Category: Stress Reduction

April 17, 2020

Eight Steps to Help You, Your Children & Your Family Thrive In Quarantine

Some of you are doing well. Some of you aren’t. There is a twisted part of some of you that actually like this “shut-down.” Because, you’ve been in a mental/emotional shut down for years. The pain of past failures punched holes in your heart. You feel it and re-experience it when you try. Your family sees it (they just don’t say anything). Your friends see it. But, they are tactful and just smile.

With each failure, you lowered the fence. With each betrayal, you widened the moat around your soul.

And now, life has caught up to you.

Part of you wants to double down and float corpse-like in the misery of the past. Quarantine is an easy excuse to kill the last spark of your ambition, binge on Netflix and pop bon-bons on the couch.

But, COVID-19 just kicked over the game-board. Life’s dice have just been changed.

Pull back the curtain of chaos around your life and the life of your family. Realize that you actually set the rules.

The Eight Rules

There are eight rules that, if applied, will stabilize you and your family. And, if you teach them to your children, you will solidify a generation.

Give your life and your children some structure.

We as humans have always needed guard rails, or banisters, especially the little humans. A simple list of the top three things you and your children need to do today will make the day go so much smoother. Start at the top and go to work. You don’t have to accomplish all three, but, just knowing the three most important things to accomplish today, gives you and your ” miniature carbon copies” satisfying direction. If you don’t finish number 2 or 3, then put them on the top of the list tomorrow.

Delayed gratification is your true best friend.

This is a perfect time to place strategic rewards on pleasurable activities. I realize that spending the day in your pajamas watching TV, Netflix binge’ng, or playing video games can be very easy. These activities are fine after the structure has been addressed. Clean your room, then reward yourself with a video game. Fold the laundry, then surf the internet. Mow the lawn, then watch Netflix. Pay the bills, then reward yourself.

People, grown and those still growing, always respond better and gain self-confidence when experiencing delayed gratification.

Teach your family the how and why of working together.

Yes, the shutdown causes problems. But, make lemon-aid out of lemons. Teach your family to cook, plan and make meals together (I know a great book with 60 wonderful ketogenic recipes). Young children can clean up, feed the dog, take out the garbage and even do their own laundry.

My wife had our children doing their own laundry at seven years old. Umm, yes, they actually can, and are capable of some complex chores at that age. Anyone that can “Call of Duty,” “Super-Mario” or dress a Barbie can sort clothes and turn on a washing machine. This is a perfect time to teach them and supervise.

Exercise as a family.

Daily family walks, runs, or weight lifting (body-weight exercises if you don’t have weights) will shake out the cobwebs. Teach your kids great health habits and you fatigue them for bedtime sooner in the process.

Tell your children stories.

Share stories around the dinner table of your adventures, successes and failures. They want to hear the how and why, it is educational for them and it is therapeutic for you. Read to your kids before bed. We worked through the entire Narnia series over a couple years and my kids still talk about it.

Or, better yet, tell them a bedtime story. The crazier the better. You will never regret it, and it will be some of the most memorable things your family may experience.

Find a project that you and they can tackle.

My daughter loves to collect Medieval swords and loves to sword-fight (Probably because of the bedtime stories we read.) We had this collection of swords that was hard to keep in a closet. So, we made a wooden sword rack together. My daughter found that she “loves to build stuff,” and this brought out a creative side of her that my wife and I had never seen.

Carve out some adult time.

You need time for yourself. You also need time with your spouse. Kids need to see that adults need some time for themselves.

I can still remember the time when my daughter called me at work in tears. When I asked what was wrong, she told me, “Mom put herself in time-out, she locked herself in the bedroom and she won’t come out.”

My wife was homeschooling the kids, it had been a difficult year and didn’t give herself time to regroup. She was frazzled. To this day, my grown children and I have learned that each of us needs some personal time. Or, we end up putting ourselves in “time-out.”

Learn and teach your family independence.

If your family, your spouse, or those you are responsible for come to you with every little unmet need and want, this quarantine is going to feel like it “lasts for years!” Train your family, and yourself, up front what they can do for themselves. And, teach them how to decide when they can do it on their own. Help them be independent. Tears and whining will probably occur, initially (probably, from your husband the most.) But, it is our job to take completely dependent infants and turn them into independent self-starting adults within 18 years.

So, dream big, take your white knuckles off the steering wheel, pull over and re-imagine your life. These eight rules are the alchemy of the soul.

September 3, 2018

The Shovel will Fail You in Obesity, Finances & Life

A few years ago, my family and I set out to build a pond.

I have always loved Koi and the serenity of a Koi pond in my own back yard was very enticing. I spent about a year planning my design and the location. I dreamed of a serene evening after a very long, hectic day seeing patients relaxing beside the pond. The sound of trickling water, the occasional splash from fish, the cool breeze passing over the mist from a water-fall would sooth my soul after a busy day in the office.

I envisioned the perfect area. An unused access path, previously worn by the previous owner with truck and trailer traffic, beside my now expanded patio. Twenty feet wide, thirty feet long and four feet deep. . . that seems just perfect.

I pulled out my shovel and set about digging. Eager to begin and filled with the energy of the final product, I set to digging. What could be so hard about digging my own pond? Think of the exercise I will be getting. Thoughts spurred me on.

Minutes later, chest heaving, face glistening with sweat, I stared in dismay at the ground. All I had to show for my wild digging was a small 1/2 inch dent in the dusty Arizona top soil.

Sonoran Clay

Over time, calcium-carbonate, along with other minerals, accumulates and dissolves into the topsoil of the very arid regions of Arizona Sonoran Desert. It forms a two to three-foot layer of soil called “caliche.” Periodic rains carry the calcium as far as three feet down into the soil, then the water rapidly evaporates in the blistering Arizona heat. This often forms two to three feet of soil that is “literally” harder than concrete.

With tremendous zeal, a great deal of sweat and a round of painful blisters, I broke my third shovel on this impenetrable ground. I realized this was much more difficult than I thought. I pulled out the back-hoe attachment for my small farm tractor. After a few hours and few gallons of diesel fuel later, still very little progress occurred.

Multiple weekends and evenings of digging in the Arizona caliche left me with three broken shovels, a ruptured hydrolic line in my tractor, anger that my expensive back-hoe attachment didn’t work, and only a small dent in the ground near my patio. Even the brute force from the tractor would not budge the clay. I wondered if dynamite would be effective? (My wife would have none of this idea).

With my exuberance quashed, I concluded that this would require much more measured exhuming.

Escape From the Prison

We often imagine, with great delight, the removal or destruction of that which enslaves or imprisons us. We dream that just a little sweat, exertion of a few shovel scoops of dirt and the foundation to our prison of obesity, addiction, debt, and depression are exposed. A few extra scoops and we imagine freedom from that prison cell.

If only I had a jack hammer and a bigger, more powerful scoop, I imagine . . . I could make short work of these manacles that bind me.

But, our manacles and prison cells do not so easily give way.

The failings of our sharpened spades and powerful back-hoes form a new, even stronger fetter – the belief that our prison cell is unbreakable, that our challenge is just too great. These failings usually leave a person cured of any further desire to break free. It quashs the dream and solidifying the depression of stagnation.

The in-fecundity of my shovel, no matter the strength and effort put behind it, was not cause to quit. It was life’s lesson that prisons and shackles often only need a simple tool.

Enter the pick-axe. During this process my wife said, “Honey, why don’t you use the pick in the garage?”

“If my shovel and the back-hoe didn’t work, there was no way I was going to break through this clay with a pick axe.” That was absurd, I thought.

Yet when I humbled myself to try, it was simple. The pick-axe was unpretentious. This simple tool allowed for an almost effortless stroke to a small area of weakness in the caliche. A large flake of soil would pop free with each stroke. The process was repeated.

Scale by scale, the dragon’s flank was exposed. Careful work of the pick-axe began to loosen layer after layer, section after section, pellicle after pellicle. Yes, it was slow work. But, each swing was a small victory.

At each little victory, my heart would leap, the dream would become ever clearer.

Working this magic again and again until finally the specter was weakened enough to pull out the shovel. And, further work, allowed for bringing back the powerful back-hoe, in gratifying scoops.

The excavation that I thought would take two months took me fourteen. But, it was gratifying.

I learned a powerful lesson. Wherever life has pinned you, fettered you or barred you in, put down the shovel, and pick up the pick-axe. Second, if you really listen, your spouse may point out the tool you really need. Don’t be afraid to chip away at it a piece at a time.

Finances

Stop waiting for the sharper shovel or the bigger back-hoe to dig yourself out of your harrowing debt, mega mortgage, or your income dwarfing spending. The jackpot or financial windfall won’t come. While others await the jackpot, put down your shovel and shoulder your pick-axe.

Pick one small debt and begin to pick at it by applying just a little extra each month until it is gone.
Cancel your extra cable, sell the motorcycle and payoff the 21% interest credit card.
If you must, pick up a side-hustle for extra to sharpen the pick.

Once you’ve lifted one flake, chip away at the next. Making progress will make it easier to continue. It doesn’t matter how long it takes, just keep at it.

Marriage

You long for resolution of the apathy, progressive resentment and mutual stalemate that permeates your relationship. You look in vain for the bigger shovel that will uncover the treasure that years of apathy have buried. You long to uncover your dreams and needs that have been covered and hardened under the clay of resentment. The shovel and the back-hoe won’t help you here.

Drop the shovel. Shoulder your pick-axe.

Kiss your wife every time you leave, even if it’s just for a ten minutes to run to the convenience store.
Hold her for five seconds longer every time you hug.
Find a gift you can give her once a week, just because.
Put down your phone and look her in the eyes when she talks to you and listen. Really listen and the flakes of hard clay will unveil the beauty of her soul.
Find a way to praise her every day, even if it is through a simple text.

Health

You long to rid yourself of your addiction to sugar, bread, stress, and sleep deprivation. You’ve tried to scoop them out of your life. You even hired a trainer with some muscle to force you to change. You’ve tried in vain to save yourself from yourself.

Trying to use the shovel here is like trying to use the shovel on steel forged walls of your life’s prison fortress. Forget the shovel. Shoulder your pick-axe.

Start with one meal and make some substitutions. My dietary plan can help you with this.
Go to bed an hour earlier. Really, you’ll be surprised that the focus you have will more than compensate for the hour of lost time in the evening.
Add a quality vitamin to your morning routine.
Take ten minutes and do 20 push-ups and 20 sit-ups, then take a 10-minute walk.
Simply remove the “white stuff” from your meals. You will be amazed at the results.
Put down your phone for 30 minutes and read that book you’ve been meaning to read, instead of surfing Facebook.

Grand-standing with your back-hoe doesn’t help you. Just swing the pick-axe once or twice. Simple daily picking with the sharp point weakens the hardest of ground and the prison walls in our lives. It takes time, so be patient.

Find the weak point, apply the pick. Day by day, little by little you will be free.

I’ve been there. I’m with you. Keep me posted on your journey.

If you’re looking for a program that teaches you how to do this, check out my membership site.

August 8, 2017

Keto Happy – Do You Live A Life of Happiness?

Founded by the Secret Society of Happy People in 1999, August 8th was officially named the National Day of Happiness. It was a day created to recognize and express happiness. (I personally think it should involve the sharing of bacon, but some may disagree.) Most people, whether they admit it or not, are searching for happiness. (Most people are searching for bacon, too, . . . but that is for another article.) We hope for happiness, we aim for happiness, and we wish happiness upon our family, friends and neighbors at holidays and birthdays. It appears to be a desired condition of the soul.

In medical school, we learn that the body is almost 80% water. One of my professors intelligently quipped, “if you’re unhappy all day, that means you are essentially a cucumber with anxiety.” For many people, happiness is really hard to find. Money is hard to find . . . but, that’s because it gets wasted by people trying to find happiness

What exactly is happiness? It is a transient condition or state of cheerfulness, contentment, satisfaction or pleasure. Many people mistake meaningfulness as happiness. Meaningfulness to one’s life is more enduring. For example, suddenly having a wind-fall of cash may make you happy for the short term. However, what you actually do with that cash over the next few days, months and years is what brings degrees of meaning to your life.

Basics of Happiness

Happiness is based upon your emotional & spiritual vision, and how living your life aligns with the principles you hold most valuable. You can’t control all of the circumstances of your life. Things both good and challenging will happen to you that you never expected. However, you have control of your own happiness. You and I are the architects of it.

In working with a majority of patients who are over 65 years old, I have found that the older we get, the more we look back and realize that external circumstances don’t really matter or determine our happiness. We determine our happiness.

How do we increase our level of happiness? There are 10 Simple Steps to Happiness:

1. Improving Health

As a doctor, I’m a huge advocate of improving your health which plays a dramatic role in happiness. Losing as little as 10 lbs has been shown to improve energy, decrease your risk for major disease, improve sleep, improve sex life, and decrease inflammation. Improvements in any of those areas will reduce stress and anxiety and increase happiness so you can imagine while improvements in ALL of these areas could dramatically change your life.

As an advocate of the ketogenic lifestyle, I’ve found that the majority of my patients are able to lose 5-15 lbs each month for the first three months using this approach. They average 2-5 lbs pf weight reduction each month there-after while following a ketogenic approach over the long term. Understanding that this is one of the long term keys to success in happiness I want to make sure you know that I’ve developed some custom strategies to help with this and will share them with you below. This lifestyle decreases risk for diabetes by 75%, improves mental clarity, and slows the aging process. (Who wouldn’t want those side effects while eating bacon?)

2. Savor Daily Experience

Bacon Wrapped Jalapenos

First, savor the daily experiences. We live our lives at such a high speed, we often neglect to take time to enjoy the experiences around us. A recent trip in down town Amarillo, Texas, brought me to the front doors of a restaurant that served cream-cheese & sausage stuffed, bacon wrapped, jalapenos (try saying that 5 times fast). I had a bit of time and decided to try them. It was the first time in 3-4 days that I actually had the chance to slow down and savor the place around me, the flavors of the food, and the atmosphere of the restaurant.

Bacon Wrapped Jalapeno’s & Happiness

Just taking a bit of time to savor these things made this experience a very memorable and happy experience that I probably won’t soon forget.

Take 3-5 minutes today to just think about where you are. Savor the smell of a rose, the color of the sky, the shape of the clouds or the sight of a bird. These sensory images can, and will, leave indelible memories and release dopamine and serotonin naturally in the brain. Savoring the daily experiences of life can be part of the process of meditation we will talk about below.

3. Volunteer

Get involved and volunteer in meaningful activities around your neighborhood, church & community. Research shows that voluntarily giving of time increases happiness in the giver. It also allows one to see, participate with and help those around you who may be less fortunate. Volunteering your time and energy regularly increases your gratitude we will discuss further below.

4. Express Gratitude

Expressing gratitude daily has been shown to dramatically increase your sense of well-being and happiness. Expressing gratitude requires awareness. It requires you to take inventory of everything around you (something you will already be doing if you are savoring your daily experiences). Gratitude can be expressed in a journal, through prayer & meditation, or directly to those around you. However, expressing gratitude requires effort.

In the Judaeo-Christian view, expressing gratitude is actually a method of expressing faith. The 17th chapter of Luke holds a biblical example of this concept. When the leper returned to express his thanks to Jesus Christ for being healed, he wasn’t told “Your gratitude made you whole.” Christ told him, “Thy faith hath made thee whole.” He implied that the act of expressing gratitude is a demonstration of faith, a necessary and essential process in human development.

5. Recognition of Personal Value

I’m not talking about your bank statement or personal financial statement. I’m talking about recognizing the value of your soul. The only successful non-medication based program to help people overcome addiction is the 12-Step Program through Alcoholics Anonymous. The essential second step of the twelve is recognition that a power greater than ours is involved in our lives. Whether, you believe in God or a greater universal power, recognition of your value is an essential perspective to gaining happiness. This has been demonstrated thousands of times through the 12-Step Programs.

Often, the feeling we have of our personal worth is based on the love and interest we receive from those around us. Yet, this love is sometimes lacking. The love of men is often imperfect, incomplete, or selfish. What if you looked at yourself with the same benevolence, love, and confidence that God does? Imagine the impact it would have on your life to understand your eternal potential as God understands it. If you could view yourself through His eyes, what influence would that have on your life? Recognition of this principle is essential to making any lasting change.

6. Become Who You Are

The celebrated Greek poet, Pindar, said, “Become who you are.” Isn’t this a paradox? How does one become who they already are?

Many of my and the younger generations grew up to the sounds and images of The Lion King. You probably remember the scene where Simba receives a visit from his father, Mufasa, the deceased king. After his father died, Simba fled from the kingdom because the guilt he felt about his father’s death. He wanted to escape his responsibility as heir to the throne.

His father appears to him and warns him: “You have forgotten who you are and so have forgotten me. Look inside yourself, Simba. You are more than what you have become. You must take your place in the circle of life.” Then this invitation is repeated several times: “Remember who you are. … Remember who you are.”

Simba, completely shaken by this experience, decides to accept his destiny. He confides in his friend, the shaman monkey, that it “looks like the winds are changing.”

The monkey replies, “Change is good.”

And Simba says: “But it’s not easy. I know what I have to do. But going back means I’ll have to face my past. I’ve been running from it for so long.”

“Where are you going?” the monkey asks him.

“I’m going back!” cries Simba.

(This is also a great movie because of the “bacon references:”)

Admit it. You smiled didn’t you!

7. Meditation

Meditation and prayer have been shown to actually change areas of the brain that relate to stress management and mood regulation. People who meditate regularly over long periods of time have better ability to find and maintain positive states like joy and compassion. Richard Davidson and his colleagues found that meditation increases brain activity in areas related to happiness as well.

8. Relationships

Happiness has been linked to quality relationships as well. Robert Wallinger, psychiatrist at Harvard University, conducted a 75 year multi-generational study on happiness. He found that the quality of the relationships was powerfully connected to happiness. Lonely people were less happy and had poorer health. People with higher-quality relationship or social ties were the happiest.

However, it wasn’t just having a relationship, but having one with a stable and consistently caring person that made the difference. Having lots of acquaintances or being in a relationship with an unreliable or abusive partner did not make people happier. Amazingly, listening (savoring shared experiences) and complimenting (expressing gratitude) improve the quality of relationships. (Sharing your bacon improves relationships as well.)

9. Food

A number of studies have demonstrated that a ketogenic diet increases gamma-aminobutyric acid (GABA), a key neuro-hormone signaling satiety and pleasure, in the brain. GABA increases sensations of happiness and euphoria. (Yes, this is why eating bacon makes you and I happier. It’s probably why the thought of bacon in the video above made you smile.) Shifting into a ketogenic state at least periodically has the effect of increasing your sense of happiness throughout the day. It is actually the ketone that does this. Whether you get into ketosis through diet alone, or through the use of exogenous ketones, both methods are effective in aiding you in your quest for happiness.

10. Allow Others to Help

I know you are probably familiar with the term it is better to give than receive but did you know there is evidence to support the reverse is true too? That happiness also comes from allowing others to help? Think about it. When you are helping others, especially when they appreciate it, you feel happiness or joy. Others experience those same feelings when they are able to help you. Think of a child that wants to make you a meal. No matter what it looks like when it gets to you, you smile and feel happy at the effort, the child smiles back proud at their success. There is happiness in giving and receiving.

So today’s your chance to receive. As a doctor, I find myself shying away from sharing this information with you directly because I never want anyone to feel like my efforts are about me. I’ve spent years learning and understanding the benefits of a Ketogenic lifestyle and spent additional years researching products that work and my local patients are experiencing tremendous results! A friend told me that not sharing this information with people directly was actually being selfish. (Ouch!) “When you know someone has a problem that you can solve, shouldn’t you share it and let them make their own decisions?”

Although that was painful to hear, it helped me commit to being more direct about how I can help all of you to feel better. If you are ready to change the way you feel and want to live a happier, healthier life, the time is NOW. Put these 10 steps in action and enjoy the benefits of a KetoLifestyle. If you want to know more about what I do, keep reading my blog, join my weekly newsletter and watch me Live Stream every week on Facebook Live & Periscope giving you free tips and tricks to stay healthier. If you know you are ready for a change, and you want to see how I can help, check out the variety of Ketogenic programs I offer to help you find the Happiness inside You! Because we all love gifts and they make us Happy, in honor of #NationalHappinessDay, you should see a pop up here for something special! ] Be sure to click here to go to the Keto Kart and cash in on better health!

However you decide to approach your day today, choose to be happy. It really is up to you.

January 5, 2016

What Are Your Biggest Weight Loss Struggles?

Join Dr. Nally on this evening’s Periscope as we talk about your biggest weight loss struggles in rapid fire style. We cover topics this evening from the effects of cheating on a ketogenic diet to how to overcome a weight loss stall . . . join us to hear the whole conversation.

December 15, 2015

The 3 Weight Loss Necessities to Weathering the Holidays

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

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

December 13, 2015

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.

After 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 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.

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?

Normal Spider (9)

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:

November 28, 2015

Common Ketosis Killers

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

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

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

Nutritional Ketosis is Most Effective as a Lifestyle Change

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

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

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

Nutritional Ketosis is a Very Low Carbohydrate Diet

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

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

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

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

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

To Effectively Maintain Nutritional Ketosis, You MUST get adequate Protein

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

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

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

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

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

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

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

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

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

Nutritional Ketosis is a High Fat Diet

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

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

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

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

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

Check Your Sweeteners At the Door

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

Don’t Even Start with Coffee Creamers

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

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

Ketosis Killing Medications

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

Estrogen

The seventh common culprit in halting weight loss is a lack of estrogen in menopausal or post-menopausal women. About 20% of women that I see in my practice who are over 55 years old, need some degree of estrogen replacement before they are able to lose weight. Estrogen plays a very large role in regulation of the metabolism and when deficient, causes weight retention or weight gain. Talk to your doctor about the risks and benefits of estrogen for you individually in this situation.

Stress

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

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

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

November 25, 2015

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?!

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:

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

The psychiatric literature suggest that up to 80% of people with depressive disorders have increased cortisol secretion (1,2,3). People 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).

Under 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:

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.
Pfohl B, Sherman B, Schlechte J, Stone R. Pituitary-adrenal axis rhythm disturbances in psychiatric depression. Arch Gen Psychiatry 1985; 42:897.
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.
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.
McEwen, B.S. The brain as a target of endocrine hormones. In Neuroendocrinology. Krieger and Hughs, Eds.: 33-42. Sinauer Association, Inc., Massachusetts, 1980.
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.
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.
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.
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.
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.
Cavagnini, F., M. Croci, P. Putignano, et al. Glucocorticoids and neuroendocrine function. International Journal of Obesity 24: S77-S79, 2000.
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.
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.