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Category: Low Carb Diet

What Can You & I Do To Prevent Viral Infections?

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

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

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

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“Keep the carbs low and the fat high.”

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

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I Can’t Do Keto Because . . .

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:

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My Feet Are Tingling (Polyneuropathy and Hyperinsulinemia)

One of the common complaints that I see in my office is chronic numbness and tingling of the hands, fingers, feet & toes.  There are multiple causes of these symptoms, but by far the most common cause in my practice is polyneuropathy caused by insulin resistance (hyperinsulinemia).

Before we dive into this particular type of nephropathy, it is important that we define a few terms. The terms “polyneuropathy,” “peripheral neuropathy,” and “neuropathy” are frequently used interchangeably, and although they can be easily confused, they are distinctly different.

Definitions

  • Polyneuropathy is a specific term that refers to a generalized sensation of tingling or numbness that uniformly affects many nerves at the peripheral sites (ends of the extremities like hands, fingers, lower legs, feet and toes).
  • Peripheral neuropathy is a less precise term.  It is frequently used synonymously with polyneuropathy, but can also refer to any disorder of the peripheral nervous system.  However, this term includes  pain or numbness that radiates from nerve roots like “sciatica” of the leg and “brachial plexopathy” causing symptoms in one hand and/or arm (mononeuropathies).
  • Neuropathy, which again is frequently used interchangeably with peripheral neuropathy and/or polyneuropathy, can refer even more generally to disorders of the central (brain & spinal cord) and peripheral nervous system (nerves of the arms and legs) and their connections to sensory organs, such as the eye and ear, and to other organs of the body, muscles, blood vessels, and glands.

Why spend time defining all this?  Because, neuropathy can be very confusing, even for the experienced physician.  And, because I am seeing, more and more frequently, cases of insulin resistance induced polyneuropathy. The polyneuropathies must be distinguished from other diseases of the peripheral nervous system, including the mononeuropathies and mononeuropathy multiplex (multifocal neuropathy), and from disorders of the central nervous system.

  • Mononeuropathy refers to focused involvement of a single nerve, usually due to a localized trauma, compression, or nerve entrapment. Carpal tunnel syndrome is a common example of a mononeuropathy.  Sciatica due to a lumbar disc bulge is another form of mononeuropathy.
  • Mononeuropathy multiplex refers to simultaneous involvement of non-adjoining sections of nerve trunks. Used loosely, this term can refer to multiple compressive mononeuropathies. However, in its more specific meaning, it identifies trauma, infection, auto-immunity or damage to multiple nerves outside the central nervous system.  This is often due to lack of blood supply due to disease based inflammation of blood vessels supplying blood to these peripheral nerves.
  • Diseases of the central nervous system such as a brain tumor, stroke, or spinal cord lesion occasionally present with symptoms that are difficult to distinguish from polyneuropathy.

Insulin Resistance and Neuropathy

Insulin resistance, or better defined hyperinsulinemia, begins 10-15 years before a person is considered “pre-diabetic” and 20 years before the onset of type II diabetes. This “over production of insulin” in response to carbohydrates, starches and sugars causes a subtle and progressive form of inflammation.  This excessive production of insulin will damage the smallest arteries (capillaries) carrying oxygen and fuel to the back of the eyes, the kidneys and the peripheral nerves of the hands, fingers, lower legs, feet and toes.

Often not identified until a person is actually diabetic, the mechanism underlying the development of this type of neuropathy is extremely complex.  It is driven by years of subtle and progressive damage to the blood vessels, and inability of the nerves to use essential B vitamins damaging the genetics of the cell.  This leads to inflammatory, metabolic, and ischemic effects causing the nerves to function poorly over time.

What Causes Polyneuropathy?

 

The mechanism of polyneuropathy damage in the patient with hyperinsulinemia three-fold.

    1. The presence of high insulin stimulates increased fat storage.  As fat cells begin to get filled, they begin to over-produce a number of inflammatory hormones including TNF-alpha, IL-6, IL-1, Adiponectin, Leptin and Resistin. These inflammatory hormones turn on auto-immunities and abnormal immune system function.
    2. At the same time, the high insulin levels suppress appropriate testosterone and estrogen production causing microscopic damage to the lining of the smallest arteries and capillaries of the body (found predominantly at the extremities, kidneys and back of the eyes).
    3. 65% of patients with insulin resistance (hyperinsulinemia) have a malformation of one or both genes that encode the MTHFR enzyme (methylenetetrahydrofolate reductase) that uses folic acid (Vitamin B9) inside the cells of the body.  Because this is genetic and is a process occurring inside the cell, it has been difficult to identify until recent advances in measuring genetic SNPs.  Single nucleotide polymorphisms, frequently called SNPs (pronounced “snips”), are the most common type of genetic variation among people.

Interestingly, MTHFR deficiencies are also strongly correlated with depression, anxiety and other forms of mental illness. MTHFR is a SNP that can easily be tested through a simple blood sample at your local lab or doctors office. And, nerve testing can be done through a simple sudomotor function test in the doctors office.  In fact, Medicare encourages this testing yearly through part of the Annual Wellness Exam.

The polyneuropathy that I see most commonly in my office can and will improve. In fact, polyneuropathy will completely resolve if you catch it early enough.  We treat it in two ways.

What Can I Do To Treat Polyneuropathy?

First, restrict carbohydrate intake.  A ketogenic or carnivore diet is the perfect approach to this.  If you don’t have a copy of my book, The KetoCure, please pick one up on my website or on Amazon.  if you are just looking to fine tune the nuts and bolts of your diet, you can get a copy of my diet recommendations here.  Carbohydrate restriction corrects the high insulin levels.  Within a few weeks, people start seeing improvement in inflammation, testosterone, estrogen and leptin resistance.

Second, get your MTHFR SNPs tested.  This can be ordered through a simple blood test through your doctor or nearby lab.  If you have one or both MTHFR mutations, treatment is simple. A mutation of the MTHFR SNP directly causes polyneuropathy, anxiety, depression and in severe cases, schizophrenia. It can also cause significant problems with homocysteine metabolism and is a significant risk factor in heart disease.

Third, use the correct form of folic acid.  If you have the MTHFR mutation, regular folic acid is ineffective.  Instead of using regular folic acid (Vitamin B9), 1000-5000mcg per day of L-methyl folate (premethylated Vitamin B9) solves the problem.  Within 90 days, over 50% of my patients feel dramatic improvement in their neuropathy and many have compete resolution of the numbness and tingling.  I see this so frequently, that a few years ago I had my multivitamins designed to include L-methyl folate instead of regular folic acid.  You can find them here at Ketoliving. com.  If you want more information on why I designed my own vitamin supplement a few years ago, you can read about them here.

So, restrict your carbs, use the appropriate form of folic acid for you, and pass the bacon!

If you are interested in getting more help on this issue, schedule an appointment with me in my office. Or, consider one of my membership options if seeing me in my office isn’t convenient for you.  Sign up today!

References:

  • Yigit, Serbulent et al. “Association of MTHFR gene C677T mutation with diabetic peripheral neuropathy and diabetic retinopathy.” Molecular vision 19 1626-30. 25 Jul. 2013.
  • Wan, Lin et al. “Methylenetetrahydrofolate reductase and psychiatric diseases.” Translational psychiatry 8,1 242. 5 Nov. 2018, doi:10.1038/s41398-018-0276-6.
  • Shelton, Richard C et al. “Assessing Effects of l-Methylfolate in Depression Management: Results of a Real-World Patient Experience Trial.” The primary care companion for CNS disorders 15,4 (2013): PCC.13m01520. doi:10.4088/PCC.13m01520.
  • Hughes R. Investigation of peripheral neuropathy. BMJ 2010; 341:c6100.
  • Morrison B, Chaudhry V. Medication, toxic, and vitamin-related neuropathies. Continuum (Minneap Minn) 2012; 18:139.
  • Pareyson D, Piscosquito G, Moroni I, et al. Peripheral neuropathy in mitochondrial disorders. Lancet Neurol 2013; 12:1011.
  • Rutkove SB, et al., Overview of Polyneuropathy. UpToDate.com. Online Jan 2020, https://www.uptodate.com/contents/overview-of-polyneuropathy?search=neuropathy&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

Did you know . . . ?

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!

Will A Low-Carbohydrate Diet Kill You?

Will a ketogenic diet or very low carbohydrate diet kill you? Will it increase your likelyhood of death?  That’s what the media and the dietary world is saying this week. Is it really true? How do you know? That’s the question that I ponder as I smoke my brisket while reading the headlines this week.

My inbox has exploded with patients and acquaintances suddenly worried that my very low-carb lifestyle is bad. This all revolves around the publishing of a study in the Lancet this week, and the interpretative spin that has been placed on it by “those in the know.”  To quote one of the NHS dietitians, Catherine Collins, RD FBDA, “In summary, this paper will disappoint those who, from professional experience, will continue to defend their low-carb cult, but contributes to the overwhelming body of evidence that supports a balanced approach to calorie intake recommended globally by public health bodies.” Either she didn’t actually read the paper, or she clearly doesn’t understand the low-carbohydrate/ketogenic dietary world. Before you go throwing out your bacon, turning off my smoker and buying bags of rice, let’s talk about some principles that seem to be completely misunderstood by the “low-fat, calorie restricting” nutritional aristocracy.

Ketogenic Diets are Powerfully Effective

First, ketogenic diets are powerfully effective. They are effective in weight loss, reduction of blood sugar, reversal of diabetes, decreasing cardiovascular risk and reduction in blood pressure. These are just a few of the powerful effects of a ketogenic lifestyle. (I wrote a whole book on the 16 different diseases dramatically improved by carbohydrate restriction.) It’s why I’ve been using carbohydrate restriction for over 14 years both personally and in my clinical practice. 85% of the people in my practice don’t respond effectively to anything other than carbohydrate restriction. This is because their insulin levels are 2-20 times normal.  The question the Lancet should be asking is “why do 85% of people fail calorie restriction?”  But, that is for another article.

Few Diets Keep the Weight Off Long-Term

Does the ketogenic diet keep weight off in the long term?  All diets seem to fail in this regard, even the ketogenic diet will show rebounding of weight after 1-2 years.  Yes, I hate to be the bearer of sour news, but as an obesity specialist, this is what I do for a living.  The Lancet article implies that the low-carb diet is singular in the issue of weight rebound, but that is not the case. The only diet I have found to effectively keep the weight off long-term is a ketogenic diet, combined with pulsed eating and the correct type of physical activity.

Definition of a Very Low-Carbohydrate Diet

Third, commentary, and the researchers themselves, extrapolate that based on the results, very low carbohydrate diets increase the risk of mortality.  However, this study wasn’t even “low-carb.”  It was Paleolithic at best.  The lowest calorie intake group was just under 1600 kcal per day and the carbohydrate restriction was only 120 grams per day.  A low-carb diet is defined as less than 100 grams per day. A very low-carbohydrate diet is defined as less than 50 grams per day, and a ketogenic diet is defined as less than 20 grams per day.  This study and the cohort studies involved in it weren’t even low-carb!!!

Only Two Data Gathering Points in 25 Years?

Fourth, although people were followed for 25 years, there were only two data gathering points consisting of 66 questions spaced 5-7 years apart asking the 15,428 participants to “remember what they ate” over previous 3-5-year intervals.  Seriously?!  I can barely remember what I ate last week and I take pictures of my food and journal my meals frequently. How can you publish an article with only two data collection points over 25 years?  And, how can extrapolated data over 25 years be accepted as valid in a premier medical journal?  It is beyond my understanding.

You Gotta Lower Insulin to Reduce Mortality

Fifth, insulin must be lowered to a “baseline level.” Increasing fat intake in the presence of abnormally elevated insulin will actually increase risk of cardiovascular disease, peripheral vascular disease, diabetes, hypertension, gout, kidney stones, and death by multiple causes. This cohort of people only partially lowered carbohydrate intake, and raised fat and or protein intake.  Those of us who’ve been treating obesity and practicing in the trenches are well aware that if you don’t bring the insulin levels under control, raising fat and protein is just a ticking time bomb.  Of course, the all-cause mortality went up in this group.  I’d expect nothing less.  This is what I saw with a large portion of my Paleolithic dietary patients.

This is also why caloric restriction doesn’t work. These participants had average calorie restriction of 1600-1800 kcal per day.  Yet their risk for all-cause mortality (death by all causes) increased.

Weight Gain Continued

Sixth, all of the groups continued to gain weight.  Body mass index increased by almost a full point ever 6 years.  Carbohydrates were NOT restricted enough to be effective.  It also, demonstrates another example of calorie restriction failure in 15,000 plus people.

That’s what I’d call successful – not really!

Smokers Not Excluded

To make matters worse, 60-70% of the population were smokers or former smokers and this study did not specifically eliminate this as a risk factor for all-cause mortality. We know that smoking dramatically increases risk of heart disease, peripheral vascular disease, hypertension, stroke, lung cancer, chronic obstructive pulmonary disease, etc. The contribution of tobacco in this cohort was not adequately isolated.

Follow the Money

Lastly, I’ve learned that when you look closely at research, it is very important to follow the money. The National Institutes of Health funded the study. They openly state that a healthy eating plan “emphasizes vegetables, fruits, whole grains, and fat-free products.”  Their position falls right in line with the WHO Millennium Development Goals established at the United Nation’s Sustainable Development Conference in 2000 and reconfirmed in September, 2015.

The World Health Organization has developed sixteen goals as their “Call to Arms.” Goals 12 and 13 specifically discuss “ensuring sustainable food consumption patterns throughout the world.” These goals specifically outline a transformational vision of the world.  This will occur by “doubling agricultural growth” and restricting food production that worsens the “carbon footprint.”

Really?!

Over the last ten years, multiple progressive groups and sites have made the claim that the greatest threat to Climate Change is the cattle industry.  They link cattle, livestock and our consumption of red meats to global warming and have been preaching the politics of nutrition.  They claim that the only real way to stop climate change and global warming is to “eat less red meat and dairy products.”

Low-carbohydrate and ketogenic diets are a threat to this transformational vision.  Because of this, we will likely see more and more scientific research used as propaganda, let’s call it what it is, to sway the general populous in their buying and eating patterns.

So, if you’ll excuse me, my smoked brisket is ready to pull off the smoker. . .

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

Is a Ketogenic Lifestyle What Everyone Needs?

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

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

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

Principle #1 – Insulin is the Master Hormone

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why Be In Ketosis – Part X: PPAR-alpha

Benefit #10 in my 25 part series on “Why Be In Ketosis?”

This evening we briefly discuss PPAR-α, a powerful hormone that is stimulated by the ketogenic state.  It has a number of known benefits.  A number of great questions also popped up that we answered.  Listen and watch as we discuss them here:

Stay tuned for more great content on Facebook Live, Periscope and Instagram.

Can You Gain Muscle On A Ketogenic Diet?

Build Muscle text

Listen in to Ketotalk Podcast #19 where we talk about inflammatory foods, building muscle with a ketogenic diet & how ketosis affects the Baby Boomer Generation.

Keto Talk is cohosted by 10-year veteran health podcaster and international bestselling author Jimmy Moore from “Livin’ La Vida Low-Carb” and Arizona Osteopath and Board Certified Obesity Medicine physician Dr. Adam Nally from “Doc Muscles” who thoroughly share from their wealth of experience on the ketogenic lifestyle each and every Thursday.

We love hearing from our fabulous Ketonian listeners with new questions–send an email to Jimmy at livinlowcarbman@charter.net. And if you’re not already subscribed to the podcast on iTunes and listened to the past episodes, then you can do that and leave a review HERE. Listen in today as Jimmy and Adam answer more engaging questions about nutritional ketosis from you the listeners.

 

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


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

The answer . . . it will improve!

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

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

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

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

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

Cholesterol Size

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

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

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

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

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

Adapt Your Life

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

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

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

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

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

Hope this helps.

KetoOS Image

References:

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

Patience: Why Weight Loss is a Slow Process?

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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:

Is Your Sweetener Making you FAT?

old-man-sour-face

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!!

 

Low-Carb Recipes: Candied Nuts & Death By Chocolate Cheese Cake

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!

 

Thinking Outside of the Box

Nine dots

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

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

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

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

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

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

Nine dots solution

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

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

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

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

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

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

Low-carb is bad

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

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

Vote for Jenna!

lcc-header3160

Our very own, Jenna Lightfoot, PA-C, made it into the Cohost Contest Final Round for Jimmy Moore’s Low Carb Conversations.  Listen to this intriguing review of the recent headlines and vote for your favorite candidate here.

LowCarbConversations Final Round

At Nally Family Practice, where Jenna is one of our in-house Paleo/Low Carb experts, we thought that they all did a fantastic job. However, we’re a little preferential on who won this final round.

But, you should be the judge.  So, click the link here, or down load the podcast from iTunes and make sure you vote ASAP!

 

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

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

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

Or you can watch the video below:

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

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

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

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

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

Today’s Weight Loss Rx . . .

A few of my patients have recently asked me, “Dr. Nally, why to you post pictures of your horse, koi and farm animals on instagram?”

Let me answer that question with the following questions:

  • Do you find yourself longing for the apocalypse?
  • Do you find yourself looking for a reason to live?
  • Are you feeling tired, irritable, stressed out?
  • Do you or you family find yourself to be overly cynical, jaded or emotionally numb?

If you can answer “yes” to any of the questions above, then I highly recommend prescription strength nature . . .

All parody and humor aside, full strength prescription nature is one of the very best treatments for stress.

I find that sitting outside with my animals, watching the birds, dogs, horses and ducks dramatically helps with lowering my stress levels and helps me re-focus.  You can see my favorite place to sit on my farm and watch nature . . . here on Katch.me

You may find the following posts very insightful in explaining how stress wreaks havoc on your weight loss, mood & emotions and how to go about fixing it:

For someone like me, who spends 14-18 hours a day taking care of illness and sickness, I have found that spending time in nature is often more therapeutic than any pill available in the pharmacy.  So, this afternoon, if your looking for me, I’ll be taking my own medicine, a prescription of Nature Rx on my horse.

Get Ready For KetoTalk with Jimmy & the Doc!

KetoTalk

KetoTalk with Jimmy & the Doc (the legendary podcaster Jimmy Moore from Livin’ La Vita Low Carb and his newest co-host, your’s truly, Dr. Adam Nally) makes its debut this Thursday, December 31st, 2015 on iTunes.  You can see the show notes at KetoTalk.com (will be up and live on January 1st, 2016).

Throughout the exciting month of January, we will be airing a brand new episode of this 20-minute show each Thursday and a special bonus episode available on Sundays just to wet your ketogenic appetite and to kick off the podcast in its first month. Then, in February we’ll settle in to our regular Thursday time slot each week.

New podcasts can take a few days to assimilate into ‪#iTunes, so don’t get discouraged if you don’t immediately see it up on iTunes. However, you can always find them at KetoTalk.com.  Jimmy and I look forward to being your go-to, Ketogenic Lifestyle source for the latest and greatest in treating the diseases of civilization!

Get a sneak peek of our new show on tomorrow’s (Wednesday, December 30th) episode of “The Livin’ La Vida Low-Carb Show” where you can hear my interview with Jimmy as a preview what is sure to be a big hit in the ‪#‎keto‬ community. Thanks in advance for supporting our new podcast!

Definition of Insanity: Cutting Calories/Restricting Fat & Expecting Weight Loss

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)

World Obesity Rates
Obesity Rates Around the World

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) Triglycerides-and-Glycerol1as 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?!!“)

de novo lipogenesis
De Novo Lipogenesis

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 Insulin and Triglyceridesbefore 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:

  1. The Triglyceride/Fatty Acid cycle is controlled by the amount of glucose present in the fat cells (conversion to glycerol phosphate) and the amount of insulin in the blood stream regulating the flow of fatty acid into the fat cell
  2. Glucose/Fatty Acid cycle or “Randle Cycle” regulates the blood sugar at a healthy level.  If the blood glucose goes down, free fatty acids increase in the blood stream, insulin decreases, and glycogen is converted to glucose in the muscle and liver.

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.

Pre-, Post-Workout Meal on Ketosis. Is it Important?

Today’s Periscope was an exciting one.  Do you really need a pre- or post-workout shake or meal?  How much protein do you need?  What’s the difference between ketosis and ketoacidosis?  Is Dr. Nally a ketogenic cheerleader? Get your answers to these and many more questions asked by some wonderful viewers this evening on today’s PeriScope.

https://katch.me/embed/v/5def6bce-4f67-363a-b5f9-3bbec8a8aea2?sync=1

Be sure to check out Dr. Nally’s new podcast called “KetoTalk with Jimmy and the Doc” with the veteran podcaster Jimmy Moore on KetoTalk.com.  The first podcast will be available on December 31, 2015.  KetoTalk with Jimmy and the Doc will be available for download for free on iTunes.

Stay tuned . . . !

Common Ketosis Killers

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

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

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

Nutritional Ketosis is Most Effective as a Lifestyle Change

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

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

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

Nutritional Ketosis is a Very Low Carbohydrate Diet

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

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

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

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

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

 

To Effectively Maintain Nutritional Ketosis, You MUST get adequate Protein

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

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

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

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

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

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

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

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

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

Nutritional Ketosis is a High Fat Diet

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

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

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

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

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

Check Your Sweeteners At the Door

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

Don’t Even Start with Coffee Creamers

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

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

Ketosis Killing Medications

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

Estrogen

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

Stress

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

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

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

Take Just A Moment and Admire . . . (Then Calculate Your Ideal Body Weight)

A patient just sent this picture to me this evening.  I got a good laugh out of it.

pile o bacon

It brought up a couple of principles. So, Seriously, take just a moment and admire this pile of bacon. . .

  • First, it’s important that we take a moment and think about what is important in life.  What really makes you tick?  To those of us following a ketogenic lifestyle (low carb, moderate protein & high fat living), this represents food, fuel, taste and a great conversation tool. This pile of bacon forces one to think about what is really important in ones life.
    This pile of bacon represents 2-3 weeks of breakfasts.
    It represents wonderful flavor for a salad.
    It becomes something wonderful to dip in guacamole.

Low Carb Gluten Free Salad

Second, how much of this bacon can one following a ketogenic lifestyle have at a meal?  That depends upon your need of protein.  We base our basic protein need on a persons calculated ideal body weight. (No, your ideal body weight is not the weight you’re supposed to reach! It is a calculation based on height that gives us a starting point fro protein needs).
Many people have asked me how to calculate ideal body weight this week.  I’ve provided the calculation below:

Ideal Body Weight (IBW) – Estimated in (kg)
Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet.
Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet.
The average female needs 1.0 g of protein per kg of ideal body weight per day.
The average male needs 1.2 g protein per kg of ideal body weight per day.
If you are exercising more than 60 minutes 5 days per week then those values increase to 1.4 grams per kg for females and 1.6 grams per kg for males.
Example:
A 6 foot male’s IBW would be 50 kg + (2.3kg x 12 inches) = 77.6 kg
A 5 foot 4 inch females IBW would be 45.5 kg + (2.3kg x 4 inches) = 54.7 kg.
If you eat three times per day, then simply divide your IBW by 3 to get the maximum protein you need per meal.
I hope that helps.

Four Most Common Weight Loss Mistakes that Halt Your Weight Loss

What are the four most common mistakes I see in the office when it comes to weight loss?  Watch Dr. Nally on today’s PeriScope as he answers that question and many others.  You can see it here with the live stream comments on: https://www.katch.me/docmuscles/v/392e5d3e-bb28-3176-a03a-83433878a5ce

Or see the video below:

How Your Fruit and Your Alcohol Stop Your Weight Loss

Fruit & Alcohol Halt Weight Loss

Yes, your fruit makes you fat just like your beer gives you a beer belly. . .

It is fascinating how similarly fructose (the sugar in fruit) and alcohol are processed through the liver.  Both of them increase insulin and both increase triglyceride production as a byproduct of their metabolism.  This is clearly pointed out in Robert Lustig’s paper published in the Journal of the American Dietetic Association in 2010.

The metabolic pathways are very clearly outlined below:

Metabolism of Ethanol

Metabolism of Fructose

You can Katch my PeriScope conversation about this below or with the comments and hearts included at Katch.me/docmuscles.

PeriScope: Expectations in the First Few Weeks of a Ketogenic Lifestyle Change

DocMuscles Freezing on Periscope

See this evenings PeriScope about things to expect in the first few weeks of a ketogenic or low-carb dietary change. Questions answered about carbohydrate restriction.

See the video here:

Or you can Katch it at the link below:

https://www.katch.me/docmuscles/v/a1fa544c-f124-38f6-a444-b24d90fcba8a

The Belly

Have a great evening and a safe weekend.

Obesity Leads to Silent Vitamin A Deficiency

Vitamin ARecent research from Cornell University, recently published in Nature, reveals that increasing obesity leads to poor uptake of Vitamin A in the organ tissues of mammals including humans.  Vitamin A (Retinol) is a key vitamin that helps in gene expression and regulation.   Vitamin A uptake has been shown to diminish in obese patients and patient with hepatic steatosis [fatty liver disease or non-alcoholic fatty liver disease (NAFTL)].

This is a key finding and gives further evidence of the genetic expression of obesity and it’s effect on both the parent and the child.   What is even more fascinating is that this appears to lead to alteration in immune response and changes in cellular differentiation in the human organs.   This means that the Vitamin A deficiencies within the organs are being driven by fatty liver infiltration that is driven by insulin resistance.  This Vitamin A deficiency cannot be detected with a blood test as serum levels of Vitamin A remain normal and has significant roll in masking the cause of autoimmunity function we are seeing more and more of throughout the world.

Metabolic effects of vitamins on the Immune System
Metabolic effects of vitamins on the Immune System

So how do you get your Vitamin A in a ketogenic diet?  Vitamin A can be found in meats (specifically liver and organ meats), eggs, butter, and cod liver oil.  It can also be found in leafy greens, squash and peppers.  The reduction in insulin production that occurs in a low-carb, ketogenic and even paleolithic diet reduces the fatty liver infiltration that arises with the standard American diet (SAD diet).  Clinically, I have seen people reverse the steatosis of the liver within 12 months in my practice through carbohydrate restriction.

More research is needed, of course, but the take home message is that the ketogenic lifestyle plays an even greater roll in genetics and immunity than we ever thought.  More to come . . . I’m sure.

You can see today’s periscope on this subject below . . .

or you can watch it here on Katch:  https://www.katch.me/docmuscles/v/0f7b9835-1ac2-378e-a844-5647e86b700d

Have a great Thursday!!!

PeriScope: #LowCarb #Motivation. Good Morning Arizona! AZ Earthquakes.

PeriScopeI have been using PeriScope as a fun method of staying in touch with each of you, my fantastic patients, and people all over the world.  If you’re interested in seeing me live, you can down-load the PeriScope app onto your iPhone, iPad or Android phone through the App Store.

You can see this mornings PeriScope (with the rolling comments and hearts on the screen) with Dr Nally here on Katch.me/docmuscles.  Katch is a great site that holds a record of all my recent PeriScopes.

Or you can watch the video stream (without comment stream) below:

If you have a question you’d like me to address on PeriScope, please let me know.

Have a great morning!!