The real weapon of mass destruction in our world:
Category: Uncategorized
Political Correctness
Political correctness is just fascism masquerading as manners.
What Law of the Universe are you Missing?
As a dual boarded physician in both family medicine and obesity medicine, Dr. Nally spent years training to understand the intricate physical laws of nature and science that keep the amazing human body functioning. When we understand how these physical laws of the natural world work, we are able to use them to our advantage.
Dr. Nally has written extensively about these laws in his twelve training modules found in the KetoClan Coaching Membership. Access to this information is invaluable and something you don’t want to miss.
You can also get access to his regular videos and live-streams at DocMuscles.Locals.com where he frequently shares clinical pearls and insights to help you along your journey to amazing health.
Doc Holiday Was Right . . .
Toward the end of Tombstone, one of my favorite movies, Wyatt Earp tells his long-time trusted friend, Doc Holiday, that he just wants to live a “normal life.” The doc’s response has resonated with me for years. His answer pierces the façade that society and civilization try to sell each of us.
“There is no such thing as a normal life. There is just life,” Said Doc Holiday.
In my 20+ years of medical practice, and almost 30 years of marriage and family, I have come to realize that the wisdom shared by this young tuberculosis infected physician was correct. What most people mean by a “normal life” is actually a calm, even, unchallenged life with neither great victories or disappointing defeats. This “normality” has a very seductive charm. A life that lacks pains, frights and failures is often dreamed of by the masses and is often portrayed on the big screen. And, in that portrayal, it emphasizes the want of challenge, opportunity and the delight of victory.
Yet, such a “normal life” is simply non-existent. Disruptions, explosions, setbacks, failures combined with celebrations and victories small and large are all part of life. The individual or family that mistakenly believes there is some way to play it safe, some private sanctuary where they can insulate themselves, has failed to take into account the mortality of an aging body, the prevalence’s of cancer, and the imperfect genetic codes we inherited. We fail to consider global financial collapse, war, and the sins and failings of a civilization of humans, each having their own moral agency. That is life. That is “real” life. We live within a test-tube of filth, mire and ever changing chaos.
We even fail to recognize the destruction that good things bring to a “normal life.” Consider an infant. The newborn baby has no respect for “normalcy.” As wonderful as the newborn child is, they seem intent on creating chaos around themselves until their needs are met, destroying the “normal” peaceful life and sleep of it’s parents.
Life Is Life
Life is life. In fact, life frequently sucks, and then we die. However, in between, there are some really joyful and momentous events that make living in this test-tube of filth and mire worth the struggle. This life was never meant to be lollipops, roses and sunshine. Days are hard, Relationships are hard. If they aren’t hard, you’re not growing. (That’s not to say abuse should ever be tolerated).
Take a relationship like marriage. Relationships are made, they don’t just happen. They are made and grow as two people strive for many of the same goals. The problem is most people don’t communicate their expectations, and frequently don’t even know what their expectations from a relationship actually are. Most people are afraid of commitment because they expect that the relationship should provide sunshine on the other side of the wedding ring and yet are shocked when that sunshine leaves a sunburn. Not knowing what their expectations should be, they leave when they don’t feel frequent pleasure and happiness.
The “normal” happy life is a façade. Most people raised on participation trophies misunderstand that the paradox of life is seeking pleasure from a relationship or a job first. That’s the most effective way of missing it. Lasting joy in life, a job, a relationship or a family occurs when one seeks that joy outside of one’s self, daily directing one’s focus on the principle of filling your life with purpose.
So, shall we call Doc Holiday prophetic? I don’t think he was a prophet, but, as a physician suffering from a chronic disease that would eventually end his life, he was correct in his assessment of life in general. The determination to create and cling to a “normal life” will result in frustration, cynicism and even bitterness because it cannot be done. In Doc Holiday’s experience, the brave doctor contracts a terminal illness like tuberculosis in his attempt to help others. The disruptions of “normalcy,” even the good ones, that affect us day to day become obstacles to the “normal.” This can cause resentment of the irritable baby, the spouse, the job, the co-worker, the daily routine and even those we desire to help.
The disruption may become such an obstacle to the facade of normal that a parent, for example, may resent the baby. Seeing that a baby, one of the most noble things a mother can bring into this world, can disrupt and even threaten the ease of someone’s “normal” life, the noble disruption may even lead one to consider aborting it. Society today worships at the alter of “normal.” Hence, the pursuit of the myth of the “normal life” actually allows the horrific to become normal.
Is there an antidote? There is. Life should be meaningful. Life should be purposeful. What brings meaning and purpose in a test-tube of mire and struggle?
All the Things We Experience Make Life Better
The Apostle Paul, in his letters to the Roman saints, gives the most expansive, all-encompassing statement about life in all of the religion and philosophy that I’ve ever read. “All things work together for good to them that love God, to them who are the called according to his purpose” (Romans 8:28).
All things, . . . not just the good stuff -not just the easy, normal stuff work for our good. It is the combination of good and bad that make this life meaningful. Seeing the meaning in your life takes an antidote against the cynicism and and bitter taste that the bad often leaves behind.
The antidote comes in a few steps:
Improve your 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?)
Use food as an antidote
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.
Savor daily experiences and record them
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 trip to down town Amarillo, Texas, a few years ago 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.
Just taking a bit of time to savor these things made this experience a very memorable and happy experience that to this day I have not forgotten.
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.
Volunteer
Doc Holiday could have groveled in the sadness of his illness and pain. But, instead, he risked his life to save the life of Wyatt Earp in Texas. Then, in 1879, he joined Earp in Las Vegas, New Mexico and then rode with him to Prescott, Arizona, and then to Tombstone. In Tombstone, local members of the outlaw Cochise County Cowboys repeatedly threatened Doc Holiday and spread rumors that he had robbed a stage. On October 26, 1881, Holiday was deputized by Tombstone city marshal Virgil Earp. The lawmen attempted to disarm five members of the Cowboys near the O.K. Corral on the west side of town, which resulted in the famous 30-second shootout, and the legendary stories and movie Tombstone.
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.
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.
Recognize 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.
Look for the growth in who you are
The celebrated Greek poet, Pindar, said, “Become who you are.” This is confusingly paradoxical. How does one become who they already are?
Many of the younger generation 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.”
Recognizing and accepting our past for what it was brings happiness. Hiding or running from our past prevents us from experiencing true joy.
Meditate
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.
The ability for a person to access the subconscious mind and to address aberrant thinking errors attached to powerful emotions confers advantages that cannot be acquired through any other medical medium. Wholeness of the mind, body and spirit are ultimately the goal. Meditation & hypnotherapy change fragmented, unhappy people into integrated, happy people by simply helping people to identify and repair the broken subconscious thought patterns that can occur in all of our day to day lives. Check out Dr. Nally’s information on mind-body medicine here.
Improve the quality of your 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. (
Don’t know where to start? Start by sharing some bacon . . .
Allow others to help
I know you are probably familiar with the phrase “it is better to give than receive,” but did you know there is evidence to support the reverse mantra is also true? 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 then 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, click the link and get a copy of my diet. Then, enjoy the benefits of a Ketogenic or Carnivorous Lifestyle.
If you want to know more about what I do, keep reading my blog, join my weekly newsletter by signing up below. Then, watch my videos every week on YouTube and listen to my Podcast giving you free tips and tricks to stay healthier. I even developed my own line of vitamins and supplements specifically for myself and my patients. 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 meaning in your life.
I Wish I Would Have Know This Sooner . . .
After graduation from medical residency, I served for four years as my AirForce Reserve unit’s biological/chemical weapons expert & physician. My job was to understand the risks of all the known biologic and chemical weapons that could be used on a human being, including severe viral and bacterial diseases that could pose a threat. My training was specifically focused on how to prevent and treat the effects of these illnesses in those under my care, military or otherwise.
I spent four years reading and researching where and when various types of masks, respirators and protective equipment would and should be used. Never once was a surgical or cloth mask ever found to be effective. Even N95 masks failed the rigors of these encounters.
This week our fearless Dr. Fauci says it’s “common sense” to wear two masks. So, my question to him and all of the other emperors of medicine is, what about three masks?
Even better yet, 10 masks makes even more “common sense!!” Where does this stop? (I stop at 11, because, my ears flop over at 12 masks.)
I’m thinking that 100 masks is 100% effective right?
I guess those filtered gas masks really aren’t essential then?!
One surgical mask decreases risk by 1-2% (yes, that’s the benefit of a mask that we’ve been required to wear). You’re more likely to have a 40% COVID risk reduction by throwing salt over your shoulder when you leave the house . . . (that’s the actual placebo effect).
The whole reason for mask wearing is to decrease “asymptomatic” transmission of COVID-19. That means, masks are supposed to decrease your risk of spreading or inhaling this virus when you or the person near you have no symptoms. Initially, we recommended wearing masks, because we did not know how infective the COVID-19 virus was to humans. We also knew that there was limited access to the N95 masks used in the hospital setting.
However, in the last 12 months, we’ve learned a great deal and we have a tremendous amount of data about treating this virus in the outpatient setting. You can follow Dr. Nally’s COVID-19 treatment protocol here.
How Contagious is COVID-19?
What’s the actual risk of spreading the virus when you have no symptoms? It’s about 0.06% if you have prolonged contact (3 hours continuous face-to-face) with a person within six hours of that person having onset of symptoms (i.e. – fever, sore throat, fatigue, headache, loss of taste or smell, or runny nose). It is very rare to be infected at all with COVID-19 asymptomatically if you contact a person 6-9 hours before they have symptoms.
In fact, a recent study revealed there were no positive tests (or asymptomatic spread) among 1,174 close contacts of asymptomatic cases. So, why are we still wearing masks? Because it is politically convenient, increases fear, and increases your likelihood of getting a vaccine.
Are There Unintended Consequences of Mask Wearing?
Is wearing a mask to decrease a minimal risk by 1% more worth the risk? Increased bacterial and fungal infections that are on the rise as a consequence of chronic and continued daily mask wearing.
I’m seeing patients with increased frequency of facial rashes, fungal infections, non COVID-19 induced bacterial infections. Reports are coming from my colleagues, all over the world, that suggest bacterial pneumonias are on the rise.
Why? Because we are wearing and re-wearing of dirty masks. Untrained members of the public are wearing medical masks, repeatedly… in a non-sterile fashion… They’re becoming contaminated. They’re pulling them off of their car seat, off the rearview mirror, out of their pocket, from their countertop, and they’re reapplying a mask that should be worn fresh and sterile every single time. And, there is no way around this when 330 million people are required to wear a mask to go to Wal-Mart or Costco.
In a recent report in Emerging Infectious Diseases, the U.S. Centers for Disease Control and Prevention (CDC) suggests what experts have stated all along: There is no conclusive evidence that cloth masks protects users from coronavirus, especially since most people do not use them correctly and do not keep them clean.
The report actually says, “To our knowledge, only 1 randomized controlled trial has been conducted to examine the efficacy of cloth masks in healthcare settings, and the results do not favor use of cloth masks. More randomized controlled trials should be conducted in community settings to test the efficacy of cloth masks against respiratory infections.”
So, why, again, are we wearing these masks?
Signs & Symptoms . . .
But Doc, these organizations really care about me and my family . . .
16 Years of Keto/Carnivore . . .
No, it’s not sustainable at all. What do you think?
Are You the King or the Second Queen?
- To build the kingdom that you dreamed about
- To live a life of benevolent power
- To be admired, respected and beloved.
- To provide safety and shelter for your queen and her cubs
- To ravish the queen and see the animal heat in her eyes
- To live in glory and honor
- And when called upon, to willingly go heart-in-mouth into the fray
Coronavirus Updates & Videos
I’ve had so much interest in my articles and videos on coronavirus (COVID-19) that I moved them to a main page here on my website. See the menu bar above “Coronavirus.”
The page can also be found at DocMuscles.com/coronavirus/. Please check it out there. I am adding new updates to the top of the page regularly as new information comes available.
Character, Judgement & Health
With the recent escalating volatility of events in the news, the vitriolic comments that are ever present on social media, and people’s deep seated feelings and convictions on the political stage, I’ve been thinking a great deal about our individual responsiblities for making judgements, our obligations in society to stand upon our convictions and the effect of this upon our health. Comments about my convictions or opinions that I have made online and/or via social media have at times been polarizing for a number of people.
In attempting to ground myself in regards to my positions and feelings, I came across an essay in William George Jordan’s book, The Crown of Individuality, published in 1909. The text, over 100 years old, is some of the most profound wisdom I’ve read in understanding our character and the use of judgement.
Part of our health comes from mental and emotional stability. I have found, in my 25 years of providing patient care, that many good people in society still lack competant ability to know how and when to make judgements. This leads to significant stress, anxiety, and insomnia in many peoples lives. In the long term , it effects one’s character and it effects one’s health.
Fourty percent of what I do every day relates to psychiatry and the effect of thought, decision and action upon our lives. Often, just defining where and when judgement becomes essential can be very helpful. William George Jordan was editor of The Saturday Night Post (1888-1889) and The Ladies Home Journal until 1891. He was a prolific author and his comments regarding character and judgement are fitting for a read, especially on a Sunday afternoon. So, what follows is Mr. Jordan’s essay in its entirety:
“Sitting in the Seat of Judgement” by William George Jordan
Character is not a simple, uniform product. It cannot be judged as dress goods—by a yard or so of sample unrolled from a bolt on the counter. It is complex, confused, uncertain, changing, subject to moods that contradict our conclusions. While knowing all this we dare to construct the whole life and character of one we may have never even met. We build it from a few hints, slurs, idle comments, or the vague rumors or absolute lies of newspaper reports—as scientists reconstruct an unknown prehistoric animal from a few bones. One judges a painting by the full view of the whole canvas; separate isolated square inches of color are meaningless. Yet we dare to judge our fellow man by single acts and words, misleading glimpses, and deceptive moments of special strain. From these we magnify a mood into a character and an episode into a life.
There is entirely too much human judging, too much flippant criticism of the acts of others. Suspicion is permitted to displace evidence, cheap shrewdness to banish charity, prejudice to masquerade as judgment. We imagine, we guess, we speculate—then pass on through the medium of indiscreet speech and idle gossip what may bring bitterness, sorrow, heartache, and injustice to others. The very ones we condemn may be battling nobly under a hail of trial and temptation where we might fall faint in the trenches or, lowering our colors, drop back in hopeless surrender.
We have a right to our preferences, our likes and dislikes, our impressions, our opinions, but we should withhold final judgment—as an honest unprejudiced juryman keeps his verdict in suspense until he has heard and tested all of the evidence. We have no right to let prejudice tyrannize over judgment and kill—the justice of the soul. We may see an act but have no luminous revelation of the motive behind it.
We idly condemn the gaiety of some man who has suffered a terrible loss, and term him heartless. Perhaps he laughs only to keep back tears that would gush like a torrent from his heart were he less brave. We criticize the parsimony of some one when it really means consecrated generosity to some one else. Over-generous forgiving may seem weakness—when it is the “ninety times nine” of a great nature. Love at its height may seem indifference. What appears conceit may be only some one’s attempt to recover a lost self-confidence he hungers to regain.
Some one’s fretfulness, or occasional outbursts of temper, may be but sparks of protest from the hidden fires of a sad life-story or some bravely borne illness unknown but to a chosen few. Meanness may in reality be poverty too proud to confess itself. We hear one side of many a story and judge by that alone. We judge often along the line of our least mental resistance. Ignorantly we condemn a man for vanity because we would be vain had we accomplished his work. There is wide difference between putting yourself in another’s place and putting him in yours. The one is an attempt at wisdom; the other a speculation in prejudice. We misinterpret motives, do not know facts, and judge from wrong standards.
In the individual life we realize that there are times when everything we do or say misrepresents us. We mean kindness but somehow the words sound cross, cruel, or misleading. Without intending it we hurt those who are dearest; we regret it, know the sad effect we are creating, yet we blunder on into deeper pitfalls. We may be even too falsely proud to explain. We are all out of key. We are tobogganing down the incline of a mood. We may not understand ourselves and in a spirit of heart-hunger may long for some one sweetly and gently to comprehend us, to see us truly, despite—ourselves and our acts.
Knowing this labyrinthic quality in us and even in human nature at its best, let us throw the golden mantle of love and kindness and justice over every thought of condemnation. How can we judge others harshly when we do not know ourselves and while we suffer so much from the misjudging from others? Let us live in the open sunlight of love, shutting our eyes in charity from adverse judging—just forgetting much, forgiving much.
Let us sweetly, sincerely, sympathetically seek in the best side of some one we know—his real, fine, true self. Let us think of the fine flowers and ignore the weeds as temporary invaders. This may prove an inspiration to some one near and dear to us to live up to our ideal of him, to be worthy of the higher levels to which our faith has raised him.
Sometimes situations arise between friends that demand rapid judgment and action. Then should we check off the items carefully, considering truly both sides of the ledger of our experience. Before pronouncing sentence let us see if in our heart of hearts we honestly believe our verdict fair, just, and true. Let us be assured it is justice—not prejudice, pique, temper, disappointment, distorted gossip, or aught else that is eclipsing the justice of our judgment. Our injustice, if such there be, may change bitterly the life of both.
One of the hardest lessons of life is to learn not to judge. Perhaps ninety percent, of the adverse criticism, comment, and judging of humanity is unnecessary and serves no useful purpose. It is not our business. It is simply our mere impertinent meddling in the affairs of others, without even a hope of being helpful or useful. It is often what we would most quickly resent—were the situations reversed.
There are times in every life when we must judge, when we should judge, and when it is vitally important that we should judge wisely and justly. There are those closely associated with us in love, friendship, or business—where it may be important for us to understand their words, their acts, their motives, and their emotions in so far as they affect ours. The very attitude of not judging until it becomes necessary gives ever dignity, calmness, poise, and fineness to these enforced judgments. The judgment that has been dulled by constant misuse, like a razor that has been used to sharpen pencils, is of little value in real need.
The wisest judgment means the best head cooperating with the best heart. It is kind, honest, charitable—seeking truth, not the verifying of a prejudice. It says ever, in prefacing its conclusions on the evidence: “As it seems to me,” “If I understand it aright,” “So far as I have been able to reason it,” “Unless I am mistaken,” or similar phrases. These represent the suspended judgment—with no tone of absolute finality. They show a willingness to modify the verdict, to soften the sentence, or to order a new trial if new evidence, new illumination, or new interpretation can be produced.
The Keto-Flu
So, you have the keto-flu. No, you’re not contagious. No, you can’t pass it on to someone else, or catch it when your friend who follows a ketogenic lifestyle sneezes.
Actually, congratulations are in order. You’ve just experienced the amazing metabolic shift that jump-starts the healing process in your body. You’re shifting to a metabolism that optimizes the use of fat in the form of ketones. During this transition, usually within the first week, people can experience a series of symptoms that have been dubbed the “keto-flu.”
Symptoms
What are the common symptoms of the keto-flu?
- Fatigue
- Headache
- Brain Fog
- Dizziness
- Nausea
- Irritability
- Light-Headedness
- Leg Cramps
These symptoms can last 3-5 days, in some people I’ve seen it last as long as two weeks. But, if you weren’t expecting it, and you don’t know what it is, it can be kind of discouraging. Don’t despair, however, if you know what it is, you can usually do a couple simple things to prevent it, or at least cause the symptoms to dramatically improve.
Cause
The keto-flu is usually caused by a shift in your body’s use of water and salt. Insulin causes the kidneys to retain sodium. When you change to a ketogenic lifestyle, your insulin levels fall to baseline and your body is able to use the sodium and potassium to remove the excess water production in each cell from fat burning. (If it didn’t, you’d swell up like beached whale.) This isn’t a bad thing, it just means that you need to add these electrolytes back into your diet in a greater degree.
The average adult human needs 3-4 grams of sodium each day and 3-4 grams of potassium each day to balance out water use and make all the cells happy. So, what’cha wait’n for? Make your cells happy.
How To Treat It
I find that putting 1/2 teaspoon of salt (I like the Himalayan Pink sea salt because it contains sodium, potassium, magnesium and zinc) in a glass of water cures the symptoms very rapidly, sometimes within minutes. It’s amazing how fast you suddenly feel the brain fog lift and your energy returns.
Another option is using a bouillon or bone broth with your meal. This adds to the overall enjoyment of the meal and replaces these needed electrolytes in a very tasty way.
If the salt replacement doesn’t do the trick, then your keto-flu may be related to the need for more fat. Often, people who start a ketogenic lifestyle cut out the carbs, but don’t put enough fat back into the system.
On the traditional American (or insert your own country of residence here) diet the body uses carbohydrate as its primary fuel and protein for building blocks. When you cut out the carbs, your body will continue to use the protein for building muscle, skin and connective tissue. However, if you don’t give it enough fat to replace the carbohydrate you removed, it’s like running your car on fumes.
You’re body will run for a while, but not very well. And, in some cases, you’ll feel like you were left on the side of the road with a body that doesn’t want to go anywhere. You’ll feel like the gas tank is empty.
If you’re not used to a diet higher in fat, your body also has to “fat-adapt,” sometimes called keto-adaptation. This is the process of your gut and cells up-regulating MCT receptors (fat channels or doorways for fat) to enter more efficiently. This can take a few weeks, and for some a few months. Not giving yourself enough fat in a ketogenic lifestyle can slow this adaptation process and also give you keto-flu-like symptoms.
What If It Doesn’t Improve?
If the leg cramps haven’t improved with the replacement of the salts and fat, you might consider yellow mustard. Mustard contains sinapoline that when metabolized through the acid of the stomach in the body has a byproduct that is similar effect to that of quinine. Patients, and myself included find that dipping summer sausage or your favorite hard cheese in some yellow mustard before bed does wonders in prevention of muscle cramps or spasm.
If the nausea turns to vomiting, or if the headache or fatigue worsens with added weakness, then it’s time to call your doctor and get checked out. Vomiting, weakness and worsening fatigue are signs of something more serious. If this happens, call your doctor.
What About Exogenous Ketones?
Lastly, the addition of exogenous ketones (ketones bonded to a salt) are also very helpful in this transition period. Drinking exogenous ketones provides added ketones, rapidly absorbed into the blood stream, and second they provide some of the sodium, potassium or magnesium needed as a replacement. You can check out my Ketogenic Kick-Start packages here. Or, you can go to Dr. Nally’s favorite ketone store at DocMusclesKetones.com and order them directly.
Either way, I hope you find this helpful as you transition to your Ketogenic Lifestyle.
Fixing the Habit-Loop of Obesity
(Fixing the habit-loop cycle of obesity is the third article in a series on habits relating to obesity and weight gain: Willpower & Self-Discipline and Habit-Loop Cycle of Obesity)
“I want you to increase your fat to 70-80% of your total food intake . . .” I stated, before I was cut off by a loud gasp, followed by a chortle. The 300 lbs male sitting on the exam table in front of me looked at me with a very skeptical smirk.
“You want me to eat fat to lose weight?!” he said after catching his breath. “You’re the first doctor who’s openly blown smoke up my a** . . . ,” chided the rotund 42 year old male shaking his index finger at me as we discussed weight loss treatments.
“Although that was standard medical treatment of the Royal Humane Society for drowning victims in 1774, . . . .” I responded. “No. I’m actually trying to help you lose weight by shifting the hormone signal in your body with food.” I replied as I recalled that the medical thought of the time was that a tobacco enema dried out the insides , warmed the body and increased the heart rate of the drowning patient. I informed my patient that the use of tobacco smoke enemas fell out of favor around 1811 when its use for drowning, typhoid, headache and stomach cramping was found to actually be cardio-toxic and ineffective.
“So, . . . blowing smoke into your rectum won’t help you lose weight, nor will it help you maintain ketosis. In fact, it might actually kill you.” I added with a smile.
Eating fat is, however, one of the keys to hormone manipulation used to fix the Habit-Loop Cycle of Obesity. So, how do we fix or alter the habit-loop of obesity discussed in the last two blog posts?
Four Part Habit-Loop of Obesity
The habit-cycle cycle of obesity consists of four parts:
- Trigger
- Response
- Reward
- Hormone Response
In my last blog post, we discussed how the trigger and the response are driven by or focused on a craving that may or may not be consciously perceived. We also learned that breaking this habit-loop cycle takes willpower we talked about in my first article, and willpower can fatigue. It has a daily shelf-life.
Fixing habits and creating new powerful habits requires identifying the components of your individual habits. That means, first, identify the routine that occurs in a habit you want to change. We want to identify a habit that drives you to eat carbohydrates when you really rather wouldn’t. You’ve tried to stop, but you struggle and when fatigued, ignore your previous thoughts and imbibe on cookies.
Identify the Routine
Weight gain, fat entering and staying in the fat cells, is stimulated by the production of insulin. Many of us who are insulin resistant, produce 2-15 times the normal amount of insulin when we indulge in carbohydrates. That’s the master hormone part of weight gain. There are 29 other hormones that play a role in weight gain, however, turning them all on or off is driven by the routine you follow in your daily habits.
In my journey to understand my weight challenges, I found a pattern that was causing my middle to grow. After a long day at work and returning home to have dinner with the family, I would often sit down to work on my charts, billing codes, labs and dictation from that day. (Thanks to the wonders of the Affordable Care Act, this immense amount of work added 3-5 hours of “home work” to my already 10 hour day at the office, only to be completed late in the evenings.)
Even though I enjoyed a late low-carb dinner with my family when I got home, I’d find myself getting hungry 2-3 hours later. While working on charts and trying to “push through” the pile of work in front of me, I’d start getting “hungry” around 10 pm. I would find myself rummaging through the fridge and freezer looking for something to eat. The problem was that I would find myself eating things that I normally wouldn’t, and I’d even find myself finishing off the quart of ice-cream in the back of the freezer left over from a birthday. No matter how much I tried to avoid this behavior, I would frequently cave to cravings between 10 pm and 1 am. (Yes, I heard the gasps from the ketogenic blogosphere, but I’m human, too.) I knew that if I, an obesity specialist, was having these challenges, you probably are, too.
So, how does one change this kind of behavior? The solution is found in the habit-loop cycle.
I started drawing out the loop. Trigger –> Go to kitchen fridge/freezer —> Reward.
What is the Trigger?
I had to ask myself some questions. What is the Trigger or Cue?
Was it actually hunger? Boredom? Stress? Fatigue?
What is the Reward?
What was the reward? Was it actually food? Change of scenery? A temporary distraction? Energy from the food?
So, I had to experiment with my reward to find out. Rewards are powerful because they satisfy cravings. However, you and I are often not aware or conscious of the craving that actually drives our behavior or routine. As Charles Duhigg states, “Most cravings are hiding in plain site. . . They are obvious in retrospect, but incredibly hard to see when we are under their sway” (1).
To figure out which craving drives which reward, I had to run a few experiments on rewards. I asked my wife to make extra fat bombs and some of her low-carb cheese cake to have in the fridge.
The next few evenings I recorded what happened. When I felt the urge to get up and go eat, I ate a few fat bombs. But that didn’t take away the craving. I tried going out and walking around the back patio and petting the dogs for a bit. I tried drinking something different instead of my routine water, Diet Dr. Pepper or exogenous ketones. No matter what I did, some of the evenings I still found myself rummaging the back of the freezer for something sugary.
What Action Eliminated the Craving?
My point here was to see which of these activities took away the cravings. I wrote down how I felt after each activity, as well as what happened after I’d cheat late at night with ice cream or chocolate. Just the action of journaling how I felt, my thoughts, emotions or words that came to mind was the key. After waiting for 15 minutes, I wrote down three words or phrases that came to mind.
I found myself journaling: “Sleepy,” “Anxious,” “Tired,” “Still Hungry”
I found that eating something I should be avoiding, like ice cream, chocolate, or sweets (Even in a low-carb home you can still find some of these things), caused me to feel short term euphoria, more relaxed and suddenly more tired.
The brain will record the scribbled words as recollections attached to emotions. It is easier to see patterns if you will actually write it down with pen and paper. The goal is to isolate what you are actually craving. The words and emotions attached to those words will give you an idea about your cravings and the cue driving it.
Five Categories of Habitual Triggers
Scientists have shown that almost all habitual triggers fit into one of five categories:
- Location
- Time
- Emotional State
- Other People
- Immediately Preceding Action
So, in trying to identify the cue driving me to the back of the freezer, I write down five things that happen the moment the urge hits (I’ve included some of my actual notes in bold from my experiment):
- Where am I? – Sitting in front of my computer at my desk in my home office.
- What time is it? – 11:32 pm
- What is my emotional state? – Tired, anxious, and overwhelmed by the volume of work
- Who else is around? – No, one. Everyone else is in bed
- What action preceded the urge? – I looked at the clock while finishing a patient’s chart
I repeated these notes and the repetitive pattern I identified was that it was late (between 10 pm – 1am) and I felt very tired and anxious.
Look at the Pattern
I realized that I wasn’t actually hungry. I was exhausted, anxious & tired. My willpower was gone for the day. Eating the sugary food has always caused me to have a huge insulin surge and when that happened, I always got more sleepy. When I ate the sugary food, I got more tired – tired enough that I would start falling asleep at my desk and end up going to bed.
I found that the craving was not for sugar at all, but for sleep. The cue was not hunger or boredom, but for time of day coupled with the emotions of fatigue and stress. The combination of time of day with these emotions were the trigger that would kick in a routine of rummaging through the pantry or freezer for something sweet, leading to an insulin response (hormone) driving me to bed. This routine had has a negative aspect, it kicked me out of ketosis causing weight gain and further cravings for the next 72 hours.
Make a Plan
So, I wrote out my plan: Go to bed at 10 pm.
I actually found that I could get up earlier, exercise and my ability to focus in the morning was much more crisp, alert and I was more effective at getting my charting and labs done in the morning and throughout the day. I haven’t rummaged the pantry for the last month and I dropped the inch off my waist that had crept back over the last year.
Now, I realize that some habits are much more difficult to break. I expect that, but hopefully this will be a starting point for you and I to begin looking at some of the hundreds of habit-loops that affect us for good or bad throughout the day.
Sometime New Habits are Required Before Bad Ones Can Be Broken
Your ability to break some of the stronger habits occurs when you set other good habits (2, 3). Habits like regular daily exercise increase the likely-hood of changing or breaking other bad habits. People get better at regulating impulses and avoiding temptations when they strengthen willpower with habits like exercise. Research shows that simply establishing a habit of exercise actually increased peoples ability to drink less, smoke less, eat better, and learn more effectively (3).
The key to change is repetition of an activity, thought statement associated with physical or emotional feeling. The repetitive action of exercise 3-6 times per week when willpower is strong increases the emotion of excitement, joy and happiness. The combination of the repetitive action physically with the emotions experienced by the accomplishment actually strengthens willpower and allows for naturally identifying and changing the triggers and cravings of other habits (3, 4). It takes at least 3-4 weeks for people to experience the effects of forming a new habit, so be patient with yourself.
Using Hormones and Your Journal to Bridge the Habit-Loop Cycle Faster
This is where journaling and fat come into the equation. The ingestion of an increased amount of fat in the diet stimulates three hormones: GLP-1, Protein YY, and Oxyntomodulin. These three hormones suppress hunger cravings by turning down the effects of hunger hormones in the hypothalamus. When we use fat as a fuel and as a reward, we can change the cravings and the weight at the same time.
We now know that the use of hormone stimulus, emotion and repetition of an action allow for parallel learning about and expecting the reward in the basal ganglia. The basal ganglia is the region of the brain that streamlines complex learning. It is the part of the brain that allows you back up a car, or riding a bike without deeply thinking about steering, pedaling and balancing. Shifting the food type to predominantly fat and lowering the carbohydrates changes the hormones in the brain. When we add journaling, by physically writing and recording our emotions, the basal ganglia learns about this reward system faster (5).
If you are ready to change your life, feel more energy, have improved concentration, better sleep and lose weight, I want to help. I’ve created a 30 Day Keto Kickstart Challenge Program starting October 1st. Click on Kickstart Challenge to join this exclusive group of Ketonians as we use the principles in these articles to successfully improve health, lose weight and feel more energy.
And, to answer your burning question, “No! Adding tobacco smoke rectally . . . doesn’t help the habit-loop cycle.”
References:
- Duhigg, Charles. The Power of Habit. Random House, New York. 2014. p. 290.
- Oaten M, Cheng K. Longitudinal Gains in Self-Regulation from Regular Physical Exercise. Journal of Health Psychology. 2006.; 11: p 717-733.
- Baumeister RP, Gailliot M, DeWall CN, Oaten M. Self-regulation and personality: How interventions increase regulatory success, and how depletion moderates the effects of traits on behavior. Journal of Personality. 2006; 74: p 1773–1801.
- Oaten M, Cheng K. “Improvements in Self-Control from Financial Monitoring,” Journal of Economic Psychology. 28 (2007): p 487-501.
- Brown J, et al., How the Basal Ganglia Use Parallel Excitatory and Inhibitory Learning Pathways to Selectively Respond to Unexpected Rewarding Cues. Journal of Neuroscience. 1999. Online OpenBU edition: https://open.bu.edu/bitstream/handle/2144/2228/99.011.pdf?sequence=1
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
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.
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.
Don’t Cry When It’s Over, Smile Because It Happened
Sometimes We Have To Let Things Go
Sometimes we have to let things go. Not because we want to, but because life changes and some responsibilities become too heavy to carry. Sometimes we have the strength to carry the weight. But, the work of carrying offsets our balance. Balancing objects can occur when the foundation is stable and boundaries are secure. Balance is the act of putting an object in a steady state of motion so that it does not fall or shift out of balance. Instability is the opposite of balance. Frequent attention must be given to the motion of the object to maintain stability. This applies to objects, responsibilities, actions and even health. But, balance in life is a myth.
Think about the Chinese acrobat. She balances on one arm, . . . then slowly adds a plate that is spinning on a stick. Then another stick, and another plate . . . However, the plates don’t keep spinning on their own. Even though the plates appear perfectly balanced, she must periodically spin them to maintain balance.
There comes a point where more than three or four plates is too much to manage. Many of us live our lives afraid to add a plate, and on the flip side, many of us try to spin too many plates. The stress of too little or too much interferes with relationships, sleep, health and sense of well-being.
Life-Balance Is A Myth
Our lives consist of attempting to balance multiple “plates” in the form of responsibilities or activities around us. Attention is taken from one activity and focused on another until that responsibility or activity is back in balance. This is why balance in life is a myth. We move from object to object, responsibility to responsibility. None of those objects ever remains completely balanced at the same time. As we focus on re-balancing one task, the others slow and begin to fall out of balance. As a husband, father, physician, speaker, entrepreneur and son of God, I wear many hats. I’ve frequently felt like a lone fireman, running from fire to fire with a garden hose, attempting to reset the balance in my responsibilities and put out fires. I know you do too. We’ve had these conversations in my office.
Life-balance is a myth I bought into. It was placed on sale by life’s “well meaning middle-managers” in school and business. I kept thinking that at some point I could attain a perfect balance in all of my care-giving, parenting and relationship activities. Recognizing this myth has helped me make some very important decisions.
Learn To Say “NO”
I am a recovering “nice guy” and part of the “nice guy syndrome” involves understanding the myth of life-balance. Learning to say “no” is not easy. I am learning to set boundaries. I am learning to stabilize foundations. As a healer, I have an innate desire to help everyone, literally everyone. This desire to help frequently comes at the detriment of family and those close to me. The work of healing is seen as a “noble calling” in our society. Because of this, I justified the need to help everyone with large amounts of time at my own expense. I’ve spend hundreds of hours answering questions about health and weight at the expense and burden of myself and my family. Saying “No,” even when an activity offsets needed balance is not easy for some of us.
Good, Better & Best
Part of that boundary setting is looking at those things that are “good, better and best.” It requires looking at the objects, responsibilities and warming fires around us and deciding which ones are good, which ones are better and which ones are best. Balancing some objects and responsibilities are good, but may actually be taking time away from some of the better or best things we could be doing. As we consider various choices in our lives, we need to remember that it is not enough that something is good. Other choices are better, and still others are best. Even though a particular choice may be more costly, the much greater value may make it the best choice of all. I’ve had to sit down with myself and my family, and make some challenging decisions.
I am learning to set boundaries. Looking at what is most important in my life at this time isn’t easy. However, it’s been made loud and clear to me that we must be able to forgo “good things” to do those things that are better or best. In medical speak, continually fixing and fine tuning the thyroid hormones doesn’t help when leptin is out of balance.
How Many Psychological Carbs Are In Your Life?
Many of us must realize that many of the good things are “psychological carbohydrates.” The carbs smell good . . . And they taste great. But, forgoing the carbs brings the greatest return in areas of our lives that are most important. Those things that are better or best are more effective at strengthening our lives and those of our families.
Pick The Best Things In Your Life To Balance
One of those decisions is to leave KetoTalk.com. The choice to leave relates specifically to selecting the best things that allow me to focus my time, energy and skills on being a good husband, father, physician and entrepreneur. I’m sure the rumors will surge, and cyberspace will fill with speculation. The truth is that I still have a wonderful relationship with Jimmy Moore, that has not changed. He and I are still great friends. Leaving KetoTalk was a very difficult decision. I will continue working with him on my upcoming book The KetoCure, and we will still be working together on the KetoLiving.com line of supplements. Non-of that will change. What will change is my focus on activities that bring the best value to my patients and my practice while at the same time bringing the greatest value to me and my family.
I love people. I love to help people. Working with thousands of amazing souls in this ketogenic journey, is an immense blessing. Unless I am assasinated by a rogue high-velocity vegan cucumber, I’m not going anywhere. You can find me and work with me here at DocMuscles.com.
How many plates are you spinning? Do you need to let something go? Is the good in your life keeping you from the better or the best?
So, don’t cry because it’s over, smile because it happened and we became great friends.
KetoDynamic Successes . . .
As I reviewed my website recently, I realized that I have posted lots of science but I’ve never posted any success stories. So, as patient’s are comfortable & willing to share, I will begin posting these experiences here on the blogosphere for the world to witness their successes and the power of the KetoDynamic Antidote.
The first success story is my own. This picture of me and my wife, were taken after I had been following a ketogenic lifestyle for about 4 years. I dropped 60 lbs, normalized my cholesterol and blood sugar also normalized. I couldn’t and wouldn’t recommend these lifestyle changes unless I was willing to follow them for the long haul myself. I call people following a ketogenic lifestyle for longer than a year “Ketonians.”
Not only mine, but hundreds of patient’s having similar successes have become the greatest reward to my career as a physician over the last 15 years. They are truly the “KetoDynamic Moments” that etch themselves into my memory and have made me such an advocate of a ketogenic lifestyle. Therefore, it is with great honor and excitement that I have been allowed to share Michelle’s story below.
Michelle started seeing me in October 2015. She has struggled with weight all her life and, now in her late 40’s, weighed 201 lbs with a waist circumference of almost 36 inches and a body mass index of 32. Her “before” picture was taken just before a Halloween activity in 2015. Her “after” picture was taken in late March 2016.
A simple ketogenic lifestyle change ( <20g of carbohydrates, moderate protein for her ideal body weight & increasing fat to > 60% of total calories) has produced almost 50 lbs of weight loss and 6 inches off her waist in just 5 months. This was with dietary change only (Michelle doesn’t exercise) and she’s still losing weight. What is dramatic, and I see it every day, is that Michelle looks younger by at least 10 years (she actually added 20 years to her life span with this weight loss already). She feels fantastic. Blood sugar and cholesterol are now under control and she has tremendous amounts of energy. Her picture in March is at a body mass index of 29.
Michelle doesn’t calorie restrict. She just eats until she is full. Congratulations, Michelle!!! And, keep up the great work.
If you’d like to share your KetoDynamic successes with me and my audience, please let me know.
Interview With God
May God’s choicest blessings be yours today and through the New Year. May you experience the restoring Grace that emanates from the child born in a humble manger and through whom this world receives access to light, truth and eternal life.
Thank you, each, for your friendship, service, love, kindness, and for helping me to nobly live in the present while looking to the future.
Merry Christmas!
Definition of Insanity: Cutting Calories/Restricting Fat & Expecting Weight Loss
Have you been cutting your calories and reducing fat and exercising your brains out and still not seeing the needle on the scale move that much? Persistently and repetitively performing an action that doesn’t produce the desired result is insanity. Cutting calories and reducing fat while expecting weight loss is akin to pouring water in the gas tank of your car and expecting it to run smoothly. Why do we do it? Are the 53, 000, 000 people with health club and gym memberships this year really insane?
This evening on PeriScope we touch on fat phobic insanity and the limiting step that actually turns weight gain on or off. (We knew about this in the 1960’s, we just ignored it.)
You can see tonight’s PeriScope with the rolling chat-box questions here at Katch.me/docmuscles. Or, you can watch the video stream below:
The only way to successfully loose weight is to modify or turn off the mechanisms that stimulate fat storage. For years we have been told that this was just a problem of thermodynamics, meaning the more calories you eat, the more calories you store. The solution was, thereby, eat less calories or exercise more, or both. We are taught in school that a 1 gram of carbohydrate contains 4 kcal, 1 gram of protein contains 4 kcal, and 1 gram of fat contains 9 kcal.
If you ascribe to the dogma that weight gain or loss is due to thermodynamics, then it’s easy to see that cutting out fat (the largest calorie containing macro-nutrient) would be the best way limit calories. For the last 65 years, we as a society have been doing just that, cutting out fat, exercising more (with the idea of burning off more calories) and eating fewer calories.
What has this dogma done for us? It’s actually made us fatter! (1)
Some may argue that we really aren’t eating fewer calories and exercising more. But most people I have seen in my office have tried and tried and tried and failed and failed and failed to loose weight with this methodology. In fact, the majority of my patients attempt caloric restriction, exercise and dieting multiple times each year with no success. The definition of insanity is “doing the same thing over and over and expecting a different result.”
Most of my patients are not insane, they recognize this and stop exercising and stop restricting calories . . . ’cause they realized, like I have, that it just doesn’t work!
If you’re one that is still preaching caloric restriction and cutting out fat, I refer you to the figure above and the definition of insanity . . . your straight-jacket is in the mail.
So, if reducing the calories in our diet and exercising more is not the mechanism for turning on and off the storage of fat, then what is?
Before I can explain this, it is very important that you appreciate the difference between triglycerides and free fatty acids. These are the two forms of fat found in the human body, but they have dramatically different functions. They are tied to how fat is oxidized and stored, and how carbohydrates are regulated.
Fat stored in the adipose cells (fat cells) as well as the fat that is found in our food is found in the form of triglycerides. Each triglyceride molecule is made of a “glyceride” (glycerol backbone) and three fatty acids (hence the “tri”) that look like tails. Some of the fat in our adipose cells come from the food we eat, but interestingly, the rest comes from carbohydrates
(“What! Fat comes from sugar?! How can this be?!!“)
We all know that glucose derived from sugar is taken up by the cells from the blood stream and used for fuel, however, when too much glucose is in the blood stream or the blood sugar increases above the body’s comfort zone (60-100 ng/dl), the body stores the excess. The process is called de novo lipogenesis, occurring in the liver and in the fat cells themselves, fancy Latin words for “new fat.” It occurs with up to 30% (possibly more if you just came from Krispy Kream) of the of the carbohydrates that we eat with each meal. De novo lipogenesis speeds up as we increased the carbohydrate in our meal and slows down as we decrease the carbohydrate in our meal. We’ve known this for over 50 years, since it was published by Dr. Werthemier in the 1965 edition of the Handbook of Physiology (2).
While we know that fat from our diet and fat from our food is stored as triglyceride, it has to enter and exit the fat cell in the form of fatty acids. They are called “free fatty acids” when they aren’t stuck together in a triglyceride. In their unbound state, they can be burned as fuel for the body within the cells. I like to think of the free fatty acids as the body’s “diesel fuel” and of glucose as the body’s version of “unleaded fuel.” The free fatty acids can easily slip in and out of the fat cell, but within the adipose cell, they are locked up as triglycerides and are too big to pass through the cell membranes. Lipolysis is essentially unlocking the glycerol from the free fatty acids and allowing the free fatty acids to pass out of the fat cell. Triglycerides in the blood stream must also be broken down into fatty acids before they can be taken up into the fat cells. The reconstitution of the fatty acids with glycerol is called esterification. Interestingly, the process of lipolysis and esterification is going on continuously, and a ceaseless stream of free fatty acids are flowing in and out of the fat cells. However, the flow of fatty acids in and out of the fat cells depends upon the level of glucose and insulin available. As glucose is burned for fuel (oxidized) in the liver or the fat cell, it produces glycerol phosphate. Glycerol phosphate provides the molecule necessary to bind the glycerol back to the free fatty acids. As carbohydrates are being used as fuel, it stimulates increased triglyceride formation both in the fat cell and in the liver, and the insulin produced by the pancreas stimulates the lipoprotein lipase molecule to increased uptake of the fatty acids into the fat cells (3).
So when carbohydrates increase in the diet, the flow of fat into the fat cell increases, and when carbohydrates are limited in the diet, the flow of fat out of the fat cells increases.
Summarizing the control mechanism for fat entering the fat cell:
- The Triglyceride/Fatty Acid cycle is controlled by the amount of glucose present in the fat cells (conversion to glycerol phosphate) and the amount of insulin in the blood stream regulating the flow of fatty acid into the fat cell
- Glucose/Fatty Acid cycle or “Randle Cycle” regulates the blood sugar at a healthy level. If the blood glucose goes down, free fatty acids increase in the blood stream, insulin decreases, and glycogen is converted to glucose in the muscle and liver.
These two mechanisms ensure that there is always unleaded (glucose) or diesel fuel (free fatty acids) available for every one of the cells in the body. This provides the flexibility to use glucose in times of plenty, like summer time, and free fatty acids in times of famine or winter when external sources of glucose are unavailable.
The regulation of fat storage, then, is hormonal, not thermodynamic. Unfortunately, we’ve know this for over 65 years and ignored it.
We’ve ignored it for political reasons, but that’s for another blog post . . .
References:
1. James, W. J Intern Med, 2008, 263(4): 336-352
2. Wertheimer, E. “Introduction: A Perspective.” Handbook of Physiology. Renold & Cahill. 1965.
3. Taubs, G. “The Carbohydrate Hypothesis, II” Good Calorie, Bad Calorie. Random House, Inc. 2007, p 376-403.
Why the Calorie is NOT King
Today in the office I had the calorie conversation again . . . three times. We have an entire society with a very influential health and fitness industry built around the almighty calorie. Has it helped? Looking at our 5 year obesity outcomes. It hasn’t helped a bit. In fact, it is worse. In 1985 only 19% of U.S. adults were obese.
In 2014, 34.5% of U.S. adults were obese. The numbers this year are approaching 35.6% You can see the dramatic increase in obesity by 1-3% every year for the last 5 years in the CDC images above.
For over 50 years we have been told that caloric restriction and fat restriction is the solution. But by the numbers above, the 58 million people in the U.S. utilize a gym or health club to burn off those calories aren’t seeing the success that they should be expecting.
Why? Because the calorie is NOT king. What do I mean by that? We don’t gain weight because of the thermogenic dogma we’ve been taught for the last 50 years. Our weight gain is driven by a hormone response to food. Hear more about why the calorie is NOT king on tonight’s PeriScope. You can Katch it here with all the live stream comments and hearts at Katch.me/docmuscles.
Or you can watch the video without the comments here:
Do You Believe In Coincidence?
This morning in my meal preparation I was thinking about when my schedule would allow me to see the newest release of Star Wars.
I noticed that my bacon was a little chewy . . . coincidence or not?
Pre-, Post-Workout Meal on Ketosis. Is it Important?
Today’s Periscope was an exciting one. Do you really need a pre- or post-workout shake or meal? How much protein do you need? What’s the difference between ketosis and ketoacidosis? Is Dr. Nally a ketogenic cheerleader? Get your answers to these and many more questions asked by some wonderful viewers this evening on today’s PeriScope.
https://katch.me/embed/v/5def6bce-4f67-363a-b5f9-3bbec8a8aea2?sync=1
Be sure to check out Dr. Nally’s new podcast called “KetoTalk with Jimmy and the Doc” with the veteran podcaster Jimmy Moore on KetoTalk.com. The first podcast will be available on December 31, 2015. KetoTalk with Jimmy and the Doc will be available for download for free on iTunes.
Stay tuned . . . !
Santa's Gone . . . Low Carb
It appears that Santa reviewed the low-carbohydrate, ketogenic science and while vacationing in South Africa, was introduced to Banting (the South African term for carbohydrate restriction).
The 3 Weight Loss Necessities to Weathering the Holidays
What are the three things you need to successfully weather the holidays with your ketosis lifestyle? What does a raindeer on a motorcycle look like? How does insulin resistance effect kidney stones and gout? How do you get back on track if you fall off the ketosis wagon? These and many more questions are answered by Dr. Adam Nally on tonight’s PeriScope.
You can see the video stream including the comment roll here at katch.me/docmuscles. Or you can watch the video below:
Caffeine . . . Weight Loss Wonder Boy or Sneaky Scoundrel?
I’ve been looking for the answer for quite some time. . . what role does caffeine play in your and my weight management journey? The answer gave me a headache. . . literally and figuratively.
As many of you, including my office staff, know, I love my Diet Dr. Pepper (and my bacon). I found that being able to sip on a little soda throughout the day significantly helped the carbohydrate cravings and munchies during a busy and stressful day at the office. Diet Dr. Pepper contains caffeine, however, I wasn’t really worried. Caffeine has been well know to have a thermogenic effect which increases your metabolism and has been thought for many years to help with weight loss among the weight loss community.
Diet Dr. Pepper is, also, one of only four diet sodas on the grocery store shelves that doesn’t contain acesulfame potassium (click here to see why most artificial sweeteners cause weight gain). The four diet sodas that I have been comfortable with my patients using are Diet Dr. Pepper, Diet Coke, Diet Mug Root-beer and Diet A&W Cream Soda. These are the last four hold out diet sodas that still use NutraSweet (aspartame) as the sweetener. Most of the soda companies have switched the sweetener in their diet sodas to the insulinogenic acesulfame potassium because it tastes more natural and aspartame has been given a media black eye of late. However, NutraSweet (aspartame) is the only sweetener that doesn’t spike your insulin or raise blood sugar (click here to find out why that is important).
Yes, I know. The ingestion of 600 times the approved amount of aspartame causes blindness in lab rats (but we’re not lab rats, and . . . have you ever met someone that drinks 600 Diet Dr. Peppers in a day? The lethal dose of bananas, which are high in potassium that will stop your heart, is 400). Aspartame can also exacerbate headaches in some (about 5% of people) and I’ve had a few patients with amplified fibromyalgia symptoms when they use aspartame. But for most of us, its a useful sweetener that doesn’t spike your insulin response, halting or causing weight gain.
But, over the last few years, I’ve noticed that increased amounts of Diet Dr. Pepper & Diet Coke seem to cause plateauing of weight and decreasing the ability to shift into ketosis, especially mine. I’ve also noticed (in my personal n=1 experimentation) that my ability to fast after using caffeine regularly seems to be less tolerable, causing headaches and fatigue 8-10 hours into the fast, symptoms that don’t seem to let up until eating. Through the process of elimination, caffeine seems to be the culprit.
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 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?
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:
- Lane JD, Barkauskas CE Surwit RS, Feinglos MN, Caffeine Impairs Glucose Metabolism in Type II Diabetes, Diabetes Care August 2004 vol. 27 no. 8 2047-2048; doi:10.2337/diacare.27.8.204
- Jankelson OM, Beaser SB, Howard FM, Mayer J: Effect of coffee on glucose tolerance and circulating insulin in men with maturity-onset diabetes. Lancet 1: 527–529, 1967
- Graham TE, Sathasivam P, Rowland M, Marko N, Greer F, Battram D: Caffeine ingestion elevates plasma insulin response in humans during an oral glucose tolerance test. Can J Physiol Pharmacol 79:559–565, 2001
- Greer F, Hudson R, Ross R, Graham T: Caffeine ingestion decreases glucose disposal during a hyperinsulinemic-euglycemic clamp in sedentary humans.Diabetes 50:2349–2354, 2001
- Keijzers GB, De Galan BE, Tack CJ, Smits P: Caffeine can decrease insulin sensitivity in humans. Diabetes Care 25:364–369, 2002
- Petrie HJ, et al. Caffeine ingestion increases the insulin response to an oral-glucose-tolerance test in obese men before and after weight loss. American Society for Clinical Nutrition. 80:22-28, 2004
- Evans SM, Griffiths RR, Caffeine Withdrawal: A Parametric Analysis of Caffeine Dosing Conditions, JPET April 1, 1999 vol. 289no. 1 285-294
- Noever R, Cronise J, Relwani RA. Using spider-web patterns to determine toxicity. NASA Tech Briefs April 29,1995. 19(4):82. Published in New Scientist magazine, 29 April 1995
Listen & Vote for Jenna!!!
Our intelligent and beautiful physician assistant, Jenna Lightfoot, PA-C, is in the running for a co-host position with Jimmy Moore on LowCarbConversations.com you can hear her on today’s podcast with Jimmy Moore and cast your vote here: Round 2 Co-host Contest.
You can also download the podcast on iTunes here.
What Doctors Mentally Do While Watching Home Alone for Christmas
I do this in my head while watching any action movie and especially Home Alone. This made my evening. . .
Serious genital trauma, fall down the stairs, thoraco-lumbar injuries, rib fractures, pulmonary contusions, oromaxillary facial fractures, orbital blowout fractures, splenic injuries, puncture wounds, second & third degree burns, closed head injuries, subdural bleeds . . . it’s all there . . .
Doctors Diagnose the Home Alone Injuries . . . thanks Distractify . . . this is a classic!!!
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.
The 5 Myths of Weight Loss
This evening we covered the 5 myths of weight loss identified through the National Weight Control Registry’s research findings. What causes “wrinkle face” for Dr. Nally? We also talked about & answered 20 minutes of rapid fire questions ranging from the amount of protein you need daily to the likelihood a human could be a bomb calorimeter . . . exciting stuff!!
You can watch the video stream below. Or you can Katch the replay with the rapid stream of exciting comments here at Katch.me/docmuscles.
What Lab Testing Do You Need to Start Your Weight Loss Journey?
What laboratory testing is necessary when you start your weight loss journey on a Ketogenic, Low-Carbohydrate, Paleolithic or any other dietary changes? Why do you need them and what are you looking for? We discuss these questions and others on today’s PeriScope. Lots of questions from around the world to day . . . this one lasted a bit longer than normal . . . 45 minutes to be specific. But it’s a good one because of all of your fantastic questions! You really don’t want to miss this one.
You can see the video below or watch the video combined with the rolling comments here on Katch.me/docmuscles.
A list of the labs that we discussed are listed below:
- Fasting insulin with 100 gram 2 or 3 hour glucose tolerance test with insulin assay every hour
- CMP
- CBC
- HbA1c
- Leptin
- Adiponectin
- C-Peptid
- NMR Liprofile or Cardio IQ test
- Lipid Panel
- Urinalysis
- Microalbumin
- Apo B
- C-reactive protein
- TSH
- Thyroid panel
- Thyroid antibodies
- AM Cortisol
This list will at least get one started, provide the screening necessary to identify insulin resistance (Diabetes In-Situ), Impaired fasting glucose, diabetes and allow for screening for a number of the less common causes of obesity.
I would highly recommend that you get these through your physician’s office so that appropriate follow up can be completed. These labs will need to be interpreted by your physician, someone who understands and is familiar with various causes of obesity.
Until next time . . .
Diabetes Mellitus – Really the Fourth Stage of Insulin Resistance
I just completed my reading of Dr. Joseph Kraft’s Diabetes Epidemic & You. This text originally printed in 2008 and was re-published in 2011. I am not really sure why I have never seen this book until now, but I could not put it down. I know, I am a real life medical geek. But seriously, you should only read this book if you are concerned about your health in the future. Otherwise, don’t read it.
For the first time in 15 years, someone has published and validated what I have been seeing clinically in my office throughout my career. Dr. Kraft is a pathologist that began measuring both glucose and insulin levels through a three hour glucose tolerance blood test at the University of Illinois, St. Joseph Hospital in Chicago. This test consists of checking blood sugar and insulin in a fasted state, and then drinking a 100 gram glucose load followed by checking blood sugar and insulin at the 30, 60, 120 and 180 minute marks (a total of three hours).
Dr. Kraft completed and recorded this test over a period of almost 30 years on 14,384 patients between 1972 and 1998. His findings are landmark and both confirm and clarify the results that I have seen and suspected for years.
I am convinced that our problem with treating obesity, diabetes and the diseases of civilization has been that we defined diabetes as a “disease” based on a lab value and a threshold instead of identifying the underlying disease process. We have been treating the symptoms of the late stage of a disease that started 15 to 20 years before it is ever actually diagnosed. Diabetes is defined as two fasting BS >126, any random blood sugar >200, or a HbA1c >6.5%. (Interestingly this “disease” has been a moving target. When I graduated from medical school it was two fasting blood sugars >140 and the test called hemoglobin A1c (HbA1c) that we use today for diagnosis didn’t even exist). The semantics associated with this problem is that many of us recognize that the disease is not actually diabetes. The disease is (as far as we understand it today) insulin resistance or hyperinsulinemia. This is where Dr. Kraft’s data is so useful. Diabetes, as it is defined above, is really the fourth stage of insulin resistance progression over a 15-20 year period and Dr. Kraft’s data presents enormous and very clear evidence to that effect.
When I first entered private practice 15 years ago, I noticed a correlation and a very scary trend that patients would present with symptoms including elevated triglycerides, elevated fasting blood sugar, neuropathy, microalbuminuria, gout, kidney stones, polycystic ovarian disease, coronary artery disease and hypertension that were frequently associated with diabetes 5-15 years before I ever made the diagnosis of diabetes mellitus. I began doing 2 hour glucose tolerance tests with insulin levels and was shocked to find that 80-85% of those people were actually diabetic or very near diabetic in their numbers. The problem with a 2 hour glucose tolerance test, is that if you are diabetic or pre-diabetic, you feel miserable due to the very profound insulin spike that occurs. A few patients actually got quite upset with me for ordering the test, both because of how they felt after the test, and the fact that I was the only physician in town ordering it. So, in an attempt to find an easier way, I found that the use of fasting insulin > 5 nU/dl, triglycerides > 100 mg/dl and small dense LDL particle number > 500 correlated quite closely clinically with those patients that had positive glucose tolerance tests in my office. There is absolutely no data in the literature about the use of this triangulation, but I found it to be consistent clinically.
I was ecstatic to see that Dr. Kraft plowed through 30 years and over 14,000 patients with an unpleasant glucose tolerance test and provided the data that many of us have had to clinically triangulate. (I’m a conservative straight white male, but if Dr. Kraft would have been sitting next to me when I finished the book this afternoon, I was so excited that I probably would have kissed him.)
Insulin resistance or hyperinsulinemia (the over production of insulin between 2-10 times the normal amount after eating carbohydrates) is defined as a “syndrome” not a disease. What Dr. Kraft points out so clearly is that huge spikes in insulin occur at 1-2 hours after ingestion of carbohydrates 15-20 years prior to blood sugar levels falling into the “diabetic range.” He also demonstrates, consistently, the pattern that occurs in the normal non-insulin resistant patient and in each stage of insulin resistance progression.
The information extrapolated from Dr. Kraft’s research give the following stages:
From the table above, you can see that the current definition of diabetes is actually the fourth and most prolifically damaging stage of diabetes. From the data gathered in Dr. Kraft’s population, it is apparent that hyperinsulinemia (insulin resistance) is really the underlying disease and that diabetes mellitus type II should be based upon an insulin assay instead of an arbitrary blood sugar number. This would allow us to catch and treat diabetes 10-15 years prior to it’s becoming a problem. In looking at the percentages of these 14,384 patient, Dr. Kraft’s data also implies that 50-85% of people in the US are hyperinsuliemic, or have diabetes mellitus “in-situ” (1). This means that up to 85% of the population in the U.S. is in the early stages of diabetes and is the reason 2050 projections state that 1 in 3 Americans will be diabetic by 2050 (2).
Insulin resistance is a genetically inherited syndrome, and as demonstrated by the data above has a pattern to its progression. It is my professional opinion that this “syndrome” was, and actually is, the protective genetic mechanism that protected groups of people and kept them alive during famine or harsh winter when no other method of food preservation was available. It is most likely what kept the Pima Indians of Arizona, and other similar groups, alive while living for hundreds of years in the arid desert. This syndrome didn’t become an issue among these populations until we introduced them to Bisquick and Beer.
The very fascinating and notably exciting aspect of this whole issue is that insulin resistance is made worse by diet and it is completely treatable with diet. This is where the low carbohydrate diet, and even more effective ketogenic diet or lifestyle becomes the powerful tool available. Simple carbohydrate restriction reverses the insulin spiking and response. In fact, I witness clinical improvement in the insulin resistance in patients in my office over 18-24 months every day. You can get a copy of my Ketogenic Diet here in addition to video based low carbohydrate dietary instruction.
Until we are all on the same page and acknowledge that diabetes is really the fourth stage of progression on the insulin resistance slippery slope, confusion and arguments about treatment approaches will continue to be ineffective in reducing the diseases of civilization.
References:
- Kraft, JR. Diabetes Epidemic & You: Should Everyone Be Tested? Trafford Publishing, 2008, 2011. p 1-124
- Boyle JP et al. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence, http://www.pophealthmetrics.com/content/8/1/29 Accessed November 22, 2015
The Ketogenic Antidote to Chronic Renal Disease
It is well know that one of the most profound complications of diabetes is damage to the kidney and the very small arteries within the kidney acting as your body’s filtration system. The kidney begins to lose the ability to adequately filter and retain microscopic protein progressively over time. As the blood sugar and insulin levels continually rise over time in the patient with diabetes or pre-diabetes, damage to the delicate filtering system of the kidneys occur. This very common and progressively damaging problem is called “nephropathy.”
We knew in 1972 that patients with diabetes had thickening of the basement membrane or endothelium of the small tubles within the kidneys. In fact, 98.6% of diabetics tested had thickening of this area of endothelium and tubules also called the renal glomeruli (1). This allows the glomerulus or filtration system of the kidney to become more “leaky” and microscopic protein loss begins to occur through the kidney. This loss of important proteins in the blood is called “albuminuria” or “micro-albuminuria.” It is a flag that further damage of the kidney can and will occur without making significant changes to lower the blood sugar and the insulin. As of today, it is not totally clear how the basement membrane is damaged at the microscopic level, however, there is some evidence that elevated insulin has both a physical and immune type effect that stimulates oxidative stress, atherogenesis, immunoglobulins, as well as the formation advanced glycation end products leading to endothelial wall damage (2).
Recent research reveals that a ketogenic diet effectively repairs and/or completely reverses the albuminuria (3).
Evidence in my office of the significant improvement in micro-albumin can be seen in the one of a number of case studies below:
72 year old male with history of diabetes, diabetic nephropathy already treated with full dose statins, ACE inhibtors, metformin, and Januvia. (Remember, microalbumin should be <30 mg/g)
Date Microalbumin HbA1c
8/12/2010 2264 mg/g 6.4% Started carb restriction <30 g per day.
10/01/2010 1274 mg/g 5.2%
1/08/2011 1198 5.8% Admits to cheating over holidays
12/26/2013 2434 mg/g 6.8% Returned from 2 yr travel-off diet
2/27/2014 399 mg/g 6.3% Restarted carb restriction <20g per day
6/20/2014 190 mg/g 7.0% Traveling – no carb restriction
10/31/2014 280 mg/g 6.9% Partial carb restriction <10 g/meal
3/14/2015 97 mg/g 6.8%
The patient began following a ketogenic diet in 2010. After improvement he moved out of town for two years and “fell of the wagon.” Upon returning h restarted his carbohydrate diet and was only partially following it. As you can see, he also admitted to some cheating on the carbohydrate restriction over the holidays. In light of this, carbohydrate restriction decreased his albuminuria from 2400 to 97 mg/g within a period of 18 months.
References:
- Siperstein MS, Unger RH, Madison LL. “Further Electron Microscopic Studies of Diabetic Microagniopathy.” Early Diabetes: Advances in Metabolic Disorders, sup 1. New York: Academic Press, 1972, p261-271.
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Nasr SH, D’Agati VD. “Nodular glomerulosclerosis in the nondiabetic smoker.” J Am Soc Nephrol. 2007;18(7):2032.
- Poplawski MM, Mastaitis JW, Isoda F, Grosjean F, Zheng F, Mobbs CV (2011) Reversal of Diabetic Nephropathy by a Ketogenic Diet. PLoS ONE 6(4): e18604. doi:10.1371/journal.pone.0018604