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Keto Approved Foods

I’ve been living and teaching patients about using a low-carb/ketogenic and carnivorous lifestyles for over 16 years.  I get thousands of questions each month about what to eat. People ask:

  • “What foods are ketogenic lifestyle approved?”
  • “Can you just give me a list of approved keto foods?”
  • “But, can’t I just have some oatmeal?”

In the past, I’ve given people seven day diets, and I’ve given them food lists.  But, you know the proverb, “give a man a fish . . .”  People still seem confused.  I’ve tried teaching people the simple ketogenic principles, “teach a man to fish . . .”  and this helps a few others.  However, there still seems to be great confusion about what foods can and should be used in a ketogenic lifestyle.  Today, I thought I would try to combine both approaches and discuss the basic macro-nutrients that make up a well formulated ketogenic diet.

Carbohydrates

Let’s start with carbohydrates.  The first principle that must be followed to enter and stay in ketosis is keep insulin from spiking.  This is done by keeping total carbohydrate intake less than 20 grams per day.  The liver produces a small amount of carbohydrate every day to protect the brain.  Therefore, a low baseline level of continuous insulin production is essential to maintain life.  However, it’s the large spikes of insulin after ingesting carbohydrate containing meals that cause the problems.  We talk about this at length in my book The Keto Cure.

Carbohydrates are the foods that most commonly cause insulin to spike.  It is the rapid rise or spike of insulin levels that drive weight gain, arterial plaque formation, heart disease, inflammation, neuropathy, kidney stones, gout and thyroid problems.  Simple and complex carbohydrates cause insulin to surge.  Those same simple and complex carbohydrates are the sugars (monosaccharides & disaccharides) and starches (polysaccharides) found in foods.

Fibers are also complex carbohydrates (polysaccharides) in the form of cellulose, lignin and pectin that are more difficult for human digestive enzymes to break down into simple digestible forms of carbohydrate.  However, juicing, blending or cooking fibers releases the carbohydrate from the complex form and makes them available to our bodies.

Carbohydrates in their various forms are present in varying amounts in foods like fruit, vegetables, grains, beans, legumes, milk, and processed foods like candy, soda & sweets. (These are the foods to limit or completely avoid).

In general, raw leafy greens contain cellulose and the carbohydrates in these vegetables when eaten raw do not need to be counted.  You are free to eat as much as you desire.  However, cooking, blending or juicing the leafy green (as noted below) does break the cellulose bonds and increases carbohydrate absorption (that is why cooked, blended, or juiced vegetables taste “sweeter”).

NOTE: I recommend 1-2 cups of raw leafy greens per day.  Leafy greens are one of the highest sources of folic acid (spinach, asparagus & okra) and without them in the diet, there is a potential risk of folate deficiency if it isn’t present in animal fat sourcesa.  This is especially problematic in pregnant and breast feeding mothers.  Yes, I hear you, eggs and meat are another source of folic acid; however, leafy greens like spinach contain four times the folic acid that eggs and meats do.  Even iceberg lettuce contains more folic acid than eggs (this is why I caution pure carnivore diets in women of child bearing age without folic acid supplementation).

Foods that are loaded with sugars and starches that should be AVOIDED or USED WITH GREAT PRUDENCE include:

Non-Leafy Green Vegetables (1 cup raw or 1/2 cup cooked) – 10 grams of carbohydrate

Asparagus
Bamboo Shoots
Beans (yellow or green)
Beets
Broccoli
Brussell sprouts
Cauliflower
Cabbage
Celery Leaves
Egg Plant
Leeks
Mushrooms
Okra
Onions
Green Onions
Scallions
Pea Pods
Peppers: Green, Red, Sweet, Hot
Sauerkraut
Spinach
Summer Squash
Turnips
Tomato
Zucchini
(Corn, Carrots and Potatoes are not listed here due to their higher carbohydrate content)

Fruits (portions below) – 15 grams of carbohydrate

Apple (1 small)
Apple Juice (1/2 cup)
Apple Sauce (1/2 cup)
Apricots (2 fresh) Page | 5
Banana (1/2)
Berries (blueberries, black berries, strawberries, loganberries, raspberries – 1 cup)
Cantaloupe (1/4 of a 6 inch melon)
Cherries (12)
Cranberries (1 cup)
Dates (3)
Figs (Fres
Grapefruit Juice (1/3rd cup)
Grapes (17 small)
Honeydew melon (1/8th of a 7inch melon)
Kiwi (1)
Lemons (2)
Mango (1/2)
Nectar (1/3rd cup canned)
Nectarine (1)
Orange (1 small orange)
Orange Juice (1/2 cup)
Peach (1 medium)
Pear (1 small)
Pineapple (1/2 cup chopped)
Plumbs (2)
Prune Juice (1/3 cup)
Prunes (2 fresh or dried)
Raisins (2 Tbsp)
Rhubarb (1 cup cooked)
Tangerine (1)
Watermelon (4 inch x 1 ½ inch thick wedge)

Breads (portions below) – 20 grams of carbohydrate

Bread: white, wheat, French, rye, pumpernickel (1 slice)
Bagel (1/3rd)
Biscuit or Roll (1 small)
Breadcrumbs (1/4th cup dry, grated)
Bread-stick (1)
Buns: hamburger, hot dog (1/2 bun)
Cereal – cooked (1/2 cup)
Cereal – puffed (1 cup)
Cereal – flakes (1/2 cup)
Corn (1/3rd cup or 1 small cob)
Crackers:
Graham (three 2 ½ inch squares)
Oyster (1/2 cup)
Saltines (5)
Soda (3)
Zwieback (2)

Macaroni noodles (1/2 cup cooked)
Matzo (one 5 inch square)
Muffin – English (1/2 plain)
Muffin – bran (1 small) Page | 6
Toast – Melba (4 rectangles)
Pasta (1/2 cup) Peas – green (1/2 cup)
Pita bread (1 small)
Popcorn – air popped, dry (3 cups)
Potato – New, Russet or sweet (1/2 cup)
Pretzels (3/4th oz)
Rice – cooked (1/3rd cup)
Rice Cakes (2 plain)
Tortilla (1 small)

Dairy (portions below) – 25 grams of carbohydrate

Milk – whole, 1%, 2% and skim (1 cup)
Powdered Skim Milk – dry (1/3rd cup)
Yogurt:
Plain (1 cup)
Light – sweetened with NutraSweet (1 cup)
Regular – fruit filled (1/2 cup)
Cottage Cheese (2 cups)
American Cheese (12 slices)

You may use hard cheeses, cream cheese, sour cream, and mascarpone as great options on a ketogenic diet because they contain very little carbohydrate and are high in fats.

Proteins

Proteins are large molecules made of of long chains of amino acids and are essential for a vast array of functions within the human being including structural formation, enzymatic reactions, immune response, cell adhesion, DNA replication, and molecular transport to name just a few.  There are 22 amino acids that make up the protein molecules used in the human body.  Interestingly, microorganisms and plants can make all 22 of these amino acids on their own.  However, humans (and a number of other mammals) can’t make 15 of these amino acids on our own and we must obtain them from our diets.

How much protein do you actually need? Understanding your individual needs baseline protein needs can be calculated from your ideal body weight (IBW).  IBW can be very easily calculated from your height and your level of activity.  I give you this calculation because many female patients I see do not eat enough protein.  Lack of protein will halt weight loss (as the body thinks it is starving.)

Your daily protein need can be calculated by the following:

Males: IBW =  50 kg + 2.3 kg for each inch over 5 feet.  Males need 1.2 g protein per kg of IBW.

Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet. Females need 1.0 g protein per kg of IBW.

If you are exercising more than 30 minutes 3 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  x 1.2g/kg if sedentary or 1.6g/kg if exercising 4-5 days per week. 

A 5 foot 4 inch females IBW would be 45.5 kg + (2.3kg x 4 inches) = 54.7 kg x 1.0g/kg if sedentary or 1.4g/kg if exercising 4-5 times per week.

 

This will give you a starting point for your daily protein needs and you can divide this number by the number of meals per day to get the protein needs at each meal.  However, many of my patients after three months of ketogenic living need more protein to continue seeing weight loss.

What if I eat too much protein? There is still significant controversy over exactly how much protein is necessary on a daily basis.  The reason is that many amino acids when ingested in significant amounts stimulate an insulin surge by themselves. These include arginine, lysine and tryptophan.  Eating proteins that are high in these three amino acids in my very insulin resistant patients will raise insulin enough to halt weight loss, cause worsening inflammation, raise blood pressure and cholesterol.

Do you have to avoid these foods on a ketogenic diet? No, however, when you are using them more than 2-3 times a week, weight loss is inhibited and one’s ability to maintain ketosis is blunted.

However, two recent studies(1, 2) demonstrate that when protein intake is increased beyond a certain threshold, growth hormone counterbalances the insulin response and stimulates muscle growth instead of weight gain. That threshold seems to be around 90 grams of protein per day as women and 150 grams of protein as men.

Yes, this is much higher protein in take than the calculation for baseline protein needs we’ve used for years outlined above.  We are learning a great deal about protein.  For years, we’ve been missing the mark on protein needs.  This revolves around the need of leucine to stimulate muscle growth.

What proteins can you use?  The following list should be helpful.  Remember that protein and fat often come packaged together in nature.  As we discuss below, to maintain adequate ketosis, total fat intake should between 70-90% of your total calories.  In order to maintain fat contents greater than 70%, you’ll want to use proteins sources that are the highest in fat (like red meat and pork) or add fat (like cooking in butter or coconut oil) to those that are lower in fat content.

Food:                                                                       Protein Content:                           Fat Content:

Ground Beef (75% Lean) –                                    16 grams per 4 oz.                                  78%

Steak (Ribeye) –                                                      39 grams per 8 oz.                                  74%

Steak (Top or Bottom Round) –                         33 grams per 6 oz.                                  53%

Bacon (pan fried) –                                                 3 grams per 1 slice                                 69%

Sausage (beef) –                                                      14 grams per 3.5 oz.                               79%

Sausage (pork) –                                                      17 grams per 3.5 oz.                               75%

Pork Chop (boneless) –                                         18 grams per 3 oz.                                  31%

Ham (cured whole boneless) –                           19 grams per 3.5 oz.                               28%

Sockeye Salmon –                                                  23 grams per 3 oz.                                  22%

Halibut –                                                                    23 grams per 3 oz.                                  19%

Chicken Breast (boneless, skinless) –                24 grams per 3 oz.                                  18%

Turkey Breast –                                                        24 grams per 3 oz.                                  15%

Tilapia –                                                                      21 grams per 3 oz.                                  13%

Yellowfin Tuna –                                                      25 grams per 3 oz.                                  10%

Light Tuna –                                                             22 grams per 3 oz.                                  8%

Deli Meats:

Pepperoni –                                                              18 grams per 3 oz.                                  83%

Roast Beef –                                                             21 grams per 3 oz.                                  48%

Canadian bacon –                                                   17 grams per 3 oz.                                  42%

Roast Turkey Breast –                                            18 grams per 3 oz.                                  15%

Snacks:

Beef Jerky (Jack Links) –                                          13 grams per 1 oz.                                  9%

Peanut Butter (Peter Pan Crunchy) –                 8 grams per 2 tbsp.                              76%

Macadamia nuts, raw                                             2.2 grams per 12 nuts                           89%

Mixed Nuts –                                                               6 grams per 2 oz.                                  79%

Almonds, raw –                                                          6 grams per 1 oz.                                   66%

Walnuts, raw –                                                           4 grams per 1 oz.                                    85%

Sunflower seeds, raw –                                            6 grams per 1 oz.                                    76%

Tofu –                                                                          12 grams per 3 oz.                                   30%

Greek Yogurt –                                                        23 grams per 8 oz.                                  0%

Cheeses:

Cream Cheese –                                                       11 grams per 3.5 oz.                               79%

Cheddar Cheese –                                                   24.6 grams per 3.5 oz.                           74%

Swiss Cheese –                                                         24 grams per 3 oz.                                 66%

Ricotta cheese –                                                      10 grams per 3.5 oz.                               63%

Eggs –                                                                        6 grams per 1 large egg                        70%

Look for foods who’s ratio of protein to fat is close to or greater than 1:1.  For example, eggs are 6 grams of protein and 6 grams of fat.

It is essential to understand that not all sources of protein are equal in their absorption in the human gut.

  • Egg protein utilization – 50%
  • Meat protein utilization – 40%
  • Cheese protein utilization – 40%
  • Whey protein utilization – 18%
  • Vegetable protein utilization – 14%

Therefore, the two most important things you can do to optimize your ketogenic lifestyle is lower the carbohydrate intake to less than 20 grams per day, and use adequate high quality protein. Muscle gain and fat loss are most effectively achieved when high quality protein is used.

If you are struggling or just getting started, get a copy of Dr. Nally’s Ketogenic Diet here.

What You MUST Know about Total Cholesterol & LDL-C on a Ketogenic Diet

Is following your Total Cholesterol and LDL-C really that important?

You may be quite surprised.

Watch as we discuss the important markers of heart disease and vascular disease risk.  We will talk about how these markers can help you understand what your body is doing in the process of making or reversing atherosclerosis (plaque in the vessels).  And, should you really be taking that STATIN (cholesterol lowering) drug?  Get the scoop here as Dr. Nally very simply points out how the right diet can and will lower your cholesterol without the use of medications.

Research in the last 10 years points to the small-dense LDL particle as the atherogenic component of cholesterol (Hoogeveen RC et al., Arterioscler Thoromb Vasc Biol, 2014 May; Ivanova EA et al., Oxidative Med Cell Longevity, 2017 Apr). Studies in the last five years have identified that elevated small-dense LDL cholesterol correlates much more closely with risk for inflammation, heart disease and vascular disease (Williams PT, et al. Atherosclerosis. 2014 April; 233(2): 713-720.)

Recent research in the last three years demonstrates that small dense LDL cholesterol is a better marker for prediction of cardiovascular disease than total LDL-C (Hoogeveen RC et al., Arterioscler Thromb Vasc Biol. May 2014, 34(5): 1069-1077l; Ivanova EA et al., Oxidative Med Cell Longev. 2017).

Additionally, higher LDL-C is actually predictive of longer life and has been demonstrated to correlate with longevity (Ravnskov U et al., BMJ Open, 2016 Jun 12;6(6): e010401).  And, a low LDL-C actually increases risk of early mortality (Schwartz I et al., Lancet 2001, 358: 351-55).

It is commonly understood that LDL-C will rise with increased saturated fat intake on a ketogenic diet. This has been know and reported in the scientific literature for over twenty years. This is to be expected, because LDL-C is really a measurement of three different LDL sub-particles (“big fluffy, medium, and small dense”). Increased saturated fat intake, while at the same time lowering carbohydrate intake, actually causes a shift in these low density particles to a bigger “fluffier” particle conformation (Griffin BA et al., Clin Sci (Lond), 1999 Sep).
The 2015 British Medical Journal, referenced above, analyzed the relevant 19 peer reviewed medical articles that included over 68,000 participants. This review showed that there is no association of high LDL-C with mortality (meaning that an elevated LDL-C does not lead to an increased risk of death from heart or vascular disease). I realize that, in stark opposition to the landmark review above, The American Heart Association’s Presidential Advisory published their position in the June 20, 2017 issue of Circulation. They stated that saturated fat is the cause of increased LDL-C and they further extrapolated that elevated LDL-C is associated with an increase in death by cardiovascular disease. This boldfaced claim is only based on one single small four year (2009-2013) literature review completed by the World Health Organization with a total of only 2353 participants, most of these studies only lasting 3-5 weeks (not nearly long enough to see fully effective cholesterol changes) and none of which had any focus on carbohydrate intake, insulin levels or LDL sub-particle measurement (Mensink RP, Geneva: WHO Library Cataloguing-in-Publication Data, 2016).

Based upon the most current scientific evidence above and my clinical experience, the large body of evidence above demonstrates the use of total cholesterol and LDL-C to determine vascular disease risk to be ineffective tools. A low carbohydrate/ketogenic diet lowers small dense LDL cholesterol, triglycerides and blood sugar and in many cases, the use of cholesterol drug (STATIN) therapy is not needed and ineffective in comparison with a ketogenic/carbohydrate restricted lifestyle.

 

Long-term weight loss

Long-Term Weight Loss: Why So Many Fail

Over fifty years of data have demonstrated that creating energy deficit through the reduction in caloric intake is effective in reducing weight. . . However, it is only for the short term (1, 2).  The biggest challenge physicians face in the treatment of obesity is that calorie restriction fails when it comes to long-term weight loss.

Isn’t Fasting Effective in Long-Term Weight Loss?

With the craze and popularity of intermittent fasting, some have claimed that intermittent fasting is more effective in weight reduction.  Recent results demonstrate that this may also be incorrect.  In the short term evaluation of caloric restriction and intermittent fasting, reduction in 15-20 lbs of weight is effectively seen and the highly publicized Biggest Loser’s losing ~ 120 lbs.  Intermittent fasting and alternate day fasting have been shown to be more effective in lowering insulin levels and other inflammatory markers in the short term.

There is, however, controversy over maintaining weight loss beyond 12 months in the calorie restriction, intermittent and alternate day fasting groups. Forty different studies in a recent literature review, thirty-one of those studies looking at forms of intermittent fasting, demonstrate that the majority of people regain the weight within the first 12 months of attempting to maintain weight loss(3, 5).  This is, also, what I have seen for over 18 years of medical practice.

Is Calorie Restriction the Only Way to Lose Fat?

Numerous “experts” claim that the only way to reduce fat is “caloric deficit.”  Variations through the use of intermittent, long-term or alternate day fasts can be found all over the internet.   In regards to calorie restriction, these “experts” with nothing more than a personal experience and a blog to back their claims preach this louder than the “televangelists” preach religion.  Based on the faith that many place in this dogma, it could be a religion.  What causes belief in this dogma is that weight and fat loss actually does occur with caloric restriction to a point.  The average person will lose 20-25 lbs, however, within 12 months of achieving this goal, most people regain all the weight.  (No one ever mentions the almost universal problem with long-term weight loss, especially those “experts.”)

Prolonged calorie restricted fasts, intermittent fasts, and alternate day fasts are often grouped together into the fasting approach, causing significant confusion among those that I speak to and counsel in my office.  There is great data that alternate day fasts do not have the reduction in resting energy expenditure that prolonged fasting, intermittent fasting and calorie restriction cause.  However, none of these approaches appears to solve the problem of weight re-gain after long-term (12-24 months into maintenance) weight loss (3).  And, a recent study of 100 men participating in alternate day fasting showed that there was a 38% dropout rate, implying that without close supervision and direction, maintenance of this lifestyle is not feasible for over 1/3rd of those attempting it.

Long-Term Weight Loss Failure Brings Tears

Failure on calorie restricted diets, low fat diets, and intermittent fasting diets with weight regain at twelve to twenty-four months is the most common reason people end up in my office in tears.  They’ve fasted, starved themselves, calorie restricted, tried every form of exercise, and still regained the weight.  Trainers, coaches and “experts” have belittled them for “cheating” or just not keeping to the diet.  Yet, we know that calorie restriction and intermittent fasting cause a rebound in leptin, amilyn, peptid YY, cholecystikinin, insulin, ghrelin, gastric inhibitory peptide and pancreatic poly peptide by twelve months causing ineffective long-term weight loss (6).  The dramatic rise in these hormones stimulates tremendous hunger, especially from ghrelin and leptin.

Hormones after weight loss
N Eng J Med 27 Oct 2011. Mean (±SE) Fasting and Postprandial Levels of Ghrelin, Peptide YY, Amylin, and Cholecystokinin (CCK) at Baseline, 10 Weeks, and 62 Weeks.

Although less problematic in alternate day fasting, these calorie restricted approaches also cause dramatic slowing of the metabolism at the twelve month mark.  In many cases, the metabolic rate never actually returns to baseline, creating even more difficulty in losing further weight or even maintaining weight (6).

Weight rebound after loss
N Engl J Med 27 Oct 2011. Mean changes is weight from 0 – 62 weeks.

Is Gastric Bypass or Gastric Sleeve the Solution?

Gastric bypass and the gastric sleeve procedures have been touted as the solution to this problem, as they decrease ghrelin, however, 5-10 years later, these patients are also back in my office.  They find that 5-10 years after these procedures the weight returns, cholesterol and blood pressure rise, and diabetes returns.  These hormones kick into high gear, stimulating hunger in the face of a slowed metabolism, that to date, has been the driver for weight regain in the majority of people.  People find it nearly impossible to overcome the hunger. You may have experienced this, I know I have.

It’s the Hormones, Baby!

So, what is the answer?  It’s the hormones.  (WARNING – You’ll hear that when your wife is pregnant, too, gentlemen).  We are hormonal beings, both in weight gain, and in pregnancy.  Trying to preach calorie control to a hormonal being is like showing up at the brothel to baptize the staff. You might get them into the water, but you’re probably not getting them returning weekly to church or pay a tithe.

Respect My HormonesSo, how do you manipulate the hormones in a way to control the rebounding hunger and suppression of metabolism?  This is where we put a bit of twist on the knowledge we’ve gained from alternate day fasting.  Recent research shows that “mild” energy deficit in a pulsatile manner, that has the ability to mimicking the body’s normal bio-rhythm’s is dramatically effective in reducing weight and maintaining normal hormonal function without cause of rebound metabolic slowing (4).

Pulsed Mild Energy Restriction

What does this mean in layman’s terms?  It means that if we provide a diet that maintains satiety hormones while providing a period of baseline total energy expenditure needs and a period of mildly reduce caloric intake in a pulsed or cyclic manner, greater weight loss occurs and there is no rebound of weight 1-2 years later.

The main reason I’ve not jumped on the intermittent fasting band wagon is the shift in leptin, amylin, ghrelin and GLP-1 signaling that regularly occurs at the 6-12 month mark.  The rebound of these hormones causes weight re-gain and is what prevents successful long-term weight loss.  A number of people come to my office and tell me they couldn’t follow a ketogenic diet, so they’re doing intermittent fasting and it works . . . for a while.  Then, they end up in my office having hit a plateau or fallen off the wagon and regained all the weight.  They are completely confused and don’t understand what happned.  Most of them are convinced it’s their thyroid or cortisol and they’ve seen every naturopath and functional medicine doctor in town.

What people really need is a simple approach to long-term weight loss without having to spend the night in the physiology lab every two weeks sleeping under a ventilated hood system.

The Ketogenic Lifestyle is a Pulsed Energy Lifestyle

  • First, it is essential to turn off the insulin load. Insulin is the master hormone.  This is done by a ketogenic lifestyle that restricts carbohydrates.
  • Second, providing adequate protein to supply maintenance of muscle and testosterone is key.
  • Third, providing adequate fat is the simple way to maintain leptin, ghrelin, amylin, GLP-1 (among the others) and long-term weight loss.  Can you eat too much fat?  Of course you can.  But, because each of us have differing levels of stress and activity each day, this fat intake becomes the lever for hunger control.
  • Fourth, the use of exogenous ketones ensures easily accessible ketone (short chain fatty acids) to modulate adipose (white fat) signaling of the liver without large caloric intake through the portal vein by first pass of liver metabolism.  The ketones also help stabilize the gut bacteria.  The combination of hormone balance between the liver and fat cells and improvement of gut bacteria suppresses key hunger hormones and aids glucose regulation between the fatty tissues and the liver.  Ketones, both endogenous and exogenous, suppress production of TNF-alpha, IL-6, resistin, and stabilize production of adiponectin and leptin from the adipose cells (7, 8, 9).

In my office, once we calculate the basic protein needs daily, we start with a 1:1 ratio of protein to fat.  Then, the fat is adjusted up or down based on hunger. Remember, hunger occurs, because your body produces hormones.  The addition of fat to a diet that is not stimulating large amounts of insulin resets the hormone patterns back to normal without causing weight gain.

Give Obese People Fat Ad Libitum?

“Sure, Dr. Nally, but what about those people who don’t know if they are hungry, bored, stressed or just have a bacon fixation?  You can’t just give them all the fat they want?!”

Why not?  Implying that people aren’t smart enough to know when they are full is a bit of a fascist philosophy, don’t you think?

Do people over eat?  Sure they do.  But, I’ve found that when you give people an antidote to hunger (using fat intake in the presence of stabilized insulin levels) over a few months, people begin to recognize true hunger from other forms of cravings.  This is especially true when they keep a diet journal.  This gives people the ability to begin listening to their own bodies, responding accordingly and governing their stress, eating, exercise and activity.  Keeping a diet journal is key to long-term weight loss.  And, isn’t helping people use their own agency to improve their health really what we’re trying to do?

Interestingly, doing this over the years seems to line up with the findings of this year’s MATADOR study in the International Journal of Obesity.  They found that mild intermittent energy restriction of about 30-33% for two weeks, then interrupting this with two weeks of a diet that was energy balanced for needs improved both short and long-term weight loss efficiency (4).  In looking at my, and my patient’s diet journals, this energy restriction of about 1/3 of needed calories cyclically seems to happens naturally with a ketogenic lifestyle, without even counting calories.  (Calories are a swear-word in my office).

What does the correct long-term wight loss program look like in a diet or meal plan?  Well, you’ll have to join the Ketogenic Lifestyle 101 Course to see what that really means to you individually.  I look forward to seeing you there.

Want to find out more about the Ketogenic Lifestyle 101 course?  CLICK HERE.

 

Have you read my book The Keto Cure?  Get a signed copy from me by clicking HERE.

References:

  1. Bronson FH, Marsteller FA. “Effect of short-term food deprivation on reproduction in female mice.” Biol Reprod. Oct 1985; 33(3): 660-7. https://www.ncbi.nlm.nih.gov/pubmed/4052528?dopt=Abstract&holding=npg
  2. Connors JM, DeVito WJ, Hedge GA. “Effects of food deprivation on the feedback regulation of the hypothalamic-pituitary-thyroid axis of the rat.” Endocrinology. Sep 1985. 117(3): 900-6. https://www.ncbi.nlm.nih.gov/pubmed/3926471?dopt=Abstract&holding=npg
  3. Seimon RV, Roekenes JA, Zibellini J, Zhu B, Gibson AA, Hills AP, Wood RE, King NA, Byrne NM, Sainsbury A. “Do intermittent diets provide physiological beneftis over continuous diets for weight loss? A systematic review of clinical trials.” Mol Cell Endo. 15 Dec 2015. 418(2): 153-172. https://www.sciencedirect.com/science/article/pii/S0303720715300800
  4. Byrne NM, Sainsbury A, King NA, Hills AP, Wood RE. “Intermittent energy restriction improves weight loss efficiency in obese men: the MATADOR study.” Int J Obes. 2018. 42:129-138.  https://www.nature.com/articles/ijo2017206
  5. Trepanowski JF, Kroeger CM, Barnosky A. “Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults.” JAMA Intern Med. Jul 2017. 177(7): 930-938. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2623528?redirect=true
  6. Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, Proietto J. “Long-term persistence of hormonal adaptations to weight loss.” N Engl J Med. 27 Oct 2011. 365: 1597-1604. http://www.nejm.org/doi/full/10.1056/NEJMoa1105816
  7. Asrih M et al., “Ketogenic diet impairs FGF21 signaling and promotes differential inflammatory responses in the liver and white adipose tissue.” PlosOne. 14 May 2015. Open Access. https://doi.org/10.1371/journal.pone.0126364
  8. Veniant MM et al. “FGF21 promotes metabolic homeostasis via white adipose and leptin in mice.” PlosOne.  Jul 2012. Open access. https://doi.org/10.1371/journal.pone.0040164
  9. Whittle AJ, “FGF21 conducts a metabolic orchestra and fat is a key player.” Endocrinology. 1 May 2016. 157(5): 1722-1724.
Basal Ganglia Fat DocMuscles #KetonianKing Adam Nally

Habit-Loop Cycle of Weight Gain & Obesity

In my last blog post about willpower, I described habits being neural impulse channels in our brain stimulated by a cue following a path leading to the same outcome each and every time – without exerting much effort. Researchers call the formation of these impulse channels habit-loop cycles.  Much of the original obesity research of the 19th century was conducted by psychiatrists and psychologists recognizing that people had habitual eating patterns.  Because of this, gluttony became the perceived influence of obesity.  This underlying philosophy still permeates the obesity research, treatment and low-carb dietary world today.  Yet, over the last 15 years, I’ve found that the habit-loop cycle is tied to powerful hormone responses. These responses to very subtle and often unknown triggers or cues powerfully drive weight gain, obesity and struggles with willpower.   How does the habit-loop cycle effect you?  Before we can change these habit-loop cycles, we have to understand what they are, and how they were created.

It’s All About That Basal Ganglia

All About That Bass (All About That Basal Ganglia) DocMuscles #KetonianKing

Meghan Trainor tells us that “It’s all about that bass . .  .” However, it’s really all about that basal ganglia. Deep inside our brains, close to the brain stem, at the location where the brain meets the spinal cord, is a little “nub” of neurological tissue called the basal ganglia.  This little nubbin of tissues was identified by the really smart scientists at MIT in the 1990’s as the location where habits are formed and executed.  The brain is – to take a quote from my favorite ogre, Shrek – “like an onion – it has layers!”

The Brain Is Like an Onion

If you picture the outer layers of the brain tissue, those closest to the hair and scalp, you can create a mental image of where our most complex thoughts occur.  When you think up a new invention, create a new way to cook with bacon, laugh at a friend’s joke, or link two complex thoughts about how habits form, you are using these outer layers of the brain.

Brain is like and onion DocMuscles #KetonianKing Habit-Loop Cycle
Like an Onion – It Has Layers! (DreamWork’s Shrek, 2001)

However, our interest today is deeper . . . much, much deeper.  Deep within the center of the brain at the basal ganglia is the location where our automatic behavior originates.  Swallowing, breathing and the startle responses are housed in this little nubbin of brain tissue.  It is this area of the brain that learns to recall and record patterns of neurological thought and stimulating action. This part of the brain has the ability, like the water drops on the mound we discussed last week, to record neural pathways and tracks leading to reduced mental effort and habit.  The basal ganglia even has the ability to store habits while the rest of the brain is asleep.  It is in this location, the basal ganglia, where the habit-loop cycle occurs.

Habits Created by Chunking

The habit-loop cycle is the process where the brain converts a sequence of actions into an automatic routine.  The really smart guys at MIT call this “chunking,” and it is the root of habit formation.  There are hundreds of behavioral chunking activities that you and I rely upon every day.  Some of these are as simple as the process you use to squirt toothpaste on your toothbrush before brushing your teeth.  Others are more complex like getting dressed or making a lunch box for the kids.

The Habit-Loop Cycle in Your Car

A habit-loop cycle is performed by this little nubbin of tissue by millions of people every morning.  Take, for example, backing your car out of the garage.  When you first learned to do this, it required huge amounts of concentration – and for very good reason. You’re steering 3000-5000 lbs of steel between a 16 foot garage-door opening into oncoming traffic.  Basal Ganglia DocMuscles #KetonianKing Habit-Loop Cycle

Safely backing your car requires you to open the garage door, unlock the car, adjust the seat, insert the key into the ignition, turn it clockwise, move the rear-view mirror and the side mirrors to visualize any obstacles, put your foot on the brake, put the car into reverse, gently remove your foot from the brake, mentally estimate the distance between the garage and the street while keeping the wheels straight and looking over your shoulder, applying a slight pressure between the gas pedal and the brake, and in some cases, slapping your teenagers hand while they fiddle with the radio dial.

But think about it . . . did you actually put any thought into these actions this morning?  You and I probably did this once or twice today without any additional thought.  It happened because the basal ganglia took over and created a habit-loop out of it.  This routine, repeated hundreds of times, became a habit, requiring very little mental effort.

Your Basal Ganglia Makes You Fat

The habit-loop cycle occurs hundreds and maybe thousands of times throughout our day. It is the cycle that drives hundreds of our activities.  In fact, it is this same cycle, in combination with 30 different hormones, that drives our weight gain or weight loss.  Yes, I said it, your basal ganglia can make you fat.

Habits Make for a Smaller Brain

Your brain will try to turn any regular routine into a habit, because habits allow our minds to slow down and conserve effort, energy and fuel. The efficient brain allows us to stop thinking about basic behaviors like walking, breathing and eating. This effort-saving effect of the brain is a major advantage, otherwise our brains would be huge, requiring heads the size of watermelons, or even the size of a water tower, causing their own weather systems.  Your wife will thank you for an efficient brain that is smaller and requires less room. Can you imaging giving birth to a watermelon or a small Chevy?  (Did you notice the size of Shrek and the Donkey’s head? Just say’n . . . )

Habits Are The Root of Behavior

What all this leads to is this – habits, as much as memory and reason, are the root of our behavior.  We often don’t remember the experiences that create our habits. However, once they are created, they influence our action without our own realization. Charles Duhigg’s book, The Power of Habit is a great resource for further information on how habits drive our behavior.

The Habit-Loop of Obesity

So, how does all this affect obesity and weight gain?  Let’s, first, look at the habit-loop cycle.  Researcher, Larry Squire, documented the habit-loop through three decades of research.  He and others published numerous articles showing that habits have a cue or trigger that stimulates a routine.  The routine leads to an outcome or reward.  The reward usually satisfies a craving.  Cue-> Routine -> Reward.  What we learn through our studies in obesity is that the reward often stimulates a hormonal response of 1-30 different hormones in brain and body leading to repeat cues or triggers.  The cravings are hormonally driven.  I call it the Habit-Loop of Obesity.

Habit-Loop of Obesity DocMuscles #KetonianKing Adam Nally

 

The Craving is the Key

Human psychology and emotion is the key behind habit creation.  First, there must be a trigger or cue.  Second, the trigger is attached to  a previously experienced emotion or craving tied to the cue.  The key to habit formation is the craving.  The craving is what stimulates the physical routine to occur.  It is an emotion or craving that drives the brain to create the habit. Third, there must be a clearly defined outcome or reward that satisfy the emotion or the craving. The emotion or craving doesn’t have to be associated with hormones, however, in the relm of obesity, it is usually tied together.

I am all about making things easier.  Your brain does it. We all do it.   And, I’m all about trying to help you lose fat and get healthy more easily. Let food be your medicine, let medicine be your food. That’s my mantra and that is as easy and natural as it gets.  But, in our day and age, we don’t always have access to growing and raising our own food.  That’s why my second mantra is – better living through chemistry.  So, I created the KetoKart.  Over the last 15 years of medical practice, I’ve found products and supplements that aid in letting food be your medicine, changing triggers, modifying hormones, and help to satisfy cravings in a healthy way to make your decisions easier.  Go to the KetoKart, see which package works for you and order it.  You’ll thank me.

How do  we change our obesity habits?  Stay tuned for the third part in this series: Fixing the Habit-Loop of Obesity.

So, I want to know . . . which package did you choose?

 

How Does Ketosis Help Insulin Resistance & Disease?

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How does ketosis help the diseases of civilization? Find out as Dr. Nally answers these and many other pertinent dietary questions this evening.

You can learn more about his multi-vitamin supplement he designed for insulin resistance/diabetic/weight management patients that he mentions in the video here at KetoLiving.com.

You can learn about exogenous ketones that he mentions helps to augment ketosis here at DymaicKetones.com.

KetoDynamic Successes . . .

Adam Tiffini 

As I reviewed my website recently, I realized that I have posted lots of science but I’ve never posted any success stories.  So, as patient’s are comfortable & willing to share, I will begin posting these experiences here on the blogosphere for the world to witness their successes and the power of the KetoDynamic Antidote.  

The first success story is my own.  This picture of me and my wife, were taken after I had been following a ketogenic lifestyle for about 4 years.  I dropped 60 lbs, normalized my cholesterol and blood sugar also normalized.  I couldn’t and wouldn’t recommend these lifestyle changes unless I was willing to follow them for the long haul myself. I call people following a ketogenic lifestyle for longer than a year “Ketonians.”

Not only mine, but hundreds of patient’s having similar successes have become the greatest reward to my career as a physician over the last 15 years.  They are truly the “KetoDynamic Moments” that etch themselves into my memory and have made me such an advocate of a ketogenic lifestyle.  Therefore, it is with great honor and excitement that I have been allowed to share Michelle’s story below. 

  
Michelle started seeing me in October 2015. She has struggled with weight all her life and, now in her late 40’s, weighed 201 lbs with a waist circumference of almost 36 inches and a body mass index of 32.  Her “before” picture was taken just before a Halloween activity in 2015.  Her “after” picture was taken in late March 2016.  

A simple ketogenic lifestyle change ( <20g of carbohydrates, moderate protein for her ideal body weight & increasing fat to > 60% of total calories) has produced almost 50 lbs of weight loss and 6 inches off her waist in just 5 months.  This was with dietary change only (Michelle doesn’t exercise) and she’s still losing weight.  What is dramatic, and I see it every day, is that Michelle looks younger by at least 10 years (she actually added 20 years to her life span with this weight loss already).  She feels fantastic.  Blood sugar and cholesterol are now under control and she has tremendous amounts of energy.  Her picture in March is at a body mass index of 29.
Michelle doesn’t calorie restrict. She just eats until she is full.  Congratulations, Michelle!!! And, keep up the great work.

If you’d like to share your KetoDynamic successes with me and my audience, please let me know. 

Too Much Fat on a Ketogenic Diet?

bacon eggsIf you are interested in the low-carb, moderate protein, high-fat, ketogenic diet, then this is the podcast for you. We zero in exclusively on all the questions people have about how being in a state of nutritional ketosis and the effects it has on your health. There are a lot of myths about keto floating around out there and our two amazing cohosts are shooting them down one at a time. Keto Talk is cohosted by 10-year veteran health podcaster and international bestselling author Jimmy Moore from “Livin’ La Vida Low-Carb” and Arizona physican and certified bariatric physician Dr. Adam Nally from “Doc Muscles” who thoroughly share from their wealth of experience on the ketogenic lifestyle each and every Thursday. We love hearing from our fabulous Ketonian listeners with new questions–send an email to Jimmy at livinlowcarbman@charter.net. And if you’re not already subscribed to the podcast on iTunes and listened to the past episodes, then you can do that and leave a review HERE. Listen in today as Jimmy and Adam answer more engaging questions about nutritional ketosis from you the listeners today in Episode 17!

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KetoOS
KetoOS – Drinkable Exogenous Ketones

Healthy Ketogenic Bio-Hacking…Come Learn How

Biohacking

Ever wondered if it is possible to change up your metabolic genetics for the better?  Come join me this week.  I’ll be speaking about Ketogenic BioHacking,  Thursday, March 31st, in Scottsdale, Arizona.  Meet me from 7-8:30pm and learn how to improve fat burning, bio-hack your epi-genetic metabolism for improved blood sugar, cholesterol, blood pressure and so much more . . .

You’ll also get to meet Kim Minert who will be signing her new book, Burn Fat for Fuel.  And, you’ll get a chance to meet the amazing Abigail Epps-Kluttz, body builder, fitness model & Pruvit Ambassador.

You can sign up at the Eventbrite link here. I look forward to seeing you!!

Ketogenic Rule #7: Abs are Made in the Kitchen – Not the Gym

Abs female Abs made in kitchen

“Doc, how do I get six-pack abs?”

I get this question almost daily. Sorry to burst your bubble, but there is NO exercise program that will give you “six-pack” abs.

Really.  You can do sit-ups, leg lifts and crunches ’till the cows come home and it will do nothing other than give you abdominal cramps.  It will also make you hungry.  I don’t care what Men’s Fitness, Bodybuilding.com, Muscle Magazine, Shape or even Doctor Oz said. There are no “6 Best Exercises for Ripped Abs.”  There is only one exercise . . . throwing the carbs in the trash (or giving them to the neighbor you don’t like.)

The “12 Step Ab Program” really only has ONE STEP . . . cut the carbs.  Let me repeat that.  There is only ONE STEP to “six-pack abs,” . . . cut the carbs.  Cardiovascular exercise does nothing for amazingly toned abdominal muscles, other than make you hungry.   Resistance exercise improves insulin resistance, but doesn’t build the abs.  Avoiding the milk, rice, wheat, oatmeal and fruit allows the abs to appear.  Yes, I’m serious.  What do bears eat? Berries.

When did you last see the a bear with “six-pack abs?”

The only way to see your “six-pack” is to remove the fat covering your “six-pack.”  The only way to get rid of fat covering your “six-pack” is to stop drinking it and lower the carbohydrate content to less than 20 grams per day.  Seriously . . .

So you’ve done 100 crunches a day for six months?  Do you see your “six-pack” now?  Exactly.

I’ve said it before and I’ll say it again.  Insanity is doing the same thing over and over and expecting a different result.

Follow the principles outlined in my past articles like The Principle Based Ketogenic Lifestyle . . . Part I & Ketogenic Principles . . . Part II and make sure you are avoiding Common Ketosis Killers.

Dr. Nally’s Favorite Exogenous Ketones

Staying in ketosis and adding 2-3 days of resistance training will melt 2-5 lbs of abdominal fat away each month.   Yes, I know it is slow . . . but that is weight (fat) that will stay off.  Use whole foods high in fat, moderate in protein and low in carbohydrate.  Use supplements like Keto//OS & Adapt bars to help when you don’t have access to a good meal or as a snack when you are hungry.  Look at the list of Low Carb Links above to get great ideas for meal preparation and sweeteners that you can use.

 

Adapt Your Life

 

 

Random Thoughts from the Toilet Paper Roll

Random-Thought-Notebook

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

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

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

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

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

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

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

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

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

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

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

KetoOS
KetoOS – Drinkable Exogenous Ketones

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

Are the Keys in the Freezer?

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

 

The Low-Carb Restaurant

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!!

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.

Why the Calorie is NOT King

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

Obesity 2011
U.S. Obesity Adult 2011
Obesity 2014
U.S. Adult Obesity 2014

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

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

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

Or you can watch the video without the comments here:

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 . . . !

The 3 Weight Loss Necessities to Weathering the Holidays

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

caffeine-content-of-popular-drinks

Ingestion of caffeine has the following effects:

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

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

Spider Normal
Normal Spider (9)
Spider Caffeine
Spider on caffeine (9)

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

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

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

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

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

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

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

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

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

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

References:

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

How Do You Know if You’re Insulin Resistant?

How do you know if you're insulin resistant? What questions need to be asked? What should your numbers be? And, many other great ketosis questions. Also, why does Dr. Nally look like he has dirt on his chin? See it here . . .

Read more

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.

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.

What Lab Testing Do You Need to Start Your Weight Loss Journey?

What laboratory testing is necessary when you start your weight loss journey on a Ketogenic, Low-Carbohydrate, Paleolithic or any other dietary changes?  Why do you need them and what are you looking for?  We discuss these questions and others on today’s PeriScope.  Lots of questions from around the world to day . . . this one lasted a bit longer than normal . . . 45 minutes to be specific.  But it’s a good one because of all of your fantastic questions!  You really don’t want to miss this one.

You can see the video below or watch the video combined with the rolling comments here on Katch.me/docmuscles.

A list of the labs that we discussed are listed below:

  • Fasting insulin with 100 gram 2 or 3 hour glucose tolerance test with insulin assay every hour
  • CMP
  • CBC
  • HbA1c
  • Leptin
  • Adiponectin
  • C-Peptid
  • NMR Liprofile or Cardio IQ test
  • Lipid Panel
  • Urinalysis
  • Microalbumin
  • Apo B
  • C-reactive protein
  • TSH
  • Thyroid panel
  • Thyroid antibodies
  • AM Cortisol

This list will at least get one started, provide the screening necessary to identify insulin resistance (Diabetes In-Situ), Impaired fasting glucose, diabetes and allow for screening for a number of the less common causes of obesity.

I would highly recommend that you get these through your physician’s office so that appropriate follow up can be completed.  These labs will need to be interpreted by your physician, someone who understands and is familiar with various causes of obesity.

Until next time . . .

 

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.

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!!!

How Fat Makes You Skinny . . . (Eating Fat Lowers Your Cholesterol?!)

Diseases seem to arrive in three’s each day in my office.  Today I had three different patients with cholesterol concerns who were notably confused about what actually makes the cholesterol worse, and what causes weight gain.  Each of them, like many patients that I see, were stuck in a state of confusion between low fat and low carbohydrate lifestyle change.   My hope is to give my patients and anyone reading this blog a little more clarity regarding what cholesterol is, how it is influenced and how it affect our individual health.

First, the standard cholesterol profile does not give us a true picture of what is occurring at a cellular level.  The standard cholesterol panel includes: total cholesterol (all the forms of cholesterol), HDL (the good stuff), LDL-C (the “bad” stuff) and triglycerides.  It is important to recognize that the “-C” in these measurements stands for “a calculation” usually completed by the lab, and not an actual measurement.  Total cholesterol, HDL-C and triglycerides are usually measured and LDL-C is calculated using the Friedewald equation [LDL = total cholesterol – HDL – (triglycerides/5)].  (No, there won’t be a quiz on this at the end  . . . so relax.)

However, an ever increasing body evidence reveals that the concentration and size of the LDL particles correlates much more powerfully to the degree of atherosclerosis progression (arterial blockage) than the calculated LDL concentration or weight (1, 2, 3).

There are three sub-types of LDL that we each need to be aware of: Large “fluffy” LDL particles (type I), medium LDL particles (type II & III), and small dense LDL particles (type IV).

Lipid Planet Image
Weight & Size of VLDL, LDL & HDL

 

Misleading LDL-C
Why LDL-C is misleading: Identical LDL-C of 130 mg/dL can have a low risk (Pattern A) with a few “big fluffy LDL particles or high risk (Pattern B) with many small dense LDL particles.

Second, it is important to realize that HDL and LDL types are actually transport molecules for triglyceride – they are essentially buses for the triglycerides (the passengers).  HDL can be simplistically thought of as taking triglycerides to the fat cells and LDL can be thought of as taking triglycerides from the fat cells to the muscles and other organs for use as fuel.

Third, it is the small dense LDL particles that are more easily oxidized and because of their size, are more likely to cause damage to the lining of the blood vessel leading to damage and blockage.  The large boyant LDL (“big fluffy LDL particles”) contain more Vitamin E and are much less susceptible to oxidation and vascular wall damage.

Lipid Danger Slide

Eating more fat or cholesterol DOES NOT raise small dense LDL particle number.  Eating eggs, bacon and cheese does not raise your cholesterol!  What increases small dense LDL particles then?  It is the presence of higher levels of insulin.  Insulin is increased because of carbohydrate (sugars, starches or fruits) ingestion. It is the bread or the oatmeal you eat with the bacon that is the culprit.  The bread or starch stimulates and insulin response.  Insulin stimulates the production of triglycerides and “calls out more small buses” to transport the increased triglyceride to the fat cells (4, 5, 6, 7).

Fourth, following a very low carbohydrate diet or ketogenic diet has been demonstrated to decreased small dense LDL particle number and correlates with a regression in vascular blockage (8, 9).  So, what does this really mean to you and me?  It means that the low-fat diet dogma that that has been touted from the rooftops and plastered across the cover of every magazine and health journal for the last 50 years is wrong. . . absolutely wrong.

I talk about this and answers questions on today’s Periscope.  You can see the recording on Katch.me with the comments in real time here:

https://www.katch.me/docmuscles/v/2f0b6d07-d56a-368b-b4f6-34a5ab3da916

 

Or, you can watch the video below:

References:

  1. Superko HR, Gadesam RR. Is it LDL particle size or number that correlates with risk for cardiovascular disease? Curr Atheroscler Rep. 2008 Oct;10(5):377-85. PMID: 18706278
  2. Rizzo M, Berneis K. Low-density lipoprotein size and cardiovascular risk assessment. QJM. 2006 Jan;99(1):1-14. PMID: 16371404
  3. Rizzo M, Berneis K, Corrado E, Novo S. The significance of low-density-lipoproteins size in vascular diseases. Int Angiol. 2006 Mar;25(1):4-9. PMID:16520717
  4. Howard BV, Wylie-Rosett J. Sugar and cardiovascular disease: A statement for healthcare professionals from the Committee on Nutrition of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation. 2002 Jul 23;106(4):523-7. PMID: 12135957
  5. Elkeles RS. Blood glucose and coronary heart disease. European Heart Journal (2000) 21, 1735–1737 doi:10.1053/euhj.2000.2331
  6. Stanhope KL, Bremer AA, Medici V, et al. Consumption of Fructose and High Fructose Corn Syrup Increase Postprandial Triglycerides, LDL-Cholesterol, and Apolipoprotein-B in Young Men and Women. The Journal of Clinical Endocrinology and Metabolism. 2011;96(10):E1596-E1605.
  7. Shai I et al. Cirulation. 2010; 121:1200-1208
  8. Krauss RM, et al. Prevalence of LDL subclass pattern B as a function of dietary carbohydrate content for each experimental diet before and after weight loss and stabilization with the diets.  American Journal of Clinical Nutrition. 2006; 83:1025-1031
  9. Gentile M, Panico S, et al., Clinica Chimica Acta, 2013, Association between small dense LDL and early atherosclerosis in a sample of menopausal women, Department of Clinical Medicine and Surgery, University “Federico II” Medical School, Naples, Italy Division of Cardiology, Moscati Hospital, Aversa, Italy A. Cardarelli Hospital, Naples, Italy

The Principle Based Ketogenic Lifestyle . . . Part I

BalanceIt has been resoundingly clear to me over the last couple of weeks that there is a tremendous need for a principle based approach to a ketogenic diet.  This approach, however, must be simple.  So many of the approaches to weight loss I read about are complex and the questions that arise from these approaches are innumerable.  Losing weight should not be as difficult as putting a man on the moon.  To quote a patient recently, “If it ain’t simple, Doc, I ain’t doing it. . .”

I agree.

Any approach that requires the conversion of food to numbers or calories or exchanges becomes cumbersome, and I personally won’t follow it for more than a week.   The principle based approach should be simple and is really based upon the mantra:

Give a man a fish and he will eat today. Teach a man to fish and he will eat for the rest of his life. 

Ketogenic diets are wrongly referred to as diets.  What I’m talking about is a ketogenic lifestyle.  Simple lifestyle design should not be hard. So, what do you say? Shall we learn to fish?!

I assume that if you’re reading this article, you already understand that weight gain is not due to an over intake of calories.   Weight gain is due to hormone signals throughout the body leading to the storage of fat . . . specifically, triglycerides being taken up into the fat cells.  The hormone that independently controls uptake of fat into each fat cell is insulin.  Insulin is an essential hormone, but too much of it stimulates the adipose (fat cells) to over-stock triglycerides or essentially “get fat.”  It, actually, is that simple.  There’s really only one rule to this lifestyle: If it raises your insulin it will halt or stall your weight loss.  Write that on your hand or your forehead or in your planner, the lifestyle revolves around that one rule.

Most people start a ketogenic diet because they want to lose weight and have failed at multiple other dietary approaches. Reasons for weight control failure are often multi-faceted, but they all start with from a position of flawed understanding. The majority of approaches to weight management come from  the false assumption that weight is gained because of an over-consumption of calories or a lack of physical activity to burn excess calories.   People have faithfully been restricting calories and exercising to exhaustion since the early 1980’s to no avail. (Well, 1% of people succeed, but the rest of us failed this approach). The definition of insanity is repetitive completion of an ineffective action and expecting a different outcome each subsequent time around. If you still think that caloric restriction and exercise is successful, I’ll be shipping your drawstring white vest and your invitation to a padded cell shortly.

Let me put it clearly.  We’ve been exercising and cutting our calories since 1975 and look at what it’s gotten us . . .

Obesity Trends 2015

. . . . a country that is now recognized as the “United States of Corpulence.”  Super-Size me has become literal. “Houston . . . we have a problem . . . !”

houston-we-have-a-problem

The rule above is based on foundational principles.  Understanding of the principles allows one to successfully apply the rule above.

PRINCIPLE 1

The first principle in a ketogenic lifestyle is understanding that the problem is not caloric, but hormonal.  Choices and actions from here on out must be based on this understanding.  Anything that will raise insulin will thwart ketosis. Insulin stimulates lipoprotein lipase, the enzyme that pulls the triglycerides into the fat cells. Without insulin, we don’t gain weight. (That’s why type I diabetes are usually very slender and skinny).

The standard lab value for normal fasting insulin levels reflect 10-22 uIU/L as the normal.  However, in my office, glucose tolerance tests and postprandial glucose tests consistent with impaired fasting glucose are routinely positive when the fasting insulin level is >5 uIU/L.

Point of Focus: If your having trouble, look at the hormones.  Food stimulates hormone responses. Focus on the hormone response to your diet.

PRINCIPLE 2

A ketogenic diet is one where the body uses fatty acids as the primary fuel. Those triglycerides mentioned above are made up of three fatty acids linked to a glycerol molecule.  To use the triglycerides, the three fatty acids must be broken away from the glycerol by hormone sensitive lipase (HSL).  Insulin directly inhibits HSL. Keeping insulin levels low is the first step in shifting to a ketogenic metabolism. Lowering insulin allows access to the fatty acids in your fat cells.  Triglycerides are not water soluble and the rate by which they can be taken up and burned in the mitochondria limits the speed by which triglycerides can be used as fuel. The by product of triglyceride burning is ketones.  Ketones themselves can be used as fuel and over 4-6 weeks, the body can enhance its ability to use ketones when fat is the primary fuel. This is called “Keto-Adaptation.”

Point of Focus: Too much carbohydrate in the diet shifts the body from it’s use of fat and triglycerides back to glucose.  In general, to become “keto-adapted,” limit carbohydrate to < 20 grams per day.  Keep protein at around 0.8 to 1 gram of protein per pound of body weight.

KetoOS
KetoOS – Drinkable Exogenous Ketones

PRINCIPLE 3

Wait a minute!? Where do the ketones come in? When fatty acids are burned or oxidized in the mitochondria of cells within the liver, they are converted into Acetyl-CoA.  The Acetyl-CoA is used to form ATP for energy in the Citric Acid Cycle.

Metabolism macronutrients

IF excess Acetyl-CoA production occurs or if inadequate oxaloacetate is present, the extra Acetyl-CoA is transformed into ketone bodies – specifically beta-hydroxybutyric acid and acetoacetic acid.  Fat can be oxidized or burned for fuel while ketones are being produced.  Ketones are much smaller molecules and can more easily be transported in the blood than triglycerides, as they are water soluble. The ketones themselves can also be used or burned as fuel as the body upregulates the mitochondria’s ability to use the ketones as fuel as well.  As I mentioned above, this process of “keto-adaptation” can take 4-6 weeks. Keto-adaptation results in humans having a greater desire to be physically active – the miraculous conversion of the couch-potato into the bacon-burning triathlete.

Point of Focus: Sugar is a drug.  Its byproduct has the same hedonic effect on the brain as morphine.  Sugar withdrawal can commonly cause headache, anxiousness, insomnia, dizziness, fatigue and moodiness within the first week of carbohydrate restriction on the road to keto-adaptation.

Ketone_bodies

PRINCIPILE 4

For the average person to become “ketotic” or reach a state of ketosis, it takes lowering the carbohydrates to less than 20 grams per day (and sometimes less than 10 grams per day) for at least 3-7 days.  Yes, it can actually take a week to reach ketosis.  I have a few patient’s that are so insulin resistant that it takes longer.  This means that to reach that fat burning state, one must maintain a low insulin response by restricting starch or carbohydrate intake to less than 20 grams per day for a minimum of a week.  For your body to efficiently use the fuel it can take up to 6 weeks.  This is why many people state that they “don’t feel good” or “can’t maintain their exercise levels” when starting a ketogenic diet. For most people, once they reach the 6 week mark, mitochondria have been unregulated and “fine tuned” to burn ketones, fat burning becomes efficient and energy levels begin to increase. In fact, for many like myself, you’ll finally feel like exercising for the first time in you life.

Point of Focus: If you’re already exercising, don’t be surprised if you feel more sluggish for the first four weeks.  If you’re not exercising, I don’t recommend starting until after you pass through the Keto-Adaptive phase.

MIchelin Tire Man Pondering

PRINCIPLE 5

Clinically, the average patient in my office will lose 5-15 lbs each month for the first three months. Then the weight loss will slow to 2-5 lbs per month. However, 1/2-1 inch continues to disappear off the waist circumference measurement every month.  THIS IS NORMAL. Continued weight loss of 15 lbs a month will leave you looking like the Michelin Tire Man – rolls of skin without fat. The body slows the weight loss to keep up with skin and connective tissue remodeling.  As long as ketosis is maintained, the fat will continue to melt away.  At this point, I’m not so worried about scale weight as I am your waist circumference.

Point of Focus: Successful ketosis does not always affect the scale, but usually causes your pants to fall down.

PRINCIPLE 6

It has been my experience that it takes about 18 months for the average patient to reverse the insulin resistance while following a carbohydrate-restricted, high-fat ketogenic lifestyle.  There is no quick fix for this. If there was, I’d be sitting on a beautiful beach in the Caribbean.

Point of Focus: The Ketogenic dietary lifestyle is actually the antidote to insulin resistance, diabetes and the diseases of civilization.

PRINCIPLE 7

Improvement in insulin resistance has also been demonstrated with mild to moderate intensity resistance exercise.  Moderate intensity resistance exercise is 20-30 minutes of exercise like walking, easy jogging, cycling, lifting weights, yoga or Pilates with speeds or weight heavy enough to break a sweat, but not so fast or heavy that you cannot carry on a conversation with your exercise partner.  Exercise improves insulin resistance – BUT IT DOESN’T CAUSE WEIGHT LOSS!  Yes, I know, Jack LaLanne just rolled over in his grave.  But, let me say that again.  Exercise improves insulin resistance, but it does not improve weight loss!! The three largest and most intensive studies of exercise involving over 67,000 people demonstrate that you can exercise till the cows come home and you’ll average about 1% weight loss.  If you exercise, realize it WILL make you hungry.  Eating the wrong food (carbohydrate containing foods) will stimulate insulin release causing your exercise to be fruitless (Actually, your diet should be “fruit-less” anyway)

Point of Focus: Exercise because you feel like it, it improves insulin sensitivity and it decreases stress, not for weight loss.

HungryPRINCIPLE 8

If you are eating enough fat, you won’t be hungry. Although this doesn’t always hold true in the case of patient’s with lepin resistance.  40-60% of patients with insulin resistance have a concomitant leptin resistance (see the article on lepin resistance here).  A ketogenic diet is one in which 50% or more of total calories come from fat.  No, you don’t have to count calories, just pick foods that contain 45% fat or more.  Look for grass fed products as they will be higher in Omega 3 fatty acids.  Red meat is 55% fat. Pork is 45% fat. This is where the chicken salad or turkey wrap fails (see Why Does Your Chicken Salad Stop Weight Loss).  Look for alternatives to replace your basic meals and snacks.  If you love chips, try pork rinds or make chips from fried cheese or pepperoni.  Guacamole is a great replacement for bean dip.

Point of Focus: There is no need to eat 3-6 times per day.  As you increase the fat in your diet you will feel more full.  Eat when you are hungry, whether that is 3 times a day or once day, listen to your body.

Adapt Your Life

PRINCIPLE 9

I’ve been following a ketogenic diet for over 10 years.  The most common complaint I hear is,  “Dr. Nally, I’m tired of eating eggs.”  Ketogenic diets don’t have to be boring. There are hundreds of resources on the web for spicing up your ketogenic diet. See the Recommended Sites page above for some ideas to start. The Ketogenic Cookbook by Jimmy Moore and Maria Emmerich is a recent edition to the literature and a fantastic resource. Check out Franziska Spritzler’s Low Carb Dietitian website and new book as well. If you live in the UK, you should see Emily Maguire’s website and blog.  She just completed a world tour, sampling all the low carbohydrate foods and restaurants around the world.  If you are a picture person, check out the Best Keto Meals of 2015 Pinterest page followed by almost 16,000 people.  If you haven’t takent the time, you should visit Dr. Andreas Eenfeldt’s website.  He is one of Sweden’s premier ketogenic doctors has an immense number of resources at his website, Diet Doctor.  Finding someone that can help you fine tune your diet is also essential.  You can find a list of doctors that use ketogenic diets here.

Point of Focus: This lifestyle will require you to use real, whole food and cook like your grandmother or great grandmother did in the past.  Unfortunately, we’ve lost a great deal of the art of cooking that needs to be re-discovered. If your lifestyle is too busy to cook and prepare real food, that busyness is probably causing you stress, another culprit in the weight gain cycle.  The truth will set you free, but it will probably make you miserable first.

PRINCIPLE 10

WARNING!  A very sweet patient of mine was given these instructions to treat her weight and blood sugar abnormalities.  She applied these principles and they worked marvelously.  She called me a few weeks later, however, mad as a wet hen.  She placed her husband (not my patient at the time) on the same dietary changes.  Her husband, who had significant blood pressure problems and was on four different blood pressure medications I later found out, had a sudden drop in his blood pressure and passed out.  As happens to many of my patients, blood pressure, ejection fraction of the heart and blood sugars quickly begin to normalize.  However, he never saw his doctor and never had is blood pressure medications adjusted.  Because of the normalization that can occur in as rapidly as 1-2 weeks, the medications became much too strong, he passed out and ended up in the emergency room. These dietary principles are effective. They are often just as powerful as a number of the medications that we routinely prescribe.

Point of Focus: Please see your doctor before beginning any of these dietary recommendations, especially if you have any underlying medical conditions including Hypertension, Diabetes, Congestive Heart Failure, Coronary Artery Disease, Gout, Kidney Stones, etc., please do not try the dietary changes alone.  Find a physician trained in the use of this type of dietary lifestyle in combination with close monitoring of your blood pressure, blood sugar and other key vital signs.

Stay tuned for Ketogenic Principles . . . Part II in the series where we’ll address Food Psychology, To Cheat or Not to Cheat, and Keeping it Real . . .