Vitamin D’s Effect on Weight and Obesity

Vitamin D plays an interesting role in may aspects of human health. It plays a role in disease prevention including osteoporosis, some cancers, autoimmune disorders, hypertension, diabetes and has recently been found to effect weight loss.

VitaminD1What is Vitamin D?  It is an oil-soluble (fat-soluble) vitamin that helps in the absorption of calcium and phosphorus in the intestine and suppresses parathyroid hormone (PTH), the hormone that stimulates bone resorption (breakdown). Vitamin D also plays a role in muscle function and in the immune system, but our understanding in these roles are still limited. (1)
Vitamin D can be found in fatty fish, cod-liver oil and eggs. In the United States, cow’s milk is supplemented with Vitamin D and this is often the source from which most people obtain it. Deficiency in Vitamin D often occurs from lack of sun exposure, inadequate intake, surgery to or damage of the intestines ability to absorb, or from kidney or liver damage resulting in problems processing Vitamin D. Recent studies reveal that obesity is a major factor in altering the way the body uses Vitamin D and stimulates PTH.Vitamin-D_Sun

I find that about 30-40% of my patients are Vitamin D deficient.  Many researches claim this is due to poor sun exposure or the use of sun screens, however, I live in Arizona.  Sun “over exposure” is usually the problem here, yet I still find that 30-40% of my patients are deficient.  My patients should be able to get enough sunlight walking from their cars to the grocery store entrance.  I disagree that “lack of sun exposure is the cause.”  Although our current labs claim vitamin D levels should be above 20 ng/dl, I find people do not get the needed effect until 25 Hydroxy-Vitamin D levels should are greater than 32-35 ng/dl.
Poor Vitamin D intake is usually the problem.

Our bodies convert 25 Hydroxy-Vitamin D into the active molecule 1,25 Dihydroxy-Vitamin D.  Recent studies reveal that higher Body Mass Index (BMI) leads to lower conversion of 25 Hydroxy-Vitamin D to 1,25 Dihydroxy-Vitamin D. (2,3)

Simply adding 25 Hydroxy-Vitamin D as a supplement frequently helps with weight management in many of my patients. Supplementation with 1000-2000 IU is often adequate.  Higher doses should be discussed with your doctor.

1C P Earthman, L M Beckman, K Masodkar and S D Sibley. The link between obesity and low circulating 25-hydroxyvitamin D concentrations: considerations and implications.International Journal of Obesity (2012) 36, 387–396; doi:10.1038/ijo.2011.119; published online 21 June 2011.
2. Frost M, Abrahamsen B, Nielsen TL, Hagen C, Andersen M, Brixen K. Vitamin D status and PTH in young men: a cross-sectional study on associations with bone mineral density, body composition and glucose metabolism. Clin Endocrinol (Oxf) 2010; 73: 573–580.

3. Konradsen S, Ag H, Lindberg F, Hexeberg S, Jorde R. Serum 1,25-dihydroxy vitamin D is inversely associated with body mass index. Eur J Nutr 2008;47: 87–91.

Interview with Howard Harkness of “N=1 Health”


Howard Harkness interview with Dr. Nally

While on the 2014 Low-Carb Cruise a few weeks ago, I had the wonderful pleasure of being interviewed by “N=1 Health‘s” Howard Harkness.  We had very nice conversation and discussed a number of topics relating to obesity medicine, weight loss, carbohydrate restriction and some of the history of medicine.  Take a look at the interview here on N=1 Health.

Thanks, Howard!

How Does Stress Cause Weight Gain?

Have you been under a great deal of stress lately?  Have you been struggling with your finances?  With your job?  Do you have ongoing struggles in your personal relationships?  Are you carrying a heavy load in school?

I frequently find that many of my patients will experience weight loss plateaus due to stress.  Patient’s frequently ask how this occurs.  The simple answer is this: our bodies are designed with a “fight or flight” response.  

If you’re in the woods and you stumble upon a bear, the sudden recognition of significant danger (you recognize that those extra few donuts will make you quite the tasty treat for the bear) will stimulate and immediate release of protective hormones into your blood stream including adrenaline and cortisol. Adrenaline increased your heart rate, dilates the blood vessels to your muscles and increases your respiratory rate.  Cortisol is the hormone that stimulates increased glycogen release from the liver.  Glycogen is a form of sugar made available so that you can immediately fight the bear or run from the bear, and the glycogen response raises your insulin level so that that fuel can be pulled right into the cells needing it.  The adrenalin and cortisol, among other hormones, are released so that blood can be shunted from your stomach and intestines to your muscles and brain to more effectively enable you to finish fighting the bear, or out run that drooling growling bear hot on your heels.

Most of us will never “stumble across a bear,” however, your boss may confront you about how you handled a recent assignment or may drop an extra pile of work on your desk.  You may run short on your finances this month, have a serious disagreement with your significant other, or someone may cut you off in traffic causing a near accident.  Any or all of these stimulate the identical “fight or flight” response. Whether the bear or the traffic, the same adrenalin and cortisol response occurs.

How does that keep you from loosing weight?  The elevated cortisol causes a cascade effect raising your insulin levels.  Insulin will remain effectively elevated in the blood stream for the next 4-12 hours.  Insulin is the primary hormone driving and stimulating weight gain.  If you’ve had 2 or 3 stressful events throughout the day, and you have not had the opportunity to burn off these stress response hormones, your body will store and/or continue to gain weight throughout the entire day.  If you have been trying to loose weight, the spike in insulin halts the weight burning process and may actually bump you out of ketosis (the process by which we burn fat as the primary fuel source) for the next 4-12 hours.
How do you prevent this from happening?  A simple 15-20 minute walk 3-5 times per week is enough to decrease the stress hormone surge that occurs from a “fight or flight” response.  Any regular exercise program will decrease these stress hormones.  Adequate sleep also decreases these hormones.
So, if your job is stressful, incorporating an exercise program as simple as a daily walk for 15-20 minutes per day will keep the proverbial “bear in the woods” from catching up to you because of your weight.

The Real . . .

Mom’s Cream Cheese Waffles

Mother’s Day is a great event in our home, and traditionally, it is a chance to make breakfast for Mom.

In our home, Mom has always loved waffles.  But changing to a low carbohydrate diet put a damper on the waffles for a while, until my sweet wife found and perfected the following recipe. (She adapted this recipe fromJennifer Eloff’s Cream Cheese Bran Waffle recipe found in her book, Splendid Low Carbing for Life Vol 1.) These waffles are amazing! They are now lovingly referred to in our home as “Mom’s Cream Cheese Waffles.”
Because I’ve found that Splenda© spikes the insulin and slows weight loss in a significant percentage of my patient’s we’ve changed up the sweetener below.

Breakfast for Mother’s Day in our home consisted of Mom’s Cream Cheese Waffles, freshly grilled thick slice bacon and strawberry flavored homemade whipped cream to top off the waffles and was easily prepared by my 13 year old daughter.  It’s a perfect Low Carb Mother’s Day meal that’ll satisfy the waffle craving and still give the gift of “ketosis”.


Cream Cheese Waffles

Mom’s Cream Cheese Waffles

16 oz regular cream cheese (softened)
6 eggs
1 cup wheat germ
1/4 cup heavy cream
1/4 cup water
1/2 cup erythritol
1-2 drops liquid Stevia (add to taste)
1 tsp baking soda
1 tsp baking  powder
1/4 tsp salt
In a food processor or electric mixer, blend the cream cheese until smooth.  Add the eggs and continue to blend.  Add the Carbalose flour, wheat germ, cream, water , Splenda, baking soda, baking power and salt.  Continue to blend.
Pour 1/4-1/2 cup onto hot greased waffle iron. Close and cook for approximately 3 minutes.
Yeild: 12-16 “plate sized” waffles
1 Waffle: approx. 7g protein, 9g fat, 1g carbs


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!!

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