Low Carb Cheese Cake

My amazing wife, among her many talents, makes a wonderful low carb cheese cake.  She has taken the recipe found in Maria Emmerich’s “Secret Weight Loss Recipes” and modified it to our family’s taste.  It has quickly become one of my family’s favorites.

Low Carb Cheesecake = 1 gram carb per serving
Individual spring-form serving pans
2 cups almond flour
1/4 cup coconut flour
1/2 cup butter melted
Pinch of salt
1/2 cup erythritol
Mix and press into spring-form pan.
5 (8 oz) packages cream cheese, softened
1 cup erythritol and 1 tsp liquid Stevia
1 TBS vanilla
1/2 cup whey Protein
1 cup sour cream
3 eggs
Preheat oven to 350F. Mix cream cheese, sweetener, protein and vanilla with an electric mixer until blended. Add eggs one at a time, mixing on low after each until blended. Blend in sour cream and pour over crust. Place a pan of water on the lower rack place cheesecake on rack above. Bake for approximately 45 minutes until set. Watch carefully!
Refrigerate overnight.
Freezes well too!
My wife will often bake them in individual sized pans (as in the picture above) so that I can pull one out of the freezer, let it thaw and cover it in whip cream and a sprinkle of berries.  Tastes fantastic!
One serving is = 1 gram of carbohydrate.

Low Carb Chocolate Chip Cookies

Low Carb Chocolate Chip Cookies

I love chocolate chip cookies! However, over the last seven years, as I have followed a low carbohydrate diet I have not been able to indulge my chocolate chip cookie craving — until recently.

My gorgeous and very ingeniousness wife has perfected her chocolate chip cookie recipe and – Oh, WOW . . .are they good.
Warm, tasty chocolate chip cookies that are actually good for you, served up by a beautiful blond in a very cute apron. . . I think this is what heaven is like.

Low Carb Chocolate Chip Cookies

Here is a snapshot of the remaining batch my wife made at our house the other day before they got eaten.  Boy, are they good. Here is the recipe:
Low Carbohydrate Chocolate Chip Cookies
1 tsp vanilla
2 eggs
2 sticks (1 cup) of butter, softened
1/2 cup Sweet Perfection
1/4 cup erythritol
1/4 cup Just Like Sugar (chicory root sweetener)
1 tsp salt
1 tsp baking soda
1 tsp baking powder
1 1/2 cup almond flour
1 cup coconut flour
1/2 cup Carbalose flour
2 ChocoPerfection Milk Chocolate bars chopped
Mix the vanilla, eggs, butter and sweeteners until creamy or fluffy. Add in all dry ingredients and mix. Add chocolate and mix. Place dough on parchment paper covered cookie sheets in 2 tsp sized scoops.
Bake at 350 degrees for 8-10 minutes.
Makes 45-50 cookies
(~ 2 net carbohydrates per cookie)

What’s Yours . . . ?

How To Start the Weight Loss Journey

Yes.  Weight loss is a journey.  It has been a journey getting to where you are, and it will be a journey getting back to that smaller size you’ve been thinking about.  So, how do you start this new path on your journey?
Great question.  That’s the question that I am asked every day by those wanting to start loosing weight. The first step is the desire to start. In the words of Napoleon Hill, “Desire is the starting point of all achievement, not a hope, not a wish, but a keen pulsating desire which transcends everything.”

First, Know Where You Are Coming From.
Get a journal and weight yourself.  Write it down and then check your weight every 2-3 days.  Don’t weigh yourself every day.  This can be discouraging and many people fluctuate 2-5 lbs every day based on meals and water intake.  
Keep a journal of your diet, plan and record your meals.  If you are being followed by a weight loss specialist, they will want to see this.  Record every thing you eat.  PlanAnd, record your water intake.  I am amazed at how many of my patient’s are dehydrated and just putting water back into their systems help them loose weight.

Second, Plan Your Day.
Planning is the key to weight loss on any program.  
You should plan your exercise and plan your meals the night before.  Failing to plan is really just planning to fail. 

Skin Tags

Skin Tags

Acanthosis Nigricans

Acanthosis Nigricans of the Neck-line

Third, What’s the Underlying Cause?You can’t loose weight unless you understand why you are gaining weight.  Two thirds of my patients are insulin resistant to some degree.  This is usually the cause of their individual weight gain.  This is why some patient’s gain more weight than others eating and exercising the same way.  Your doctor will need to identify this through blood work.  If your waist circumference is larger than 40 inches as a male or 35 inches as a female, you’re probably insulin resistant. As a rule of thumb,  if you walk toward the wall and the first thing that touches the wall is your belly, you’re insulin resistant.   If you have skin tags or thickened browning skin at areas of skin folds, you are probably insulin resistant.

Insulin resistance requires a dramatically different dietary approach than the low fat diet or calorie restricted diet.  If you are insulin resistant a low fat diet will not be very effective and you may even gain weight on a low fat diet.  If you have any of these symptoms, you need to follow up with your doctor or weight management specialist.
Loosing weight is possible.  As a journey, it will probably have a number of components that will be necessary to make it effective for you. Either way, enjoy the journey!!

Fat Thoughts . . .

As a bariatrician, I think about fat all the time.  I guess you could say I have a lot of “fat thoughts.”

I frequently hear patient’s tell me, “Dr. Nally, I’m eating RIGHT, but I’m just NOT losing weight!”

If you’re not losing weight, your not eating correctly. 99% of your weight loss success is related to your diet. We have been poorly misinformed over last 40 years as to what a “correct” diet contains. We’ve been told to follow a low fat diet for the last 40-50 years.  However, it is very apparent as patient’s follow a low fat diet that only a small percentage of them have success in weight loss, and the majority actually gains more weight and remains significantly hungry.  When you look at the body’s physiology, fat restriction only stimulates increased hunger.  The intake of any form of carbohydrate, whether that be simple or complex, stimulates an insulin response.  Based on our genetics, that insulin response can be variable. some of us respond normally and others respond with between 2-10 times the normal insulin surge.  Insulin is actually the hormone that drives weight loss or weight gain.
You and I will not be able to effectively lose weight until we control the response of insulin, and this can only be done through carbohydrate restriction.

Inflammation Killer – A Ketogenic Diet


Symptoms of Inflammation seen in Diabetes Mellitus

A recent study published in the Annals of Internal Medicine demonstrate significant improvement in overall inflammation in type II diabetic patients following a carbohydrate restricted diet versus a low fat calorie restricted diet.  Another bit of proof demonstrating what I’ve been seeing in my office over the last 8 years.  The study reveals significant improvement in glycemic (blood sugar) control in those following a low carbohydrate diet as well as significant lowering of C-reactive protein, IL-1 and IL-6 over those following a low fat diet. You can see the study here.

Ketogenic Diet Reduces Diabetic Nephropahty

A common problem that arises in patients with diabetes is that of “nephropathy.”  Nephropathy is damage to or disease of the kidney.  In diabetic patients,Image they commonly begin to loose the ability to adequately filter and retain microscopic protein needed in the body. As the blood sugar and insulin levels progressively rise over time, damage to the delicate filtering system of the kidneys occur.
Very impressive results revealing improved kidney function were found in both Type I and Type II diabetic mice placed on a low carbohydrate, or ketogenic, diet in just and 8 week period of time. The nephropathy (reduced passage of protein through the kidneys) was completely reversed in all the mice. This is the first in what I suspect will be a series of articles showing that ketogenic diets have significant effect on reversal of age related and diabetic tissue damage.  See the article here.

I Like My Green Eggs & Ham . . .

sam i am

Green Eggs & Ham

You know, Dr. Seuss was right, the whole egg is actually good for you.
A recent study from the University of Connecticut demonstrated that eating the whole egg actually decreases LDL (the bad cholesterol) sub-particles and insulin resistance in Metabolic Syndrome better than the egg white or the egg substitute. 

I like green eggs and ham!
I do!! I like them, Sam-I-am!
And I would eat them in a boat!
And I would eat them with a goat…
And I will eat them in the rain.
And in the dark. And on a train.
And in a car. And in a tree.
They are so good so good you see!

Fat Thoughts on Cholesterol

As a medical bariatrician and family practitioner specializing in low-carbohydrate diets, I often see the panic stricken look on people’s faces when they look at their cholesterol profiles just after starting a carbohydrate restriction life-style.  

First, it is very important to understand that if you check your cholesterol within the first 4-6 weeks of dietary changes, there will be a transient rise in the cholesterol profile as your adipose tissues (fat cells) release your new fuel source into the blood stream and the mitochondria in the one trillion cells in your body convert from the use of glucose to the use of ketones (derived from triglycerides) as the primary fuel source.  This is not a problem as the body is designed to handle this increase in triglyceride and cholesterol. I explain to patient’s that we are essentially making the figurative change from “un-leaded fuel to diesel fuel.”

Second, the standard cholesterol profile does not give you a true picture of what is occurring at a cellular level.  The standard cholesterol panel checks 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” stands for a calculation usually completed by the lab. 


Cholesterol Particle Sizes

Total cholesterol, HDL and triglycerides are usually measured and LDL-C is measured using the Friedewald equation [LDL = total cholesterol – HDL – (triglycerides/5)].

Third, it is also important to realize that HDL and LDL are actually transport molecules (the buses for the triglycerides (the passengers). HDL is taking triglycerides to the fat cells and LDL is taking triglycerides from the fat cells to the muscles and other organs for use as fuel. 

When you being a low carbohydrate diet, your blood glucose availability as the primary fuel source drops and triglycerides become the primary source.  It takes your body 4-6 weeks to increase the number of mitochondria necessary to effectively use triglycerides as the primary fuel.  (This is why many athletes and patients who are active will feel slightly sluggish during their exercise for the first few weeks). 

Once your body accommodation to the new fuel, there will be a notable drop in LDL-C and a rise in the HDL.

But this still doesn’t answer the question and relieve the panic seen above. A deep sigh and the look of relief occurs when I explain that LDL-C doesn’t give us the real story.

To make it simple and understandable, LDL is made up of three main sub-types  big fluffy ones, medium sized ones, and small dense ones. It’s the small dense ones that contain lipoprotien A [Lp(a)] found in increased vascular risk. Recent studies reveal that heart disease and atherosclerosis is caused by the small dense LDL molecules.

A low carbohydrate diet causes the small dense cholesterol to drop and there is a rise in the two other sub-types   This shift in sub-types can actually elevate the Total Cholesterol number and occasionally the LDL-C.

If you are following a low carbohydrate diet, get your cholesterol levels checked.  It is more ideal to get an NMR Lipoprofile or VAP Cholesterol test that will give you an LDL particle number and this can be explained more fully by your doctor.

Now, off to the fridge . . . where did I put that package of bacon . . . ?

FDA Approves Avantame (New Artificial Sweetener)

ImageThe FDA approved an intense new artificial sweetener, Advantame. Because of its chemical similarity, Aspartame now has a super sweet cousin. This sweetener, 20,000-37,000 times more sweet than table sugar (sucrose), is found in powder form and dissolves in water. However, it does partially break down when exposed to heat or used in heated drinks, so it may not be that great for cooking.
Similar to Aspartame, one of the breakdown metabolites is phenylalanine, implying that those with sensitivity to phenylalanine or PKU may need to avoid it, however, the amount of phenylalanine produced when ingested was felt to be fairly negligible.

My interest was peaked by the fact that Advantame does not raise blood sugar or insulin levels in the multiple animal and three humans studies reviewed here and here. This implies that it probably won’t cause weight gain and the studies in animals actually revealed some negligible weight loss.

The FDA claims this is a very safe artificial sweetener due to it’s intense sweetness and requirement for only small quantities to be effective. In fact, Josh Bloom from the American Council on Science and Health was quoted saying that, “About the only way this stuff could harm you is if you were run over by a truck that was delivering it.”

From the perspective of weight loss, this may be another sweetener that could be used effectively on a carbohydrate restricted diet.

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