A number of people have asked me about how I smoke my pork shoulders. Pork shoulder is a perfect meal if you are on a ketogenic or carnivorous diet. The smoking process is quite simple. The key is in the simplicity. I’ve use a Traeger Select Elite pellet smoker for the last 10 years, but your favorite smoker will do.
In our house, we will smoke a 9-10 lbs pork shoulder and then use the pulled pork for meals throughout the week. I often do most of my smoking on the weekend when I am home and then we have some of the most tasty leftovers throughout the week.
But, before I dive into the recipe and process, we should take a moment to look at the historical essentials of bacon and it’s origins from the pork shoulder.
Bacon Dates Back to 1500 BC
The Chinese were the first to record cooking of salted pork bellies more than 3000 years ago. This makes bacon one of the world’s oldest processed meats.
Romans Called It “PETASO“
Bacon eventually migrated westward where it became a dish worth of modern-day foodies. The Romans made petaso, as they called it, by boiling salted pig shoulder with figs, then seasoning the mixture with pepper sauce. Wine was, of course, a frequent accompaniment. For my wine connoisseur friends, please tell me which wine goes best with bacon. . . you know who you are.
The Word Refers to the “Back” of a Pig
The word bacon comes from the Germanic root “-bak,” and refers to the back of the pig that supplied the meat. Bakko become the French bacco, which the English then adopted around the 12th century, naming the dish bacoun. Back then, the term referred to any pork product, but by the 14th century bacoun referred specifically to the cured meat.
The First Bacon Factory Opened in 1770
For generations, local farmers and butchers made bacon for their local communities. In England. where it became a dietary staple, bacon was typically “dry cured” with salt and then smoked. In the late 18th century, a businessman named John Harris opened the first bacon processing plant in the county of Wiltshire, where he developed a special brining solution for finishing the meat. The “Wilshire Cure” method is still used today, and is a favorite of bacon lovers who prefer a sweeter, less salty taste.
“Bringing Home The Bacon” Goes Back Centuries
These days, the phrase refers to making money, but it’s origins have nothing to do with income. In 12th century England, churches would award a “flitch,” or a side, of bacon to any married man who swore before God that he and his wife had not argued for a year and a day. Men who “brought home the bacon” were seen as exemplary citizens and husbands.
Bacon Helped Make Explosives During World War II
In addition to planting victory gardens and buying war bonds, households were encouraged to donate their leftover bacon grease to the war effort. Rendered fats created glycerin, which in turn created bombs, gunpowder, and other munitions. A promotional film starring Minnie Mouse and Pluto chided housewives for throwing out more than 2 billion pounds of grease every year: “That’s enough glycerin for 10 billion rapid-fire cannon shells.”
Hardee’s Frisco Burger Was a Game Changer for Bacon
Bacon took a beating in the 1980s, when dieting trends took aim at saturated fats and cholesterol. By the ’90s, though, Americans were ready to indulge again. Hardee’s Frisco Burger, one of the first fast-food burgers served with bacon, came out in 1992 and was a hit. It revived bacon as an ingredient, and convinced other fast-food companies to bacon-ize their burgers. Bloomberg called it “a momentous event for fast food, and bacon’s fate, in America.”
The Average American Consumes 18 lbs of Bacon Each Year
Savory, salty, and appropriately retro: The past couple years have been a bonanza for bacon, with more than three quarters of restaurants now serving bacon dishes, and everything from candy canes to gumballs now flavored with bacon. Recent reports linking processed meats to increased cancer risk have put a dent in consumption, and may have a prolonged effect. But for now, America’s love affair with bacon continues.
There is a Church of Bacon
This officially sanctioned church boasts 13,000 members under the commandment “Praise Bacon.” It’s more a rallying point for atheists and skeptics than for bacon lovers, per se, and there’s no official location as of yet. But the church does perform wedding ceremonies and fundraisers, and has raised thousands of dollars for charity. All bacon praise is welcome, even if you’re partial to vegetarian or turkey bacon over the traditional pork. Hallelujah!
There is a Bacon Camp
It’s like summer camp, but with less canoeing and more bacon cooking. Held every year in Ann Arbor, Michigan, Camp Bacon features speakers, cooking classes, and other bacon-related activities for chefs and enthusiasts eager to learn more about their favorite food.
Modern Technology Wants to Help You Wake Up and Smell the Bacon
An ingenious combination of toaster and alarm clock, the Wake ‘n Bacon made waves a few years back with the promise of waking up to fresh-cooked bacon. Sadly, the product never made it past the prototype phase, but those intent on rising to that smoky, savory aroma were able to pick up Oscar Mayer’s special app, which came with a scent-emitting attachment.
There Is A Bacon Sculpture of Kevin Bacon
It had to happen eventually. Artist Mike Lahue used seven bottles of bacon bits, lots of glue, and five coats of lacquer to create a bust of the Footloose star, which sold at auction a few years back. No word on how well the bacon bit Bacon bust has held up.
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Dr. Nally’s Smoked Pork Shoulder
Apply dry rub liberally to all sides of the pork shoulder 30-60 minutes before putting the shoulder onto the smoker using the following dry spices:
Refrigerate the pork shoulder after applying dry rub until ready to place on the smoker.
Preheat smoker to 250˚F degrees and place the pork shoulder fat side up onto the grill. Smoke it until internal temperature reaches 150-160˚F.
To Wrap Or Not To Wrap?
I wrap my pork shoulders in two layers of foil, to better seal in flavor and juiciness. I don’t wrap my briskets (unless I plan on storing them for later use).
Once the meat gets to around 160° internal temp (around the four to five hour mark) is the perfect time to wrap. Your pork shoulder should have excellent color and bark at this point.
Wrap the pork up in foil and place it back on the smoker, making sure you keep your temp probe in and wrap the foil around it. Once it is wrapped, place it fat side up and continue to smoke it at 250˚F until it reaches an internal temperature of 205˚F.
How Long Does It Take to Smoke a Pork Shoulder?
Smoking time averages 60-90 minutes per pound, depending on the level of doneness smoked at 250 degrees.
If you’re going to slice it, cook to 185˚F.
If your going to pull the pork smoke it longer, until it reaches 205˚F.
My son was craving Reese’s Peanut Butter Eggs during the Easter holiday. My wife came up with these peanut butter bars and I think this is now one of my favorite low-carb treats. Be aware, you have to restrict portion sizes. Too much peanut butter and peanut flour can kick me out of ketosis. But if you are looking for something to satisfy a craving, this will do it and you can still maintain ketosis with two servings.
Peanut Butter Bar Recipe:
Peanut Butter Bar Base
1/2 cup butter
3/4 cup Confectioner’s Swerve
1 tsp liquid sucralose
1 cup peanut butter
1 scoop Iso-100 vanilla protein powder
1/2 cup peanut flour
Stir in all ingredients into pan on medium heat on stove-top. Once mixed, press onto half-sized cookie sheet. (caution it is hot)
Chocolate Topping
4 oz unsweetened baking chocolate
1/2 cup cream
3/4 cup Confectioner’s Swerve
1 tsp liquid sucralose
1/2 tsp vanilla.
Wisc together in pan on medium heat. Once mixed, pour over the peanut butter bar base in the cookie sheet.
Refrigerate until solid.
One serving is approximately a 2 inch x 2 inch square.
I’ve been admiring rib-eye roasts over the years. I also love the prime rib from which they are made. It has been a secret desire of mine to be able to make my own keto friendly smoked rib-eye roast or prime rib, and when I was in Costco last week, I saw a beautiful roast on sale. Over the last 12-13 years of following a ketogenic life-style, I’ve developed a palate for a good rib-eye or prime rib cut cooked to perfection.
So, what does a man do when shown meat on sale, and his wife is no where to be found?
Yep, you guessed it. . . I’m now the proud owner of a beautiful rib-eye roast.
After much perusing of the various “inter-webby” recipes and smoker recommendations, this is what I came up with.
Out of the package, you can see this marvelous bone-in roast is delightful. (Actually, this is the picture is of the 20 lb roast from the Costco website.) Mine only had four bones and was only 5 lbs, but as a male, when you see this picture, you have to wipe the drool off the corners of your mouth.
I peeled back the excess fat from the meat side and then, I trimmed up the excess fat off the bone for presentation.
Dr. Nally’s Butter Herb Butt Rub
I then created the following butter/herb rub:
1 cube of butter
2 tablespoons freshly chopped sage
2 tablespoons freshly chopped time
2 tablespoons freshly chopped rosemarie
1 tablespoon parsley flakes
10 garlic cloves dices
This is a good time to fire up your smoker or go out and ignite your pellet smoker.
For the busy doc, this works nicely for me, and it works as that best grill I’ve ever used as well (but, that’s for another post). I like this because you can purchase various pellet types based on the meat you’re smoking. For a number of my steaks, I like to use the mesquite pellets, however, I picked hickory for this roast. You could use oak or even cherry might be nice. Traeger sells a mixture of woods for those days when you really can’t decide.
For this roast, you want to get your smoker going and up to 275 degrees.
Once my smoker was heated up and set to my desired temperature, I went back into the kitchen and I finished up my rub. The butter was softened for 20 seconds in the microwave and the herbs were all added to the butter and mixed nicely.
Prepping the Roast
A slice in the rib-eye roast was made every two inches parallel with the bones on top and bottom, and the butter/herb mixture was rubbed onto all sides of the roast, making sure to stuff the incisions in the meat with extra butter/herb mix. Then, my favorite rub was patted liberally all over the roast. The butter gives a nice adhesive for my liberal application of the butt rub of choice.
I’m a huge fan of Bad Byron’s Butt Rub Barbecue Seasoning. It is keto-friendly, one of the few that doesn’t have added sugar, maltodextrin or dextrose that I’ve found (unless you make your own). See my article on sweeteners if you are wondering why this is important.
The roast was placed on the smoker/grill and timer was set for 2 hours. This will put your internal temperature somewhere between 125-135 degrees. I like my rib-eye medium, so I may need to leave it on for an hour longer.
Meat Preparation Temperatures
Unfortunately, no one ever explains this stuff to you, so, I found a nice temperature chart on the ReluctantGormet.com (thanks G. Stephen Jones!) The goal for the meat is to get it to the temperature below when it is served. If the meat is pulled off the smoker around 5 degrees below the temperature listed below, and you give the meat 5-10 minutes to “rest” while covered with some foil, the bone will bring the core temperature to the desired preparation temperature. I’ve modified the list below for my and your easy viewing pleasure here:
Note: These are NOT USDA recommendations. The USDA temperatures are notably 10-15° higher because of food safety issues, however, many professional chefs are not cooking your medium-rare steak to 150°. You’d send it back in a heartbeat if that were the case.
Next, the cooking process begins. With the smoker pre-heated to 275 degrees, the roast was placed on the smoker, bone side down. I closed the lid . . . and began writing this post.
At the two hour mark, the roast was up to 120 degrees with my old meat thermometer. My next investment will be an instant read digital Thermopro meat thermometer that gives an instantaneous and accurate core temperature of your roast. After cooking this roast, I can see why one would be very helpful.
It actually took 3 hours to reach a core temperature of 140 degrees. It was worth the wait. My wife and daughter are not usally fans of prime rib or rib roast in the past, however, they devoured this. I don’t think I will ever order prime rib again, when I can cook my own that tastes this good.
Why post something like this?
First, smoking meat makes you feel like a man. Seriously, your testosterone feels like it goes up by 50-100 points smoking a good slab of meat. People always ask me what I personally eat on holidays or celebrations. This is a do-able recipe you can add to your file, and your man card.
Second, the preparation for this took me no more than 15 minutes, and I chopped and diced all my own fresh herbs. It would have taken me 3 minutes to do this if I hadn’t used fresh herbs.
Third, This roast cost me $45 at Costco and it will serve eight to ten people (or my family and lots of really yummy left overs for the next week). And, each steak I slice off this roast tastes like I took my family for $60 a-piece steaks at the fancy over-priced steak house down the road . . . I call it “gourmet-keto for the budget conscious.”
Anyway, leave me your comments. And, if you have a favorite smoker recipe. Include Bacon Boy (you can find his printable image in the right side panel) in the picture, and I’ll enter you in a drawing for the next Keto-Cart Kickoff.
Ok, for those of you who are using Keto/OS (I commend you for your insightful use of the next step in ketogenic metabolism bio-hacking), I have discovered one of my new favorite mixes. (If you’ve already tried this mix, then where have you been and why didn’t you tell me about it?!)
Enter Keto//OS – exogenous ketones that aid in shifting you into ketosis. Yes, they actually do work and usually bump my ketones up 0.5 mmol/L to 1.5 mmol/L when I use them.
So, I mixed my orange flavored Keto//OS version 2.1 with Diet A&W Cream Soda, and voala, Orange Cream that takes me back to childhood memories!! You gotta try this.
As you know, I have no problem with using Diet Dr. Pepper, Diet Coke (NOT Coke Zero!), Diet Mug Rootbeer & Diet A&W Cream Soda. The sweetener that these four sodas use does not kick you out of ketosis, and I am OK with my patients using them on my Ketogenic diet. (Yes, I am OK with most of my patient’s using aspartame. Yes, I’ve actually read the studies . . . have you?! That’s why I’m OK with it’s use.)
If you haven’t tried Keto//OS yet, you can get your sample here.
The most exaggerated “frowney” face I get in the office seems to occur when patient’s find out that they cannot eat oatmeal or cereal any longer when following a low-carbohydrate dietary lifestyle. No, oatmeal is NOT good for you . . . I don’t care what WebMD recently said. No, steel-cut oats are even worse (1/4th cup of steel-cut oats is 27 grams of carbohydrate – Who only eats 1/4th cup of oatmeal? Most people eat at least 1/2 -1 cup at a sitting. You do the math . . .)
When I mentioned this to a disabled patient, even her service dog frowned.
Now, before you go running to Larry, the Quaker Oats Mascot (he’s been around for over 140 years), and ask his weight loss advise, I have the solution.
Larry, the Quaker Oats mascot loses 10 lbs for new 2012 cover (He finally figures it out after 137 years)
My angelic wife, Tiffini, the amazing homestead chef and animal husbandry specialist on our little farm, started making low-carb granola for our horseback trail rides. Prior to our discovery of a ketogenic lifestyle, granola was a staple in our pantry, on road trips and in the saddle bags on the trail. This has now replaced any craving either of us had for granola. It carries nicely all day in a Ziplock bag on horseback. It even tastes fantastic in a bowl with unsweetened almond milk as a breakfast alternative if you’re tired of eggs and bacon (but, who ever tires of eggs and bacon? I know . . . Right?!!)
I’ve been nibbling from this actual cookie-sheet of low-carb granola while writing this post. . . I wish you were here to share it with. Soooooo very good, and good for your ketogenic lifestyle. I think I’m going to eat another handful while I finish up Part II of the Principle Based Ketogenic Lifestyle post. Enjoy . . .
In a food processor, process the almonds and 1 cup of the pecans until it resembles coarse crumbs. Using a knife (preferably a sharp one – remember all bleeding stops eventually), chop the remaining 1/4 pecans coarsely.
Melt the butter and place it in mixing bowel or mixer (We use a Kitchen Aid Mixer). Pour the coarsely chopped nuts into the mixing bowl. Stir in flax seed meal, sunflower seeds, coconut flakes, pepitas and vanilla whey protein powder. Blend in the remaining wet mixture, egg whites and add a pinch of salt. Mix until it forms “clumps.”
Spread the mixture evenly on a large wax paper covered baking or cookie sheet and bake at 350 degrees F for 20-25 minutes or until golden brown. Let it cool on the baking sheet to crisp up for a few hours.
It can be stored in a Ziplock bag in the refrigerator.
While at the house last night, Jimmy Moore, his wife Christine, and my wife Tiffini made this delicious cinnamon swirl cheese cake from The Ketogenic Cookbook. I think I have a new favorite!!! I seriously have not had a better cheesecake and this one is lowcarb, gluten free and keeps you in ketosis. Thank you Jimmy Moore and Maria Emmerich for such a yummy recipe. (I even had some for breakfast this morning . . . . mmmmm).
If you want a great low carb recipe, pick up a copy of the book and turn to page 336.
ery October I get a hankering for homemade root beer. But it is usually loaded with sugar. Thanks to Maria Emmerich and her amazing recipes, that doesn’t have to happen this year. She just posted this on her site today and I can’t wait to try this as I sit by my fire pit roasting some hot dogs with my kids . . . Thanks Maria.
I pasted a copy of her root beer image below just to make you drool, too . . .
I recently read a blog post decrying anyone that would recommend a low carbohydrate / ketogenic diet to their patients.
What?!
In fact, this particular blog outlined a number of “adverse reactions” to a ketogenic diet, and based upon these perceived reactions, the writer advised severe caution with its use in just about anyone. It is important to note at the outset that most of the data this blogger quotes are from older studies completed in children for the treatment of epilepsy with specific liquid ketogenic dietary meal replacements. (Not what you’d expect in a low-carb / ketogenic diet for the average obese adult today.)
Diet Confusion
Thanks to recent misinformation by a number of medical professionals, including the person writing the blog referenced above, a poor understanding of fatty acid metabolism by the general community, and a distinct lack of understanding of human adaptability recorded over the last 5,000-6,000 years, there is still significant confusion about ketogenic diets.
It is important to recognize the crucial fact that the human body is designed to function quite well when supplied any of three macronutrients: carbohydrates, proteins or fats. It does so through an amazing series of enzymatic reactions referred to as the Krebs (tricarboxylic acid) cycle, producing needed ATP (adenosine triphosphate) required for our muscles to contract, our heart to beat and our diaphragm to expand our lungs. What’s even more amazing that that the body was designed to recognize the season we are in based up on the food we eat. That is, until we invented refrigerators in 1913. (Now our bodies think it’s year round summer time . . . wait . . . I live in Arizona where it is year round summer time.)
No, this is not a post about unplugging your refrigerator, living on solar, getting off the grid and saving energy.
Our bodies recognize the seasons we are in based upon inherent hormone release. The key hormone is insulin. Insulin can be looked at as the seasonal indicator to our bodies. Insulin production rises and falls based on our intake of carbohydrates (sugar, starches, some fibers). Insulin, essentially, tells our bodies when it is a “time of plenty” and when it was a “time of famine.” Why? You ask. We didn’t have refrigerators 100 years ago and you were lucky if you had a root cellar. The body needs to know when to store for the famine (the winter) that was around the corner. Insulin is that signal.
During the summer, potatoes, carrots, corn and other fruits are readily available. These are all starchy carbohydrates and they all require the body to stimulate an insulin response so that they can be absorbed. Insulin stimulates fat storage (J Clin Invest. 2000;106(4):473-481. doi:10.1172/JCI10842). Just like bears, our bodies were designed to store for the winter.
If you think back in history, your grandparents probably used stored meats & cheeses that could be salted or smoked for preserving during this time of year. Those crossing the plains were commonly found with pemmican, a concentration of fat and protein used as a portable nutrition source in the absence of other food. (Chapter VIII. Narrative of the Life of David Crockett, of The State of Tennessee, Written by Himself, Sixth Edition [E.L. Carey and A. Hart:Philadelphia] 1834, 1837; Marcy, The Prairie Traveler, p. 31.) Think about conversations you may have had with your grandmother when she told you that for Christmas, she received an orange. A single orange for a gift?! Many of my patients drink 12-15 of them in a glass every morning. The winter diets of our grandparents were very low in starches and carbohydrates. When carbohydrate intake is low, little insulin is produced.
Again, insulin is the hormone that tells you that you’re in “a time of plenty” and stimulates weight gain and cholesterol production to prepare for winter. Those prescribing the use of ketogenic diets understand this innate human adaptive trait, and use it to effect changes in weight, cholesterol and other desired metabolic changes.
Three types of ketones. Uptodate.com, May 2015
Now, let’s define the difference between ketosis and keto-acidosis and try to clarify the misinformation that is being spread around the blogosphere.
A ketone is a molecule the body produces from the breakdown of fat and some proteins (amino acids). There are specifically three types of ketones: beta-hydroxybutyric acid, acetoacetic acid and acetone. If ketosis was “bad,” then why would our bodies produce these molecules? They are not bad, and in fact, multiple studies show that the body is often more efficient and effective when it functions on ketones rather than glucose as its primary fuel source. The body can only supply a limited amount of sugar or glucose for fuel. If you talk to runners, marathoners or triathletes, they will tell you that after about 45-90 minutes of continuous endurance exercise the glucose supply runs out and they will experience what is termed a “bonk” (have a low-blood sugar or hypoglycemic episode). Unfortunately, our bodies can only store about 18-24 hours of glucose.
Metobolic Changes of Ketogenic Diet (American Journal of Physiology – Endocrinology and Metabolism Published 1 June 2007 Vol. 292 no. 6, E1724-E1739 DOI: 10.1152/ajpendo.00717.2006)
However, the body can store days upon days of fat in the form of triglyceride in the fat cells. Triglyceride is broken down into ketones. If glucose is the “unleaded” fuel, you can think of ketones as the “diesel fuel” that is easier to store and runs longer.
The average body functioning on ketones as the primary fuel will have a ketone level measured in the blood somewhere between 0.4 and 4 mmol/L. Because of a balance that is created by the use of ketones and a feedback mechanism that kicks in when the ketone level rises, the body will maintain a pH of around 7.4.
Ketoacidosis is dramatically different. If you are a type I diabetic, you don’t produce any insulin. The feedback mechanism regulating ketone use is broken and the ketone levels and triglyceride breakdown speeds up because the body can’t access glucose and can’t produce insulin. The ketone levels spike and the level can rise to > 25 mmol/L. In the presence of a high blood sugar and high ketone level, the acid level in the blood shifts to a pH of less than 7.3. This is referred to as metabolic acidosis and can be life threatening as the low pH shuts down the bodies’ enzymatic processes and a person becomes critically ill and without treatment, can die. (Kitabchi AE et al., Clinical features and diagnosis of diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults. www.uptodate.com, May 2015.)
If you’re not a type I diabetic, you have nothing to worry about. Regardless of what the “ketogenic nay-sayers” blog about, your liver makes approximately 240g of glucose per day, this stimulates a basal release of insulin which keeps the pH in check. It’s also what keeps weight loss at a consistent pace of around 2-10 lbs per month.
If you are a type I diabetic, don’t fret. Carbohydrate restriction can still be used very effectively. It just takes some balancing and understanding of your individual metabolism. Talk to your physician and/or medical bariatrician about how to follow a carbohydrate restricted diet while using insulin.
What about all the other “adverse effects” the blogosphere and other so-called experts claim about ketogenic diets?
Let’s take them on one by one. Are you ready?
Gastrointestinal (GI) disturbances – Yes. Any time you change your diet you may experience diarrhea, constipation or gassiness. Most of the time, this is because you are either 1) not eating enough leafy greens (fiber) or 2) you’re using a supplement that contains an artificial sweetener. Most of the studies on ketogenic diets did not incorporate fiber and the studies used to make this point were on children who used a ketogenic fat supplement shake or liquid preparations containing these artificial sweeteners to make them palatable. If you have spoken to any bariatrician, they will tell you, the best way to follow a ketogenic diet is to eat real food. If you want to read about the anecdotal GI effects of sweeteners, read the comment section in Amazon about the Haribo Sugar Free Gummy Bears.
Inflammation Risk – In every patient that I have placed on a ketogenic diet in the last 8 years, all inflammatory markers including CRP, Sedimentation Rate and Uric Acid have all decreased. Inflammation gets better on an appropriately formulated ketogenic diet. The older studies of ketogenic diets in children contain most of their fat from Omega-6 fatty acids from vegetable oil which will increase inflammation and oxidative stress, spike the cortisol levels and have the secondary effect of actually raising the triglycerides. (Simopoulos AP,The importance of the ratio of omega-6/omega-3 essential fatty acids, Biomed Pharmacother., 2002 Oct;56(8):365-79.)
Muscle Cramps/Weakness – The process of weight loss occurs by burning fat into CO2 and water. We breathe the CO2 out, but the water produced has to follow salts out through the kidneys. Hence, we lose salts. This can cause weakness and muscle cramps. The solution? Stop restricting salt on a low carbohydrate diet. We are the only mammal that restricts salt and we do it because low-fat diets cause us to retain water. Low carbohydrate diets do the opposite. Use sea salt or sip beef or chicken bouillon broth with your dinner. The use of yellow mustard also helps (the small amount of quinine in yellow mustard stops the cramping). If you have congestive heart failure, talk to your doctor about monitoring your salt intake in balance with your diuretic or water pill.
Hypoglycemia – If you read the ketogenic diet research, most of it was done on epileptic children. The diets called for a period of starvation, then the use of a ketogenic liquid based on the John’s Hopkin’s protocol. It is a well-known fact in medicine that starvation in children can frequently cause hypoglycemia, especially in children with other genetic or congenital defects leading to forms of epilepsy. In clinical practice, with ketogenic diet use in adults, hypoglycemia is rare.
Low Platelet Count (Thrombocytopenia) – Again, this was seen in the epileptic children who were placed into starvation first, then introduced a liquid fat replacement shake to stop intractable seizures. These liquids or shakes were often nutrient deficient in other essentials. Folic acid, B12 and copper deficiency can occur when not eating “real food.” Low platelet counts are rarely seen on ketogenic diets based around “real food.” Many children in the ketogenic studies had been on or were concomitantly on valproic acid for their seizures. Valproic acid is commonly known to cause thrombocytopenia (Barry-Kravis E et al, Bruising and the ketogenic diet: evidence for diet-induced changes in platelet function. Ann Neurol. 2001 Jan;49(1):98-103.; Kraut E, Easy Bruising, http://www.uptodate.com, May 2015.)
Easy Bruising – This is usually due to inadequate protein supplementation as was the case in much of the ketogenic literature where protein levels were also restricted. (Kraut E, Easy Bruising, http://www.uptodate.com, May 2015.)
Pancreatitis – Patients who are insulin resistant or have impaired fasting glucose commonly have high triglycerides. Elevation in triglycerides itself is a cause of pancreatitis. Ketogenic diets lower the triglycerides. However, if a patient has not been following their diet as directed, spikes in the triglycerides can occur placing the person at risk for pancreatitis.
Long QT Intervals/Heart Arrhythmias – The list of things causing Long QT intervals and abnormal heart rhythms is long and variable (Acquired Long QT Syndrome. Berul C et al. www.uptodate.com, May 2015). It is well know that starvation, rapid weight loss and liquid protein diets can cause a delay in the conduction signal in the heart. Anyone wishing to start any diet should have an electrocardiogram (EKG) through their doctor to ensure that the diet (of any type) doesn’t exacerbate a prolonged QT interval.
Three year weight loss and metabolic improvement in a patient on a Low-Carb / Ketogenic diet. Note: Patient admits to not following ketogenic diet during holidays from Nov 2013 – Feb 2014 (see the dramatic changes to the body when cheating happens)
Cardiomyopathy – Prolonged QT intervals have been associated with cardiomyopathy and the former can stimulate the later. Any diet that has the potential to prolong a QT interval has the potential to cause cardiomyopathy. Hence the need for regular EKG monitoring on any diet (Acquired Long QT Syndrome. Berul C et al. www.uptodate.com, May 2015).
Lipid/Cholesterol Changes – In the 8 years I have been applying ketogenic diets to patients, I have seen dramatic improvement in the triglycerides and HDL levels. The only time triglycerides rise over 100 is if the patient is using artificial sweeteners or is cheating on the carbohydrate restriction. Total cholesterol commonly rises, however, this is indicative of the fact that there is a shift in the LDL particle size and this affects the calculation of both total cholesterol and LDL-C. In light of this, most of my patients have dramatic improvement in triglycerides and small dense LDL particle number. I’ve included the common cholesterol changes I seen in my office as a few case reports to demonstrate the effectiveness of a ketogenic diet:
2 year ketogenic dietary labs and weight loss
Myocardial Infarction – It is interesting that one blogger includes this on the list of adverse reactions, however, when you actually read the study, the author of the paper make an “assumption” that there was potential for heart attack due to an elevated total cholesterol, however, a correlation was never made. Again, in the 8 years I have been using ketogenic diets, I have seen dramatic improvement in cholesterol profiles, inflammatory markers, atherosclerosis and carotid intimal studies (Shai I et al, Circulation 2010; 121:1200-1208).
Three year metabolic history of a Low-Carbohydrate / Ketogenic diet
Menstrual Irregularities / Amenorrhea – It is well known that any diet causing protein or other nutritional deficiency will affect the menstrual cycle first and growth second. The only time menstrual irregularities occur with a ketogenic or Low-Carb diet is when a patient is not taking in enough protein or is not eating real food. What amazes me is that a properly applied ketogenic diet causes normalization of the menstrual cycle, and in my practice, I’ve had a number of women successfully be able to conceive after making a ketogenic dietary change.
For more details on the nutrient content of a ketogenic diet, see the recent article by a friend of mine, Maria Emmerich. She’s been creating ketogenic diets for years and has a number of fantastic books my wife and I have been using in our home over the last nine years. She is one among many that can give you some direction on how to devise a healthy, real food based ketogenic diet. See the page on my website here that will give you some direction in formulating your Ketogenic Lifestyle.
Nally Family Low-Carb / Ketogenic Cheese Cake
So, to celebrate Mother’s Day, today, with my family, I am going to indulge in some Low-Carb / Ketogenic Cheese Cake!! Happy Mother’s Day, to all of you and especially to all you mothers out there making a healthy difference in the lives of your families! (You can find the recipe for this delicious cheese cake here)
In the words of Sir William Ostler, “If it were not for the great variability among individuals, medicine might well be a science and not an art.”
A few of my patient’s have fallen off the carbohydrate restriction waggon this last year. In celebration of restarting your low-carb lifestyle and resolutions to improve your health, I propose the following celebration.
1) Go home right at 5pm
2) Pull out your favorite skillet (mine is a well used Lodge Cast Iron pan)
3) Remove your favorite full fat sausage from the freezer.
4) Look up your favorite cream cheese waffle recipe.
5) Make your self a Sausage Sanctuary, a Bacon Bungalow or a Low-Carb Cabin (whatever tickles your fancy) in celebration of restarting your carbohydrate restriction and removing the carbage from your life.
I suggest you use a Low-Carb cream cheese waffle you can find here for the roof.
There are a number of recipes for “Fat Bombs” on the internet, but this one is my wife’s version. These have been a lifesaver for starting and maintaining a Low-Carbohydrate or Ketogenic diet over the last few years. They are fantastic mid-meal or anytime Low-Carb snacks, full of satiating fat, that really help during the holidays. I mentioned Fat Bombs to my patients in my Low-Carb Group Visit Class today and I promised to post them here:
Fat Bombs:
1 stick of real Butter softened
1 cup Coconut Oil
1/2-2/3 cup Erythritol
1 tsp liquid Stevia
1/3 cup Cocoa Powder
1 cup Peanut Butter or Almond Butter
2 cups chopped Macadamia Nuts or slivered Almonds
1-2 cups of Coconut
Mix together and place 1-2 table spoon sized scoops in small muffin tin or on wax paper. Must be kept refrigerated to remain firm.
A number of my patients have asked what I use personally as a protein supplement and whether I use protein shakes. I’ve struggled to find a great tasting protein shake that does not contain any artificial sweeteners (see my article The Skinny On Sweeteners) that raise the insulin levels. Most of the pre-prepared shakes (including the Adkins, EAS, Muscle Milk, and many others) will significantly slow weight loss and knock you out of ketosis due to an insulin response stimulated by drinking them.
My sweet wife just perfected our family’s favorite high fat, low carbohydrate protein shake. Oh, it’s good and it’s filling. You’ll love it and you won’t be hungry for at least 3-4 hours after savoring this sweet taste-bud sensation.
This is a great shake for a mid-meal snack or a quick meal on the go.
For those on a ketogenic or low-carbohydrate diet, whole wheat flour or almond flour is often substituted for with coconut flour. Found this cool chart at “Maria Mind Body Health.” Maria Emmerich has given me permission to post it here for you, my wonderful patients and followers.
We use many of Maria’s recipes in my home, but occasionally you may want to convert your own recipe and this chart will help. My wife is the cook in our family, and probably already knows how to do this, but for those just beginning your ketogenic journey, this will be a big help in recipe conversion.
I’ve had patient’s ask me in the room how to substitute for flour. Here’s the answer. Remember, you have to double the eggs per cup. Thanks Maria!!
Mother’s Day is a great event in our home, and traditionally, it is a chance to make breakfast for Mom.
In our home, Mom has always loved waffles. But changing to a low carbohydrate diet put a damper on the waffles for a while, until my sweet wife found and perfected the following recipe. (She adapted this recipe fromJennifer Eloff’s Cream Cheese Bran Waffle recipe found in her book, Splendid Low Carbing for Life Vol 1.) These waffles are amazing! They are now lovingly referred to in our home as “Mom’s Cream Cheese Waffles.”
Breakfast for Mother’s Day in our home consisted of Mom’s Cream Cheese Waffles, freshly grilled thick slice bacon and strawberry flavored homemade whipped cream to top off the waffles and was easily prepared by my 13 year old daughter. It’s a perfect Low Carb Mother’s Day meal that’ll satisfy the waffle craving and still give the gift of “ketosis”.
In a food processor or electric mixer, blend the cream cheese until smooth. Add the eggs and continue to blend. Add the Carbalose flour, wheat germ, cream, water , Splenda, baking soda, baking power and salt. Continue to blend.
Pour 1/4-1/2 cup onto hot greased waffle iron. Close and cook for approximately 3 minutes.
My amazing wife, among her many talents, makes a wonderful low carb cheese cake. She has taken the recipe found in Maria Emmerich’s “Secret Weight Loss Recipes” and modified it to our family’s taste. It has quickly become one of my family’s favorites.
Preheat oven to 350F. Mix cream cheese, sweetener, protein and vanilla with an electric mixer until blended. Add eggs one at a time, mixing on low after each until blended. Blend in sour cream and pour over crust. Place a pan of water on the lower rack place cheesecake on rack above. Bake for approximately 45 minutes until set. Watch carefully!
Refrigerate overnight.
Freezes well too!
My wife will often bake them in individual sized pans (as in the picture above) so that I can pull one out of the freezer, let it thaw and cover it in whip cream and a sprinkle of berries. Tastes fantastic!
I love chocolate chip cookies! However, over the last seven years, as I have followed a low carbohydrate diet I have not been able to indulge my chocolate chip cookie craving — until recently.
My gorgeous and very ingeniousness wife has perfected her chocolate chip cookie recipe and – Oh, WOW . . .are they good.
Warm, tasty chocolate chip cookies that are actually good for you, served up by a beautiful blond in a very cute apron. . . I think this is what heaven is like.
Low Carb Chocolate Chip Cookies
Here is a snapshot of the remaining batch my wife made at our house the other day before they got eaten. Boy, are they good. Here is the recipe:
Low Carbohydrate Chocolate Chip Cookies
1 tsp vanilla
2 eggs
2 sticks (1 cup) of butter, softened
1/2 cup Sweet Perfection
1/4 cup erythritol
1/4 cup Just Like Sugar (chicory root sweetener)
1 tsp salt
1 tsp baking soda
1 tsp baking powder
1 1/2 cup almond flour
1 cup coconut flour
1/2 cup Carbalose flour
2 ChocoPerfection Milk Chocolate bars chopped
Mix the vanilla, eggs, butter and sweeteners until creamy or fluffy. Add in all dry ingredients and mix. Add chocolate and mix. Place dough on parchment paper covered cookie sheets in 2 tsp sized scoops.
Prepping the Roast
Smoker prepped . . . check!
ulated by drinking them.
