Relentless mental bombing of the citizens of the world and particularly the United States with thought control in the form of propaganda and censorship has been the drive behind the reason so many of my patients have been unvaccinated. A significant majority in my practice are unvaccinated because the others were mentally conditioned so avoid “quacks” who use “horse de-wormers” as part of their treatment protocol.
Immensely satisfying as it is to help so many people feel better quickly while avoiding hospitalization and death, it has also been very traumatic. I have listened to hundreds of stories of patients as they relate the events that occurred to them because of their unvaccinated status. Story after story of job loss, retracted invitations to weddings, seeing newborn grandchildren, baby showers and family reunions, travel restrictions, restrictions from attending concerts, restaurants, movies and even being banned from Christmas with vaccinated family members. This is only made worse as they have been estranged from church, friends, family and colleagues who disinvited them to holiday gatherings or other work events.
Another source of trauma is the stories from my vaccinated patients who trusted the authorities when they said they are “safe and effective” who honestly tried to do what they were being told is the “right thing” for their community and nation. The majority of these people have been now been vaccine injured and/or deeply remorseful after they came to discover that the institutions, they trusted has so egregiously lied to them. I have over 100 in my practice who have suffered blood clots, myocarditis, colitis, fatigue, and neurological damage from their decisions to be vaccinated. What is even worse, is that many of them have suffered the same discrimination after refusing to accept a 2nd, 3rd, or 4th shot, in light of the 6-18 months of post-COVID syndrome fatigue and myalgia they suffered preventing them from functioning normally in society, some of which are still not back to normal.
A third source of major trauma is the reprimands and reports to medical boards from medical staff, hospital organizations, employer organizations and insurance plans for my use of “off label” treatments of my patients. The additional threats to my practice and staff made by these groups to which I used to aspire and admire. Traumatic were the hours I had to spend, and still spend today, defending myself and an advocating for my patient’s rights to be completely informed and chose the medical care they wanted.
To the unvaccinated, those of you who were capable of such personality, courage and critical ability, you are undoubtedly the best of humanity. You are everywhere, in all ages, levels of education, states and ideas. You are of a special kind of soul; you are the soldiers that every army of light wants to have in its ranks. You are the parents that every child wants to have and the children that every parent dreams of having. You are beings above the average of your societies, you are the essence of the people who have built all cultures and conquered horizons. These are those who may look normal, but you are the modern day superheroes.
You did what others could not, you were and are the tree that withstood the hurricane of insults, discrimination and social exclusion. And you did it because you thought you were alone, and believed you were the only ones.
Banned from your families’ tables at Christmas, you’ve never seen anything so cruel. You lost your jobs, let your careers sink, had no more money … but you didn’t care. You suffered immeasurable discrimination, denunciation, betrayal and humiliation … but you kept going.
Never before in humanity has there been such a “casting.” Now we know who are the best on planet Earth. Women, men, old, young, rich, poor, of all races or religions, the unvaccinated, the chosen of the invisible ark, the only ones who managed to resist when everything collapsed.
That’s you, you passed an unimaginable test that many of the toughest Marines, Commandos, Green Berets, astronauts and geniuses could not withstand.
You are made of the stuff of the greatest who ever lived, those heroes born among ordinary men who glow in the dark.
You and I cannot simply hope that this will pass or that someone will save the day. Do NOT comply.
I am honored to have had the opportunity to meet and know so many who have suffered greatly but endured by sticking to truth, principle and mutual support. You are indeed, the best of humanity.
In the last two decades, it has become more and more clear that the average American has trouble facing reality. The average American has trouble facing truth. It affects each of us, and it is affecting physicians, nurses and health professionals individually.
At least once a week, one of my patient’s refuses to get on the scale. Why would you visit the doctor to improve your health, and yet refuse to look at a measure of health? Yet, that is the accepted culture of today.
Language of Euphemism
Another evidence of this can be seen in the changes to our language. Our language has become flowered with euphemism and politically correct phrases. It is why we have a whole generation hyper-focused on “cancel culture.” People have set aside their faith to live by their feelings. People no longer accept another’s right to share their perspective or express themselves, especially if it hurts another’s feelings. We’ve created soft language that has taken the life out of life and medicine.
Shell Shock to PTSD
An example of this change is the softening of language describing what happens to a persons nervous system when in combat. During World War I from 1914 to 1918, if a soldier’s nervous system became overwhelmed due to the fatigue, stress and horror of battle it was called “shell shock.” The term describes the power and struggle that occurs with this overwhelming stress. The word almost echos the rattle of a cannon on one’s soul. Men would return home with hysteria, muscle contractions, heart palpitations, dizziness, depression, blindness, paralysis, insomnia, loss of appetite, flashbacks, nightmares or unable to speak without any physical damage to explain the symptoms. Because little was understood about the cause, it was seen as a sign of emotional weakness. Many were even branded as deserters or cowards because of the condition shell shock would cause. At the end of the war, 80,000 men were diagnosed with shell shock in the British Army medical facilities.
But instead of addressing the pain and addressing the trauma, we buried it under the jargon and euphemisms. After the second world war in 1945, we toned the term down because we didn’t want to hurt anyone’s feelings describing them as “shell shocked.” So, we called it “Battle Fatigue.” It is the same problem, overwhelming a person’s emotional coping mechanisms and nervous system with stress to the point of failure, but “battle fatigue” just sounded better, and softer.
Enter the Korean War of 1950-1951. Actually, we softened that too. It wasn’t really a war, we were told, and our leaders turned it from war into a softer more acceptable “Korean Conflict.” Men and women who encountered the same overpowering effects on the nervous system from witnessing the horror of battle, death and destruction were told they had “operational exhaustion.” This was an even softer term that allowed for a further avoidance of the truth.
Five years later, the U.S. entered a 19 year “conflict” with Vietnam. The politicians of the time didn’t want to call it war either. The same trauma causing shell shock in World War I was experienced by men and women in Vietnam. Seeing the horrors of battle on a daily basis and only being allowed to police those attacking you with guerrilla warfare in a foreign country led to severe trauma in many of our soldiers. Fighting was intense and millions of people were killed including 60,000 U.S. soldiers. Yet, we further softened the term “operational exhaustion” with the same symptoms of shell shock to “Post-traumatic Stress Syndrome (PTSD).” (Hey, at least they added a hyphen, right?)
Waking The Tiger – Working Through Trauma
Trauma is trauma, no matter how or where you experience it. Because of it’s complexities, the treatment of trauma can’t be addressed here, but according to Peter Levine in his book Waking the Tiger, trauma, no matter what the cause, must be worked through. Peter Levine does a wonderful job in explaining this in his second follow up book In An Unspoken Voice. There are additional treatments for burnout. The brain has a consistent pattern that it follows to resolve trauma and burnout. If that pattern is disrupted, shell shock, battle fatigue, operational exhaustion or PTSD ensues.
Elizabeth Metraux describes this in her 2018 article this way: “I was on my honeymoon in Colombia when I first became aware of the true extent of my post-traumatic stress disorder. My husband and I were walking across a smooth, granite platform to take a closer look at a fountain in downtown Cartagena. As we neared the structure, mist from the fountain’s jets dampened the ground at my feet.
“I froze, paralyzed with fear by a flashback — my first — triggered by something as ordinary as wet pavement on a warm day.
“Two years earlier, I was working in civic engagement efforts in Baghdad. One morning, as I walked across a smooth, granite platform toward my apartment, gunfire erupted. I tried to run, but my flip-flops bested me on the pavement, still damp from an early mopping. I slipped and fell backward, hitting my head hard enough to knock me out. When I opened my eyes minutes later, the platform was covered with my blood.
“That happened 15 years ago this week, those Ides of March when American forces invaded Iraq.
“Back home in the U.S., it was clear to those around me that I had PTSD. It wasn’t until six months after my honeymoon, however, that I had the courage to acknowledge that I needed help. It’s not easy seeing your own weaknesses, much less conceding them. But when my habitual glass of wine with dinner became a bottle, and fireworks left me sore and sleepless for days, it was hard to fight the signs.
“Celexa for guilt. Ambien for sleep. Therapy for months. My psychologist and primary care physician spoke regularly to coordinate my care. Most importantly, family and friends became members of my care team. Isolation is a trauma victim’s ill-advised drug of choice, one my loved ones and clinicians wouldn’t let me take.”
Most Physicians Suffer from Moral Trauma combined with PTSD
What concerns me is that many of today’s heath-care workers, physicians and nurses, suffer from PTSD and moral trauma. Dr. Metraux goes on to describe a conversation she has that is reminiscent of many recent conversations I’ve had with my colleagues:
“A few weeks ago, I was talking with a physician who served our country in Iraq. We chatted nostalgically about the taste of sand and shawarma before he said something that gave me pause: ‘You know, I’d go back to the field any day. Beats practicing in my clinic.’
“‘Why’s that?’ I asked.
“’I didn’t become a doc to put up with billing codes and power struggles. I thought that PTSD would hit when I came home from Fallujah. It’s so much worse when I come home from the office. Truth is, I’ve lost my sense of purpose.’”
Physician burnout is easily chalked up to the 4-8 minute hurried visit with 30-40 patients per day, and the additional 6-8 hours spent each day entering patient information into an electronic medical record, combined with the life-and-death decisions this profession requires routinely every day. Add to it a time when a physicians and nurses are called upon to be the only people in the clinics and hospitals taking care of a viral infection still unknown in its full spectrum. But, that doesn’t even scratch the surface.
Thousands of Tiny Betrayals of Purpose
The real cause of injury is the fear created by a society that doesn’t really want to hear or face the truth, and the hundreds and thousands of tiny betrayals of purpose that occur every day in the clinic or the hospital. Most physicians find themselves expressing horror and disgust at how far they’ve been steered away from their primary purpose of taking care of people. Clinicians and nurses, much like combat veterans, are forced to take actions every day that contradict their core purpose – sometimes compulsory, sometimes voluntary. It causes a slow imperceptible unwinding of character.
The 4-8 minute visit means the physician can’t take time to build a real relationship with you or take care of the whole person whose real diagnosis can’t be logged into a computer. The 8 hours of daily charting requires the clinicians eyes to be taken off their patients, missing the humanity that brought us to the work in the first place. The government mandated “quality metrics” imposed on every patient encounter by Medicare, Medicaid and intrusive insurance plans that crowds out the deeper connection with patients to help them manage triggers, feel truly cared for and navigate treatments. Each of these are a “tiny betrayals of purpose,” 30-40 times a day over the course of weeks and months and years. When you subconsciously betray yourself with every interaction you have throughout the day, it adds up.
Medicine now requires clinicians to practice in a manner inconsistent with their values, because it saves costs, increases access and improves quality, . . . maybe. Then, add a new virus with an unknown morbidity, mortality and infectivity to the spectrum without a clear treatment protocol. Then add to that layers of bureaucratic regulation and mandates around treatment and insurance.
In 20 years of medical practice, including battlefield medicine, I’ve never seen physicians express public fear, angst and fatigue in the course of their duty. I’ve seen it every day in the last year.
We Lose a Physician Every Day
Since 2018, over 400 physicians committed suicide per year. Every day, at least one physician commits suicide (Tanwar D, Amer Psych Asso 2018 Annual Meeting). That is the highest rate of suicide in any profession. 40 suicides per 100,000 is twice that of the general population. This rate is higher than the military. The claim is that doctors are under-treated or untreated for their depression. It is more than that. Doctors and nurses alike are experiencing “shell shock,” or in today’s vernacular, “post-traumatic stress disorder” and being force to live, work and function all while suffering with subconscious moral injury. It goes untreated and unrecognized.
It’s why your doctor is curt with you. It’s why he or she can only spend five minutes with you in the exam room. It’s why you get the sense of fear from them when dealing with COVID-19. It’s why there is confusion about wearing masks and why so many physicians struggle to keep up with the ever changing science. It’s why 30% of them are divorced. It’s why 73% of the physicians and 50% of nurses you meet are effected by burnout, trauma and PTSD.
The challenge, is it’s only going to get worse before it gets better. Some will leave medicine, some will leave life. Others will suffer until it kills them. Unless, you and I change it. Until then, society will be offended.
I’m not sure what it is about this time of year . . . maybe the post-holiday weight gain, or the fear of pulling out a swimming suit in a few months. But I have had a number of people, both men and women, in the office with excessive estrogen levels.
Estrogen excess and estrogen dominance are two hormone abnormalities I find commonly in both men and women in my practice. These two issues are frequently complicating factors that make feeling good and weight loss difficult. They are, also, often the main reasons people don’t see dramatic improvement in a person’s symptoms of energy, fatigue and mental clarity when they’ve already changed their diet and lifestyle.
IMPORTANT NOTE BEFORE WE GO ON: This information applies to patient who already have normal thyroid function and corrected insulin resistance. If your thyroid is off or if you are still significantly insulin resistant, it will affect estrogen and other male and female hormones, so follow a ketogenic diet and get your thyroid balanced FIRST!
What is Estrogen Dominance?
I’ve addressed estrogen dominance in a previous blog post. You can find it here. Estrogen dominance is a condition where there is an abnormal estrogen/progesterone ratio. The estrogen/progesterone ratio MUST be balanced. Normal estrogen levels with low progesterone (this can commonly occur with the use of a synthetic progestin (HRT) in female patients) is a common scenario that falls into the estrogen dominance pattern.
What is Estrogen Excess?
Estrogen excess is a situation where progesterone levels may be normal but estrogen is elevated (an abnormal ratio can also be present in this condition).
The symptoms of excess estrogen can be:
Depression
Fatigue
Poor Concentration
Irregular menstrual bleeding in women
Breast tenderness
Fibrocystic Breast Changes
PMS
Decreased Libido
Uterine Fibroids
Endometriosis
Water Retention/Bloating
Fat Gain around the hips and thighs
Breast and Uterine Cancers
Why is too much estrogen a problem?
Estrogen naturally stimulates cells to grow and multiply. Natural estrogens are essential. But, too much estrogen increases thyroid binding globulin, inactivating the thyroid function causing abdominal weight gain. Too much estrogen changes the body’s ability to remodel bone.
Estrogen is essential to stabilize the inner lining of arteries, however, excessive estrogen doubles one’s risk for stroke and increases the risk of coronary atherosclerosis and heart attack. Too much estrogen increases the size of the prostate, increases risk of prostate cancer and increases the risk of rheumatoid arthritis.
Estrogen excess is an elusive condition. Measuring estrogen levels is not frequently done, and most doctors were never trained to look at the three separate forms of estrogen in men and women. I had no idea this was an issue until about five years ago.
What causes excess estrogen?
The eleven most common causes of estrogen excess are:
Commercially raised meat & dairy products from animals dosed with high levels of bovine growth hormone.
Insecticide or pesticide residues on fruits and vegetables.
Tap water with petroleum derivatives
Paraben containing shampoo, lotion, soap, toothpaste, & cosmetics. Paraben is absorbed through the skin. There is a 100% absorption that misses first pass liver detoxification
Pthalates – soft plastic containing material or plastic wrapped food heated in the microwave releasing xenostrogens into the food.
Artificial sweeteners including MSG (propyl-gallate and 4-hexylresorcinol are the two most common). Canned foods that have been lined with a plastic coating called BPA (bisphenol-A). Most processed foods have some additive that you will want to avoid.
Foods containing soy or soy protein isolate contain unnaturally high amounts of plant estrogens (phytoestrogens).
Red dye #3 (erythrosine and phenosulfothiasize) found in food
Dryer Sheets containing high levels of xenoestrogens. Chronic skin exposure leads to permeation of the xenoestrogens into the skin.
Birth control pills (conventional synthetic estrogen containing hormone replacement)
Tampons and sanitary napkins containing dioxins, chlorine, fragrance, wax, surfactant, and rayon play a role in significant xenoestrogen absorption.
Other diseases can cause estrogen ratio’s to be elevated. These include liver disease, zinc deficiency, excessive alcohol intake, obesity, calcium deficiency, insulin resistance, diabetes, and excessive testosterone therapy.
How does a person naturally decrease excess estrogen if it is present?
Decrease xenoestrogen exposures:
Reduce use of plastics where possible
Do not microwave food in plastic containers
Avoid the use of plastic wrap to cover or microwave the food
Use glass or ceramic containers where possible
Do not leave plastic water containers, especially drinking water, in the sun
If a plastic water container was heated up significantly (like a water bottle being left in the car in the Arizona sun), throw it away.
Don’t refill plastic water bottles
Avoid freezing water in plastic bottles for drinking later
Avoid butylated hydroxyanisole (BHA) as a food preservative
Limit skin care products containing xenoestrogenic substances
Use cruciferous vegetables like broccoli that contain indole-3carbiol (I3c).
Increase Omega-3 fat intake
Exercise
Use rosemary and turmeric (berberine)
Reduce weight
Use Vitamin D
Stop drinking alcohol
Stop smoking
These hormones, like estrogens, progesterone and testosterone can be easily checked by your doctor through blood or salivary testing. The key is a balance in the ratio between progesterone and estrogens.
The two estrogens that are essential to test are:
Estrone (E1)
Estradiol (E2)
These can be ordered through your doctor. Estrogens can take 2-3 months to balance out. It may take some time after making changes to see your levels normalize. Don’t fret.
What if natural methods don’t fix the problem?
When natural methods of lowering estrogen levels are ineffective, then your doctor will recommend treatment. A number of other effective medicinal approaches including:
In my clinical experience, a ketogenic lifestyle is foundational to balancing these hormones consistently and naturally. Carbohydrate restriction by itself corrects many of the diseases of civilization. I addressed this in my book The Keto Cure. For many, there are few more steps necessary to living a long, happy and healthy life.
In my office, in addition to the ketogenic or carnivorous diet, I add on Berberine Plus 500mg twice daily with meals. This has been shown to notably improve the insulin resistance, lower estrogen and improve progesterone naturally.
Years ago, this was hard to find, so I created my own supplement line and these can be found at Ketoliving.com. Go to Ketoliving. com and order your bottle of Berberine Plus right now, before it is too late. I designed my own pharmaceutical grade berberine so that my patients could make sure they are getting real berberine in the doses I want you to have.
The treatment of this issue isn’t difficult. There is much more to come on this subject. I will address each of the progesterone, testosterone, DHEA and sex hormone binding globulin abnormalities in my future blogs. So, keep an eye on my web page DocMuscles.com/blog/.
So, get your hormones checked by someone who understand this problem and knows how to treat it. Second, limit estrogen stimulating sources in your diet and environment. Third, control you diet and order a bottle of Berberine Plus right away.
Over the last 18 years of my practice, I’ve seen tremendous success in helping people improve their health when low-carbohydrate dietary changes are anchored as the foundation of treatment. However, there is still a group of people that struggle with seeing success. Even with the most effective ketogenic dietary control, there are those that see abnormal weight gain, inability to lose weight, poor libido, fatigue, foggy thinking, mood swings, persisting depression, headaches, bloating, breast tenderness, fibro-cystic breast changes, hair loss, and hot flashes. They may not experience all these symptoms, however, many are often present. If you have been following a ketogenic lifestyle and are still experiencing any of these symptoms, you are probably suffering from estrogen dominance.
Estrogen dominance is a condition that elusively effects thousands of women (and men) and your doctor probably doesn’t even know about it. I didn’t know about it. I, like all of my physician colleagues, were trained in school that the symptoms above are related to fluctuations of estrogen as a woman ages (or dropping of testosterone as a man ages). We were, and still are, taught that they are fixed by giving more powerful doses of estrogen or testosterone.
Over the years of my clinical experience, giving more estrogen frequently didn’t work. And, giving men more testosterone didn’t work either. What I found very effective, for many, was changing the diet. And, for about 85% of people, the symptoms list above resolved. However, the cause of the symptoms above in that last 15% of patients I see was still elusive. Examinations, blood tests, and even psychological evaluations never revealed the answer. Giving synthetic estrogen, progestin or testosterone when the blood work showed abnormality partially alleviated some of the symptoms for a few months, but then the patients would end up back in my office with the symptoms having returned.
I’ve found a number of problems following the “standard” medical approach to using synthetic sex hormones.
The first problem is that estrogen, progesterone and testosterone are heavily bound to proteins in the blood. It is only the free component of the three forms of estrogen and progesterone in the body and the free testosterone that acts upon the delicate cells located throughout the body. Blood testing does not account for the levels of free estrogen forms and progesterone effectively. These can only be tested through salivary testing.
The second obstacle is that the synthetic forms of progesterone (progestin), cannot effectively enter the brain. When synthetic forms are used, a person only gets half the benefits of progesterone found in the human body. This is why so many women have depression, anxiety and foggy brain feelings when using the synthetic versions.
The third challenge is that pharmaceutical companies cannot patent a drug that is identical to your human hormones. The chemical structure of the synthetic estrogen, progestin or testosterone must be slightly different. Hormones effectively work on certain aspects of various cells throughout the body, however, progesterone and progestin (the synthetic version found in medroxyProgesterone) DO NOT have the same hormonal effect on each cell. Natural progesterone is broken down by the stomach when ingested. That’s why progestin was invented, however, it doesn’t act the same in the body and only does half the job.
The fourth dilema is that much of our food in the standard American Diet stimulates increased estrogen production or inhibits clearance of estrogen excess through the gut and digestive tract. This happens in men and women. We can get excess estrogen from animals treated with hormones in meats, milk and dairy products. Hydrogenated oils in processed foods change the way estrogen and progesterone are handled in the body. These unstable fats increase the effects of estrogen on the body and amplify the risk for cancers. Excessive omega-6 fatty acids in the diet magnify estrogen receptor response to estrogen.
Estrogen metabolism in the liver and removal in the gut are dependent on vitamins B & E, magnesium and idol-3-carbinol (IC3). Diets without adequate IC3 from glucobrassicin found in leafy green and crucirferous vegetables allow re-uptake of estrogen in the gut leading to high estrogen levels and estrogen dominance. This is where gut health is even more important, and where I see failure in the “carnivore” approach to a ketogenic lifestyle.
The fifth problem is that the more estrogen I give a person, the more estrogen receptors are unregulated to the surfaces of the cells in the body. When that happens, more estrogen is required. Excess estrogen can actually cause many of the same symptoms present in progesterone deficiency including:
Irregular or heavy bleeding
Breast tenderness
Depression
Fatigue
Poor concentration
Fibrocystic breast changes
Decreased libido
Fibroid growth on the uterus
Endometriosis
Water retention and bloating
Fat gain around hips and thighs
Bone mineral loss (osteoporosis)
Hair loss
Skin thinning
Disturbed sleep
Breast and uterine cancer
More estrogen isn’t needed. Balancing natural progesterone with the current estrogen the body is already making is the solution in most cases. This can only be effectively assessed through a salivary hormone test.
In my clinical experience, a ketogenic lifestyle is foundational to balancing these hormones consistently and naturally. Carbohydrate restriction by itself corrects many of the diseases of civilization. I addressed this in my book The Keto Cure. For many, there are few more steps necessary to living a long, happy and healthy life.
The treatment to this issue isn’t difficult. For that reason, much more is to come on this subject. I will address each of the points above in future blogs. However, the first step is get your hormones checked by someone who understand this problem. And, then knows how to interpret it and treat it.
“Doc, if I don’t get my testosterone up, I’m just going to die!”
I’ve been hearing that statement from men more and more often lately. And, the answer isn’t what you’d think.
If you’ve watched late night TV recently, you’ve probably seen the many advertisements for testosterone supplements for low testosterone in men or what is now being called “Low T” Syndrome. It seems like this is the new advertising trend so much that patient’s use the term “Low T” as part of their conversations.
Watch the four minute short below about how your testosterone and sense of fatigue is being driven by your oatmeal or breakfast cereal . . .
Is it that men have just stopped making testosterone? Suddenly, everyone’s testosterone is low and men are complaining about fatigue, libido, and erectile dysfunction . . . or are they?
It’s actually the oatmeal . . . and the breakfast cereals. Clinically, when a man cuts the cereals and oatmeal out of his diet, he actually increases testosterone by 50-150 points within 1-2 months.
If you practice medicine long enough, you’ll see a trend that seems to have arisen as our waistlines have expanded. About half of the men in my office with insulin resistance, pre-diabetes or diabetes have low testosterone levels. But this shouldn’t be a surprise. Type II diabetes, metabolic syndrome and insulin resistance are all driven by an over production in insulin in response to a carbohydrate load in the meal. Patients with these conditions produce between two to ten times the normal insulin in response to a starchy meal. A number of studies both in animal and human models demonstrate that insulin has a direct correlation on testosterone suppression in the blood. This has been demonstrated in both men and women. In fact, glucose intake has been shown to suppress testosterone and LH in healthy men by suppressing the gonadal hormone axis and more predominant testosterone suppression is seen in patient with insulin resistance or metabolic syndrome.
In fact, to put it simply, insulin increases the conversion (aromitization) of testosterone to estrogen in men (it does the opposite in women by interacting with the hormone FSH). Interestingly, leptin resistance has a similar effect. I tend to see the worst lowering of testosterone in men with both insulin and leptin resistance.
What that basically means is that your breakfast cereal or oatmeal decreases your ability to maintain testosterone by up to 50% (1), lowers your ability to stabilize muscle (2), increases your risk for heart attack and stroke and makes you fat!
Death by oatmeal . . . really?
Yes.
How to you improve your testosterone? Supplemental testosterone has been shown to help, but it comes with some risks, including prostate enlargement and stimulating growth of prostate cancer. The most natural way to improve your testosterone is to change your diet.
A low carbohydrate or ketogenic diet turns down the insulin production and allows the testosterone to be available for use by the body. A ketogenic diet has the effect of reducing leptin resistance as well through weight loss. A simple dietary change of this type is frequently seen in my office to increase testosterone by 100-150 points.
What is a ketogenic diet? It is a diet that restricts carbohydrates to less than 30 grams per day, thereby causing the body to use ketones as the primary fuel source. So, for breakfast tomorrow morning, hold the oatmeal (1/2 cup of Quaker Instant Oatmeal is 31 grams of carbohydrates) and have the bacon and eggs. And, rather than have the cheesecake for desert this evening, have an extra slice of steak butter on your rib-eye and hold the potato.
Or, you might consider using a high fat shake with exogenous ketones. This is my breakfast each morning:
Exogenous ketones mixed in sparkling water, 2 tablespoonfuls of coconut oil and my multi-vitamin and I’m usually full until after noon.
Either way, get rid of your breakfast cereals or oatmeal . . . it’s killing ya!
Adrenal Fatigue? Adrenal Insufficiency? Cortisol? PseudoCushing’s Syndrome? What do these terms mean and why are they all over the internet these days? And, what do they have to do with your weight loss?
This was our topic this evening on PeriScope. Katch Dr. Nally speak about this topic with rolling comments at Katch.me/docmuscles. Or you can watch the video below:
If you’re not sure about what this is, you’re not alone. I think I’ve heard the term “Adrenal Fatigue” at lease four times a day for the last three months. If you ask your doctor, they’ll probably scratch their heads too. The funny thing is that “Adrenal Fatigue” isn’t a real diagnosis, but it is all over the internet and it shows up in the titles of magazines in the grocery store every day. There’s even and “Adrenal Fatigue For Dummies” so it must be real, right?!
No. It isn’t a real diagnosis. It is a conglomeration of symptoms including fatigue, difficulty getting out of bed in the morning, and “brain fog” that have been lumped together to sell an “adrenal supplement.” (Sorry, but that’s really what it is all about.) Do a Google search and the first five or six sites describing adrenal fatigue claim the solution is taking their “special adrenal supplement.”
I know what you’re thinking, “Your just a main stream, Western Medicine doctor, Dr. Nally, you wouldn’t understand.” Actually, I do understand.
Adrenal fatigue has risen in popularity as a “lay diagnosis” because many patients show up at their doctors office with significant symptoms that actually interfere with their ability to function, and after all the testing comes back negative for any significant illness, they are told that they are normal. But the patient still has the symptoms and no answer or treatment has been offered. It’s discouraging. . . very discouraging.
That’s because the symptoms are actually the body’s response to chronic long term stress. Many of my patients, myself included, have found themselves “stuck” in their weight loss progression, feeling fatigued, struggling to face the day, with a number of symptoms including cold intolerance, memory decline, difficulty concentrating, depression, anxiety, dry skin, hair loss, and even infertility in some cases. Is it poor functioning adrenal glands? No, your feeling this way because the adrenal glands are actually doing their job!!
If the adrenal glands weren’t working you’d experience darkening of the skin, weight loss, gastric distress, significant weakness, anorexia, low blood pressure, and low blood sugar. The symptoms are actually called Addison’s disease and it is actually fairly rare (1 in 100,000 chance to be exact). So what is causing the symptoms you ask?
There are a number of reasons, but one that I am seeing more and more frequently is “Pseudo-Cushings’s Syndrome.” Pseudo-Cushing’s Syndrome is a physiologic hypercortisolism (over production of cortisol) that can be caused by five common issues:
Chronic Physical Stress
Severe Bacterial or Fungal Infections that Go Untreated
Malnutrition or Intense Chronic Exercise
Psychological Stress – including untreated or under-treated depression, anxiety, post-traumatic stress, or dysthymia (chronic melancholy)
Alcoholism
The psychiatric literature suggest that up to 80% of people with depressive disorders have increased cortisol secretion (1,2,3). People with significant stressors in their life have been show to have an increased corsiol secretion. Chronic stress induces hyperactivity of the hypothalamic-pituitary-adrenal axis causing a daily, cyclic over production of cortisol and then normalization of cortisol after resolution of the stressor. This cortisol response is not high enough to lead to a true Cushing’s Syndrome, but has the effect of the symptoms listed above and begins with limiting ones ability to loose weight.
I’m convinced that this is becoming more and more prevalent due to the high paced, high-stress, always on, plugged in, 24 hour information overload lives we live.
What is cortisol? It is a steroid hormone made naturally in the body by the adrenal cortex (outer portion of the adrenal gland). Cortisol is normally stimulated by a number of daily activities including fasting, awakening from sleep, exercise, and normal stresses upon the body. Cortisol release into the blood stream is highest in the morning, helping to wake us up, and tapers into the afternoon. Cortisol plays a very important role in helping our bodies to regulate the correct type (carbohydrate, fat, or protein) and amount of fuel to meet the bodies physiologic demands that are placed upon it at a given time (4,5,6).
Under a stress response, cortisol turns on gluconeogensis in the liver (the conversion of amino acids or proteins into glucose) for fuel. Cortisol, also, shifts the storage of fats into the deeper abdominal tissues (by stimulating insulin production) and turns on the maturation process of adipocytes (it makes your fat cells age – nothing like having old fat cells, right?!) In the process, cortisol suppresses the immune system through an inhibitory effect designed to decrease inflammation during times of stress (7,8,9). If this was only occurring once in a while, this cascade of hormones acts as an important process. However, when cortisol production is chronically turned up, it leads to abnormal deposition of fat (weight gain), increased risk of infection, impotence, abnormal blood sugars, brain fog, head
aches, hypertension, depression, anxiety, hair loss, dry skin and ankle edema, to name a few.
The chronic elevation in cortisol directly stimulates increased insulin formation by increasing the production of glucose in the body, and cortisol actually blunts or block-aids the thyroid function axis. Both of these actions halt the ability to loose weight, and drive weight gain.
Cortisol also increases appetite (10). That’s why many people get significant food cravings when they are under stress (“stress eaters”). Cortisol also indirectly affects the other neuro-hormones of the brain including CRH (corticotrophin releasing hormone), leptin, and neuropeptide Y (NPY). High levels of NPY and CRH and reduced levels of leptin have also been shown to stimulate appetite and cause weight gain (10-11).
How do you test for Pseudo-Cushing’s Syndrome?
Testing can be done by your doctor with a simple morning blood test for cortisol. If your cortisol is found to be elevated, it needs to be repeated with an additional 24 hour urine cortisol measurement to confirm the diagnosis. If Cushing’s Syndrome is suspected, some additional blood testing and diagnostic imaging will be necessary. Pseudo-Cushing syndrome will demonstrate a slightly elevated morning cortisol that doesn’t meet the criteria for true Cushing’s type syndrome or disease.
How do you treat it?
First, the stressor must be identified and removed. Are you getting enough sleep? Is there an underlying infection? Is there untreated anxiety or depression present? Are you over-exercising? These things must be addressed.
Second, underlying depression or anxiety can be treated with counseling, a variety of weight neutral anti-depressant medications or a combination of both. Many of my patients find that meditation, prayer, and journaling are tremendous helps to overcoming much of the anxiety and depression they experience.
Third, adequate sleep is essential. Remove the television, computer, cell phone, iPad or other electronic distraction from the bedroom. Go to bed at the same time and get up at the same time each day. Give yourself time each day away from being plugged in, logged in or on-line.
Fourth, mild intensity (40% of your maximal exertion level) exercise 2-3 days a week was found to lower cortisol; however, moderate intensity (60% of your maximal exertion level) to high intensity (80% of your maximal exertion level) exercise was found to raise it (12). A simple 20 minute walk, 2-3 times per week is very effective. Find a hobby that you enjoy and participate in it once or twice a week. Preferably, a hobby that requires some physical activity. The activity will actually help the sleep wake cycles to improve.
Fifth, follow a low carbohydrate or ketogenic diet. Ketogenic diets decrease insulin and reverse the effect of long term cortisol production. Ketogenic diets a have also been shown to decrease or mitigate inflammation by reducing hyperinsulinemia commonly present in these patients (13).
So, the take home message is . . . take your adrenal glands off of overdrive.
References:
Pfohl B, Sherman B, Schlechte J, Winokur G. Differences in plasma ACTH and cortisol between depressed patients and normal controls. Biol Psychiatry 1985; 20:1055.
Pfohl B, Sherman B, Schlechte J, Stone R. Pituitary-adrenal axis rhythm disturbances in psychiatric depression. Arch Gen Psychiatry 1985; 42:897.
Gold PW, Loriaux DL, Roy A, et al. Responses to corticotropin-releasing hormone in the hypercortisolism of depression and Cushing’s disease. Pathophysiologic and diagnostic implications. N Engl J Med 1986; 314:1329.
Ely, D.L. Organization of cardiovascular and neurohumoral responses to stress: implications for health and disease. Annals of the New York Academy of Sciences (Reprinted from Stress) 771:594-608, 1995.
McEwen, B.S. The brain as a target of endocrine hormones. In Neuroendocrinology. Krieger and Hughs, Eds.: 33-42. Sinauer Association, Inc., Massachusetts, 1980.
Vicennati, V., L. Ceroni, L. Gagliardi, et al. Response of the hypothalamic- pituitary-adrenocortical axis to high-protein/fat and high carbohydrate meals in women with different obesity phenotypes. The Journal of Clinical Endocrinology and Metabolism 87(8) 3984-3988, 2002.
Wallerius, S., R. Rosmond, T. Ljung, et al. Rise in morning saliva cortisol is associated with abdominal obesity in men: a preliminary report. Journal of Endocrinology Investigation 26: 616-619, 2003.
Epel, E.S., B. McEwen, T. Seeman, et al. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat.
Psychosomatic Medicine 62:623-632, 2000.
Tomlinson, J.W. & P.M. Stewart. The functional consequences of 11_- hydroxysteroid dehydrogenase expression in adipose tissue. Hormone and Metabolism Research 34: 746-751, 2002.
Epel, E., R. Lapidus, B. McEwen, et al. Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior.Psychoneuroendocrinology 26: 37-49, 2001.
Cavagnini, F., M. Croci, P. Putignano, et al. Glucocorticoids and neuroendocrine function. International Journal of Obesity 24: S77-S79, 2000.
Hill EE, Zack E, Battaglini C, Viru M, Vuru A, Hackney AC. Exercise and circulating cortisol levels: the intensity threshold effect. J Endocrinol Invest. 2008. Jul;31(7):587-91.
Fishel MA et al., Hyperinsulinemia Provokes Synchronous Increases in Central Inflammation and β-Amyloid in Normal Adults. Arch Neurol. 2005;62(10):1539-1544. doi:10.1001/archneur.62.10.noc50112.
Ketogenic Lifestyle – the Balance of Endocrinology & Psychology
Over the last few weeks, I’ve had the pleasure of talking to a number of patients and friends about what it means to live a ketogenic lifestyle. A low-carbohydrate or ketogenic lifestyle is different from a low-carb diet. It is different because the definition of lifestyle implies the way a person lives their life that reflects specific attitudes and values, not just how they eat. My recent posts, The Principle Based Ketogenic Lifestyle – Part I and Ketogenic Principles – Part II, focus on fundamental principles making the ketogenic lifestyle one in which balance and grounding in all aspects of life can occur. When the mind, the body or the spirit are out of balance or un-grounded, symptoms of metabolic inefficiency, sickness or disease result.
I have been fascinated, as a family practitioner, that the body produces “warning flags,” when there is dysfunction in one of these areas: mind, body & spirit. These warning flags are byproducts of inefficient inter-related functionality between the body’s systems and it is one of the foundation principles of osteopathic medicine. Prior to the advent of many of our diagnostic techniques today like MRI, CT scan, advanced laboratory evaluations, and ultrasound, these were the only indicators of disease that a physician could identify, and upon which diagnosis was made. These flags often show up on the skin, in the hair or nails, in the complexion, or in general appearance or mannerisms.
Skin Tags (fibroepitheial polyps) under the arm
For example,”skin tags” are now recognized as pathognomonic, specifically indicative, of insulin resistance and will often occur up to 20 years before impaired fasting glucose or diabetes is ever recognized.
Exopthalmos (bulging or protruding of the eyes) from hyperthyroidism
Exopthalmos, or protrusion of the eyes, is pathognomonnic for overactive thyroid function (hyperthyroidism), and spider angiomas occur as a somatic flag that cirrhosis of the liver is present.
Alligator Skin (severe dry skin) found in hypothyroidism
Hair loss and dry skin, or “alligator skin,” represents the exact opposite with an under-active thyroid (hypothyroidism).
Spider angioma seen with cirrhosis
When metabolic pathways get “clogged” or flow of blood, lymphatic fluid or hormones do not reach the destinations they were meant to reach, symptoms of accumulation or poor function begin to arise.
The osteopath is also trained to recognize a corollary Chapman’s Reflex Points that act as flags for dysfunction in specific organs or regions of the body. These points relate directly to what causes the pathognomonic flag. I frequently identify abdominal, adrenal, pancreatic and liver Chapman’s points present in those with insulin resistance, inflammatory diseases, pre-diabetes and diabetes. Understanding how to interpret and use these flags comprises four years of medical school and three to four years of residency and often years of clinical application.
Mental or spiritual pathways can often be bloc-aided by poor recognition of, or refusal to acknowledge, individual truths in our lives. Interestingly, the signs or warning flags of spiritual dysfunction are also expressed physically.
“Oh, no?! Dr. Nally are you going to get all religious on us?”
Maybe.
Over the last 15 years of my medical practice, I’ve witnessed the spiritual component of the “mind, body, spirit” unit, or lack thereof, have profound impact on the body’s ability to heal. Every one of us must defeat what Sigmund Freud called the pleasure principle – the human instinct to seek pleasure and avoid pain, including recollections or memories that are painful. Hiding from these memories because of pain is very common and is part of human nature. We often believe that thinking about or re-living the truth may cause us individual overwhelming un-survivable grief. So, we naturally bury the thoughts and emotions and feelings deep down into our subconscious minds.
In fact, we take irrational risks, busy ourselves, use food or drink for short term comfort and move from one distracting or debilitating relationship to another. We lose and then regain gain weight, become workaholics, hide behind thousands of texts, social media posts and emails in order to protect ourselves from the part of ourselves that we don’t want to think about.
However, when we step away from the distractions and courageously look at our individual history, our personal life story, honestly and completely, feelings of sadness, anxiety, regret and anger may often arise. These painful emotions bring with them essential insights into how experiences will help you and I individually grow, become a better people, and help others along the path. It takes faith to trust that these experiences will not destroy us, but were allowed to occur by a loving Father or Creator, understanding that for you and I to grow, we must each be given individual agency to chose. It takes faith to recognize that that Father has your individual best interest in mind. Hiding from these emotions clogs the mental and spiritual systems and fuels disabling depression, anxiety, insomnia and fatigue. These feelings, real as they are, persist when there is no other physical sign of illness. That’s because this illness is not physical. It is spiritual. When we are out of line with the truths that bring peace and balance to our lives, negative, self-limiting patterns of activity and fear stifle growth and development mentally.
It is fascinating to me that on more than one occasion, as an osteopath, when a patient suffering from these symptoms gets a massage or has an osteopathic or chiropractic manipulative treatment, they may suddenly become tearful or have unexpected release of emotion. Physical treatment over the areas of congestion can, and do, cause a reflex triggering of mental, emotional or spiritual release of tensions.
How do I know that it is truth we are hiding from? Take the words of the Buddhist teacher Sogyal Rinpoche found in The Tibetan Book of Living and Dying among many others throughout the ages:
“Saints and mystics throughout history have adorned their realizations with different names and given them different faces and interpretations, but what they are all fundamentally experiencing is the essential nature of the mind. Christians and Jews call it “God”; Hindus call it “the Self,” “Shiva,” “Brahman,” and “Vishnu”; Sufi mystics name it “the Hidden Essence”; and the Buddhists call it “buddha nature.” At the heart of all religions is the certainty that there is a fundamental truth, and that this life is a sacred opportunity to evolve and realize that truth.”
“Wait a minute, what does all this have to do with a ketogenic lifestyle?”
The ketogenic lifestyle is one that is based on values. A patient following a ketogenic diet recognizes that food has just as powerful effect on the hormones of the body as does prescription drugs. Understanding the value of hormone balance and the principles that effect weight, inflammation, blood pressure and cholesterol, the ketogenic lifestyle is one in which carbohydrates are restricted in an individually tailored way to obtain the end goal. How does a ketogenic lifestyle balance mind and spirit?
Step One –
Put down your force-field. This takes courage and it takes faith. Your force-field is any distraction that keeps you from thinking and feeling and identifying truth. These include excessive alcohol, illicit drugs, binge eating, smoking, gambling, working excessively or getting lost in repetitive dramatic romantic relationships .
Believe me, the force-field gets heavier every day. After my father passed away at age 58 from the major complications of diabetes and my sister committed suicide a few years later, I threw myself into work and church service. I worked 16-18 hour days, completed a second board certification in Obesity Management and a fellowship in Health Policy, all while serving as a bishop and counselor in my church. I found that I could raise my force-field of justification to hide from the pain and emotions of family illness and depression.
But the force-field saps your energy and cheats you out of seeing your full potential. I found that as long as I held up my force-field (and some of us care more than one), I couldn’t see the experiences that made me who I am and connect me with those I was trying to serve and help. As long as I was holding up my force-field, I was living in the fear of re-experiencing the pain of loss and the worry of future disease, . . . and people sense that.
You don’t have to drop the force-field all at once. You don’t have to quit work and become a hobbit. You just have to lower the field a little bit, enough to peek over and let the Eternal Truth shine on you. Truth is a funny and powerful thing. The more we overcome our reluctance, face the pain and the fear, the more we realize just how often things begin to go well for us. Living in the presence of great truth and eternal law and being guided by permanent values is what keeps a man patient when the world ignores him, and calm and unspoiled when the world praises him.
Step Two–
Identify emotional or behavioral patterns that you want to change. If you don’t know, ask a trusted friend, your spouse, or your relatives. As I think back over the years, I had a couple trusted friends pull me aside and identify a few of those patterns face to face. I appreciate that, and I’ve never forgotten it.
Make a list of the events in your life that you regret and wish you would have made a different decision.
Go over the list as many times as you need to to identify the pattern or theme that seems to tie the regrets together.
Then actually write down the theme or reason that you identified as the cause. This allows you to identify and remove the corrupted soft-ware of your soul.
This process can take time and is often camouflaged by denial.
Major insight often comes as a knock on the door of denial, so listen carefully to what is being said. Listen to yourself listening. Psychiatrists say that if something said while listening to a patient makes them suddenly feel sad or irritable, then that may be a meaningful theme in the patient’s life. Listen to your gut feelings as you go through the day. Don’t ignore a prompting from your soul.
Step Three –
Realize that today’s negative emotional and behavioral patterns are connected with painful memories and unsolved past conflicts.
Do you get a gut feeling that you want to change the subject when someone brings up a financial setback? Do you want to reply with one liners like, “I’m sure it will all work out?” Are there other topics that make you uncomfortable? Ask yourself why that topic makes you uncomfortable . . . seriously, ask yourself, and then answer yourself. Do you suspect your spouse of cheating when there is no objective evidence to support the suspicions? Recognize these uncomfortable feelings are our subconscious waving flags to make us each aware of unresolved conflicts within our mind and spirit.
Remember, we attract the type of energy we give off.
Step Four–
Pray to whatever higher power you believe in. Meditation, prayer and “ponderizing” brings a reservoir of faith and courage to find and to face the truth. If you have the faith, get on your knees and sincerely ask God for help facing your truth and the challenges, fears and sadness that reflecting upon it may initially bring. I promise you that you will gain the strength to accomplish the task. It will bring the strength to overcome the hidden trauma in your earlier life and will give you the strength to resist the call of ice cream at 3 am.
Following these four simple steps, keeps you vigilant to the physical and spiritual warning flags that may arise on your ketogenic journey and will bring great confidence while modifying your diet to balance your body’s hormonal milieu. Confidence inspires courage. Those with courage and confidence in themselves, and faith that they are on the right path, are unstoppable. Good luck . . . I look forward to seeing you on my journey down the same path.
People with significant stressors in their life have been show to have an increased corsiol secretion. Chronic stress induces hyperactivity of the hypothalamic-pituitary-adrenal axis causing a daily, cyclic over production of cortisol and then normalization of cortisol after resolution of the stressor. This cortisol response is not high enough to lead to a true 
Under a stress response, cortisol turns on gluconeogensis in the liver (the conversion of amino acids or proteins into glucose) for fuel. Cortisol, also, shifts the storage of fats into the deeper abdominal tissues (by stimulating insulin production) and turns on the maturation process of adipocytes (it makes your fat cells age – nothing like having old fat cells, right?!) In the process, cortisol suppresses the immune system through an inhibitory effect designed to decrease inflammation during times of stress (7,8,9). If this was only occurring once in a while, this cascade of hormones acts as an important process. However, when cortisol production is chronically turned up, it leads to abnormal deposition of fat (weight gain), increased risk of infection, impotence, abnormal blood sugars, brain fog, head
