Category: Weight Gain
What Does a Strong Core Do for You?
I am amazed after just two treatments.
100 percent of the muscle contracts with this amazing technology. Nothing else does that like EMSculptNEO.
I am personally amazed at how much better my motorcycle riding, fencing and sword-fighting has improved with just two core treatments. He is absolutely correct. It’s amazing what you can do when you strengthen your core.
4-6 treatments one week apart. HIFEM + RF gives you 20,000 crunches in 30 minutes while burning fat through a patented radiofrequency wavelength between contractions. I cannot tell you how amazed I am by this technology.
30% more muscle and 25% fat reduction – you can’t beat that.
When combined with a daily exercise program, and a ketogenic diet, you will see AMAZING results. Cut your carbohydrates back to less than 20 grams per day. For women, I recommend 90 grams of protein or more daily. For men, I recommend 150 grams of protein daily or more to see the best results.
Call the office and schedule your consultation with me today!!
Office Number: (623) 584-7805.
#LeadFolloworGetOutOrMyWay #JustKeepEsterifying #Ketogenic #Keto #KetogenicLifestyle #Carnivore #DrAdamNally #DocMuscles #DocMusclesLive #DocTalk #DocsWhoLift #LiftRunShoot #DocMusclesLife #PlantBasedDietsSuck YouTube.com/drnally/.
Dr Nallys Lasers: #PicoSure #Icon #SculpSure #TempSure #EMScuptNeo #EMSella #EMFace
Why Add EMSculpt and EMSella to My Practice?
I just added two amazing treatments to our office toolbox: EMSculpt and EMSella. I am so excited about these two treatments.
Why add these to the practice? As a family practitioner who focuses on the treatment of insulin resistance, pre-diabetes, diabetes and obesity, I’ve been looking for safe and effective ways to improve muscle and decrease fat. Ketogenic and carnivorous diets are the most effective way to do this naturally, of course including a good exercise program should be a significant part of these diets. Yet, many of my patients over 40 are already seeing the effects of aging, obesity and muscle decline.
Lack of core strength leads to gait instability, weakness, increased likelihood of falling and breaking a hip. Poor core strength is also a factor in incontinence, erectile dysfunction and poor sexual function.
We know that improving core strength has a very powerful positive effect in reducing these problems. Yet, a significant number of my patients over 65 have a hard time exercising due to arthritis and other diseases.
These are revolutionary devices that simultaneously emit both radiofrequency and high-intensity electromagnetic energies (HIFEM).
The end result is more fat reduction and muscle growth than any single gold-standard product for less time and less money. . . 25% more muscle and 30% reduction in fat on average after just four treatments*.
When used with a ketogenic or carnivorous diet, these treatments are a game changer for getting rid of that last bit of stubborn fat.
In combing EMSculpt for the abdomen and EMSella for the pelvic floor, it creates “core to floor” muscle strengthening and stability that is an amazing and very effective adjunctive treatment to a regular exercise program.
These treatments are perfect for postpartum mothers, men, elite athletes and women who suffer from incontinence. They are all a perfect fit for this treatment as results include improved strength, balance and posture; alleviated back pain; and improved urinary issues and sexual health in both men and women. When EMSella is used in conjunction with other muscle development devices like Emsculpt, you’re building core strength, posture developments and sexual health improvements for both men and women.
And, although core strength is not something you see, it is something you can definitely feel.
Call our office for your first treatment today!!
*US FDA clearances:
Your results may vary. You may feel intense heat during the treatment, but it should never be painful. If you experience pain during the treatment, immediately discontinue the treatment and speak with your treatment provider. Treatment should not be applied over scar tissue, or if you have electronic or metal implants. As with any heat-based therapy, burns may result. As with any medical procedure, ask your doctor if the EMSCULPT NEO® procedure is right for you. EMSCULPT NEO® is indicated for non-invasive lipolysis (breakdown of fat) of the abdomen and thighs and reduction in circumference of the abdomen and thighs with Skin Type I to Skin Type VI; and for non-invasive lipolysis (breakdown of fat) of the upper arms limited to skin types II and III and BMI 30 or under. EMSCULPT NEO® is also indicated for improvement of abdominal tone, strengthening of the abdominal muscles, development of firmer abdomen; strengthening, toning, and firming of buttocks, thighs, and calves; and improvement of muscle tone and firmness, for strengthening muscles in arms.
Overcoming a Weight Loss Stall On a Ketogenic Diet
What do you do when you hit a weight loss stall while living a ketogenic lifestyle? Find out below. Dr. Nally goes into detail on the multiple causes of stalling while following a low-carbohydrate or ketogenic lifestyle. He dispels the myths around counting calories and macros. And, he discussed the basics of overcoming a stall.
Help Dr. Nally have time to make more great videos: https://www.patreon.com/docmuscles
The Shovel will Fail You in Obesity, Finances & Life
A few years ago, my family and I set out to build a pond.
I have always loved Koi and the serenity of a Koi pond in my own back yard was very enticing. I spent about a year planning my design and the location. I dreamed of a serene evening after a very long, hectic day seeing patients relaxing beside the pond. The sound of trickling water, the occasional splash from fish, the cool breeze passing over the mist from a water-fall would sooth my soul after a busy day in the office.
I envisioned the perfect area. An unused access path, previously worn by the previous owner with truck and trailer traffic, beside my now expanded patio. Twenty feet wide, thirty feet long and four feet deep. . . that seems just perfect.
I pulled out my shovel and set about digging. Eager to begin and filled with the energy of the final product, I set to digging. What could be so hard about digging my own pond? Think of the exercise I will be getting. Thoughts spurred me on.
Minutes later, chest heaving, face glistening with sweat, I stared in dismay at the ground. All I had to show for my wild digging was a small 1/2 inch dent in the dusty Arizona top soil.
Sonoran Clay
Over time, calcium-carbonate, along with other minerals, accumulates and dissolves into the topsoil of the very arid regions of Arizona Sonoran Desert. It forms a two to three-foot layer of soil called “caliche.” Periodic rains carry the calcium as far as three feet down into the soil, then the water rapidly evaporates in the blistering Arizona heat. This often forms two to three feet of soil that is “literally” harder than concrete.
With tremendous zeal, a great deal of sweat and a round of painful blisters, I broke my third shovel on this impenetrable ground. I realized this was much more difficult than I thought. I pulled out the back-hoe attachment for my small farm tractor. After a few hours and few gallons of diesel fuel later, still very little progress occurred.
Multiple weekends and evenings of digging in the Arizona caliche left me with three broken shovels, a ruptured hydrolic line in my tractor, anger that my expensive back-hoe attachment didn’t work, and only a small dent in the ground near my patio. Even the brute force from the tractor would not budge the clay. I wondered if dynamite would be effective? (My wife would have none of this idea).
With my exuberance quashed, I concluded that this would require much more measured exhuming.
Escape From the Prison
We often imagine, with great delight, the removal or destruction of that which enslaves or imprisons us. We dream that just a little sweat, exertion of a few shovel scoops of dirt and the foundation to our prison of obesity, addiction, debt, and depression are exposed. A few extra scoops and we imagine freedom from that prison cell.
If only I had a jack hammer and a bigger, more powerful scoop, I imagine . . . I could make short work of these manacles that bind me.
But, our manacles and prison cells do not so easily give way.
The failings of our sharpened spades and powerful back-hoes form a new, even stronger fetter – the belief that our prison cell is unbreakable, that our challenge is just too great. These failings usually leave a person cured of any further desire to break free. It quashs the dream and solidifying the depression of stagnation.
The in-fecundity of my shovel, no matter the strength and effort put behind it, was not cause to quit. It was life’s lesson that prisons and shackles often only need a simple tool.
Enter the pick-axe. During this process my wife said, “Honey, why don’t you use the pick in the garage?”
“If my shovel and the back-hoe didn’t work, there was no way I was going to break through this clay with a pick axe.” That was absurd, I thought.
Yet when I humbled myself to try, it was simple. The pick-axe was unpretentious. This simple tool allowed for an almost effortless stroke to a small area of weakness in the caliche. A large flake of soil would pop free with each stroke. The process was repeated.
Scale by scale, the dragon’s flank was exposed. Careful work of the pick-axe began to loosen layer after layer, section after section, pellicle after pellicle. Yes, it was slow work. But, each swing was a small victory.
At each little victory, my heart would leap, the dream would become ever clearer.
Working this magic again and again until finally the specter was weakened enough to pull out the shovel. And, further work, allowed for bringing back the powerful back-hoe, in gratifying scoops.
The excavation that I thought would take two months took me fourteen. But, it was gratifying.
I learned a powerful lesson. Wherever life has pinned you, fettered you or barred you in, put down the shovel, and pick up the pick-axe. Second, if you really listen, your spouse may point out the tool you really need. Don’t be afraid to chip away at it a piece at a time.
Finances
Stop waiting for the sharper shovel or the bigger back-hoe to dig yourself out of your harrowing debt, mega mortgage, or your income dwarfing spending. The jackpot or financial windfall won’t come. While others await the jackpot, put down your shovel and shoulder your pick-axe.
- Pick one small debt and begin to pick at it by applying just a little extra each month until it is gone.
- Cancel your extra cable, sell the motorcycle and payoff the 21% interest credit card.
- If you must, pick up a side-hustle for extra to sharpen the pick.
Once you’ve lifted one flake, chip away at the next. Making progress will make it easier to continue. It doesn’t matter how long it takes, just keep at it.
Marriage
You long for resolution of the apathy, progressive resentment and mutual stalemate that permeates your relationship. You look in vain for the bigger shovel that will uncover the treasure that years of apathy have buried. You long to uncover your dreams and needs that have been covered and hardened under the clay of resentment. The shovel and the back-hoe won’t help you here.
Drop the shovel. Shoulder your pick-axe.
- Kiss your wife every time you leave, even if it’s just for a ten minutes to run to the convenience store.
- Hold her for five seconds longer every time you hug.
- Find a gift you can give her once a week, just because.
- Put down your phone and look her in the eyes when she talks to you and listen. Really listen and the flakes of hard clay will unveil the beauty of her soul.
- Find a way to praise her every day, even if it is through a simple text.
Health
You long to rid yourself of your addiction to sugar, bread, stress, and sleep deprivation. You’ve tried to scoop them out of your life. You even hired a trainer with some muscle to force you to change. You’ve tried in vain to save yourself from yourself.
Trying to use the shovel here is like trying to use the shovel on steel forged walls of your life’s prison fortress. Forget the shovel. Shoulder your pick-axe.
- Start with one meal and make some substitutions. My dietary plan can help you with this.
- Go to bed an hour earlier. Really, you’ll be surprised that the focus you have will more than compensate for the hour of lost time in the evening.
- Add a quality vitamin to your morning routine.
- Take ten minutes and do 20 push-ups and 20 sit-ups, then take a 10-minute walk.
- Simply remove the “white stuff” from your meals. You will be amazed at the results.
- Put down your phone for 30 minutes and read that book you’ve been meaning to read, instead of surfing Facebook.
Grand-standing with your back-hoe doesn’t help you. Just swing the pick-axe once or twice. Simple daily picking with the sharp point weakens the hardest of ground and the prison walls in our lives. It takes time, so be patient.
Find the weak point, apply the pick. Day by day, little by little you will be free.
I’ve been there. I’m with you. Keep me posted on your journey.
If you’re looking for a program that teaches you how to do this, check out my membership site.
Ketogenic Weight Loss Class
I’ve opened up my ketogenic weight loss class to the public. Come and join us if you are struggling to lose weight. Many people are struggling to understand how a ketogenic diet works, or finding confusion with all of the different “experts” teaching people to live a ketogenic lifestyle.
Come join me this Friday, and lets put you on a course for success.
Long-Term Weight Loss: Why So Many Fail
Over fifty years of data have demonstrated that creating energy deficit through the reduction in caloric intake is effective in reducing weight. . . However, it is only for the short term (1, 2). The biggest challenge physicians face in the treatment of obesity is that calorie restriction fails when it comes to long-term weight loss.
Isn’t Fasting Effective in Long-Term Weight Loss?
With the craze and popularity of intermittent fasting, some have claimed that intermittent fasting is more effective in weight reduction. Recent results demonstrate that this may also be incorrect. In the short term evaluation of caloric restriction and intermittent fasting, reduction in 15-20 lbs of weight is effectively seen and the highly publicized Biggest Loser’s losing ~ 120 lbs. Intermittent fasting and alternate day fasting have been shown to be more effective in lowering insulin levels and other inflammatory markers in the short term.
There is, however, controversy over maintaining weight loss beyond 12 months in the calorie restriction, intermittent and alternate day fasting groups. Forty different studies in a recent literature review, thirty-one of those studies looking at forms of intermittent fasting, demonstrate that the majority of people regain the weight within the first 12 months of attempting to maintain weight loss(3, 5). This is, also, what I have seen for over 18 years of medical practice.
Is Calorie Restriction the Only Way to Lose Fat?
Numerous “experts” claim that the only way to reduce fat is “caloric deficit.” Variations through the use of intermittent, long-term or alternate day fasts can be found all over the internet. In regards to calorie restriction, these “experts” with nothing more than a personal experience and a blog to back their claims preach this louder than the “televangelists” preach religion. Based on the faith that many place in this dogma, it could be a religion. What causes belief in this dogma is that weight and fat loss actually does occur with caloric restriction to a point. The average person will lose 20-25 lbs, however, within 12 months of achieving this goal, most people regain all the weight. (No one ever mentions the almost universal problem with long-term weight loss, especially those “experts.”)
Prolonged calorie restricted fasts, intermittent fasts, and alternate day fasts are often grouped together into the fasting approach, causing significant confusion among those that I speak to and counsel in my office. There is great data that alternate day fasts do not have the reduction in resting energy expenditure that prolonged fasting, intermittent fasting and calorie restriction cause. However, none of these approaches appears to solve the problem of weight re-gain after long-term (12-24 months into maintenance) weight loss (3). And, a recent study of 100 men participating in alternate day fasting showed that there was a 38% dropout rate, implying that without close supervision and direction, maintenance of this lifestyle is not feasible for over 1/3rd of those attempting it.
Long-Term Weight Loss Failure Brings Tears
Failure on calorie restricted diets, low fat diets, and intermittent fasting diets with weight regain at twelve to twenty-four months is the most common reason people end up in my office in tears. They’ve fasted, starved themselves, calorie restricted, tried every form of exercise, and still regained the weight. Trainers, coaches and “experts” have belittled them for “cheating” or just not keeping to the diet. Yet, we know that calorie restriction and intermittent fasting cause a rebound in leptin, amilyn, peptid YY, cholecystikinin, insulin, ghrelin, gastric inhibitory peptide and pancreatic poly peptide by twelve months causing ineffective long-term weight loss (6). The dramatic rise in these hormones stimulates tremendous hunger, especially from ghrelin and leptin.
Although less problematic in alternate day fasting, these calorie restricted approaches also cause dramatic slowing of the metabolism at the twelve month mark. In many cases, the metabolic rate never actually returns to baseline, creating even more difficulty in losing further weight or even maintaining weight (6).
Is Gastric Bypass or Gastric Sleeve the Solution?
Gastric bypass and the gastric sleeve procedures have been touted as the solution to this problem, as they decrease ghrelin, however, 5-10 years later, these patients are also back in my office. They find that 5-10 years after these procedures the weight returns, cholesterol and blood pressure rise, and diabetes returns. These hormones kick into high gear, stimulating hunger in the face of a slowed metabolism, that to date, has been the driver for weight regain in the majority of people. People find it nearly impossible to overcome the hunger. You may have experienced this, I know I have.
It’s the Hormones, Baby!
So, what is the answer? It’s the hormones. (WARNING – You’ll hear that when your wife is pregnant, too, gentlemen). We are hormonal beings, both in weight gain, and in pregnancy. Trying to preach calorie control to a hormonal being is like showing up at the brothel to baptize the staff. You might get them into the water, but you’re probably not getting them returning weekly to church or pay a tithe.
So, how do you manipulate the hormones in a way to control the rebounding hunger and suppression of metabolism? This is where we put a bit of twist on the knowledge we’ve gained from alternate day fasting. Recent research shows that “mild” energy deficit in a pulsatile manner, that has the ability to mimicking the body’s normal bio-rhythm’s is dramatically effective in reducing weight and maintaining normal hormonal function without cause of rebound metabolic slowing (4).
Pulsed Mild Energy Restriction
What does this mean in layman’s terms? It means that if we provide a diet that maintains satiety hormones while providing a period of baseline total energy expenditure needs and a period of mildly reduce caloric intake in a pulsed or cyclic manner, greater weight loss occurs and there is no rebound of weight 1-2 years later.
The main reason I’ve not jumped on the intermittent fasting band wagon is the shift in leptin, amylin, ghrelin and GLP-1 signaling that regularly occurs at the 6-12 month mark. The rebound of these hormones causes weight re-gain and is what prevents successful long-term weight loss. A number of people come to my office and tell me they couldn’t follow a ketogenic diet, so they’re doing intermittent fasting and it works . . . for a while. Then, they end up in my office having hit a plateau or fallen off the wagon and regained all the weight. They are completely confused and don’t understand what happned. Most of them are convinced it’s their thyroid or cortisol and they’ve seen every naturopath and functional medicine doctor in town.
What people really need is a simple approach to long-term weight loss without having to spend the night in the physiology lab every two weeks sleeping under a ventilated hood system.
The Ketogenic Lifestyle is a Pulsed Energy Lifestyle
- First, it is essential to turn off the insulin load. Insulin is the master hormone. This is done by a ketogenic lifestyle that restricts carbohydrates.
- Second, providing adequate protein to supply maintenance of muscle and testosterone is key.
- Third, providing adequate fat is the simple way to maintain leptin, ghrelin, amylin, GLP-1 (among the others) and long-term weight loss. Can you eat too much fat? Of course you can. But, because each of us have differing levels of stress and activity each day, this fat intake becomes the lever for hunger control.
- Fourth, the use of exogenous ketones ensures easily accessible ketone (short chain fatty acids) to modulate adipose (white fat) signaling of the liver without large caloric intake through the portal vein by first pass of liver metabolism. The ketones also help stabilize the gut bacteria. The combination of hormone balance between the liver and fat cells and improvement of gut bacteria suppresses key hunger hormones and aids glucose regulation between the fatty tissues and the liver. Ketones, both endogenous and exogenous, suppress production of TNF-alpha, IL-6, resistin, and stabilize production of adiponectin and leptin from the adipose cells (7, 8, 9).
In my office, once we calculate the basic protein needs daily, we start with a 1:1 ratio of protein to fat. Then, the fat is adjusted up or down based on hunger. Remember, hunger occurs, because your body produces hormones. The addition of fat to a diet that is not stimulating large amounts of insulin resets the hormone patterns back to normal without causing weight gain.
Give Obese People Fat Ad Libitum?
“Sure, Dr. Nally, but what about those people who don’t know if they are hungry, bored, stressed or just have a bacon fixation? You can’t just give them all the fat they want?!”
Why not? Implying that people aren’t smart enough to know when they are full is a bit of a fascist philosophy, don’t you think?
Do people over eat? Sure they do. But, I’ve found that when you give people an antidote to hunger (using fat intake in the presence of stabilized insulin levels) over a few months, people begin to recognize true hunger from other forms of cravings. This is especially true when they keep a diet journal. This gives people the ability to begin listening to their own bodies, responding accordingly and governing their stress, eating, exercise and activity. Keeping a diet journal is key to long-term weight loss. And, isn’t helping people use their own agency to improve their health really what we’re trying to do?
Interestingly, doing this over the years seems to line up with the findings of this year’s MATADOR study in the International Journal of Obesity. They found that mild intermittent energy restriction of about 30-33% for two weeks, then interrupting this with two weeks of a diet that was energy balanced for needs improved both short and long-term weight loss efficiency (4). In looking at my, and my patient’s diet journals, this energy restriction of about 1/3 of needed calories cyclically seems to happens naturally with a ketogenic lifestyle, without even counting calories. (Calories are a swear-word in my office).
What does the correct long-term wight loss program look like in a diet or meal plan? Well, you’ll have to join the Ketogenic Lifestyle 101 Course to see what that really means to you individually. I look forward to seeing you there.
Want to find out more about the Ketogenic Lifestyle 101 course? CLICK HERE.
Have you read my book The Keto Cure? Get a signed copy from me by clicking HERE.
References:
- Bronson FH, Marsteller FA. “Effect of short-term food deprivation on reproduction in female mice.” Biol Reprod. Oct 1985; 33(3): 660-7. https://www.ncbi.nlm.nih.gov/pubmed/4052528?dopt=Abstract&holding=npg
- Connors JM, DeVito WJ, Hedge GA. “Effects of food deprivation on the feedback regulation of the hypothalamic-pituitary-thyroid axis of the rat.” Endocrinology. Sep 1985. 117(3): 900-6. https://www.ncbi.nlm.nih.gov/pubmed/3926471?dopt=Abstract&holding=npg
- Seimon RV, Roekenes JA, Zibellini J, Zhu B, Gibson AA, Hills AP, Wood RE, King NA, Byrne NM, Sainsbury A. “Do intermittent diets provide physiological beneftis over continuous diets for weight loss? A systematic review of clinical trials.” Mol Cell Endo. 15 Dec 2015. 418(2): 153-172. https://www.sciencedirect.com/science/article/pii/S0303720715300800
- Byrne NM, Sainsbury A, King NA, Hills AP, Wood RE. “Intermittent energy restriction improves weight loss efficiency in obese men: the MATADOR study.” Int J Obes. 2018. 42:129-138. https://www.nature.com/articles/ijo2017206
- Trepanowski JF, Kroeger CM, Barnosky A. “Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults.” JAMA Intern Med. Jul 2017. 177(7): 930-938. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2623528?redirect=true
- Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, Proietto J. “Long-term persistence of hormonal adaptations to weight loss.” N Engl J Med. 27 Oct 2011. 365: 1597-1604. http://www.nejm.org/doi/full/10.1056/NEJMoa1105816
- Asrih M et al., “Ketogenic diet impairs FGF21 signaling and promotes differential inflammatory responses in the liver and white adipose tissue.” PlosOne. 14 May 2015. Open Access. https://doi.org/10.1371/journal.pone.0126364
- Veniant MM et al. “FGF21 promotes metabolic homeostasis via white adipose and leptin in mice.” PlosOne. Jul 2012. Open access. https://doi.org/10.1371/journal.pone.0040164
- Whittle AJ, “FGF21 conducts a metabolic orchestra and fat is a key player.” Endocrinology. 1 May 2016. 157(5): 1722-1724.
Patience: Why Weight Loss is a Slow Process?
Watch this weekend’s Periscope conversation about why weight loss is slow and why anything that is worthwhile takes time.
You can watch the Periscope Video below:
What Are Your Biggest Weight Loss Struggles?
Join Dr. Nally on this evening’s Periscope as we talk about your biggest weight loss struggles in rapid fire style. We cover topics this evening from the effects of cheating on a ketogenic diet to how to overcome a weight loss stall . . . join us to hear the whole conversation.
Thinking Outside of the Box
The image above has nine dots within a square. Your task, using only four lines is to connect ALL nine dots WITHOUT ever raising your pen, pencil or finger (Please don’t use a sharpie on your computer screen . . . it doesn’t come off).
You may have seen this puzzle previously . . . it’s made its rounds in corporate training circles. But the underlying principle remains true. The solution requires you to expand your thinking or to “think outside the box.”
Whenever you find yourself on the side of the majority, it is time to pause and reflect. (Mark Twain)
Why should we limit ourselves to thinking outside the box. Can’t we just get rid of the box?
True discovery consists in seeing what everyone has seen . . . then, thinking what no one has thought.
The answer can be found when those four lines are used beyond the box our mind creates:
What good has the box done us? People were burned at the stake because they refused to believe the Earth was not the center of the universe. People were beheaded because they had a sneaking suspicion that the world was not flat.
Why is it so very hard to accept that our weight gain and diabetes are driven by a hormonal signal, and not by gluttony or caloric intake of fat? The definition of insanity is doing the same thing repetitively and expecting a different outcome. How long have you been restricting calories and fat with only minimal or no improvement in your weight, blood sugar, cholesterol or general feeling of health?
The main problem with the current thought model, or dogma, on the obesity’s cause is that it does not account for metabolic syndrome. Metabolic syndrome is insulin resistance. It is an over production of insulin in the presence of ANY form of carbohydrate (sugar or starch).
In the practice of medicine over the last 15 years, I noticed that a very interesting pattern emerged. There was always a spike in fasting and postprandial insulin levels 5-10 years prior to the first abnormal fasting and postprandial blood sugars. These patients were exercising regularly and eating a diet low in fat. But they saw continued weight gain and progressed down the path of metabolic syndrome. 10-15 years later, they fall into the classification of type II diabetes. What I now lovingly refer to as stage IV insulin resistance.
The only thing that seems to halt this progressive process with any degree of success is carbohydrate restriction. Fasting insulin levels return to normal, weight falls off, and the diseases of civilizations seem to disappear as insidiously as they arose.
So you tell me, is the world flat? Is the Earth the center of the universe?
What is a low carbohydrate or ketogenic diet? 15 years of practical in the trenches experience have helped me develop a very simple program to help you lose and maintain your weight. Access to this program, video help and access to blog articles at your fingertips are offered through my online membership site.
You can also hear me each week a I discuss low carbohydrate, paleolithic and ketogenic diets with the Legendary Jimmy Moore on KetoTalk.com
PeriScope: Weight Loss, Gut Health & Pond Scum…In The New Year
Good morning from Arizona. I’ve had a few people ask about how gut health relates to a ketogenic diet. This is a great question and one that I think can be answered best by taking a closer look at my natural koi pond and learning a little about pond scum.
So, sit back and look at the similaries between your gut and how nature balances a pond system: Katch.me
Or you can watch the video below:
The four tenets of health that we touch on above that are essential to understand before you can understand gut health:
- The body is a unit and works as such with all parts enhancing the whole
- The body is capable of self-regulation, self-healing, and health-maintenance
- Structure & function are reciprocally interrelated
- Rational treatment of the body must be based upon understanding the principles above and assisting or augmenting those principles
Keys to gut health and pond balancing that we touch on:
- Remove the toxins from entering the system like:
- Antibiotic overuse
- Caffeine
- Artificial Fat
- Artificial Sweeteners
- Repair the system and it’s ability to balance the system
- Takes time
- Provide structure for the bacteria to which it can bind
- Provide essential vitamins and minerals like KetoEnhance & Omega-3 fatty acids
- Periodic Fasting
- Restore the bacteria or flora of the system
- Prebiotics (fermented foods like sauerkraut, kimchi, Japanese natto, etc.)
- Probiotics like Dietary KetoBalance (can be purchased in the office)
- Replace the salts and pH balance where necessary
- Replace electrolytes
- Limit things that shift the pH balance
Hope this gives you a starting point for your New Year!!
Today’s Weight Loss Rx . . .
A few of my patients have recently asked me, “Dr. Nally, why to you post pictures of your horse, koi and farm animals on instagram?”
Let me answer that question with the following questions:
- Do you find yourself longing for the apocalypse?
- Do you find yourself looking for a reason to live?
- Are you feeling tired, irritable, stressed out?
- Do you or you family find yourself to be overly cynical, jaded or emotionally numb?
If you can answer “yes” to any of the questions above, then I highly recommend prescription strength nature . . .
All parody and humor aside, full strength prescription nature is one of the very best treatments for stress.
I find that sitting outside with my animals, watching the birds, dogs, horses and ducks dramatically helps with lowering my stress levels and helps me re-focus. You can see my favorite place to sit on my farm and watch nature . . . here on Katch.me
You may find the following posts very insightful in explaining how stress wreaks havoc on your weight loss, mood & emotions and how to go about fixing it:
- How Does Stress Cause Weight Gain?
- Stress . . . The Weight Loss Killer
- Common Ketosis Killers
- Adrenal Insufficiency, Adrenal Fatigue, Pseudo-Cushing’s Syndrome – Oh My!
- How Does Exercise Help Ketosis?
- Principle Based Ketogenic Lifestyle – Part I
- Principle Based Ketogenic Lifestyle – Part II
- The Simple Effects of Ponderizing
For someone like me, who spends 14-18 hours a day taking care of illness and sickness, I have found that spending time in nature is often more therapeutic than any pill available in the pharmacy. So, this afternoon, if your looking for me, I’ll be taking my own medicine, a prescription of Nature Rx on my horse.
Does Jung & Myers-Briggs Typology Effect Obesity?
Sitting around the dinner table this evening we began discussing personality types. As a fun exercise, we each took the Jung Typology Test based on Jung and Myers-Briggs findings about personality. If you haven’t taken this personality test, you might find it quite interesting and the topic of hours of conversation around the dinner table . . . as we did this evening. The test is free on-line and takes about 10 minutes.
The actual Myers-Briggs Type Indicator costs about $50.00 and includes an interpretation by someone trained in giving the test. It differs slightly in its questions and the way the testing is interpreted.
Both tests provide an interesting insight into your individual psychological preferences regarding four categories. According to Carl G. Jung’s theory of psychological types published in 1971, people can be characterized, first, by their preference or general attitude about the source of and how they express their energy:
- Extraverted (E) vs. Introverted (I)
The second preference is one of the two functions of perception, or related to how they perceive information coming from either the external or internal world:
- Sensing (S) vs. Intuition (N)
and the third preference relates to how one processes the information that they have received, acting as one of the two functions of thought or judgement:
- Thinking (T) vs. Feeling (F)
Isabel Briggs Myers, a researcher and practitioner of Jung’s theory, proposed that the fourth preference related to how one applies or implements the information that he or she processed above. She proposed a judging-perceiving relationship as the fourth dichotomy influencing personality type in 1980:
- Judging (J) vs. Perceiving (P)
Each of these dichotomies represents an opposite pole of preference and each of us have a dominant pole toward which we gravitate.
Based upon your dominant traits, a personality type index is assigned.
Kim and Lee studied these personality preferences and how they relate to diet, health and propensity toward obesity. Their findings were interesting in that expression, perception and judgement did not seem to have any bearing on health or obesity. However, the application of judgement vs perception did play a role in health. Judging (J) means that a person organizes all of his or her life events and, as a rule, sticks to those plans. Perceiving (P) means that he or she is inclined to improvise and explore alternative options.
Significantly better dietary and health behaviors were identified in those preferring Judging (J) versus those preferring Perceiving (P) traits. Those preferring the Judging (J) behaviors included eating breakfast, regularly eating three meals a day, smoking less, exercising more and having a lower tendency to nocturnal eating.
The findings show that the use of Jung Type or Myers-Briggs Type Indicator may be helpful in identifying and index those with a Perceiving (P) trait that would benefit from dietary and exercise education, nutritional counseling and/or behavior modification programs.
It has been my experience that those with a “P” type dichotomy preference would benefit greatly from daily food planning and journaling.
So, what is your Jung/Myers-Briggs type?
Just for fun, and because my kids were very curious about what each personality type would appear as in character, I’ve included the Jung/Myers-Briggs Disney typing.
I’m an ENFJ, just in case you’re curious.
References:
- Jung, C. G. (1971). Psychological types (Collected works of C. G. Jung, volume 6, Chapter X)
- Briggs Myers, I. (1980, 1995) Gifts Differing: Understanding Personality Type
- Kim BS, Lee YE. College Students’ Dietary and Health Behaviors related to Their Myers-Briggs Type Indicator Personality Preferences. Korean J Community Nutr. 2002 Feb;7(1):32-44. Korean.
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.
Pre-, Post-Workout Meal on Ketosis. Is it Important?
Today’s Periscope was an exciting one. Do you really need a pre- or post-workout shake or meal? How much protein do you need? What’s the difference between ketosis and ketoacidosis? Is Dr. Nally a ketogenic cheerleader? Get your answers to these and many more questions asked by some wonderful viewers this evening on today’s PeriScope.
https://katch.me/embed/v/5def6bce-4f67-363a-b5f9-3bbec8a8aea2?sync=1
Be sure to check out Dr. Nally’s new podcast called “KetoTalk with Jimmy and the Doc” with the veteran podcaster Jimmy Moore on KetoTalk.com. The first podcast will be available on December 31, 2015. KetoTalk with Jimmy and the Doc will be available for download for free on iTunes.
Stay tuned . . . !
The 3 Weight Loss Necessities to Weathering the Holidays
What are the three things you need to successfully weather the holidays with your ketosis lifestyle? What does a raindeer on a motorcycle look like? How does insulin resistance effect kidney stones and gout? How do you get back on track if you fall off the ketosis wagon? These and many more questions are answered by Dr. Adam Nally on tonight’s PeriScope.
You can see the video stream including the comment roll here at katch.me/docmuscles. Or you can watch the video below:
Caffeine . . . Weight Loss Wonder Boy or Sneaky Scoundrel?
I’ve been looking for the answer for quite some time. . . what role does caffeine play in your and my weight management journey? The answer gave me a headache. . . literally and figuratively.
As many of you, including my office staff, know, I love my Diet Dr. Pepper (and my bacon). I found that being able to sip on a little soda throughout the day significantly helped the carbohydrate cravings and munchies during a busy and stressful day at the office. Diet Dr. Pepper contains caffeine, however, I wasn’t really worried. Caffeine has been well know to have a thermogenic effect which increases your metabolism and has been thought for many years to help with weight loss among the weight loss community.
Diet Dr. Pepper is, also, one of only four diet sodas on the grocery store shelves that doesn’t contain acesulfame potassium (click here to see why most artificial sweeteners cause weight gain). The four diet sodas that I have been comfortable with my patients using are Diet Dr. Pepper, Diet Coke, Diet Mug Root-beer and Diet A&W Cream Soda. These are the last four hold out diet sodas that still use NutraSweet (aspartame) as the sweetener. Most of the soda companies have switched the sweetener in their diet sodas to the insulinogenic acesulfame potassium because it tastes more natural and aspartame has been given a media black eye of late. However, NutraSweet (aspartame) is the only sweetener that doesn’t spike your insulin or raise blood sugar (click here to find out why that is important).
Yes, I know. The ingestion of 600 times the approved amount of aspartame causes blindness in lab rats (but we’re not lab rats, and . . . have you ever met someone that drinks 600 Diet Dr. Peppers in a day? The lethal dose of bananas, which are high in potassium that will stop your heart, is 400). Aspartame can also exacerbate headaches in some (about 5% of people) and I’ve had a few patients with amplified fibromyalgia symptoms when they use aspartame. But for most of us, its a useful sweetener that doesn’t spike your insulin response, halting or causing weight gain.
But, over the last few years, I’ve noticed that increased amounts of Diet Dr. Pepper & Diet Coke seem to cause plateauing of weight and decreasing the ability to shift into ketosis, especially mine. I’ve also noticed (in my personal n=1 experimentation) that my ability to fast after using caffeine regularly seems to be less tolerable, causing headaches and fatigue 8-10 hours into the fast, symptoms that don’t seem to let up until eating. Through the process of elimination, caffeine seems to be the culprit.
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
The 5 Myths of Weight Loss
This evening we covered the 5 myths of weight loss identified through the National Weight Control Registry’s research findings. What causes “wrinkle face” for Dr. Nally? We also talked about & answered 20 minutes of rapid fire questions ranging from the amount of protein you need daily to the likelihood a human could be a bomb calorimeter . . . exciting stuff!!
You can watch the video stream below. Or you can Katch the replay with the rapid stream of exciting comments here at Katch.me/docmuscles.
What Lab Testing Do You Need to Start Your Weight Loss Journey?
What laboratory testing is necessary when you start your weight loss journey on a Ketogenic, Low-Carbohydrate, Paleolithic or any other dietary changes? Why do you need them and what are you looking for? We discuss these questions and others on today’s PeriScope. Lots of questions from around the world to day . . . this one lasted a bit longer than normal . . . 45 minutes to be specific. But it’s a good one because of all of your fantastic questions! You really don’t want to miss this one.
You can see the video below or watch the video combined with the rolling comments here on Katch.me/docmuscles.
A list of the labs that we discussed are listed below:
- Fasting insulin with 100 gram 2 or 3 hour glucose tolerance test with insulin assay every hour
- CMP
- CBC
- HbA1c
- Leptin
- Adiponectin
- C-Peptid
- NMR Liprofile or Cardio IQ test
- Lipid Panel
- Urinalysis
- Microalbumin
- Apo B
- C-reactive protein
- TSH
- Thyroid panel
- Thyroid antibodies
- AM Cortisol
This list will at least get one started, provide the screening necessary to identify insulin resistance (Diabetes In-Situ), Impaired fasting glucose, diabetes and allow for screening for a number of the less common causes of obesity.
I would highly recommend that you get these through your physician’s office so that appropriate follow up can be completed. These labs will need to be interpreted by your physician, someone who understands and is familiar with various causes of obesity.
Until next time . . .
How to Stay Motivated on Carbohydrate Restriction
This evening on PeriScope, we talked about the 10 things you can do to stay motivated on your low-carb lifestyle. A number of great questions were asked including:
- How much carbohydrate should be restricted?
- What labs should you be monitoring regularly?
- What’s a normal blood sugar?
- Why is Dr. Nally freezing in Denver?
- Is fermented food good for you?
- Why should you eat pickles and kimchi even when you’re not pregnant?
And, much much more . . . It’s like a college ketogenic course on overdrive . . . for FREE!!!
You can see the PeriScope with the comments rolling in real-time here: katch.me/docmuscles
Or, you can watch the video stream below:
See you next time.
How Your Fruit and Your Alcohol Stop Your Weight Loss
Yes, your fruit makes you fat just like your beer gives you a beer belly. . .
It is fascinating how similarly fructose (the sugar in fruit) and alcohol are processed through the liver. Both of them increase insulin and both increase triglyceride production as a byproduct of their metabolism. This is clearly pointed out in Robert Lustig’s paper published in the Journal of the American Dietetic Association in 2010.
The metabolic pathways are very clearly outlined below:
You can Katch my PeriScope conversation about this below or with the comments and hearts included at Katch.me/docmuscles.
How Fat Makes You Skinny . . . (Eating Fat Lowers Your Cholesterol?!)
Diseases seem to arrive in three’s each day in my office. Today I had three different patients with cholesterol concerns who were notably confused about what actually makes the cholesterol worse, and what causes weight gain. Each of them, like many patients that I see, were stuck in a state of confusion between low fat and low carbohydrate lifestyle change. My hope is to give my patients and anyone reading this blog a little more clarity regarding what cholesterol is, how it is influenced and how it affect our individual health.
First, the standard cholesterol profile does not give us a true picture of what is occurring at a cellular level. The standard cholesterol panel includes: total cholesterol (all the forms of cholesterol), HDL (the good stuff), LDL-C (the “bad” stuff) and triglycerides. It is important to recognize that the “-C” in these measurements stands for “a calculation” usually completed by the lab, and not an actual measurement. Total cholesterol, HDL-C and triglycerides are usually measured and LDL-C is calculated using the Friedewald equation [LDL = total cholesterol – HDL – (triglycerides/5)]. (No, there won’t be a quiz on this at the end . . . so relax.)
However, an ever increasing body evidence reveals that the concentration and size of the LDL particles correlates much more powerfully to the degree of atherosclerosis progression (arterial blockage) than the calculated LDL concentration or weight (1, 2, 3).
There are three sub-types of LDL that we each need to be aware of: Large “fluffy” LDL particles (type I), medium LDL particles (type II & III), and small dense LDL particles (type IV).
Second, it is important to realize that HDL and LDL types are actually transport molecules for triglyceride – they are essentially buses for the triglycerides (the passengers). HDL can be simplistically thought of as taking triglycerides to the fat cells and LDL can be thought of as taking triglycerides from the fat cells to the muscles and other organs for use as fuel.
Third, it is the small dense LDL particles that are more easily oxidized and because of their size, are more likely to cause damage to the lining of the blood vessel leading to damage and blockage. The large boyant LDL (“big fluffy LDL particles”) contain more Vitamin E and are much less susceptible to oxidation and vascular wall damage.
Eating more fat or cholesterol DOES NOT raise small dense LDL particle number. Eating eggs, bacon and cheese does not raise your cholesterol! What increases small dense LDL particles then? It is the presence of higher levels of insulin. Insulin is increased because of carbohydrate (sugars, starches or fruits) ingestion. It is the bread or the oatmeal you eat with the bacon that is the culprit. The bread or starch stimulates and insulin response. Insulin stimulates the production of triglycerides and “calls out more small buses” to transport the increased triglyceride to the fat cells (4, 5, 6, 7).
Fourth, following a very low carbohydrate diet or ketogenic diet has been demonstrated to decreased small dense LDL particle number and correlates with a regression in vascular blockage (8, 9). So, what does this really mean to you and me? It means that the low-fat diet dogma that that has been touted from the rooftops and plastered across the cover of every magazine and health journal for the last 50 years is wrong. . . absolutely wrong.
I talk about this and answers questions on today’s Periscope. You can see the recording on Katch.me with the comments in real time here:
https://www.katch.me/docmuscles/v/2f0b6d07-d56a-368b-b4f6-34a5ab3da916
Or, you can watch the video below:
References:
- Superko HR, Gadesam RR. Is it LDL particle size or number that correlates with risk for cardiovascular disease? Curr Atheroscler Rep. 2008 Oct;10(5):377-85. PMID: 18706278
- Rizzo M, Berneis K. Low-density lipoprotein size and cardiovascular risk assessment. QJM. 2006 Jan;99(1):1-14. PMID: 16371404
- Rizzo M, Berneis K, Corrado E, Novo S. The significance of low-density-lipoproteins size in vascular diseases. Int Angiol. 2006 Mar;25(1):4-9. PMID:16520717
- Howard BV, Wylie-Rosett J. Sugar and cardiovascular disease: A statement for healthcare professionals from the Committee on Nutrition of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation. 2002 Jul 23;106(4):523-7. PMID: 12135957
- Elkeles RS. Blood glucose and coronary heart disease. European Heart Journal (2000) 21, 1735–1737 doi:10.1053/euhj.2000.2331
- Stanhope KL, Bremer AA, Medici V, et al. Consumption of Fructose and High Fructose Corn Syrup Increase Postprandial Triglycerides, LDL-Cholesterol, and Apolipoprotein-B in Young Men and Women. The Journal of Clinical Endocrinology and Metabolism. 2011;96(10):E1596-E1605.
- Shai I et al. Cirulation. 2010; 121:1200-1208
- Krauss RM, et al. Prevalence of LDL subclass pattern B as a function of dietary carbohydrate content for each experimental diet before and after weight loss and stabilization with the diets. American Journal of Clinical Nutrition. 2006; 83:1025-1031
- Gentile M, Panico S, et al., Clinica Chimica Acta, 2013, Association between small dense LDL and early atherosclerosis in a sample of menopausal women, Department of Clinical Medicine and Surgery, University “Federico II” Medical School, Naples, Italy Division of Cardiology, Moscati Hospital, Aversa, Italy A. Cardarelli Hospital, Naples, Italy
Don't Fear Fat
Don’t fear the fat. If you haven’t seen the movie Cereal Killers, you should watch it by clicking here. D.J. O’Neill ditches wheat and sugar in a food plan consisting of 70% fat – under the guidance of legendary South African Sports Scientist Prof. Tim Noakes.
Hypertension and Insulin Resistance
Hypertension (elevated blood pressure) is one of the triad symptoms of metabolic syndrome. I see this to some degree a very large majority of the people seen in my office. Many people are so used to having borderline or elevated blood pressure, and not successfully controlling it through caloric restriction, they are told it is a “genetic problem,” placed on blood pressure medication and sent on their way. The problem is that most of these people will have a progressive elevation in blood pressure over time and these medications are continually raised until the person is on four or five different blood pressure medications at maximal doses. Again, their genetics are blamed and that is the end of it. Or is it?!
When I first started treating the insulin resistance problem in the human, rather than the blood pressure problem, I began to see immediate reductions in blood pressure within one to two weeks. So much of a reduction that if I didn’t warn the patient that they should begin to back down their medications, they would experience symptoms of dizziness, light-headedness, headache and a few patient’s nearly passing out. I often wondered why applying a ketogenic diet had such a profound effect on blood pressure so quickly. Dr. Robert Lustig helped answer that question for me.
In order to understand how the Standard American Diet (we call it the SAD diet in my office) raises your blood pressure, it is important to understand how the body processes the basic sugar molecule. Sugar is one glucose molecule bound to a fructose molecule. This is broken down in the body and 20% of the glucose is metabolized in the liver, the other 80% is sent on to be used as fuel throughout the body. Fructose, however, is where the problems arise. 100% of the fructose is metabolized in the liver, and the by product of fructose metabolism is increasing the liver’s production of MORE glucose and the byproduct of uric acid. Uric acid is produced and this inhibits the production of nitric oxide. The diminished nitric oxide in the presence of an increased level of glucose (stimulating increased insulin production) constricts the blood vessels and raises blood pressure. Yes, that donut you just ate raised your blood pressure for the next 12 hours.
All of this can be seen in the really complex diagram found in Dr. Lustig’s 2010 article:
So, how do you lower your blood pressure through diet? First, cut out all the simple sugars. These include anything with table sugar, high fructose corn syrup and corn syrup.
Second, limit your overall intake of other sources of carbohydrates including any type of bread, rice, pasta, tortilla, potato, corn and carrots. Realize that fruit is fructose, and when taken with other forms of glucose can have the same effect as table sugar.
Third, if you are taking blood pressure medications, see your doctor about close monitoring of your blood pressure as it can drop within 1-2 weeks of making these dietary changes.
The Gateway Called Death
The life of a close friend and patient was recently taken. This has been weighing upon my mind of late, as a similar event occurred in the life of my sister a few years ago. I looked over the words and passages I wrote a few years ago, and for some reason, felt strongly that I should include them here. I write this blog to help those struggling with weight, diabetes and the diseases of civilization. One of those diseases frequently affecting weight is the depression and fear that accompanies the death of a loved one. Often, the answers science offers are not enough and we are required to rely upon our faith. I share some of that with you here.
I have spent the majority of my professional life in the acquisition of knowledge and its application in the relief of significant illness. My greatest foes have been ignorance, disease, distress, disability and, ultimately, death. I come in contact almost daily with seriously ill patients facing the very real prospect of death. Of necessity, I have come to look upon death as a formidable foe to be fought. For all conscientious doctors, death’s gateway from life threatens us as the prospect of individual defeat.
The famed scientist Madame Marie Curie returned to her home the night of the funeral of her husband, Pierre Curie, who was killed in an accident in the streets of Paris. She made this entry in her diary:
“They filled the grave and put sheaves of flowers on it. Everything is over. Pierre is sleeping his last sleep beneath the earth. It is the end of everything, everything, everything.”
What is this thing that men call death,
This quiet passing in the night?
Tis not the end, But Genesis
Of better worlds and greater light.
O God, touch though my aching heart,
And calm my troubled, haunting fears.
Let hope and faith, transcendent pure,
Give strength and peace beyond my tears.
There is not death, but only change
With recompense for won;
The gift of Him who loved all men,
The Son of God, the Holy One.
(G. B. Hinckley)
However, every patient of every doctor, if followed long enough will pass away. The first rule of surgery is that “all bleeding stops eventually.” The inescapable rule of life is that no matter how good your treatments are, all patient’s will meet the undertaker, eventually.
When this happens, and it happens to all of us, a sense of sadness naturally prevails regardless of the age or nature of the deceased.
If death is to happen to all of us, then why do we feel sadness at the death of a friend or loved one?
This sadness is caused by the feeling of loss tied to three age-old unanswered questions:
- Did you and I exist before we were born, and if so, where were we?
- Why are we here together and what is the purpose of this life?
- Where do we go when we die?
Are there answers to these questions?
When science does not have the answers, I have found great hope and answers in hidden within the teachings of my faith. I share them with you, not to preach or offend, but in hopes that you might find peace and solace in your life as I have in mine.
The spiritual leader Wilford Woodruff said “that if the people knew what was behind the veil, they would try by every means . . . that they might get there, but the Lord in his wisdom has implanted the fear of death in every person that they might cling to life and thus accomplish the designs of their creator.” (The Gateway We Call Death, Russell M. Nelson, p.96)
The Lord explained to Moses, “For this is my work and my glory, to bring to pass the immortality and eternal life of man.” (Moses 1:39)
This work and glory is referred to by a number of names including The Plan of Salvation, The Plan of Redemption, The Plan of Eternal Progression, The Plan of Happiness and others.
I often speak with people that say to me, “I just want to be happy.” Or they question me asking, “Will I ever really be happy?”
Happiness is the object and design of our existence . . . and well be the end thereof if we pursue the path that leads to it. Along this path lies virtue, uprightness, faithfulness, holiness and keeping the commands of our Creator. So how does this help us find happiness in the face of the death of a friend or loved one?
The answers are found in contemplation of the the three age-old questions. First, where were we before we were born?
The Old Testament prophet Job, one of the more ancient writers of the Bible, gives us some insight. The Lord asked him the same question: “Who is this that darkeneth counsel by words without knowledge? Gird up now thy loins like a man; for I will demand of thee, and answer thou me. Where was thou when I laid the foundation of the earth . . . when the morning stars sang together, and all the sons of God shouted for joy?” (Job 38:2-7)
You and I must have been somewhere – the Lord asked us where we were. And, who were all the “sons of God shouting for joy?” Why were they shouting? Where were they?
The apostle, Luke, in the New Testament answers those questions years later as he lays out the genealogy of the human family. He starts at Christ and then names each subsequent father leading up to ” . . . Enos, which is the son of Seth, which was the son of Adam, which was the son of God.” (Luke 3:38)
The apostle, John, must have had some idea of a pre-mortal existence because of the way they phrased the question to Jesus Christ about the man who was born blind, “Master, who did sin, this man or his parents, that he was born blind?” (John 9:2) The question was not “could he have sinned before he was born?” but instead, “who did sin?” Christ’s answer implied that both were possible, but neither was the case in this situation.
Paul writes to the Hebrews, “Furthermore, we have had fathers of our flesh which corrected us, and we gave them reverence; shall we not much rather be in subjection to the Father of our Spirits, and live?” (Hebrews 12:9) We are also given instruction to open our prayers with a phrase like, “Our Father in Heaven.” Hence, He is the Father of our Spirits, our Heavenly Father, our spiritual Father.
We then are brothers & sisters in the spiritual sense, and Jesus Christ is our elder brother, being the firstborn spirit child of God. If this is the case, then all of us, including you and I, were among the sons and daughters of God who shouted for joy along with Adam.
The Lord explained to Moses, “I have created all things, of which I have spoken, spiritually before they were naturally upon the face of the earth . . . for in heaven created I them.” (Moses 3:5) In addition to this, we learn from Moses that a council was held in heaven in which you and I were present. At this grand council, the plan to create this earth, including the fall of Adam, and the Atonement of Jesus Christ was presented and accepted.
There was, however, someone who opposed this plan. Lucifer rebelled and was cast out of heaven with those who chose to follow him.
If all this is true, then it means you and I accepted this plan and here we are. Accepting this plan as described by the prophet Abraham is defined as accepting our First Estate.
So, the first question is where did we come from? We came from the presence of God, the pre-mortal spirit world, in the company of all our spirit brothers and sisters.
Second question, why are we here? Trying to wrap the whole of this question into a nutshell gives us the following answer.
First, on the eternal perspective, progression requires that we each have our own physical mortal body that has the capacity of becoming refined, immortalized or glorified through the process of death and subsequently resurrection.
Second, we had to be sent somewhere outside of the presence and powerful righteous influence of God our Father to prove ourselves, to exercise our own agency, and determine in this life the nature of our life to come – the life after death. One of the prophets, Jacob, tells us that Adam & Eve were expelled out of the Garden of Eden into a “lone and dreary world” and on a probation of sorts, where a person could chose from a myriad of different things that were either good or evil. It is necessary for man to taste the bitter to enable him to appreciate the good, is one way to explain it.
The ancient prophet Alma calls this a probationary state, a time to repent, to grow, to learn responsibility, and to prepare for the next life. (Alma 12:24, 42:4)
Said the Lord, “And thus did I, the Lord God, appoint unto man in the days of his probation – that by his natural death he might be raised in immortality unto eternal life, even as many as would believe.” (Doctrine & Covenants 29:43)
Obtain a Body . . . Prove Ourselves . . . Get Experience . . . this is your first estate.
Some of us live 80 years, some of us live 50 years, some of us live 39 years, and some live only a brief few years on this earth. Will you and I be given as much time? There are laws to be learned and lived, ordinances to experience, and covenants to be made and kept, and faith and obedience to demonstrate in this life.
Third, where do we go from here? Where will I go when I die? Where have friends and family that have passed on gone to?
The penitent thief on the cross being crucified with the Savior, Jesus Christ, asked the Him the same question. The Savior responded with this answer, “Today shalt thou be with me in paradise.” (Luke 23:43)
Christ died in the literal sense that you and I will die. He underwent a physical dissolution by which His immortal spirit was separated from His body of flesh and bones, and that body was actually dead. While the corpse lay in Joseph’s rock-hewn tomb, the living Christ existed as a disembodied Spirit. Where was He? We naturally assume that he went where spirits of the dead ordinarily go. He was in the disembodied state a Spirit among spirits. He went to the Spirit world.
We know that the spirit world is not heaven, as the Savior, on the third day after his crucifixion, met the weeping Mary Magdalene and said: “I am not yet ascended to my Father.” He had gone to Paradise as he told the penitent thief, but not to the place where God dwells. Sprit Paradise, therefore, is not Heaven, or the place where God the Eternal Father and his celestialized children dwell and make their abode. Spirit Paradise is a place where dwell
righteous and repentant disembodied spirits between bodily death and resurrection. Another division of the spirit world is reserved for those disembodied beings who have lived lives of wickedness and who remain impenitent even after death.
The ancient prophet Alma explained to his son Corianton who was confused on this matter, “Now there is must needs be a space betwixt the time of death and the time of resurrection.” (Alma 40:6) “Now concerning this state of the soul between the death and the resurrection, behold it has been made know unto me by an angel that the spirits of all men, as soon as they are departed from this mortal body, yea, the spirits of all men, whether they be good or evil, are taken home to God who gave them life. And then shall it come to pass, that the spirits of those who are righteous are received into a state of happens, which is called Paradise, a state of rest from all their troubles and from all care and sorrow.”
“And the spirits of the wicked, yea, who are evil – for behold they have no part nor portion of the Spirit of the Lord; for behold they chose evil works rather than the good; therefore, the spirit of the devil did enter into them, and take possession of their house – this is the state of the souls of the wicked, yea, in darkness, and as a state of awful, fearful looking for the fiery indignation of the wrath of God upon them; thus they remain in this state, as well as the righteous in paradise, until the time of their resurrection.” (Alma 40:11-14)
The Spirit World is therefore quite a unique place.
Another apostle and scriptural historian, Bruce R. McConkie, explains from the Savior’s parable of the rich man and Lazarus, “The spirit world is divided into two parts: Paradise which is the abode of the righteous, and hell which is the abode of the wicked. Until the death of Christ, these two spirit abodes were separated by a great gulf, with the intermingling of their respective inhabitants strictly forbidden.” (Luke 16:19-31) We know that Christ visited this spirit world because the apostle Peter’s biblical account tells us the following: “For Christ also hath once suffered for sins, the just for the unjust, that he might bring us to God, being put to death in the flesh, but quickened by the Spirit: by which also he went and preached unto the spirits in prison; Which sometime were disobedient, when once the long-suffering of God waited in the days of Noah, while the ark was a preparing, wherein few, that is, eight souls were saved by water.” (1 Peter 3:18-20)
When Christ visited the Spirit world, he also organized the affairs of this kingdom such that the righteous spirits began teaching the His gospel to those who had not heard it and those who were disobedient or wicked. Although, there are two spheres within the one spirit world, there is now some intermingling of the righteous and the wicked that inhabit those spheres; and when the wicked spirits repent, they leave their prison-hell and join the righteous in spirit paradise. Hence Joseph Smith said, “Hades, Sheol, paradise, spirit prison are all one: it is a world of spirits. The righteous and the wicked all go to the same world of spirits until the resurrection.” (Teachings, p. 310).
Life, work and activity all continue in the spirit world. Men and women have the same talents and intelligence there which they had in this life. They possess the same attitudes, inclinations, and feelings there which they had in this life. They believe the same things, as far as eternal truths are concerned: they continue in effect, to walk in the same path they were following in this life. (Mormon Doctrine, Spirit World, McConkie) The prophet Amulek said, “That same spirit which doth possess your bodies at the time that ye go out of this life, that same spirit will have power to possess your body in the eternal world.” (Alma 34:34) Thus, if a man has the spirit of charity and the love of truth in his heart in this life, that same spirit will possess him in the spirit world.
Family and friends who have passed away with the spirit of joviality and happiness will find it will carry them forward in the gospel and in the teaching of the gospel to many others on the other side.
When I leave this frail existence,
When I lay this mortal by,
Father, Mother, may I meet you
In your royal courts on high?
Then at length, when I’ve completed
All you sent me forth to do,
With your mutual approbation
Let me come and dwell with you.
(Eliza R. Snow, “O My Father,” Hymns, #292)
This post mortal world is a place to await resurrection. All will be resurrected. The Atonement of Jesus Christ ensures a universal resurrection. “For as in Adam all die, even so in Christ shall all be made alive.” (1 Cor 15:22) Judgment will then, after the resurrection, be passed on all according to individual works and obedience while in mortality. The great prophet Nephi says, “For by grace are they saved after all they can do.” (2 Nephi 25:23) Said the Savior to His disciples, “Yet a little while, and the world seeth me no more, but ye see me because I live and ye shall live also.” (John 14:19)
Inheriting the glory that Christ has been resurrected into is conditional and is based upon the laws by which individuals choose to govern their mortal lives.
Said the prophet Alma, “The plan of restoration is requisite with the justice of God; for it is requisite that all things should be restored to their proper order. Behold, it is requisite and just, according to the power and resurrection of Christ, that the soul of man should be restored to its body, and that every part of the body should be restored to itself.
“And it is requisite with the justice of God that men should be judged according to their works; and if their works were good in this life, and the desires of their hearts were good, that they should also as the last day, be restored unto that which is good.” (Alma 41:2-3)
The righteous who understand and live the truth will be resurrected to receive a glory in heaven referred to as Celestial and Paul refers to this as comparable to the glory of the Sun. In this celestial kingdom also known as the Kingdom of God, marriages and eternal family relationships are secured, eternal progress and progression is uninterrupted forever and ever.
The less valiant who choose the lesser law will be resurrected to receive a glory Terrestrial that Paul compares to the glory of the moon. They chose not to enjoy that which they could have enjoyed. These would not accept the words of the prophets in this life and died in their sins, but accepted afterwards.
And to the undisciplined, wicked, liars, sorcerers, adulterers, whoremongers, and the unrepentant who are shut out in spirit prison until the Savior finishes his work (D&C 76:85), they will be resurrected to a glory Telestial or that equivalent, as Paul puts it, to the “glory of the stars, for one star differeth from another star in glory.” (1 Corinthians 15:40-44) The remainder will become attached to Perdition, those who refuse any part of the Atonement of Christ – those that are cast off forever, as the scriptures say, into outer darkness.
What of those that have taken their lives prematurely when the Lord has said, “Thou shalt not kill”? Are they consigned to spirit prison and later a telestial glory?
Another of the Lord’s modern day apostles, M. Russell Ballard, recently stated that there are “some things we know, and some we do not . . . [the] judgment for sin is not always as cut and dried as some of use seem to think. . . the Lord recognizes differences in intent and circumstances: Was the person who took his life mentally ill? Was he or she so deeply depressed as to be unbalanced or otherwise emotionally disturbed? Was the suicide a tragic, pitiful call for help that went unheeded too long or progressed faster than the victim intended? Did he or she somehow not understand the seriousness of the act? Was he or she suffering from a chemical imbalance in their system that led to despair and a loss of self control? Obviously, we do not know the full circumstances surrounding every suicide. Only the Lord knows the details, and he it is who will judge our actions here on earth.” (Liahona, March 1988, Suicide: Some Things We Know, and Some We Do Not)
Said the prophet Joseph Smith: “While one portion of the human race is judging and condemning the other without mercy, the Great Parent of the universe looks upon the whole of the human family with a fatherly care and paternal regard . . . He is a wise Lawgiver, and will judge all men, not according to the narrow contracted notions of men, but ‘according to the deeds done in the body whether they be good or evil,’ . . . We need not doubt the wisdom and intelligence of the Great Jehovah; He will award judgment or mercy to all nations according to their several deserts, their means of obtaining intelligence, the laws by which they are governed, the facilities afforded them of obtaining correct information, and His inscrutable designs in relations to the human family; and when the designs of God shall be made manifest, and the curtain of futurity be withdrawn, we shall all of us eventually have to confess that the Judge of all the earth has done right.” (Teachings of the Prophet Joseph Smith, Salt Lake City, Deseret Book, 1938, p218)
When we are judged, the Lord will take all things into consideration: our genetic and chemical makeup, our mental state, our intellectual capacity, the teachings we have received the traditions of our fathers, our health, and so forth.
That is the plan. Those are the answers. Death, then, is a gateway.
Upon the cross he meekly died
For all mankind to see
That death unlocks the passageway
Into eternity.
(Hymns, #184 – “Upon the Cross of Calvary”)
“The keeper of the gate is the Holy One of Israel; and he employeth no servant there; and there is none other way save it be by the gate; for he cannot be deceived, for the Lord God is his name.” (2 Nephi 9:41)
To live, to love, and to be loved are the essence of what is important in this life. Those we have known and passed on have lived great lives, they were loved and are still loved.
Mourning and tears are normal – in fact, they are a healthy reaction. Mourning is one of the purest expressions of deep love. It is a natural response in accord with divine commandment: “Thou shalt live together in love, insomuch that thou shalt weep for the loss of them that die.” (D&C 42:45)
By mortal standard time, it’ll be much longer than we like till we see our loved ones again. By eternal standard time – “We’ll see you soon.”
Until then watch. There are another set of hands you should look for, pierced at the palms and at the wrists. You will recognize His hands when you see them. You will recognize Him when you see Him. His hands are always open. The brightness of His eyes and smile will warm the darkest recesses of your soul. When you meet Him, touch his hands, feel the mark in his side, and bow at His feet. He knows you by name. He knows each of us by name. He will offer you the peace, the rest and the love that you seek.
“To everything there is a season, and a time to every purpose under heaven: A time to be born and a time to die . . . A time to weep, and a time to laugh, at time to mourn, and a time to dance . . . a time to get and a time to loose . . . a time to embrace . . . and a time to love.” (Ecclesiastes 3:1-8)
This death of which I speak eventually comes to all. It comes to some in childhood, to some in ripe old age, and to others in the prime of life. To some it comes by natural means, anticipated and expected, to others it comes without warning, unannounced. It may come quietly in the peace of the night, or it may come violently in the confusion of an instant, but assuredly, it comes to all.
To you my beloved friends, patients and family, remember His invitation. “Come unto me, all ye that labor and are heavy laden, and I will give you rest. Take my yoke upon you, and learn of me; for I am meek and lowly in heart; and ye shall find rest unto your souls. For my yoke is easy, and my burden is light.” (Matthew 11:28-30)
This yoke is a conviction, a way of life; it is called the Gospel of Jesus Christ. It does not take away challenges, disappointments, frustrations, pain or sorrow. But, when lived, it lifts burdens, lightens loads, and makes life bearable. It empowers you with light and strength from on high to learn and grow from experiences in spite of whatever life brings.
This is my conviction. This I know to be true. It is what brings hope in the battle against the inevitable foe, death. May it bring you the warmth of heart and the solace of soul that it brings to me as I ponder its meaning in my life and the lives of my family. May the knowledge of the Plan of Salvation bring you comfort in knowing that those we care about have passed through the gateway we call death to look forward upon immortality and the Glory of the Savior Jesus Christ.
Fat Phobia . . . The Religion
“You want me to eat WHAT?! But that’s . . . ,it’s . . . FAT, really?”
” Yes, it is.”
Every day, instruction to my patients is initially seen as Food Pyramid heresy and My Plate iconoclasm. Yes, I want you to flip the Food Pyramid on its head, and push everything off My Plate and fill it with fat. . . Really. . . Yes, I do.
I was counseled by many school professors over the years that there are two things you should avoid talking about: Religion & Politics. The ketogenic or low carbohydrate dietary conversation involves both. “Fat Phobia” is a Religion. We have demonized fat and sainted the treadmill. You see, fat got a bad wrap when the bomb calorimeter was invented. We realized that there was twice as much energy found in fat that there was in carbohydrate or protein. Early nutritionists, understanding that heat is a form of energy, and realizing that energy is conserved, found that food substrates contain a set amount of energy that can be measured in a closed environment. Naturally, the Law of Thermodynamics got applied to lend understanding in how people gain or loose weight. We coined the term “you are what you eat” based upon our understanding of the Laws of Thermodynamics. The calorie became “king.”
- 1 gram of carbohydrate = 4 kcal
- 1 gram of protein = 4 kcal
- 1 gram of fat = 9 kcal
For the last sixty years (an entire generation of humans) we have based our diet around the calorimetry of food and have labeled them as good or bad based upon calories. To loose weight, we are taught, you either have to eat food containing fewer calories (fat has the most calories per volume so it must be bad!) or burn it off faster than you take it in (did you go exercise at that new gym next door), right? Wrong.
First, you and I are not bomb calorimeters. We are not closed systems. We harbor variable levels of symbiotic bacteria (these also burn fuel at variable rates) and our body temperatures fluctuate to regulate other enzymatic and hormonal processes.
Second, bomb calorimetery functions on the premise that volumes are also held at a constant. Human volume and density change daily. Simple chemistry tells us that volume = mass / density. The average human mass fluctuates by 5lbs every day and our density changes based upon our hydration status (the amount of water we drink). Because these two variables are not constant in a human being, it is impossible to correctly apply the Laws of Thermodynamics to the human body and accurately predict weight gain or loss.
Third, hormones! (Anyone married to a pregnant female understands that nothing is as it seems when hormones are involved.) We have a plethora of hormones that change the rate in which fuels are burned or stored in the human body. Our GI flora (symbiotic bacteria in the human gastrointestinal tract) are also affected by hormones and do not have set rates of fuel use or breakdown. What this means is that you and I process food at different rates and derive different levels of energy and fuel from the same donut. Genetics plays a leading role in how these hormones are used and turned on and off. Fat is burned or stored in the body based on a hormonal mechanism I described in a previous post you can read here.
Asking patients to reduce carbohydrate intake to less than 20 grams per day and increasing fat intake to up to 70% of total caloric intake is essentially 20th century nutritional apostasy.
The dietary concepts from the Food Pyramid and My Plate have been embraced by our country for over sixty years. Changing our views on these as a country will be for many like changing religions. For those of us “with eyes to see and ears to hear” our work is cut out for us.
Low-Carb Protein Shake
A number of my patients have asked what I use personally as a protein supplement and whether I use protein shakes. I’ve struggled to find a great tasting protein shake that does not contain any artificial sweeteners (see my article The Skinny On Sweeteners) that raise the insulin levels. Most of the pre-prepared shakes (including the Adkins, EAS, Muscle Milk, and many others) will significantly slow weight loss and knock you out of ketosis due to an insulin response stimulated by drinking them.
My sweet wife just perfected our family’s favorite high fat, low carbohydrate protein shake. Oh, it’s good and it’s filling. You’ll love it and you won’t be hungry for at least 3-4 hours after savoring this sweet taste-bud sensation.
This is a great shake for a mid-meal snack or a quick meal on the go.
Dr. Nally’s Low Carb High Fat Protein Shake:
- 3/4 cup of frozen strawberries
- 1 tbsp of extra virgin olive oil or coconut oil
- 1 scoop of ISO-100 Gourmet Berry flavor protein powder (carb free)
- 1-2 drops liquid Stevia
- 1 1/2-2 cups of heavy whipping cream
[One serving (~ 2 cups) is 4.5 grams of carbohydrate]
Blend to preferred texture. . . (may add more heavy whipping cream if it is still too thick).
Enjoy!!
Burnout
Ask yourself the following questions:
- Does your job limit interaction with people and/or do you spend most of your time with a computer screen?
- Have you become cynical or critical at work?
- Do you drag yourself to work and have trouble getting started once you arrive?
- Have you become irritable or impatient with co-workers, customers or clients?
- Do you lack the energy to be consistently productive?
- Do you lack satisfaction from your achievements?
- Do you feel disillusioned about your job?
- Are you using food, drugs or alcohol to feel better or to simply not feel?
- Have your sleep habits or appetite changed?
- Are you troubled by unexplained headaches, backaches or other physical complaints?
These are the ten most common signs of “burnout.” 46% of respondents in surveys indicate at least one of the above symptoms of burnout. Two or more of these imply that you are suffering from some degree of “burnout.” The classic triad of burnout is:
- Exhaustion
- Cynicism
- Questioning the quality of your work, or questioning whether you are making a difference in the world any longer
What is burnout? It is defined by “Mr. Webster” as “physical or mental collapse caused by overwork or stress.” But, that definition doesn’t seem to do it justice, and many people experiencing burnout don’t actually “collapse.” They do, however, become significantly less productive, depressed, and loose the enjoyment of life. Work begins to feel like slavery, exercise becomes a chore, food begins to have associations with guilt, friendships are seen as obligations and love looses its luster and looks more like a social construct.
Burnout is often likened to discontent, however, these are two very different emotional feelings. Discontent can be defined as dissatisfaction with ones circumstances. There are two kinds of discontent in this world: the discontent that works and the discontent that wrings its hands. The first kind often gets what it wants and the second looses what it has.
Burnout differs from discontent, in that continued work toward a goal brings on the triad of emotional exhaustion, depersonalization and the feeling of reduced personal accomplishment. Burnout is, in reality, the sum total of hundreds of thousands of tiny betrayals of purpose.
Burnout can occur in any field of work, however, a study published in the 2012 issue of JAMA reveals that over 40% of the ~800,000 U.S. physicians are experiencing burnout and are more prone to burnout than any other worker in the United States. The journal Academic Medicine recently reported that medical students, when compared to age-matched fellow college graduates, reported significantly higher rates of burnout.
So, how do you overcome burnout?
I’m an Osteopath. I see disease in the context and inter-relationship of the mind, body & spirit. Overcoming burnout requires one to restore balance in these three areas. I am impressed by the work of Charlie Hoehn in his book, Play it away: A workaholic’s cure for anxiety. Charlie does a wonderful job of describing the broken inter-relationship of the mind, body and spirit in a person experiencing burnout.
The first step to repairing the broken inter-relationship is to recognize and remove those anchors keeping you tethered to the feelings of burnout. The anchors are the stressors that cause you to worry on a daily and weekly basis. Journaling these stressors, writing them down in 3-5 word sentences is the start. Identify which of these stressors is the biggest or causes the most angst, then write out the following question. “How can I eliminate [stressor] from my life? Do this with the largest two or three stressors. Then write out a solution that is small and uncomplicated to each stressor. Put the solution to work immediately. If your solution has not improved your feelings of stress and anxiety within a week, then drop the first and try to find a second stressor, or otherwise switch to a second solution. Journaling these thoughts, questions, feelings and answers allows your mind to change from a self-centered focus to an action based focus. It clears the mind to move into action. Nothing is more important in reducing burnout, than nourishing the imagination. Using a journal helps stimulate thought and the imagination.
The second technique is scheduling some real play. Write down the five most fun activity involved with play that you did as a child. Then, set aside dedicated time for your favorite activity of play. It is essential that you actually schedule this play time into your daily activities. There are a couple of rules associated with play time.
- Disconnect from all social media
- Harmony of the playtime is more important than winning
- Have some serious fun
- Shoot for 30 minutes of play time per day
- This should ideally be done outside in the fresh air and sunlight
“A lack of play should be treated like malnutrition: it’s a health risk to your body and your mind.” (Stuart Brown)
“Play is the highest form of research.” (Albert Einstein)
Technique number three is related to sleep. It is essential that you have a consistent bedtime and give yourself the opportunity to take an afternoon nap. You can optimize your sleep by turning off electronics before getting into bed, going to bed at the same time each night, decreasing the room temperature to 68-70 degrees Fahrenheit, draw the curtains to make the room dark, and use a relaxing loop of quite background sound like ocean waves, or the sound of a trickling stream to ease your mind (can be found on a number of apps).
It may take up to a week for your body to unwind and get used to this schedule. Also, schedule a 20 minute afternoon nap.
Meditation and/or prayer is the fourth technique. Sit or kneel, close your eyes and observe the thoughts that enter your mind for 10-15 minutes. Listen to and keep your breathing calm and deep. Pay attention to the rhythm of your breathing. Reading can also be a form of meditation and has become an important refreshing part of alleviating burnout. We can only be as good as the books that we read. Read, ponder over and talk about good books.
Fifth, eat healthy meals with healthy friends. Decrease the carbohydrates and increase the good omega 3 fats in your diet. The insulin response to carbohydrates stimulates the inflammatory and parasympathetic nervous system making you more fatigued and tired. Reduce the bread, rice, pasta, potatoes, carrots and corn intake in your diet.
Increasing the good fat in your diet (like Kerrygold Irish Butter, Coconut Oil, Olive Oil, and real animal fats) actually increases your bodies access to essential B vitamins and improves the use of Vitamin D. Making dietary changes become a habit is often easier when it is done with a friend. Schedule opportunities to eat healthy meals with family or friends attempting to do the same thing. You will help support each other and be more likely to succeed.
The last recommendation is spend time in nature. One weekend a month spend at least two hours out in nature. Take a hike, go on a nature walk, go camping, swim in the river, etc. Give yourself permission to unplug during these times. Then, pay close attention to how you feel when your in different environments.
In the words of Shakespeare, “Self-love, my liege, is not so vile a sin/As self-neglecting” (King Henry V, Act 2, scene 4).
I conclude with the rhetorical question, “If you work for a living, why do you kill yourself working?” (The Good, The Bad, and the Ugly)
Stress . . . . The Weight Loss Killer
Has your weight loss plateaued? Are you struggling to meet your weight loss goals? Have you struggled to lose weight in spite of doing everything “correctly?” Are you still struggling with those last few pounds?
You’re not alone. Many of my patients, myself included, have found themselves “stuck” in their weight loss progression. There are a number of reasons you may not be loosing weight, but one that I am seeing more and more frequently is “Pseudo-Cushings’s Syndrome.” Pseudo-Cushing’s Syndrome is a physiologic
hypercortisolism (high level of cortisol) that can be caused by a number of problems:
- Physical stress
- Severe bacterial or fungal infection
- 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 a raised cortisol secretion. Chronic stress induces hyperactivity of the hypothalamic-pituitary-adrenal axis causing an over production of cortisol and normalization of their cortisol levels occurs after resolution of the stressor. This cortisol response is not high enough to lead to a true Cushing’s Syndrome, but effects ones ability to loose weight.
I suspect this is becoming 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 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 into glucose) for fuel. Cortisol, also, shifts the storage of fats into the deeper abdominal tissues and turns on the maturation process of adipocytes (fat cells). In the process, it suppresses the immune system to decrease inflammation during times of stress (7,8,9). In the short run, this is an important process, however, when cortisol production is chronically turned up, it leads to abnormal deposition of fat, increased risk of infection, impotence, abnormal blood sugars, head
aches, hypertension and ankle edema, to name a few.
The chronic elevation in cortisol directly stimulates an increase in insulin by increasing the production of glucose in the body, and cortisol blockaids the thyroid axis. Both of these actions halt the ability to loose weight, 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 (10-11).
How do you test for Pseudo-Cushing’s Disease?
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.
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.
So, the take home message . . . It’s not the stress that’s killing us, it’s our reaction to it.
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.
Coconut Flour Conversion Chart
For those on a ketogenic or low-carbohydrate diet, whole wheat flour or almond flour is often substituted for with coconut flour. Found this cool chart at “Maria Mind Body Health.” Maria Emmerich has given me permission to post it here for you, my wonderful patients and followers.
We use many of Maria’s recipes in my home, but occasionally you may want to convert your own recipe and this chart will help. My wife is the cook in our family, and probably already knows how to do this, but for those just beginning your ketogenic journey, this will be a big help in recipe conversion.
I’ve had patient’s ask me in the room how to substitute for flour. Here’s the answer. Remember, you have to double the eggs per cup. Thanks Maria!!