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Why Add EMSculpt and EMSella to My Practice?

I just added two amazing treatments to our office toolbox: EMSculpt and EMSella. I am so excited about these two treatments.

Why add these to the practice? As a family practitioner who focuses on the treatment of insulin resistance, pre-diabetes, diabetes and obesity, I’ve been looking for safe and effective ways to improve muscle and decrease fat. Ketogenic and carnivorous diets are the most effective way to do this naturally, of course including a good exercise program should be a significant part of these diets. Yet, many of my patients over 40 are already seeing the effects of aging, obesity and muscle decline.

Lack of core strength leads to gait instability, weakness, increased likelihood of falling and breaking a hip. Poor core strength is also a factor in incontinence, erectile dysfunction and poor sexual function.

We know that improving core strength has a very powerful positive effect in reducing these problems. Yet, a significant number of my patients over 65 have a hard time exercising due to arthritis and other diseases.

These are revolutionary devices that simultaneously emit both radiofrequency and high-intensity electromagnetic energies (HIFEM).

The end result is more fat reduction and muscle growth than any single gold-standard product for less time and less money. . . 25% more muscle and 30% reduction in fat on average after just four treatments*.

When used with a ketogenic or carnivorous diet, these treatments are a game changer for getting rid of that last bit of stubborn fat.

In combing EMSculpt for the abdomen and EMSella for the pelvic floor, it creates “core to floor” muscle strengthening and stability that is an amazing and very effective adjunctive treatment to a regular exercise program.

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These treatments are perfect for postpartum mothers, men, elite athletes and women who suffer from incontinence. They are all a perfect fit for this treatment as results include improved strength, balance and posture; alleviated back pain; and improved urinary issues and sexual health in both men and women. When EMSella is used in conjunction with other muscle development devices like Emsculpt, you’re building core strength, posture developments and sexual health improvements for both men and women.

And, although core strength is not something you see, it is something you can definitely feel.

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Call our office for your first treatment today!!


*US FDA clearances:

Your results may vary. You may feel intense heat during the treatment, but it should never be painful. If you experience pain during the treatment, immediately discontinue the treatment and speak with your treatment provider. Treatment should not be applied over scar tissue, or if you have electronic or metal implants. As with any heat-based therapy, burns may result. As with any medical procedure, ask your doctor if the EMSCULPT NEO® procedure is right for you. EMSCULPT NEO® is indicated for non-invasive lipolysis (breakdown of fat) of the abdomen and thighs and reduction in circumference of the abdomen and thighs with Skin Type I to Skin Type VI; and for non-invasive lipolysis (breakdown of fat) of the upper arms limited to skin types II and III and BMI 30 or under. EMSCULPT NEO® is also indicated for improvement of abdominal tone, strengthening of the abdominal muscles, development of firmer abdomen; strengthening, toning, and firming of buttocks, thighs, and calves; and improvement of muscle tone and firmness, for strengthening muscles in arms.

Adrenal Insufficiency, Adrenal Fatigue, PseudoCushing’s Syndrome – Oh My!

Adrenal Fatigue? Adrenal Insufficiency?  Cortisol? PseudoCushing’s Syndrome?  What do these terms mean and why are they all over the internet these days? And, what do they have to do with your weight loss?

This was our topic this evening on PeriScope.  Katch Dr. Nally speak about this topic with rolling comments at Katch.me/docmuscles.  Or you can watch the video below:

If you’re not sure about what this is, you’re not alone. I think I’ve heard the term “Adrenal Fatigue” at lease four times a day for the last three months.  If you ask your doctor, they’ll probably scratch their heads too.  The funny thing is that “Adrenal Fatigue” isn’t a real diagnosis, but it is all over the internet and it shows up in the titles of magazines in the grocery store every day.  There’s even and “Adrenal Fatigue For Dummies” so it must be real, right?!  Adrenal Fatigue for Dummies

No.  It isn’t a real diagnosis.  It is a conglomeration of symptoms including fatigue, difficulty getting out of bed in the morning, and “brain fog” that have been lumped together to sell an “adrenal supplement.” (Sorry, but that’s really what it is all about.)  Do a Google search and the first five or six sites describing adrenal fatigue claim the solution is taking their “special adrenal supplement.”

I know what you’re thinking, “Your just a main stream, Western Medicine doctor, Dr. Nally, you wouldn’t understand.”  Actually, I do understand.

Adrenal fatigue has risen in popularity as a “lay diagnosis” because many patients show up at their doctors office with significant symptoms that actually interfere with their ability to function, and after all the testing comes back negative for any significant illness, they are told that they are normal.  But the patient still has the symptoms and no answer or treatment has been offered.  It’s discouraging. . . very discouraging.

That’s because the symptoms are actually the body’s response to chronic long term stress.  Many of my patients, myself included, have found themselves “stuck” in their weight loss progression, feeling fatigued, struggling to face the day, with a number of symptoms including cold intolerance, memory decline, difficulty concentrating, depression, anxiety, dry skin, hair loss, and even infertility in some cases.  Is it poor functioning adrenal glands? No, your feeling this way because the adrenal glands are actually doing their job!!

If the adrenal glands weren’t working you’d experience darkening of the skin, weight loss, gastric distress, significant weakness, anorexia, low blood pressure, and low blood sugar.  The symptoms are actually called Addison’s disease and it is actually fairly rare (1 in 100,000 chance to be exact).  So what is causing the symptoms you ask?

There are a number of reasons, but one that I am seeing more and more frequently is “Pseudo-Cushings’s Syndrome.Pseudo-Cushing’s Syndrome is a physiologic hypercortisolism (over production of cortisol) that can be caused by five common issues:

  1. Chronic Physical Stress
  2. Severe Bacterial or Fungal Infections that Go Untreated
  3. Malnutrition or Intense Chronic Exercise
  4. Psychological Stress – including untreated or under-treated depression, anxiety, post-traumatic stress, or dysthymia (chronic melancholy)
  5. Alcoholism

The psychiatric literature suggest that up to 80% of people with depressive disorders have increased cortisol secretion (1,2,3).  HPA Stress responsePeople with significant stressors in their life have been show to have an increased corsiol secretion. Chronic stress induces hyperactivity of the hypothalamic-pituitary-adrenal axis causing a daily, cyclic over production of cortisol and then normalization of cortisol after resolution of the stressor.  This cortisol response is not high enough to lead to a true Cushing’s Syndrome, but has the effect of the symptoms listed above and begins with limiting ones ability to loose weight.

I’m convinced that this is becoming more and more prevalent due to the high paced, high-stress, always on, plugged in, 24 hour information overload lives we live.

What is cortisol? It is a steroid hormone made naturally in the body by the adrenal cortex (outer portion of the adrenal gland). Cortisol is normally stimulated by a number of daily activities including fasting, awakening from sleep, exercise, and normal stresses upon the body. Cortisol release into the blood stream is highest in the morning, helping to wake us up, and tapers into the afternoon. Cortisol plays a very important role in helping our bodies to regulate the correct type (carbohydrate, fat, or protein) and amount of fuel to meet the bodies physiologic demands that are placed upon it at a given time (4,5,6).

HPAThyroidUnder a stress response, cortisol turns on gluconeogensis in the liver (the conversion of amino acids or proteins into glucose) for fuel. Cortisol, also, shifts the storage of fats into the deeper abdominal tissues (by stimulating insulin production) and turns on the maturation process of adipocytes (it makes your fat cells age – nothing like having old fat cells, right?!)  In the process, cortisol suppresses the immune system through an inhibitory effect designed to decrease inflammation during times of stress (7,8,9).  If this was only occurring once in a while, this cascade of hormones acts as an important process.  However, when cortisol production is chronically turned up, it leads to abnormal deposition of fat (weight gain), increased risk of infection, impotence, abnormal blood sugars, brain fog, head
aches, hypertension, depression, anxiety, hair loss, dry skin and ankle edema, to name a few.

The chronic elevation in cortisol directly stimulates increased insulin formation by increasing the production of glucose in the body, and cortisol actually blunts or block-aids the thyroid function axis. Both of these actions halt the ability to loose weight, and drive weight gain.
Cortisol also increases appetite (10).  That’s why many people get significant food cravings when they are under stress (“stress eaters”). Cortisol also indirectly affects the other neuro-hormones of the brain including CRH (corticotrophin releasing hormone), leptin, and neuropeptide Y (NPY). High levels of NPY and CRH and reduced levels of leptin have also been shown to stimulate appetite and cause weight gain (10-11).

How do you test for Pseudo-Cushing’s Syndrome?  

Testing can be done by your doctor with a simple morning blood test for cortisol. If your cortisol is found to be elevated, it needs to be repeated with an additional 24 hour urine cortisol measurement to confirm the diagnosis. If Cushing’s Syndrome is suspected, some additional blood testing and diagnostic imaging will be necessary.  Pseudo-Cushing syndrome will demonstrate a slightly elevated morning cortisol that doesn’t meet the criteria for true Cushing’s type syndrome or disease.

How do you treat it?

First, the stressor must be identified and removed.  Are you getting enough sleep?  Is there an underlying infection? Is there untreated anxiety or depression present?  Are you over-exercising?  These things must be addressed.

Second, underlying depression or anxiety can be treated with counseling, a variety of weight neutral anti-depressant medications or a combination of both.  Many of my patients find that meditation, prayer, and journaling are tremendous helps to overcoming much of the anxiety and depression they experience.

Third, adequate sleep is essential.  Remove the television, computer, cell phone, iPad or other electronic distraction from the bedroom.  Go to bed at the same time and get up at the same time each day. Give yourself time each day away from being plugged in, logged in or on-line.

Fourth, mild intensity (40% of your maximal exertion level) exercise 2-3 days a week was found to lower cortisol; however, moderate intensity (60% of your maximal exertion level) to high intensity (80% of your maximal exertion level) exercise was found to raise it (12).  A simple 20 minute walk, 2-3 times per week is very effective.  Find a hobby that you enjoy and participate in it once or twice a week.  Preferably, a hobby that requires some physical activity. The activity will actually help the sleep wake cycles to improve.

Fifth, follow a low carbohydrate or ketogenic diet.  Ketogenic diets decrease insulin and reverse the effect of long term cortisol production.  Ketogenic diets a have also been shown to decrease or mitigate inflammation by reducing hyperinsulinemia commonly present in these patients (13).

So, the take home message is . . . take your adrenal glands off of overdrive.

References:

  1. Pfohl B, Sherman B, Schlechte J, Winokur G. Differences in plasma ACTH and cortisol between depressed patients and normal controls. Biol Psychiatry 1985; 20:1055.
  2. Pfohl B, Sherman B, Schlechte J, Stone R. Pituitary-adrenal axis rhythm disturbances in psychiatric depression. Arch Gen Psychiatry 1985; 42:897.
  3. Gold PW, Loriaux DL, Roy A, et al. Responses to corticotropin-releasing hormone in the hypercortisolism of depression and Cushing’s disease. Pathophysiologic and diagnostic implications. N Engl J Med 1986; 314:1329.
  4. Ely, D.L. Organization of cardiovascular and neurohumoral responses to stress: implications for health and disease. Annals of the New York Academy of Sciences (Reprinted from Stress) 771:594-608, 1995.
  5. McEwen, B.S. The brain as a target of endocrine hormones. In Neuroendocrinology. Krieger and Hughs, Eds.: 33-42. Sinauer Association, Inc., Massachusetts, 1980.
  6. Vicennati, V., L. Ceroni, L. Gagliardi, et al. Response of the hypothalamic- pituitary-adrenocortical axis to high-protein/fat and high carbohydrate meals in women with different obesity phenotypes. The Journal of Clinical Endocrinology and Metabolism 87(8) 3984-3988, 2002.
  7. Wallerius, S., R. Rosmond, T. Ljung, et al. Rise in morning saliva cortisol is associated with abdominal obesity in men: a preliminary report. Journal of Endocrinology Investigation 26: 616-619, 2003.
  8. Epel, E.S., B. McEwen, T. Seeman, et al. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat.
    Psychosomatic Medicine 62:623-632, 2000.
  9. Tomlinson, J.W. & P.M. Stewart. The functional consequences of 11_- hydroxysteroid dehydrogenase expression in adipose tissue. Hormone and Metabolism Research 34: 746-751, 2002.
  10. Epel, E., R. Lapidus, B. McEwen, et al. Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior.Psychoneuroendocrinology 26: 37-49, 2001.
  11. Cavagnini, F., M. Croci, P. Putignano, et al. Glucocorticoids and neuroendocrine function. International Journal of Obesity 24: S77-S79, 2000.
  12. Hill EE, Zack E, Battaglini C, Viru M, Vuru A, Hackney AC. Exercise and circulating cortisol levels: the intensity threshold effect. J Endocrinol Invest. 2008. Jul;31(7):587-91.
  13. Fishel MA et al., Hyperinsulinemia Provokes Synchronous Increases in Central Inflammation and β-Amyloid in Normal Adults. Arch Neurol. 2005;62(10):1539-1544. doi:10.1001/archneur.62.10.noc50112.

Ketogenic Principles . . . Part II

There are three constants in life: change, choice & principles.   Change, ironically acting as a constant, is the variable that we have limited control over.  Accepting that change is going to happen, that change is constant, and making choices to prepare for those changes is the key to success.  My last post introduced the 10 Principles of the Ketogenic Lifestyle.  This post will discuss choice as a foundation for those principles outlined in the ketogenic lifestyle.  Choices are directly influenced by the balance between the mind, the body and the spirit of man.

LIFESTYLE PRINCIPLE 1 – WHEREVER YOU GO, THERE YOU ARE

People seem to get sidetracked off a ketogenic lifestyle for a number of reasons, but the most common I hear is that they were traveling, had company visit or they were on vacation.  Successfully living a lifestyle requires that you first know who you are and where you are before you can consistently make good, solid, principle based choices. So I ask, who are you?  Are you defined by your job, by your finances, by your travels, by your friends or by your vacations?  Each of these experiences is unique.  Our experiences place both good and bad before us.  I have come to learn over time and countless interactions with people that nothing is coincidental.  Everything, good and bad, happen for a reason.

Today’s society teaches the Pleasure Principle.  This is the human instinct to seek pleasure and avoid pain, including avoiding painful recollections.  We often define ourselves by those things that bring us pleasure.  We each go through personal tests, failures and triumphs. Some of us harness all of those experiences for good, others find worsening mental paralysis due to fear of them. We often hide from the painful experiences and attempt to bury or forget them.  Food is often involved with many of the experiences of life, and for a significant number of people, the endorphin release from eating a meal, sometimes just the act of chewing, may be the only pleasure one experience in a day, in a week or a in a year. Many people hide from painful recollections behind the simple pleasure produced by the eating of “comfort foods.”  Food, and our opportunities to experience pleasure from it’s various flavors, textures and physical stimulus, begin to define us.  However, hiding from life’s painful memories with momentary pleasures usually prolongs or makes the problem worse. The ingestion of simple foods containing glucose and fructose, their effect on the liver, and the hedonistic hormonal response is the basis of addiction, and simple carbohydrates provide the perfect fix.

weight watchers diet pillsFascinatingly, when fructose is metabolized in the liver, in the presence of glucose (the basic structure of sugar – one fructose molecule bound to a glucose molecule), the byproduct has a hedonic (pleasure experiencing) effect on the exact same pleasure receptors in the brain that bind to morphine.   Yes, that’s why the M&M’s make you forget your troubles and why the Jolly Rancher is so jolly.  And, its the same reason you crave another do-nut two hours after you ate the entire baker’s dozen.

Although obesity has been recognized as a disease, our use of foods to celebrate with people or events in life is still a form of pleasure seeking. Excuses to deviate from healthy behavior under the guise of family, vacation, or social requirements, acknowledges our willingness to hide from pain with hedonic drugs like chocolate chip cookies and cotton candy.  In fact, it’s usually a welcomed and and expected acceptable excuse.

“Dr. Nally, I can cheat eat and bad, (meals loaded with starch) because I’m on vacation” . . . from my problems.  It’s so acceptable, we’ve based movie themes around it. Vacation from your problems

Healing can only occur when one is willing to confront and talk about the reasons, the real reasons you’d rather experience the endorphins from the do-nuts with your family instead of acknowledge your weakness, stresses, and fears.  Many of us are so afraid of where we might be, we avoid acknowledging where and who we are.  It takes courage not to take the easy path.  And I will be the first to admit, pizza is the easy path and it’s scenic views are decorated with french fry palms and sunset clouds of apple fritters.

“There appears to be a conscience in mankind which severely punishes the man who does not somehow and at some time, at whatever cost to his pride, cease to defend and assert himself, and instead confess himself fallible and human. Until he can do this, an impenetrable wall shuts him out from the living experience of feeling himself a man among men.  Here we find a key to the great significance of true, un-stereotyped confession – a significance known in all the initiation and mystery cults of the ancient world, as is shown by a saying from the Greek mysteries: “Give up what thou hast, and thou will receive.” (Carl Jung)

We have a choice about what to eat and when to eat, however, each choice has a reward and/or a consequence.

Points of Focus: Where are you and what are you hiding from?  Sharing your weaknesses actually empowers you you overcome them. This can often be accomplished through the simple act of journaling, planing your meals the day before and journaling your successes and failures in that plan the following day.  Allowing yourself and others insight into your times of weakness actually brings strength.  It allows one to look at the reasons for food choices base on how you feel, and how you felt after the choice.  If forces one to think about a choice before it ever has to be made.  In my 15 years of medical practice, I have yet to hear a child find fault with a parent who worked tirelessly to make ends meet, admittedly struggled with alcoholism, battled against disease or fought against belittling for a belief. The child has always expressed their admiration of their parent’s courage and understanding of why decisions were made, even when erroneous. It takes courage to admit that wherever you go – there you are.

LIFESTYLE PRINCIPLE 2 – KEEP IT REAL

Keep it realI no longer believe in coincidence.  Whether you have thought about it or not, every interaction you have with others (even our interaction . . . your reading this blog), are not by coincidence. There is a reason.  Whether you believe it or not, everything around us testifies that God exists; the Hand of Providence can be seen from the rotation of the earth, planets and stars, the precision of the seasons, the balance of the atmosphere allowing for the perfect pressures and concentration of elements to sustain a life giving breath, to the perfect replication of DNA within billions of cells throughout the body.  I’m not trying to get religious, and, no, I can’t prove this through the scientific method . . . But, if the Big Bang started the universe, what started the Big Bang?  Where did the first atom or molecule or particle of dust come from?  I have a very difficult time accepting that you and I are here by accident, by a chaotic explosion that created order.  That implies that there must be a plan, and that plan had to have been set in motion by a Creator.  That also implies that that Creator placed solutions to our challenges, including the diseases of civilization, within our grasp and available to those seeking the solutions upon the earth today.

I have seen enough in my medical career to know that simple coincidence has frequently become significantly important, life changing and often life saving. This does not happen by accident and screams loud and clear that there is a plan for you and me.  No good father would lock his child in a room without doors or windows or any escape without everything in the room, both good and bad, pointing to the reason the child was in the room, and pointing the way for the child to become his or her best self, physically and emotionally.  Life has meaning. It is supposed to. If we get off track, coincidence and interactions lead us back.

“Behold, the hour cometh, yea, is now come, that ye shall be scattered, every man to his own, and shall leave me alone: and yet I am not alone because the Father is with me.” (John 16:32)

The Bible, among other records, records the voices of men and women from years past transcribing their experiences with the Hand of Providence, how that spiritual void was filled, how it helped the with choice and how our lives have deeper meaning and consequence, even amidst significant adversity.

Take a week and look at the synchronicity of your life.  Journal about it.  Don’t dismiss a second invitation from someone to discuss an opportunity or meet someone your friend thinks could be important to you, open that book that someone left behind on the subway seat beside you. Don’t assume it is meaningless, that some kind person returned your sunglasses or your wallet.   Look at the simple interactions and recent relationships.  These are the breadcrumbs and the street signs from a loving Creator, a loving Father.

Keeping it real means nothing less than complete authenticity.  The last place you want to be is in the first-class seat on the plane to no-where.  Have the faith to get off the plane and take the bus, ride your bike, or even swim upstream in the direction you’re supposed to be going. Look for the coincidences, bread crumbs and spiritual street signs in your life.

How does this relate to a ketogenic lifestyle?  Every religion or spiritual tradition speaks of a polestar.  The polestar is that anchor to which the entire solar system is tied by invisible aerial chords and the engine that powers the universe.  Those cords are connected with our own individual polestars.  A ketogenic lifestyle is one that encompasses mind, body and spirit.  It is a lifestyle that demands that you link and align your personal polestar with the truth inside and around you.  It takes both courage and faith, but it brings immeasurable strength and help in achieving your goals.  A person out of balance with life is under stress.  Chronic stress produces excessive cortisol and other powerful adrenal hormones that displace the body’s and the mind’s endocrinologic balance, leading to weight gain, weight retention, and chronic disease.  This often has significant effect externally on the body in processes seen like depression, anxiety, fibromyalgia, and allowing for amplification of inflammation and auto-immune dysfunction.  We refer to this inter-relationship in the medical community as psychosomatic and/or viscerosomatic dysfunction, the psyche (the mind) and/or the viscera (internal endocrine organs) directly and adversely influence the function of the soma (the structural body separate from the mind).

“He who does not know himself, does not know anything, but he who knows himself, knows the depth of all things. 

” . . . If you bring forth what is within you, what you bring forth will save you. If you do not bring forth what is within you, what you do not bring forth will destroy you.”  (Book of Thomas the Contender)

Point of Focus: Your life is never without meaning. Keep it real by recognizing that diet alone may not compete your answer for physical health.  Having courage and faith allow you to see and embrace the truth that is right in front of you. The  Alcoholics Anonymous’ 12 step program only becomes successful when one realistically and courageously applies their faith to align with the truth they have felt all along.  For any long-term lifestyle change to take place, one must connect and live the principles before one truly knows they are true.  In this way the Ketogenic Lifestyle becomes real.

KetoOS
KetoOS – Drinkable Exogenous Ketones

LIFESTYLE PRINCIPLE 3 – TO cheat, or NOT to cheat, that is the question

cheat mealI have been asked this question by every patient I have placed on a ketogenic diet at least once and often three or four times throughout the course of our treatment plan. I usually answer this question with a question. “Why do you want to cheat?”

The desire to cheat usually arises form one of three reasons:

  1. You’re not eating enough fat to satiate your appetite and you are truly hungry.  The body recognizes that it can use and absorb glucose much faster than fat, as fuel, so it naturally will crave “sweets.”  In this case, the case of true hunger, solution is to increase your fat intake.  You should be eating at least 50% of your total calories in the form of fat.
  2. Insulin loads are still high, stimulating rebound hunger and hedonistic cravings. You’re either eating too many carbohydrates with your diet or you’re using a sweetener that stimulates insulin without raising blood sugar  (See my article The Skinny about Sweeteners).
  3. Cheating with a specific food fulfills a psychological need, feeds an addiction or represents an obligation to fulfill a societal ritual. Journaling helps to identify and break this cycle.

If you are truly in ketosis the cravings to cheat don’t exist, they actually disappear.  Other societal rituals, like birthdays, anniversaries, weddings, spiritual ceremonies or rites of passage are often tied to or use food as symbolism.  In these cases, the decision to cheat is really yours.

When a person cheats, it can take as many as 3-5 days to get back into ketosis, and for some 2-3 weeks.  Carbohydrate cravings will rebound and often be present for up to 72 hours after cheating. You have to decide if cheating is worth 3 days of carbohydrate cravings and 3-7 days of stifled weight loss.

Point of Focus: There are no Ketosis Police! Really. They don’t exist!  Dr. Nally will not show up in uniform on your doorstep with a set of handcuffs and a bag of pork rinds. You won’t be arrested for eating bread and those of us who have been following a strict ketogenic lifestyle for years really don don’t mind at all if you decide to cheat.  We will smile and we may even ask you how it tastes or if you liked the flavor, but don’t be self-conscious, because when one is in ketosis for a few months, we really don’t crave cheating any longer, and we won’t judge you. And, don’t feel obligated to justify why your cheating, this is a lifestyle.  You probably won’t ask me why I chose to wear long sleeves on a hot day in Arizona, for the same reason I won’t ask you why you decided to wear a Speedo.

LIFESTYLE PRINCIPLE 4 – Hunger Management

Man-vs-Shark_11Life comes at you pretty fast and if you’re not prepared, hunger can bite you.  Most people fall off the wagon when they are unprepared for missing a meal on a stressful day. I’ve recently heard the argument that “there is no wagon, so don’t worry about falling off.”  This is false security that leaves one unprepared for life events.  Pioneers traveled in wagons for two reasons.   First, the wagon held supplies essential for survival.  Second, wagons usually traveled in wagon trains.  This means that there was more than one person on the wagon and there was more than one wagon on the trail with you. Traveling with a wagon train meant you had others on the same trail with the same tools for safety and support.

In the world of fast foot, fast photos and speedy delivery, we often don’t adequately prepare for hunger or cravings.  There are some essential hunger management tools for the Ketogenic Lifestyle:

  1. Eat meals containing >50% fat.  This, in and of itself, delays hunger and ensures the satiety center of the brain is happy for longer periods of time.
  2. Carry rescue foods with you or keep them at your office or in your fridge at home. These include low-carb nuts like almonds, walnuts, macadamia nuts; Keep hard and string cheese handy for a snack.  Use sliced deli-meats with the cheese as a snack when the cravings kick in.  Pork Rinds, beef jerky, olives, are great natural food options.
  3. If you have time and can cook, develop your favorite “Fat Bombs and have a bag full in the fridge for those cravings.
  4. Having the moral support of a buddy, spouse, friend or work companion who checks on your progress daily, assists with meals and meal choices is priceless. Periscope, a free Twitter based App, has become a means of checking in with your Ketogenic Support group around the world that connects to those you follow on Twitter.  You can follow me, @docmuscles, and a number of fascinating health Periscopes that focus on ketogenic, low-carb, whole food paleo approaches:  @livinlowcarbman, @_danielleeaton, @kasandrinos, @fatissmartfuel, @domskitchen, @mikemutzel, @keribrewster, @tombilyeu, @glutenfreenj, @paleocomfort.
  5. Being accountable to yourself in a diet journal daily and to your doctor regularly every 1-2 months also helps keep motivation going forward. Jimmy Moore, author and podcaster at the Livin’ La Vida Low-Carb Show has also posted one of the most extensive lists of physicians specializing in ketogenic diets from around the world.  You can find that list here.

LIFESTYLE PRINCIPLE 5 – Stress Reduction

Pages and pages can be written about stress reduction.  In fact, I’ve written about the chemical responses that stress has on weight gain in my post, Stress. . . The Weight Loss Killer.  But there are a few daily essentials that should be added into the Ketogenic Lifestyle to manage stress.

First, are you getting adequate sleep? Remove the television, computer, cell phone, iPad or other electronic distraction from the bedroom.  Go to bed at the same time and get up at the same time each day. Give yourself time each day away from being plugged in, logged in or on-line.

Second, over exercising or being malnourished can cause chronic stress. I have a number of patient that have been convinced that they have to work out 60 minutes a day 6-7 days per week.  It is essential that you realize muscles need a minimum of 48-72 hours to recover from specific types of exercise.  If you run for 60 minutes.  It will take your muscles 48 hours to recover from the running. If you do upper body weight lifting, it will take 48-72 hours for those muscles to recover from that weight lifting.  Exercising the same muscle group with the same exercise over stresses the muscles and leads to significant chronic stress, spiking the cortisol levels and halting weight loss and raising cholesterol & triglycerides.  Under eating or fasting to starvation has the same effect.

Third,  mild intensity (40% of your maximal exertion level) exercise 2-3 days a week was found in a recent study to lower cortisol and decrease over-all stress, raising serotonin and dopamine in the brain; however, moderate intensity (60% of your maximal exertion level) to high intensity (80% of your maximal exertion level) exercise was found to raise it.  A simple 20 minute walk, 2-3 times per week is very effective at stress reduction, reduction in cortisol and improvement in ketosis.

Point of Focus: The goal is cortisol reduction. This can be done through regular and restful sleep and mild exercise. Chronic elevation in cortisol directly stimulates an increase in insulin by increasing the production of glucose in the body, and cortisol blockaids the thyroid axis. Both of these actions halt the ability to loose weight, amplifies the production of inflammatory hormones and drives weight gain. Cortisol also increases appetite.  That’s why many people get significant food cravings when they are under stress (“stress eaters”). Cortisol also indirectly affects the other neuro-hormones of the brain including CRH (corticotrophin releasing hormone), leptin, and neuropeptide Y (NPY). High levels of NPY and CRH and reduced levels of leptin have also been shown to stimulate appetite.

Hopefully, this gives you some starting points and direction to your Ketogenic Lifestyle.  If I’ve missed something that you’ve found to be essential, let me know. Its always great to hear what has helped you in your Ketogenic journey.  Until next time, pass the butter!!!

Nutritional Values of Commonly Used Ketogenic Foods

I’ve had a number of emails and requests from patient’s to locate a source for fat percentages and protein contents of various foods as they prepare and follow a ketogenic lifestyle.  I’ve looked all over, however, nothing easy and concise has made itself readily available, and there hasn’t been a simple one page tool at your fingertips . . .

Hopefully, this list will start to fill that gap.  Use the list to calculate protein and fat levels as needed.  Let me know if I can add to the list or if there are foods you commonly use that I’ve missed.  Keep the ketones up and your waistline down!

Nutritional Values of Common Ketogenic Foods:

Food:                                                                       Protein Contents:                                Fat Contents:

Steak (Ribeye) –                                                      65 grams per 8 oz.                                 49%

Steak (Top or Bottom Round) –                             23 grams per 3 oz.                                  33%

Ground Beef (75% Lean) –                                      22 grams per 3 oz.                                 55%

Pork Chop (boneless) –                                            26 grams per 3 oz.                                15%

Ham –                                                                      17 grams per 3.5 oz.                              12%

Bacon (grilled) –                                                      22 grams per 3.5 oz.                               75%

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

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

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

Turkey Breast –                                                       24 grams per 3 oz.                                  15%

Yellowfin Tuna –                                                     25 grams per 3 oz.                                  10%

Light Tuna –                                                             22 grams per 3 oz.                                 8%

Halibut –                                                                  23 grams per 3 oz.                                  19%

Sockeye Salmon –                                                   23 grams per 3 oz.                                  22%

Tilapia –                                                                   21 grams per 3 oz.                                  13%

Deli Meats:

Roast Beef –                                                            18 grams per 3 oz.                                  16%

Canadian bacon –                                                    15 grams per 3 oz.                                  33%

Pepperoni –                                                             18 grams per 3 oz.                                  83%

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%

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:

Swiss Cheese –                                                        24 grams per 3 oz.                                  66%

Cream Cheese –                                                      11 grams per 3.5 oz.                               79%

Ricotta cheese –                                                      10 grams per 3.5 oz.                               63%

Cheddar cheese –                                                    24.6 grams per 3.5 oz.                            74%

Eggs –                                                                      6 grams per 1 large egg                         60%

(Adapted from http://www.caloriecount.com)

A printable PDF copy of this information is available here:

Nutritional Value of Common Foods.

To live in the presence of great truths and eternal laws, to be led by permanent ideals –  that is what keeps a man patient when the world ignores him, and calm and unspoiled when the world praises him.  Hopefully, these posts are adding to your stable ideals.