Category: Low Carb Food

January 1, 2018

Smoked New Year’s Eve Ribeye Roast

I’ve been admiring rib-eye roasts over the years. I also love the prime rib from which they are made. It has been a secret desire of mine to be able to make my own keto friendly smoked rib-eye roast or prime rib, and when I was in Costco last week, I saw a beautiful roast on sale. Over the last 12-13 years of following a ketogenic life-style, I’ve developed a palate for a good rib-eye or prime rib cut cooked to perfection.

So, what does a man do when shown meat on sale, and his wife is no where to be found?

Yep, you guessed it. . . I’m now the proud owner of a beautiful rib-eye roast.

After much perusing of the various “inter-webby” recipes and smoker recommendations, this is what I came up with.

Out of the package, you can see this marvelous bone-in roast is delightful. (Actually, this is the picture is of the 20 lb roast from the Costco website.) Mine only had four bones and was only 5 lbs, but as a male, when you see this picture, you have to wipe the drool off the corners of your mouth.

I peeled back the excess fat from the meat side and then, I trimmed up the excess fat off the bone for presentation.

Dr. Nally’s Butter Herb Butt Rub

I then created the following butter/herb rub:

1 cube of butter
2 tablespoons freshly chopped sage
2 tablespoons freshly chopped time
2 tablespoons freshly chopped rosemarie
1 tablespoon parsley flakes
10 garlic cloves dices

This is a good time to fire up your smoker or go out and ignite your pellet smoker.

I use a Traeger Select Elite pellet smoker.

For the busy doc, this works nicely for me, and it works as that best grill I’ve ever used as well (but, that’s for another post). I like this because you can purchase various pellet types based on the meat you’re smoking. For a number of my steaks, I like to use the mesquite pellets, however, I picked hickory for this roast. You could use oak or even cherry might be nice. Traeger sells a mixture of woods for those days when you really can’t decide.

For this roast, you want to get your smoker going and up to 275 degrees.

Once my smoker was heated up and set to my desired temperature, I went back into the kitchen and I finished up my rub. The butter was softened for 20 seconds in the microwave and the herbs were all added to the butter and mixed nicely.

Prepping the Roast

A slice in the rib-eye roast was made every two inches parallel with the bones on top and bottom, and the butter/herb mixture was rubbed onto all sides of the roast, making sure to stuff the incisions in the meat with extra butter/herb mix. Then, my favorite rub was patted liberally all over the roast. The butter gives a nice adhesive for my liberal application of the butt rub of choice.

I’m a huge fan of Bad Byron’s Butt Rub Barbecue Seasoning. It is keto-friendly, one of the few that doesn’t have added sugar, maltodextrin or dextrose that I’ve found (unless you make your own). See my article on sweeteners if you are wondering why this is important.

Smoker prepped . . . check!

Keto friendly smoked rib-eye roast prepped . . . check!

Roast has been rubbed down . . . check!

We’re ready!

The roast was placed on the smoker/grill and timer was set for 2 hours. This will put your internal temperature somewhere between 125-135 degrees. I like my rib-eye medium, so I may need to leave it on for an hour longer.

Meat Preparation Temperatures

Unfortunately, no one ever explains this stuff to you, so, I found a nice temperature chart on the ReluctantGormet.com (thanks G. Stephen Jones!) The goal for the meat is to get it to the temperature below when it is served. If the meat is pulled off the smoker around 5 degrees below the temperature listed below, and you give the meat 5-10 minutes to “rest” while covered with some foil, the bone will bring the core temperature to the desired preparation temperature. I’ve modified the list below for my and your easy viewing pleasure here:

	Rare	Medium-Rare	Medium	Medium-Well
Beef Steaks	130°	135°	145°	160°
Beef Roasts	125°	130°	145°	160°
Lamb Chop	130°	135°	145°	160°
Lamb Roast	130°	130°	145°	160°
Pork Roast		130°	140°	150°
Veal Chops		135°	145°	160°
Veal Roasts		130°	145°	160°

Adapted from http://www.reluctantgormet.com/meat-doneness-chart

Note: These are NOT USDA recommendations. The USDA temperatures are notably 10-15° higher because of food safety issues, however, many professional chefs are not cooking your medium-rare steak to 150°. You’d send it back in a heartbeat if that were the case.

Next, the cooking process begins. With the smoker pre-heated to 275 degrees, the roast was placed on the smoker, bone side down. I closed the lid . . . and began writing this post.

At the two hour mark, the roast was up to 120 degrees with my old meat thermometer. My next investment will be an instant read digital Thermopro meat thermometer that gives an instantaneous and accurate core temperature of your roast. After cooking this roast, I can see why one would be very helpful.

It actually took 3 hours to reach a core temperature of 140 degrees. It was worth the wait. My wife and daughter are not usally fans of prime rib or rib roast in the past, however, they devoured this. I don’t think I will ever order prime rib again, when I can cook my own that tastes this good.

Why post something like this?

First, smoking meat makes you feel like a man. Seriously, your testosterone feels like it goes up by 50-100 points smoking a good slab of meat. People always ask me what I personally eat on holidays or celebrations. This is a do-able recipe you can add to your file, and your man card.

Second, the preparation for this took me no more than 15 minutes, and I chopped and diced all my own fresh herbs. It would have taken me 3 minutes to do this if I hadn’t used fresh herbs.

Third, This roast cost me $45 at Costco and it will serve eight to ten people (or my family and lots of really yummy left overs for the next week). And, each steak I slice off this roast tastes like I took my family for $60 a-piece steaks at the fancy over-priced steak house down the road . . . I call it “gourmet-keto for the budget conscious.”

Anyway, leave me your comments. And, if you have a favorite smoker recipe. Include Bacon Boy (you can find his printable image in the right side panel) in the picture, and I’ll enter you in a drawing for the next Keto-Cart Kickoff.

Happy New Year!!

February 3, 2016

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.

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).

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.)

“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.

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.
Berkley Heart Lab’s Gradient Gel Electrophoresis – This test gives a differentiation based on particle estimation between Pattern A and Pattern B
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.
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.
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.

References:

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.

January 30, 2016

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

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

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

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

Links referenced in this video:

Red & Processed Meats: Bacon Fear-Mongering

Calculating Your Protein Needs from Ideal Body Weight

The Power of a Good Vitamin

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

January 21, 2016

Is Your Sweetener Making you FAT?

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!!

January 4, 2016

Thinking Outside of the Box

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

January 1, 2016

Vote for Jenna!

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.

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!

December 29, 2015

Get Ready For KetoTalk with Jimmy & the Doc!

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!

December 23, 2015

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)

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) 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?!!“)

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 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:

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
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.

December 22, 2015

Why the Calorie is NOT King

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

U.S. Obesity Adult 2011

U.S. Adult Obesity 2014

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

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

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

Or you can watch the video without the comments here:

December 19, 2015

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 . . . !

December 16, 2015

Santa's Gone . . . Low Carb

It appears that Santa reviewed the low-carbohydrate, ketogenic science and while vacationing in South Africa, was introduced to Banting (the South African term for carbohydrate restriction).

December 15, 2015

The 3 Weight Loss Necessities to Weathering the Holidays

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

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

November 28, 2015

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.

I’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 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.

If 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.That 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

Fifth 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 20% 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.

November 24, 2015

The 5 Myths of Weight Loss

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.

November 23, 2015

Diabetes Mellitus – Really the Fourth Stage of Insulin Resistance

I just completed my reading of Dr. Joseph Kraft’s Diabetes Epidemic & You. This text originally printed in 2008 and was re-published in 2011. I am not really sure why I have never seen this book until now, but I could not put it down. I know, I am a real life medical geek. But seriously, you should only read this book if you are concerned about your health in the future. Otherwise, don’t read it.

For the first time in 15 years, someone has published and validated what I have been seeing clinically in my office throughout my career. Dr. Kraft is a pathologist that began measuring both glucose and insulin levels through a three hour glucose tolerance blood test at the University of Illinois, St. Joseph Hospital in Chicago. This test consists of checking blood sugar and insulin in a fasted state, and then drinking a 100 gram glucose load followed by checking blood sugar and insulin at the 30, 60, 120 and 180 minute marks (a total of three hours).

Dr. Kraft completed and recorded this test over a period of almost 30 years on 14,384 patients between 1972 and 1998. His findings are landmark and both confirm and clarify the results that I have seen and suspected for years.

I am convinced that our problem with treating obesity, diabetes and the diseases of civilization has been that we defined diabetes as a “disease” based on a lab value and a threshold instead of identifying the underlying disease process. We have been treating the symptoms of the late stage of a disease that started 15 to 20 years before it is ever actually diagnosed. Diabetes is defined as two fasting BS >126, any random blood sugar >200, or a HbA1c >6.5%. (Interestingly this “disease” has been a moving target. When I graduated from medical school it was two fasting blood sugars >140 and the test called hemoglobin A1c (HbA1c) that we use today for diagnosis didn’t even exist). The semantics associated with this problem is that many of us recognize that the disease is not actually diabetes. The disease is (as far as we understand it today) insulin resistance or hyperinsulinemia. This is where Dr. Kraft’s data is so useful. Diabetes, as it is defined above, is really the fourth stage of insulin resistance progression over a 15-20 year period and Dr. Kraft’s data presents enormous and very clear evidence to that effect.

When I first entered private practice 15 years ago, I noticed a correlation and a very scary trend that patients would present with symptoms including elevated triglycerides, elevated fasting blood sugar, neuropathy, microalbuminuria, gout, kidney stones, polycystic ovarian disease, coronary artery disease and hypertension that were frequently associated with diabetes 5-15 years before I ever made the diagnosis of diabetes mellitus. I began doing 2 hour glucose tolerance tests with insulin levels and was shocked to find that 80-85% of those people were actually diabetic or very near diabetic in their numbers. The problem with a 2 hour glucose tolerance test, is that if you are diabetic or pre-diabetic, you feel miserable due to the very profound insulin spike that occurs. A few patients actually got quite upset with me for ordering the test, both because of how they felt after the test, and the fact that I was the only physician in town ordering it. So, in an attempt to find an easier way, I found that the use of fasting insulin > 5 nU/dl, triglycerides > 100 mg/dl and small dense LDL particle number > 500 correlated quite closely clinically with those patients that had positive glucose tolerance tests in my office. There is absolutely no data in the literature about the use of this triangulation, but I found it to be consistent clinically.

I was ecstatic to see that Dr. Kraft plowed through 30 years and over 14,000 patients with an unpleasant glucose tolerance test and provided the data that many of us have had to clinically triangulate. (I’m a conservative straight white male, but if Dr. Kraft would have been sitting next to me when I finished the book this afternoon, I was so excited that I probably would have kissed him.)

Insulin resistance or hyperinsulinemia (the over production of insulin between 2-10 times the normal amount after eating carbohydrates) is defined as a “syndrome” not a disease. What Dr. Kraft points out so clearly is that huge spikes in insulin occur at 1-2 hours after ingestion of carbohydrates 15-20 years prior to blood sugar levels falling into the “diabetic range.” He also demonstrates, consistently, the pattern that occurs in the normal non-insulin resistant patient and in each stage of insulin resistance progression.

The information extrapolated from Dr. Kraft’s research give the following stages:

Stages of insulin resistance by 3 hr OGTT extrapolated from “Diabetes Epidemic & You”

From the table above, you can see that the current definition of diabetes is actually the fourth and most prolifically damaging stage of diabetes. From the data gathered in Dr. Kraft’s population, it is apparent that hyperinsulinemia (insulin resistance) is really the underlying disease and that diabetes mellitus type II should be based upon an insulin assay instead of an arbitrary blood sugar number. This would allow us to catch and treat diabetes 10-15 years prior to it’s becoming a problem. In looking at the percentages of these 14,384 patient, Dr. Kraft’s data also implies that 50-85% of people in the US are hyperinsuliemic, or have diabetes mellitus “in-situ” (1). This means that up to 85% of the population in the U.S. is in the early stages of diabetes and is the reason 2050 projections state that 1 in 3 Americans will be diabetic by 2050 (2).

Insulin resistance is a genetically inherited syndrome, and as demonstrated by the data above has a pattern to its progression. It is my professional opinion that this “syndrome” was, and actually is, the protective genetic mechanism that protected groups of people and kept them alive during famine or harsh winter when no other method of food preservation was available. It is most likely what kept the Pima Indians of Arizona, and other similar groups, alive while living for hundreds of years in the arid desert. This syndrome didn’t become an issue among these populations until we introduced them to Bisquick and Beer.

The very fascinating and notably exciting aspect of this whole issue is that insulin resistance is made worse by diet and it is completely treatable with diet. This is where the low carbohydrate diet, and even more effective ketogenic diet or lifestyle becomes the powerful tool available. Simple carbohydrate restriction reverses the insulin spiking and response. In fact, I witness clinical improvement in the insulin resistance in patients in my office over 18-24 months every day. You can get a copy of my Ketogenic Diet here in addition to video based low carbohydrate dietary instruction.

Until we are all on the same page and acknowledge that diabetes is really the fourth stage of progression on the insulin resistance slippery slope, confusion and arguments about treatment approaches will continue to be ineffective in reducing the diseases of civilization.

References:

November 20, 2015

How to Stay Motivated on Carbohydrate Restriction

This evening on PeriScope, we talked about the 10 things you can do to stay motivated on your low-carb lifestyle. A number of great questions were asked including:

How much carbohydrate should be restricted?
What labs should you be monitoring regularly?
What’s a normal blood sugar?
Why is Dr. Nally freezing in Denver?
Is fermented food good for you?
Why should you eat pickles and kimchi even when you’re not pregnant?

And, much much more . . . It’s like a college ketogenic course on overdrive . . . for FREE!!!

You can see the PeriScope with the comments rolling in real-time here: katch.me/docmuscles

Or, you can watch the video stream below:

See you next time.

November 18, 2015

Chewing the Phat with Dr. Nally (The Psychology of Fat & Many Other Questions)

Join me as we chew the phat of ketogenic lifestyles PeriScope style and answer many questions like, “Why do I get ‘hangry’?” What causes hypoglycemia? How many times a day should I eat? and many more . . .

We talk briefly about why 60% of people with insulin resistance may need methylated folic acid to help with B vitamin absorption/use and where it can be found. (See me recent article about this called The Power of a Good Vitamin.)

You can see the whole PeriScope conversation on Katch.me/docmuscles with the comments scrolling or you can see the video stream below:

Thanks for visiting!!!

November 5, 2015

Obesity Leads to Silent Vitamin A Deficiency

Recent 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

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!!!

October 17, 2015

Nutritional Values of Brisket . . . on the Fly . . .

My family and I enjoyed some “moist brisket” from Rudy’s Country Store and Barbecue this evening. This is one of my favorite meals. I ordered up 2 lbs knowing that I’d have some to save for later this week. How do you calculate up the ketotic nutritional values for this meal? Easy.

Nutritional values can often be found on the menu or on the web (you might have to ask for it). Rudy’s Country Store kindly places their nutritional information on the web and you can locate it here.

Now, the image above is 2 lbs of moist brisket (with extra bark) and nutritional values are calculated per 1/2 lbs. serving size as noted below. (No, I did not eat this whole thing.) I saved 3/4’s of it for another meal sometime in the next few days.

The Nutritional facts above can be somewhat misleading if you add up the grams of protein, fat and carbohydrate you end up with 93 grams total (the misleading part is that 93 grams does not equal 1/2 lbs. The assumption is that the values are “pre-cooked”). But what I am looking for is the ratio of fat per serving. One serving size has 50 grams of fat and 41 grams of protein. 54% of this brisket is from fat. If you eat the entire 1/2 lbs you’ll go over you protein needs for that meal (assuming that I need only 30-35 grams of protein per meal – 3 meals a day). I only at about 1/3rd lbs. (totally stuffed afterwards) and so 54% of my meal was fat (keeps me in ketosis) and 1/3 lb of the brisket has about 27 grams protein.

Did I calculate all this up before I ate. Absolutely not. I just ate and amazingly, I got full somewhere between 1/4 lb and 1/3 lbs. The key is listen to your body. It will tell you when you are full (unless you are cheating and eating carbs with it, then all bets are off and the satiety signal is delayed).

By the way, it was delicious.

October 12, 2015

Ordering the Low-Carb Ketogenic Burger

Running some errands this morning and the tummy became a little rumbly. That’s my sign that it’s time to fuel the Doc’s Muscles. My son and I love Five Guys. They make a mean burger and cater to my every Ketogenic whim.

Here was today’s burger:

The lettuce wrapped bacon burger with mustard (and a pickle just for some flair). Pure saturated fat awaiting ketosis wrapped in foil. (Kind of makes your mouth water, doesn’t it?)

Add the bacon for a little more fat and the mustard for flavor and to prevent leg cramps (yellow mustard contains just enough quinine that it stops leg cramps) that can occur with dehydration in the Arizona heat (it was 93 degrees F today) and I’m a happy man.

Hope your lunch was just as good.

October 11, 2015

Low-Carb Maple Pecan Granola . . . (No More Frowney Faces) a DocMuscle’s Favorite

The most exaggerated “frowney” face I get in the office seems to occur when patient’s find out that they cannot eat oatmeal or cereal any longer when following a low-carbohydrate dietary lifestyle. No, oatmeal is NOT good for you . . . I don’t care what WebMD recently said. No, steel-cut oats are even worse (1/4th cup of steel-cut oats is 27 grams of carbohydrate – Who only eats 1/4th cup of oatmeal? Most people eat at least 1/2 -1 cup at a sitting. You do the math . . .)

When I mentioned this to a disabled patient, even her service dog frowned.

Now, before you go running to Larry, the Quaker Oats Mascot (he’s been around for over 140 years), and ask his weight loss advise, I have the solution.

Larry, the Quaker Oats mascot loses 10 lbs for new 2012 cover (He finally figures it out after 137 years)

My angelic wife, Tiffini, the amazing homestead chef and animal husbandry specialist on our little farm, started making low-carb granola for our horseback trail rides. Prior to our discovery of a ketogenic lifestyle, granola was a staple in our pantry, on road trips and in the saddle bags on the trail. This has now replaced any craving either of us had for granola. It carries nicely all day in a Ziplock bag on horseback. It even tastes fantastic in a bowl with unsweetened almond milk as a breakfast alternative if you’re tired of eggs and bacon (but, who ever tires of eggs and bacon? I know . . . Right?!!)

I’ve been nibbling from this actual cookie-sheet of low-carb granola while writing this post. . . I wish you were here to share it with. Soooooo very good, and good for your ketogenic lifestyle. I think I’m going to eat another handful while I finish up Part II of the Principle Based Ketogenic Lifestyle post. Enjoy . . .

—————————————————————————

Tiffini’s Maple Pecan Granola (Low-Carb)

1/4 cup butter

1 1/2 cup almonds

1 1/4 cups pecans, divided

1 cup flax seed meal

1/2 cup sunflower seeds – salted

1 cup coconut flakes, unsweetened finely chopped

1/2 cup vanilla whey protein powder – we like ISO-100

1/2 cup pepitas (pumpkin seeds), salted

1/4 cup granulated erythritol

1/8th tsp stevia extract

1 pinch of salt

2 egg whites

1 tsp EZ Sweetz (or 1/2 cup of Sweet Perfection)

1/4 cup Walden Farms Carb Free Maple Syrup

In a food processor, process the almonds and 1 cup of the pecans until it resembles coarse crumbs. Using a knife (preferably a sharp one – remember all bleeding stops eventually), chop the remaining 1/4 pecans coarsely.

Melt the butter and place it in mixing bowel or mixer (We use a Kitchen Aid Mixer). Pour the coarsely chopped nuts into the mixing bowl. Stir in flax seed meal, sunflower seeds, coconut flakes, pepitas and vanilla whey protein powder. Blend in the remaining wet mixture, egg whites and add a pinch of salt. Mix until it forms “clumps.”

Spread the mixture evenly on a large wax paper covered baking or cookie sheet and bake at 350 degrees F for 20-25 minutes or until golden brown. Let it cool on the baking sheet to crisp up for a few hours.

It can be stored in a Ziplock bag in the refrigerator.

Yields 10 servings

1/3rd cup per serving

~ 4 g net carbs

14 g protein

30 g fat

Recipe was modified from Carolyn Ketchum’s Maple Pecan Flax Granola in Low-Carbing Among Friends, Volume – 1, pg. 169, Eureka Publishing, 2011.

September 30, 2015

Cinnamon Swirl Cheese Cake . . . (I think this will be a desert on the menu in Heaven)

While at the house last night, Jimmy Moore, his wife Christine, and my wife Tiffini made this delicious cinnamon swirl cheese cake from The Ketogenic Cookbook. I think I have a new favorite!!! I seriously have not had a better cheesecake and this one is lowcarb, gluten free and keeps you in ketosis. Thank you Jimmy Moore and Maria Emmerich for such a yummy recipe. (I even had some for breakfast this morning . . . . mmmmm).

If you want a great low carb recipe, pick up a copy of the book and turn to page 336.

Until next time . . . keep the ketones high!

September 21, 2015

Homemade Rootbeer – Ketosis Style!!

ery October I get a hankering for homemade root beer. But it is usually loaded with sugar. Thanks to Maria Emmerich and her amazing recipes, that doesn’t have to happen this year. She just posted this on her site today and I can’t wait to try this as I sit by my fire pit roasting some hot dogs with my kids . . . Thanks Maria.

I pasted a copy of her root beer image below just to make you drool, too . . .

Link on the recipe at her site HERE.

(Another great use for the SodaStream as well . . . the day just keeps getting better!)

September 8, 2015

Snack Time . . . Bacon Chips & Guacamole!!

To maintain ketosis, the key is keeping the fat content high and the carb content low . . .while moderating the protein intake. Unless you are running triathalon’s, body building daily or exercising more than 45 minutes daily, most women don’t need more than 70-80 grams of protein per day. Most men don’t need more than 80-90 grams per day.

Now, stop looking at your phone and go make some bacon chips . . . 🙂

July 24, 2015

Handy Charts for Maintaining Ketosis

I found these charts to be very helpful when trying to calculate your fat intake with a meal. Fish can be challenging in calculating fat content. After reading these charts, I’m craving some sashimi’ed mackerel and salmon.

Great charts like these can be found at http://mariamindbodyhealth.com/charts/

Enjoy!!

June 27, 2015

Crispy Fat Bomb

I am always impressed by good pictures, great recipes and and scrumptious food. My wife knows this. Finding great ketogenic recipes is essential. The reason, is that to loose weight and remain in ketosis, it is often essential to increase fat intake to at least 50% of your total calories. Fat Bombs are a great snack idea that helps one accomplish this task. Increasing fat to that level can be challenging for some. Maria Emmerich has posted another tasty and tantalizing high fat, low carbohydrate snack. Check out her recipe for the Crispy Fat Bomb. This is one of those great high fat, low carb tools to keep you in ketosis.

On of my patient’s was just asking about another good Fat Bomb Recipe. So, thanks, Maria!! And, my patient’s thank you too. Try this one out. Please let me know what you think of the crispy versus Tiffini’s Fat Bombs.

June 24, 2015

The Many Names of Sugar

Found this info-graphic while surfing Banner Health’s information pages. Many of my patients get a very confused look on their face when I ask them to restrict carbohydrates. Sugar is the most prevalent form of carbohydrate in the Standard American Diet or SAD diet. Sugar comes by more than one name. This info-graphic is actually very helpful. All of these names are synonymous with weight gain and cholesterol formation.

April 25, 2015

Lily's Chocolate . . . It's Quite Tastey!!

We just got a sample pack of Lily’s Chocolate. This is a Stevia and erythritol sweetened chocolate that has no aftertaste and doesn’t cause the stomach upset that many experience with chicory root based products. I am always looking for good low carbohydrate alternatives for snacks, as rescue foods, or to assist in baking.

My wife found this chocolate in a recipe that Carolyn Ketchum had posted on her website, All Day I Dream About Food. It is quite tastey!! Thanks, Caroyln!! (By the way, I dream about food all day long, too.)

I scanned a copy of the wrapper for the Salted Almond & Milk Flavor. I have to admit, I ate half the bar. It was that good!!

For those looking for an alternative chocolate for a snack or to use in a recipe, this may be the answer. You can find their whole line of chocolates here.

Hope this helps.

April 17, 2015

Why Your Oatmeal is Killing Your Libido

Have you noticed that there are a large number of advertisements in the media about checking your testosterone or “Low T” Syndrome? It seems like this is the new advertising trend on the radio and late night TV.

Suddenly, everyone’s testosterone is low and men are complaining about their libido, . . . or are they?

Benefits of Testosterone Optimization. (Image Credit: ArtOfManliness.com)

If you practice medicine long enough, you’ll see a trend that seems to have arisen as our waistlines have expanded. About half of the men in my office with insulin resistance, pre-diabetes or diabetes have low testosterone levels. But this shouldn’t be a surprise. Type II diabetes, metabolic syndrome and insulin resistance are all driven by an over production in insulin in response to a carbohydrate load in the meal. Patients with these conditions produce between two to ten times the normal insulin in response to a starchy meal. A number of studies both in animal and human models demonstrate that insulin has a direct correlation on testosterone suppression in the blood. This has been demonstrated in both men and women. In fact, glucose intake has been shown to suppress testosterone and LH in healthy men by suppressing the gonadal hormone axis and more predominant testosterone suppression is seen in patient with insulin resistance or metabolic syndrome.

Image Credit: www.townsendletter.com/July2012/metsyndrome0712.html

In fact, to put it simply, insulin increases the conversion (aromitization) of testosterone to estrogen in men (it does the opposite in women). Interestingly, Leptin resistance has a similar effect. I tend to see the worst lowering of testosterone in men with both insulin and leptin resistance.

How to you improve your testosterone? Supplemental testosterone has been shown to help, but it comes with some risks, including prostate enlargement and stimulating growth of prostate cancer. The most natural way to improve your testosterone is to change your diet.

A low carbohydrate or ketogenic diet turns down the insulin production and allows the testosterone to be available for use by the body. A ketogenic diet has the effect of reducing leptin resistance as well through weight loss. A simple dietary change of this type is frequently seen in my office to increase testosterone by 100-150 points.

KetoOS – Drinkable Exogenous Ketones

What is a ketogenic diet? It is a diet that restricts carbohydrates to less than 50 grams per day, thereby causing the body to use ketones as the primary fuel source. So, for breakfast tomorrow morning, hold the oatmeal (1/2 cup of Quaker Instant Oatmeal is 31 grams of carbohydrates) and have the bacon and eggs. And, rather than have the cheesecake for desert this evening, have an extra slice of steak butter on your rib-eye and hold the potato.

March 27, 2015

Why Does Your Chicken Salad Stop Weight Loss?

I have multiple patients that come to my office that we follow and treat for weight loss and metabolic syndrome. They are discouraged that their weight loss has stopped or is very, very slow. The most frequent problem I find when they bring in their food journals is the “healthy chicken salad.”

“What?! But, Doc, Chicken Salad is healthy?! RIGHT?”

The chicken salad shows up on their journal almost daily. Somehow, we’ve been indoctrinated that the chicken salad is good for us. I want you to look closely at the image that was recently shared on the internet below. How is the nutrient value of your chicken salad any different than the Big Mac?

Why is this unhealthy? The carbohydrate content greater than 20-30 grams will cause a spike in insulin. When insulin spikes, the body is told to store fat (and it will store fat for up to 12 hours) . . . Yes, the 24 grams of fat in the salad now become dangerous in the presence of an insulin spike. In my patients with metabolic syndrome, they will produce between two and ten times the insulin and store two to ten times the fat. (Ten Big Macs would have tasted better . . . )

There is actually more carbohydrate in your salad than in the big mac. Why not add a strawberry shake just to finish putting the nail in the coffin? And we wonder why we are having trouble with weight loss?

The other issue, and probably of even greater importance, is that chicken breast has the second highest content of lysine & argenine (two of the 10 essential amino acids) count of all the poultry family. This is second only to turkey breast, which also contains a large amount of tryptophan (a third essential amino acid that spikes insulin). Why is this a problem? Because argenine, tryptophan and lysine all stimulate an insulin response on their own, separate from glucose. We need these amino acids, however, when our meals contain a predominance of these amino acids, it rasies insulin significantly in those who are insulin resistant (pre-diabetic).

Those 43 carbohydrates, plus the stimulus from a meat high in argenine, lysine and tryptophan, spike your insulin, kick you out of nutritional ketosis and slow weight loss for up to 48 hours.

Please, if you are following a low-carb or ketogenic diet, get rid of the chicken salad.

If you want to learn more about this, read my article on the eight most common reasons you can’t lose weight.