneys. In fact, 98.6% of diabetics tested had thickening of this area of endothelium and tubules also called the renal glomeruli (1). This allows the glomerulus or filtration system of the kidney to become more “leaky” and microscopic protein loss begins to occur through the kidney. This loss of important proteins in the blood is called “albuminuria” or “micro-albuminuria.” It is a flag that further damage of the kidney can and will occur without making significant changes to lower the blood sugar and the insulin. As of today, it is not totally clear how the basement membrane is damaged at the microscopic level, however, there is some evidence that elevated insulin has both a physical and immune type effect that stimulates oxidative stress, atherogenesis, immunoglobulins, as well as the formation advanced glycation end products leading to endothelial wall damage (2).
Recent research reveals that a ketogenic diet effectively repairs and/or completely reverses the albuminuria (3).
Evidence in my office of the significant improvement in micro-albumin can be seen in the one of a number of case studies below:
The patient began following a ketogenic diet in 2010. After improvement he moved out of town for two years and “fell of the wagon.” Upon returning h restarted his carbohydrate diet and was only partially following it. As you can see, he also admitted to some cheating on the carbohydrate restriction over the holidays. In light of this, carbohydrate restriction decreased his albuminuria from 2400 to 97 mg/g within a period of 18 months.
References:
