Don’t miss this podcast as Dr. Nally discusses the sugar alcohol, erythritol, and what the Cleveland Clinic’s study really means to those following a Ketogenic Lifestyle. Is there another reason behind attacking erythritol?
After hearing this podcast, you decide.
Since the very first muscle derived myostatin protein was identified as a myokine in 1997, over 600 myokines have been identified to date (Gorgens et al., 2015). However, the majority of these myokines are still not sufficiently characterized.
Why is this important? This frequently neglected topic plays a central roll in diet and exercise in those people trying to lose or maintain their weight. Myokines are the key actors in muscle development and size, and and they influence weight gain or loss in a pretty dramatic way.
The myokines are a subclass of interlukins. Interlukins are a group of naturally occurring proteins that mediate communication between cells. They are like the rapid text messages between teenagers in the same room communicating with each other. Interleukins regulate cell growth, differentiation, and motility. They are particularly important in stimulating immune responses, such as inflammation.
A few years ago, research demonstrated in the Journal of Experimental Biology that there is a notable increase in the plasma concentration of IL-6 during exercise (Pedersen and Febbraio, 2008). This is followed by the appearance of IL-1 receptor antagonist (IL-1ra) and the anti-inflammatory cytokine IL-10. Concentrations of the these cytokines, IL-8, macrophage inflammatory protein 1a (MIP-1a) and MIP-1b are elevated after strenuous exercise.
Thus, the cytokine response to exercise is not preceded by an increase in plasma TNF-a. Even though there may be a moderate increase in the systemic concentration of these cytokines, the underlying fact is that the appearance of IL-6 in the circulation is by far the most marked and precedes that of the other cytokines (Pedersen and Febbraio, 2008).
When IL-6 is produced by macrophages, it leads to an inflammatory response, whereas muscle cells produce and release IL-6 without activating classical pro-inflammatory pathways. The fact that IL-6 can sometimes act as a pro-inflammatory and sometimes as an anti-inflammatory agent appears to be more dependent on the environment (muscle versus immune cell) than on whether IL-6 is activated in an acute or chronic fashion (Pedersen and Febbraio, 2008). This essentially means that strenuous exercise is a good form of stress, stabilizing the muscle, causing growth and not adversely affecting the immune system.
At the same time, IL-15 is expressed in human skeletal muscle (Pedersen et al., 2007). C2C12 tubule contraction in the muscle stimulates the IL-15 release. It possesses anabolic effects on skeletal muscle in vitro and in vivo and may also take part in reducing adipose tissue mass (Pedersen et al., 2007). Therefore, IL-15 has been suggested to be involved in muscle–fat crosstalk. Recently, we demonstrated that IL-15 mRNA levels were upregulated in human skeletal muscle following a bout of strength training (Nielsen et al., 2007), suggesting that IL-15 may accumulate within the muscle as a consequence of regular training.
What is fascinating is that there is a negative relationship between IL-15 and truncal fat mass, but not limb fat mass. That means that the more resistance exercise you participate in regularly, the lower your truncal fat becomes.
Another cytokine actor in this opera of human metabolism is Brain Derived Neurotrophic Factor (BDNF). BDNF is a fascinating hormone produced in the brain. In humans, a BDNF release from the brain was observed at rest and increased 2- to 3-fold during exercise. Both at rest and during exercise, the brain contributed 70–80% of the circulating BDNF, while this contribution decreased following 1h of recovery. In mice, exercise induced a 3- to 5-fold increase in BDNF mRNA expression in the hippocampus and cortex, peaking 2h after the termination of exercise.
Matthews and colleagues studied whether skeletal muscle would produce BDNF in response to exercise (Matthews et al., 2009) and found that BDNF mRNA and protein expression were increased in human skeletal muscle after exercise. However. muscle-derived BDNF appeared not to be released into the circulation. BDNF mRNA and protein expression were increased in muscle cells that were electrically stimulated.
You can augment the presence of BDNF with curcumin. Curcumin is a natural isolate derived from turmeric an has been show to have anti-inflammatory, anti-oxidant and anti-depressant properties through its ability to raise BDNF. Using curcumin daily with a regular exercise program helps to improve brain function and reduce mental and physical stress (4, 5)
Why is this important? Because, BDNF increased phosphorylation of AMPK and acetyl-CoA carboxylase (ACC) and enhanced fat oxidation both in vitro and ex vivo. In layman’s terms, that means that regular exercise stimulates the burning of fat for 1-2 hours after exercise. This can be exercise from resistance training or from HIFEM like EMSculpt or electromagnetic stimulus.
What is the take home message from all this geeky science stuff?
Resistance exercise improves muscle regeneration, fatty acid oxidation, fat metabolism, muscle repair, mitochondrial biogenesis (increasing numbers of mitochondria). So if you are not participating in at least 3 days of resistance exercise per week, I’d encourage you to do so.
If you are looking for a simple body weight exercise program that can be done at home. I’ll send you my program for free. Go to docmuscles.com/exercise and sign up.
Check out my latest video on the treatment of chronic kidney disease with ketogenic and carnivorous lifestyles.
A number of people have asked me about how I smoke my pork shoulders. Pork shoulder is a perfect meal if you are on a ketogenic or carnivorous diet. The smoking process is quite simple. The key is in the simplicity. I’ve use a Traeger Select Elite pellet smoker for the last 10 years, but your favorite smoker will do.
In our house, we will smoke a 9-10 lbs pork shoulder and then use the pulled pork for meals throughout the week. I often do most of my smoking on the weekend when I am home and then we have some of the most tasty leftovers throughout the week.
But, before I dive into the recipe and process, we should take a moment to look at the historical essentials of bacon and it’s origins from the pork shoulder.
The Chinese were the first to record cooking of salted pork bellies more than 3000 years ago. This makes bacon one of the world’s oldest processed meats.
Bacon eventually migrated westward where it became a dish worth of modern-day foodies. The Romans made petaso, as they called it, by boiling salted pig shoulder with figs, then seasoning the mixture with pepper sauce. Wine was, of course, a frequent accompaniment. For my wine connoisseur friends, please tell me which wine goes best with bacon. . . you know who you are.
The word bacon comes from the Germanic root “-bak,” and refers to the back of the pig that supplied the meat. Bakko become the French bacco, which the English then adopted around the 12th century, naming the dish bacoun. Back then, the term referred to any pork product, but by the 14th century bacoun referred specifically to the cured meat.
For generations, local farmers and butchers made bacon for their local communities. In England. where it became a dietary staple, bacon was typically “dry cured” with salt and then smoked. In the late 18th century, a businessman named John Harris opened the first bacon processing plant in the county of Wiltshire, where he developed a special brining solution for finishing the meat. The “Wilshire Cure” method is still used today, and is a favorite of bacon lovers who prefer a sweeter, less salty taste.
These days, the phrase refers to making money, but it’s origins have nothing to do with income. In 12th century England, churches would award a “flitch,” or a side, of bacon to any married man who swore before God that he and his wife had not argued for a year and a day. Men who “brought home the bacon” were seen as exemplary citizens and husbands.
In addition to planting victory gardens and buying war bonds, households were encouraged to donate their leftover bacon grease to the war effort. Rendered fats created glycerin, which in turn created bombs, gunpowder, and other munitions. A promotional film starring Minnie Mouse and Pluto chided housewives for throwing out more than 2 billion pounds of grease every year: “That’s enough glycerin for 10 billion rapid-fire cannon shells.”
Bacon took a beating in the 1980s, when dieting trends took aim at saturated fats and cholesterol. By the ’90s, though, Americans were ready to indulge again. Hardee’s Frisco Burger, one of the first fast-food burgers served with bacon, came out in 1992 and was a hit. It revived bacon as an ingredient, and convinced other fast-food companies to bacon-ize their burgers. Bloomberg called it “a momentous event for fast food, and bacon’s fate, in America.”
Once the meat gets to around 160° internal temp (around the four to five hour mark) is the perfect time to wrap. Your pork shoulder should have excellent color and bark at this point.
Wrap the pork up in foil and place it back on the smoker, making sure you keep your temp probe in and wrap the foil around it. Once it is wrapped, place it fat side up and continue to smoke it at 250˚F until it reaches an internal temperature of 205˚F.
Smoking time averages 60-90 minutes per pound, depending on the level of doneness smoked at 250 degrees.
If you’re going to slice it, cook to 185˚F.
If your going to pull the pork smoke it longer, until it reaches 205˚F.
See the video below for instructions on how to make my favorite three egg folded omlet . . .
Twice a week I join up with my HEMA (Historical European Martial Arts) group and sword fight. My wife and I participated with group sparing yesterday. It is a wonderful group of peeps.
We all live very stressful lives. Stresses come in the form of phone calls, getting cut off in traffic, and angry outbursts from people around us. These short bursts of stress act like a bear chasing you through the woods. Every time that “fight or flight” signal kicks in, it is the physiological equivalent of eating a donut. Literally.
If you don’t already, you need a physical release valve. You must have a physical outlet 3-6 days per week to burn off the accumulating adrenalin and cortisol or your anxiety, depression and fatigue will overwhelm you. Research shows that progressive repetitive daily bouts of stress that aren’t physically dissipated leads to weight gain, anxiety and depression.
(After 50 years, I’ve finally figured out how to relax . . .)
The real weapon of mass destruction in our world:
Many people are looking for natural sources of collagen. Every day in my clinic, I get asked about which collagen supplement I recommend using. People have been convinced over the years by great sales and marketing that they must have some form of supplemental collagen.
This is an important question, because there are many benefits to collagen. As the most abundant protein in our body, collagen is essential for:
· Fighting signs of aging like wrinkles
· Improving joint health and osteoarthritis
· Healing Irritable Bowel & Leaky Gut Syndrome
· Boosting metabolism
· Improving mental health
· Reducing the appearance of cellulite
· Strengthening hair & nails
· Great looking skin
In the body, collagen is mostly found in the skin, bones, and joints. It also is found in the lining of the gut. We’ve known for years that gut health is incredibly important for overall health!
Collagen in the body is made up of amino acids which wrap together to make a triple-helix structure. The helix structure is why collagen is so strong.
The amino acids which make up collagen are:
· Glycine: Makes up about 33% of collagen
· Proline: Makes up about 10% of collagen
· Hydroxyproline: Makes up about 10% of collagen
· Hydroxylysine: Makes up about 1% of collagen
The 5 most common types are Type I, II, III, IV and V.
· Type I Collagen is the most abundant in our body (over 90%) and stronger than steel by weight. It is found in skin, hair, nails, muscle, joints and organs.
· Type II Collagen makes up movable joints.
· Type III (the so-called ‘baby collagen’) is the second most abundant collagen in human tissue.
· Type IV forms basal lamina, the epithelium-secreted layer of the basement membrane.
· Type V is present in cell surfaces, hair and placenta.
Our bodies make collagen out of amino acids we consume through food. However, as we age, our bodies ability to make collagen declines. Thus, around the age of 30, collagen production begins to diminish by about 1% to 2% yearly. By the age of 40, you and I lose 10% to 20% of our collagen!
UV rays, cigarette smoke, pollution, poor diet lacking in the necessary amino acids causes our skin’s structural integrity to be compromised.
Our dermis is made up of more than 80% Type I Collagen and 15% Type III Collagen, along with Elastin and Hyaluronic Acid, and specialized cells called ‘Fibroblasts’ (the essential ‘collagen factories’ that synthesize new collagen).
Together they are the key components for the extracellular matrix which gives our skin its structure, elasticity and firmness.
Collagen is the key foundational protein for healthy, youthful-looking skin.
To produce collagen, our bodies first need to have amino acids as the building blocks for collagen. Millions of people around the world were indoctrinated in the low-fat diet dogma taught in grade school since the 1970’s. If you’ve been eating a low fat, vegetarian or vegan diet, which is lacking in those crucial amino acids, your body won’t be able to produce enough collagen!
Why? Because those amino acids above are found in animal proteins and animal fats, specifically from the connective tissues of cows and pigs (amazing how bacon is necessary for everything, right?!)
To make things worse, naturally-occurring enzymes in our bodies also break down collagen. Environmental factors like pollution, free radicals, and excessive sun exposure can also break down collagen.
When it comes to sources of collagen, you won’t find anything better than gelatin. Why? Because gelatin IS collagen. As mentioned above, gelatin comes from the connective tissue of cows, pigs and is found in whites and yolks of eggs. You can also get some types of collagen from fish.
Slow cooking or smoking beef and pork liquifies the connective tissues in these meats and creates the moistness that is so very delicious.
The great thing about gelatin is that it is easy for the body to digest and absorb. But, don’t expect your wrinkles or joint pain to disappear overnight.
Yes, you can buy expensive collagen powders or gelatins and help pay for supplement company CEO’s boat. And, some of these have been shown to be effective in helping the skin. However, most of the stuff you find in the supermarket is so highly processed that it isn’t likely to deliver any benefits.
Many collagen supplements found in powders can also cause diarrhea, bloating, a sensation of heaviness in the gut and stomachache.
Instead, save your money. Consume slow cooked beef & pork, eggs, fish and/or cook with bone broth. It will do wonders for your hair, skin and nails and it tastes great.
1. https://www.ncbi.nlm.nih.gov/books/NBK21582/
3. https://pubmed.ncbi.nlm.nih.gov/23949208/
No, it’s not sustainable at all. What do you think?
The daily question that I get asked by my patients, and from those around the internet, relates to burning one’s own fat. “Don’t you have to limit the calories and limit fat you eat to burn your own body fat?”
It seems everyone has a differing opinion on this question and a few of them have two opinions (you know who you are). Very few of these opinions are grounded in the actual science of weight loss.
I hear coaches, trainers and even a number physicians argue, name call and rant about the need to cut calories to lose fat. Yet, most of my patients “cut their calories” 200-1000 per day without successful fat reduction. They may increase their exercise by 400-600 calories per day and still no weight loss. This is the same crazy ineffective instruction we’ve been given for the last 50 years.
To be honest, there is a percentage of those in the fitness and modeling worlds upon which this dogma is effective and that is because of normal insulin levels and significant exercise. However, for the other 85% of the world who work over 40-80 hours a week, have children and families, serve in our churches and occasionally have a social life, myself included, it doesn’t work. If we were all paid to exercise 2 hours a day and take “butt selfies” on Instagram, it might be easier.
Yes, you will probably lose 20 lbs. with calorie restriction, but your testosterone will drop by up to 50%, sex hormone binding globulin will double, and over time your basal metabolic rate will slow due to dramatic and often permeant reduction in thyroid function. This makes it nearly impossible to lose more than that 20 lbs, and then you will regain the weight once calorie levels return to normal within 18-24 months. (No one ever talks about that little problem, do they?)
For those of you that want to see success in weight loss, let’s outline a few essential principles that the trainers, keto-coaches and social media talking heads aren’t mentioning.
First, insulin has to be kept at a baseline. The reason that 85% of people don’t, won’t and can’t see effective weight loss beyond 20-30 lbs long term (greater than 2 years) with calorie restriction is that 85% of the population has some degree of insulin resistance. It’s not a disease, it’s a syndrome associated with the effect of the standard American diet. I wrote a whole book about it called The Keto Cure. We know that insulin and catecholamines increase the rate by which fat is stored.
Second, glucacon is a counter active hormone to keep your blood sugar from bottoming out. The presence of glucagon stimulates fat burning. Intermittent fasting and ketogenic dietary intake allow blood sugar to drop below 70 mg/dL (3.9 mmol/L) causing glucagon release and stimulate increased release of free fatty acids from the fat cells.
Third, two hormones, epinephrine and norepinephrine, are produced when blood sugar drops below 67 mg/dL (3.7 mmol/L). Exercise lowers blood sugar to this level and stimulates additional burning of fat by engaging the release of glucagon and epinephrine and norepinephrine. Exercise, also, has three other myokine hormonal effects making weight loss more successful when the diet is correctly balanced.
The fourth principle that is essential to understand relates to growth hormone. Growth hormone stimulates and preserves muscle tissue, has a suppressive effect on insulin. Growth hormone increases with exercise, sleep, intermittent fasting and when protein intake is at least greater than 90 grams per day in women and around 1 gram of protein per body weight in men. This is notably higher than previous calculations on protein that I have written about in the past. Recent research, also found here, here and here, demonstrates that increased protein above 90-100 grams per day enhances muscle growth and stabilization and further suppresses insulin production beyond what we previously understood.
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Contrary to what the media has been saying about protein sources, not all protein is absorbed in the same way. When it comes to absorption in the human gut and use by the human metabolism, protein sources differ in their effectiveness:
Lastly, release of fat from the fat cell is mediated by natriuretic peptides and cGMP through the release of catecholamines, prostaglandins and nicotinic acid. Interestingly, the major positive regulators of human lipolysis are catecholamines and natriuretic peptides (NPs). Fatty acid release from fat cells triples when catecholamines and natriuretic peptides are released. Catecholamines are produced by exercise, stimulants and stress, and natriuretic peptides are stimulated by short change fatty acids (ketones).
For the science geeks in who follow my blog, I’ve included the following picture that summarizes the effects of these hormones on the fat cell. The figure below shows the major pathways by which insulin, thyroid, catecholamines, testosterone and sympathomimetics effect fatty acid release from adipose tissue.
The take home message from this information is this, effective long term weight loss cannot be achieved by calorie restriction. Effective weight loss (specifically fat loss and muscle gain) is most effectively achieved when carbohydrates are restricted, protein is optimized, and proper exercise adequately triggers the release of fat burning hormones.
Click HERE and get a copy of my ketogenic diet.
Get a copy of my diet and 13 learning modules with coaching and online assistance by becoming a member of Dr. Nally’s KetoClan.
I’d like to know, what combination has been most effective for you?
Have a great day!
Adam (eat your bacon) Nally, DO
I’ve been living and teaching patients about using a low-carb/ketogenic and carnivorous lifestyles for over 16 years. I get thousands of questions each month about what to eat. People ask:
In the past, I’ve given people seven day diets, and I’ve given them food lists. But, you know the proverb, “give a man a fish . . .” People still seem confused. I’ve tried teaching people the simple ketogenic principles, “teach a man to fish . . .” and this helps a few others. However, there still seems to be great confusion about what foods can and should be used in a ketogenic lifestyle. Today, I thought I would try to combine both approaches and discuss the basic macro-nutrients that make up a well formulated ketogenic diet.
Let’s start with carbohydrates. The first principle that must be followed to enter and stay in ketosis is keep insulin from spiking. This is done by keeping total carbohydrate intake less than 20 grams per day. The liver produces a small amount of carbohydrate every day to protect the brain. Therefore, a low baseline level of continuous insulin production is essential to maintain life. However, it’s the large spikes of insulin after ingesting carbohydrate containing meals that cause the problems. We talk about this at length in my book The Keto Cure.
Carbohydrates are the foods that most commonly cause insulin to spike. It is the rapid rise or spike of insulin levels that drive weight gain, arterial plaque formation, heart disease, inflammation, neuropathy, kidney stones, gout and thyroid problems. Simple and complex carbohydrates cause insulin to surge. Those same simple and complex carbohydrates are the sugars (monosaccharides & disaccharides) and starches (polysaccharides) found in foods.
Fibers are also complex carbohydrates (polysaccharides) in the form of cellulose, lignin and pectin that are more difficult for human digestive enzymes to break down into simple digestible forms of carbohydrate. However, juicing, blending or cooking fibers releases the carbohydrate from the complex form and makes them available to our bodies.
Carbohydrates in their various forms are present in varying amounts in foods like fruit, vegetables, grains, beans, legumes, milk, and processed foods like candy, soda & sweets. (These are the foods to limit or completely avoid).
In general, raw leafy greens contain cellulose and the carbohydrates in these vegetables when eaten raw do not need to be counted. You are free to eat as much as you desire. However, cooking, blending or juicing the leafy green (as noted below) does break the cellulose bonds and increases carbohydrate absorption (that is why cooked, blended, or juiced vegetables taste “sweeter”).
NOTE: I recommend 1-2 cups of raw leafy greens per day. Leafy greens are one of the highest sources of folic acid (spinach, asparagus & okra) and without them in the diet, there is a potential risk of folate deficiency if it isn’t present in animal fat sourcesa. This is especially problematic in pregnant and breast feeding mothers. Yes, I hear you, eggs and meat are another source of folic acid; however, leafy greens like spinach contain four times the folic acid that eggs and meats do. Even iceberg lettuce contains more folic acid than eggs (this is why I caution pure carnivore diets in women of child bearing age without folic acid supplementation).
Foods that are loaded with sugars and starches that should be AVOIDED or USED WITH GREAT PRUDENCE include:
Non-Leafy Green Vegetables (1 cup raw or 1/2 cup cooked) – 10 grams of carbohydrate
Asparagus
Bamboo Shoots
Beans (yellow or green)
Beets
Broccoli
Brussell sprouts
Cauliflower
Cabbage
Celery Leaves
Egg Plant
Leeks
Mushrooms
Okra
Onions
Green Onions
Scallions
Pea Pods
Peppers: Green, Red, Sweet, Hot
Sauerkraut
Spinach
Summer Squash
Turnips
Tomato
Zucchini
(Corn, Carrots and Potatoes are not listed here due to their higher carbohydrate content)
Fruits (portions below) – 15 grams of carbohydrate
Apple (1 small)
Apple Juice (1/2 cup)
Apple Sauce (1/2 cup)
Apricots (2 fresh) Page | 5
Banana (1/2)
Berries (blueberries, black berries, strawberries, loganberries, raspberries – 1 cup)
Cantaloupe (1/4 of a 6 inch melon)
Cherries (12)
Cranberries (1 cup)
Dates (3)
Figs (Fres
Grapefruit Juice (1/3rd cup)
Grapes (17 small)
Honeydew melon (1/8th of a 7inch melon)
Kiwi (1)
Lemons (2)
Mango (1/2)
Nectar (1/3rd cup canned)
Nectarine (1)
Orange (1 small orange)
Orange Juice (1/2 cup)
Peach (1 medium)
Pear (1 small)
Pineapple (1/2 cup chopped)
Plumbs (2)
Prune Juice (1/3 cup)
Prunes (2 fresh or dried)
Raisins (2 Tbsp)
Rhubarb (1 cup cooked)
Tangerine (1)
Watermelon (4 inch x 1 ½ inch thick wedge)
Breads (portions below) – 20 grams of carbohydrate
Bread: white, wheat, French, rye, pumpernickel (1 slice)
Bagel (1/3rd)
Biscuit or Roll (1 small)
Breadcrumbs (1/4th cup dry, grated)
Bread-stick (1)
Buns: hamburger, hot dog (1/2 bun)
Cereal – cooked (1/2 cup)
Cereal – puffed (1 cup)
Cereal – flakes (1/2 cup)
Corn (1/3rd cup or 1 small cob)
Crackers:
Graham (three 2 ½ inch squares)
Oyster (1/2 cup)
Saltines (5)
Soda (3)
Zwieback (2)
Macaroni noodles (1/2 cup cooked)
Matzo (one 5 inch square)
Muffin – English (1/2 plain)
Muffin – bran (1 small) Page | 6
Toast – Melba (4 rectangles)
Pasta (1/2 cup) Peas – green (1/2 cup)
Pita bread (1 small)
Popcorn – air popped, dry (3 cups)
Potato – New, Russet or sweet (1/2 cup)
Pretzels (3/4th oz)
Rice – cooked (1/3rd cup)
Rice Cakes (2 plain)
Tortilla (1 small)
Dairy (portions below) – 25 grams of carbohydrate
Milk – whole, 1%, 2% and skim (1 cup)
Powdered Skim Milk – dry (1/3rd cup)
Yogurt:
Plain (1 cup)
Light – sweetened with NutraSweet (1 cup)
Regular – fruit filled (1/2 cup)
Cottage Cheese (2 cups)
American Cheese (12 slices)
You may use hard cheeses, cream cheese, sour cream, and mascarpone as great options on a ketogenic diet because they contain very little carbohydrate and are high in fats.
Proteins are large molecules made of of long chains of amino acids and are essential for a vast array of functions within the human being including structural formation, enzymatic reactions, immune response, cell adhesion, DNA replication, and molecular transport to name just a few. There are 22 amino acids that make up the protein molecules used in the human body. Interestingly, microorganisms and plants can make all 22 of these amino acids on their own. However, humans (and a number of other mammals) can’t make 15 of these amino acids on our own and we must obtain them from our diets.
How much protein do you actually need? Understanding your individual needs baseline protein needs can be calculated from your ideal body weight (IBW). IBW can be very easily calculated from your height and your level of activity. I give you this calculation because many female patients I see do not eat enough protein. Lack of protein will halt weight loss (as the body thinks it is starving.)
Your daily protein need can be calculated by the following:
Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet. Males need 1.2 g protein per kg of IBW.
Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet. Females need 1.0 g protein per kg of IBW.
If you are exercising more than 30 minutes 3 days per week then those values increase to 1.4 grams per kg for females and 1.6 grams per kg for males.
Example:
A 6 foot male’s IBW would be 50 kg + (2.3kg x 12 inches) = 77.6 kg x 1.2g/kg if sedentary or 1.6g/kg if exercising 4-5 days per week.
A 5 foot 4 inch females IBW would be 45.5 kg + (2.3kg x 4 inches) = 54.7 kg x 1.0g/kg if sedentary or 1.4g/kg if exercising 4-5 times per week.
This will give you a starting point for your daily protein needs and you can divide this number by the number of meals per day to get the protein needs at each meal. However, many of my patients after three months of ketogenic living need more protein to continue seeing weight loss.
What if I eat too much protein? There is still significant controversy over exactly how much protein is necessary on a daily basis. The reason is that many amino acids when ingested in significant amounts stimulate an insulin surge by themselves. These include arginine, lysine and tryptophan. Eating proteins that are high in these three amino acids in my very insulin resistant patients will raise insulin enough to halt weight loss, cause worsening inflammation, raise blood pressure and cholesterol.
Do you have to avoid these foods on a ketogenic diet? No, however, when you are using them more than 2-3 times a week, weight loss is inhibited and one’s ability to maintain ketosis is blunted.
However, two recent studies(1, 2) demonstrate that when protein intake is increased beyond a certain threshold, growth hormone counterbalances the insulin response and stimulates muscle growth instead of weight gain. That threshold seems to be around 90 grams of protein per day as women and 150 grams of protein as men.
Yes, this is much higher protein in take than the calculation for baseline protein needs we’ve used for years outlined above. We are learning a great deal about protein. For years, we’ve been missing the mark on protein needs. This revolves around the need of leucine to stimulate muscle growth.
What proteins can you use? The following list should be helpful. Remember that protein and fat often come packaged together in nature. As we discuss below, to maintain adequate ketosis, total fat intake should between 70-90% of your total calories. In order to maintain fat contents greater than 70%, you’ll want to use proteins sources that are the highest in fat (like red meat and pork) or add fat (like cooking in butter or coconut oil) to those that are lower in fat content.
Food: Protein Content: Fat Content:
Ground Beef (75% Lean) – 16 grams per 4 oz. 78%
Steak (Ribeye) – 39 grams per 8 oz. 74%
Steak (Top or Bottom Round) – 33 grams per 6 oz. 53%
Bacon (pan fried) – 3 grams per 1 slice 69%
Sausage (beef) – 14 grams per 3.5 oz. 79%
Sausage (pork) – 17 grams per 3.5 oz. 75%
Pork Chop (boneless) – 18 grams per 3 oz. 31%
Ham (cured whole boneless) – 19 grams per 3.5 oz. 28%
Sockeye Salmon – 23 grams per 3 oz. 22%
Halibut – 23 grams per 3 oz. 19%
Chicken Breast (boneless, skinless) – 24 grams per 3 oz. 18%
Turkey Breast – 24 grams per 3 oz. 15%
Tilapia – 21 grams per 3 oz. 13%
Yellowfin Tuna – 25 grams per 3 oz. 10%
Light Tuna – 22 grams per 3 oz. 8%
Deli Meats:
Pepperoni – 18 grams per 3 oz. 83%
Roast Beef – 21 grams per 3 oz. 48%
Canadian bacon – 17 grams per 3 oz. 42%
Roast Turkey Breast – 18 grams per 3 oz. 15%
Snacks:
Beef Jerky (Jack Links) – 13 grams per 1 oz. 9%
Peanut Butter (Peter Pan Crunchy) – 8 grams per 2 tbsp. 76%
Macadamia nuts, raw 2.2 grams per 12 nuts 89%
Mixed Nuts – 6 grams per 2 oz. 79%
Almonds, raw – 6 grams per 1 oz. 66%
Walnuts, raw – 4 grams per 1 oz. 85%
Sunflower seeds, raw – 6 grams per 1 oz. 76%
Tofu – 12 grams per 3 oz. 30%
Greek Yogurt – 23 grams per 8 oz. 0%
Cheeses:
Cream Cheese – 11 grams per 3.5 oz. 79%
Cheddar Cheese – 24.6 grams per 3.5 oz. 74%
Swiss Cheese – 24 grams per 3 oz. 66%
Ricotta cheese – 10 grams per 3.5 oz. 63%
Eggs – 6 grams per 1 large egg 70%
Look for foods who’s ratio of protein to fat is close to or greater than 1:1. For example, eggs are 6 grams of protein and 6 grams of fat.
It is essential to understand that not all sources of protein are equal in their absorption in the human gut.
Therefore, the two most important things you can do to optimize your ketogenic lifestyle is lower the carbohydrate intake to less than 20 grams per day, and use adequate high quality protein. Muscle gain and fat loss are most effectively achieved when high quality protein is used.
If you are struggling or just getting started, get a copy of Dr. Nally’s Ketogenic Diet here.
I’ve taken a tremendous interest in the recent deaths caused by the corona-virus infection. The reason for my interest is high C-reactive protein (CRP), high interleukin-1 (IL-1), high interlukin-33 (IL-33) and high interleukin-6 (IL-6) levels in patients with this illness. Recent data, literally hot off the press, demonstrates that those with the greatest risk of death had the highest CRP, IL-6 and IL-33 levels.
I have a large population of metabolic syndrome, hyperinsulinemia and diabetic patients in my practice. About 85% of my practice has hyperinsulinemia. They over produce insulin between 2-30 times normal in response to any form of ingested carbohydrate (simple and complex sugars, fruit, pasta, cereal, oatmeal, etc.) High insulin causes elevated CRP, IL-6 and IL-33.
A very interesting fact was published four days ago in The Lancet. They published a study looking at 191 patients in two hospital centers in China. The authors found that the highest rates of death occurred in those with current hypertension, diabetes, elevated cholesterol (high triglycerides and LDL) and/or coronary artery disease (heart disease or atherosclerosis of the arteries). This virus traditionally causes a simple common cold. Seeing this data in this particular viral strain dramatically changed my perspective on this virus.
These maladies (hypertension, diabetes, elevated cholesterol & coronary artery disease) are the four most common medical problems that I seen in my clinic, and they affect 85% of my practice population. All four are caused and driven by hyperinsulinemia. The higher your insulin response to starches or sugars, the more likely you are to have hypertension, diabetes, elevated cholesterol and heart disease.
This elevated insulin in response to eating any starch or sugar, hyperinsulinemia, causes a rise in molecules called cytokines. C-Reactive Protein (CRP), Interleukin-1 (IL-1), Interleukin-6 (IL-6) and Interleukin-33 (IL-33) are the cytokines that are abnormally and chronically elevated in hyperinsulinemia. These cytokines are responsible for mediating the inflammatory response to illness, injury and stress in the body. They control how your body responds with release of white blood cells, macophages, and other immune cells. These molecular hormones are ALWAYS chronically elevated in patients with hypertension (elevated blood pressure), pre-diabetes, diabetes, elevated cholesterol, coronary heart disease and obesity.
CRP is a reactive protein produced by the liver in response to inflammation. It is an “acute phase reactant” signaling the body’s immune system to respond to stress, inflammation or infection. The presence of insulin directly raises CRP. In my clinical experience, CRP normalizes within about three days of insulin returning to a normal level.
IL-1,IL-6 & IL-33 are all cytokines. They stimulate increased body temperature, regulate fevers, modulate macrophages and stimulate other immune cells to function in various parts of the body when infection or inflammation occurs. These dual acting hormones are produced by a number of cells, but predominantly by the adipocytes (fat cells) and pneumocytes (lung cells).
IL-6 has a negative feedback on the liver’s ability to sense the presence of insulin. Elevated insulin levels over time cause increased size of fat cells. This causes abnormally high levels of IL-6 production from the adipocytes and decreases the signal of insulin on the liver – leading to insulin resistance, pre-diabetes and diabetes. Elevation of IL-6 often persists until the fat cells shrink back down to a non-obese size. IL-6 can also stimulate elevated CRP as well.
Elevated insulin on top of the presence of a viral infection in the lungs stimulates additional increase in IL-33. A normal rise in IL-33 increases fluid and cells like macrophages around the lungs causing a normal immune response. This is part of the healing process, but if IL-33 is already chronically elevated in hyperinsulinemia, then a burst of IL-33 leads to the pneumonia, hypoxia and blood clotting that commonly occurs in those with severe coronavirus infections. IL-33 has been implicated as one of the drivers in the “cytokine storm” found in severe coronavirus infection patients. The presence of IL-33 increases production of IL-6 leading to a “storm of hormones” (cytokine storm) being overproduced from the lungs and fat cells.
Patients with elevated IL-1,IL-6, IL-33 and CRP were at much greater risk of mortality when exposed to COVID-19. Those that died, all of them, from this viral infection had IL-6, IL-33 and CRP levels twice as high as those who recovered from the illness. That is profound.
Temporal changes in laboratory markers from illness onset in patients hospitalized with COVID-19.
What does this mean to you and me? It means that those with elevated interleukin levels are more likely to experience a severe complication if exposed to this virus. That means that 85% of my practice, if not controlling hyperinsulinemia, is at higher risk of mortality. That’s what got my attention. Hopefully, it gets your attention.
But, don’t stress out. As of the writing of this post, 9-10% of the population may get sick (that is the current statistical data we have over the last three months). Relax , because 92% of people who get the virus won’t be severe enough to warrant hospitalization. And, only 0.4% of people will die from COVID-19. That’s actually lower than the current influenza numbers of 0.43% mortality. (Statistics taken from https://www.worldometers.info/coronavirus/) .
A recent paper written by Qasim Bukhari and Yusuf Jameel, both from the Massachusetts Institute of Technology, analyzed global cases of the disease caused by the virus, COVID-19. They found that 90% of the infections occurred in areas that are between 37.4 and 62.6 degrees Fahrenheit (3 to 17 degrees Celsius), and in areas with an absolute humidity of 4 to 9 grams per cubic meter (g/m3). Absolute humidity is defined by how much moisture is in the air, regardless of temperature. (https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3556998)
Arizona just hit temperatures of 100 degrees Fahrenheit this week, the last week in April. This means, if the research is correct, there should be a notable decline in the transmission and number of infections in hot and/or humid areas of the country like the south and south west regions.
What can be done about it? Follow a ketogenic lifestyle. Studies published in November, 2019, reveal that a ketogenic lifestyle has an enhancing effect on immunity by suppressing viral replication and barrier effect through γδ T cells in the lung.
This dietary approach is, also, the only one that I have seen clinically lowering CRP and IL-6 when using it long term. Ketosis may be the perfect prevention. Over the last 16 years of using ketogenic lifestyles, I have seen this pattern improve thousands of times. The presence of ketones immediately suppresses the production of IL-6 and improves the stimulus for CPR production at the liver. Cutting out carbohydrates lowers insulin back to a normal baseline within 3-7 days for most people. CRP returns to normal within three days of fixing your diet. And, IL-6 begins to decline immediately. In my obese patients, it can take 18-24 months for IL-6 to return back to normal.
Don’t stress. The overly hyped fear mongering produced in the media in the last two weeks raises your stress level. Turn off the T.V. and stop listening to the 24 hour news cycles. Over the next couple of weeks, while the risk of viral exposure is the highest, the following precautions are essential:
Taiwan and Hong Kong have instituted strict quarantines and you can see their effect in the graph below.
Above all, enjoy some bacon. Seriously.
You can’t eat bacon? Have a nice rib eye. Either way, based on the data above, your ketogenic lifestyle is the very best thing you can do to avoid serious infections, including COVID-19.
I talk about this an much more here on my YouTube video:
I’ve had multiple people send me links to people and/or “supposed experts” recommending the use of quinine to prevent coronavirus or COVID-19. In my perspective, this is really bad advice and borders on malpractice.
Quinine was and still is used for the treatment of malaria. Yet, there are some significant reasons using quinine is, and should continue to be, limited. Anyone recommending liberal daily use of quinine does not have any grasp of the potential for harm and death that can arise with the use of this substance. I have seen quinine toxicity on a number of occasions in my 20 years of medical practice, and it ain’t pretty.
There is absolutely no evidence that using quinine prevents infection from coronaviruses or COVID-19. Quinine differs in its mechanism of action from hydroxychloroquine, one of the drugs currently under investigation for use with COVID-19. Please, DO NOT confuse the two.
Quinine use is the most common cause of immune-mediated drug induced thrombotic microangiopaty (DITMA), a life threatening condition caused by small-vessel platelet clots. In a systematic review of all published reports describing drugs and other substances as a suspected cause of thrombotic microangiopathy (TMA), quinine was responsible for 34 of 104 cases in which there was definite evidence for a causal association (33 percent) [1].
The Oklahoma Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome (TTP-HUS) Registry found quinine-associated TMA in 19 of 509 patients (4 percent) referred for a possible TMA over a 25-year period and found quinine as the cause of DITMA in 20 of 23 patients (87 percent) for whom a drug could be implicated as having a definite or probable causal association with the TMA [2, 3].
A 2017 report describing the 19 individuals included in this registry found the following features [3]:
Quinine is implicated in causing neutropenia (decrease of white blood cells in the immune system). When it occurs, neutropenia is often accompanied by other organ-system findings that may include thrombocytopenia (low platelet count), microangiopathic hemolytic anemia (the most common being DITMA referenced above), rash, acute kidney injury, fever/chills, and others. The mechanism in many cases appears to be an acute, immune-mediated reaction to the drug. Evidence to support these associations was evaluated in a 2016 systematic review of published reports, which found neutropenia in 24 (17 percent) of the 142 patients who had an immune-mediated quinine reaction.
The problem that many physicians find is that quinine tablets may be borrowed from a friend or family member, or the exposure may occur from a beverage like Schwepps (eg, tonic water, bitter lemon). And tonic water is loaded with sugar or high fructose corn syrup. This high carbohydrate content, in combination with quinine is a perfect storm for kidney failure.
In the United States, the only available quinine tablet (Qualaquin) requires a prescription, and the only approved indication is for malaria treatment. This restricted availability of quinine tablets may explain why we have not seen a patient with quinine-induced TMA since 2009 [3]. There are also several over-the-counter tablets and herbal remedies for leg cramps available in the United States that may contain quinine, and quinine tablets can be purchased over-the-counter in Canada and other countries. Quinine may also be added to drugs of abuse such as cocaine.
Importantly, TMA from quinine can be triggered either by a single ingestion (eg, one quinine tablet, one quinine-containing beverage) occurring many months or years after a previous exposure, up to 10 years in our experience. This is because the drug-dependent antibodies can persist for many years, but they cannot react with target cells in the absence of the drug. Acute immune-mediated tissue damage can occur within hours of re-exposure. It is not known whether the homeopathic doses of quinine present in remedies for leg cramps in the United States can trigger TMA, but in principle, immune-mediated DITMA can occur with extremely low levels of re-exposure.
Chronic kidney disease is common following quinine-induced TMA [3].
So, please, don’t follow bad advice about using quinine from people who have no concept of what these drugs can really do.
Please see my Coronavirus Page for information and recommendations on prevention and treatment.
The following general measures are recommended to reduce transmission of infection:
Dr. Nally talks about each of these in his latest YouTube video below:
“Keep the carbs low and the fat high.”
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For more information about any of the things mention above and in other videos, you can find the links below:
I hear this all the time. “I can’t eat keto because. . . ”
What is your excuse?
I am amazed at how tightly people cling to these excuses. They are just that excuses. In the 16 years I’ve been training people how to use these diets to treat disease, I have yet to find one that is not just an excuse that covers up the real reason . . .
Check out my video on this:
In the light of the recent coronavirus toilet paper shortage, the proxy war with Ukraine, the attack on domestic energy by our Administration, the possibility of nuclear war, and the crash of the Silicon Valley Bank, I started thinking about how I could effectively follow a ketogenic or carnivore lifestyle in an emergency.
What it would take to maintain a ketogenic diet through a natural disaster or crisis? Those of you that know me, know that my wife and I have, for the last 30 years of our marriage, tried to keep a year’s supply of essentials in storage for emergencies, a life crisis or catastrophes.
Some of you may call me a “prepper.” And, I’m very happy to wear that hat. (But, I will remember that when you show up on my doorstep and you’re not prepared.)
My wife and I try to follow the principle of “prepare every needful thing,” so that, if adversity, illness, or calamity arise, we can appropriately care for ourselves, our neighbors and lend support to those around us. That preparation has been life-saving and budget saving on a number of occasions through the course of our marriage.
Before I dive into this too far, lets define the basic concept of emergency preparedness when it comes to food storage. There are really three main components you need to think about:
The recommendation is to store foods that are part of your normal diet in a three-month supply. As you develop a longer-term storage, focus on other staples that can last for years. Most information that surrounds food storage revolves around food and other items that preserve well over time. The challenge is that these usually come in the form of complex carbohydrates. These longer-term supplies are easiest to store in the form of wheat, rice, pasta, oats, beans and potatoes.
“But, wait a minute,” you say. “Aren’t you a keto/carnivore doctor? You’re suddenly going to eat carbs in an emergency?”
The answer is “no.” I am dramatically healthier and I feel much better when eating a ketogenic/carnivore lifestyle. In an emergency or time of crisis, suddenly changing my diet will make me and my family feel and perform even worse throughout the day. That’s not what someone needs when they are trying to live through a crisis.
Those that know me, know that I have a very strong family history of diabetes, heart disease, hypertension, kidney failure, gout, thyroid disease, and cerebral vascular disease (strokes) that sit upon the branches of my family tree. Suddenly “carbing-up” and switching my diet isn’t a wise thing for me or my family.
Currently, the majority of my ketogenic/carnivore food is stored in my freezers and refrigerator. (Yes, I have three freezers). Part of my emergency plan for food if I needed to stay in place involves keep those freezers running. It, also, involves the ability to cook that food.
Over time, I have acquired a generator and stored fuel that I can get running immediately allowing me to keep the freezers cold. I’ve built two sets of solar arrays, separate from my home’s electrical grid, that allow me to harness power from the sun and recharge battery packs to operate other appliances as necessary. I even have the ability to power appliances with my vehicles/camping trailer.
Stored propane or other gas to run stoves or grills is essential. These need to be rotated and canisters need to be checked for leaks and safety.
One of the greatest lessons I learned was that near-by local ranchers and farmers are happy to sell me half a cow if I’d just ask. This literally provides me meat for months at a time. However, you’ll need an entire freezer to store all this meat. And, a new freezer, plus half a cow, can be a large expense up front.
Locally, here in Arizona, I use Arizona Grass Raised Beef Company to provide me frozen grass fed meats. I know the owners personally, and they produce some of the best steaks in the country.
Hunting is another way of bringing home large quantities of meat. If you are a hunter, bringing home a deer or elk also provides months of good quality grass-fed food for you and the family. I am a bow hunter. Learning to hunt and staying prepared for hunting season keeps me in shape, and it is also a way to provide meat on the table if the grocery stores are empty.
The challenge with this strategy alone, is that it relies upon our staying in and around our home in time of an emergency. If, for some reason, we had to leave our home, it wouldn’t be practical to haul freezers and refrigerators around. So, doing some re-thinking for those types of emergencies is also essential.
Over the years, the members of my family have followed low-carb, ketogenic or strict carnivorous diets depending on their needs and goals. I may be doing a stricter keto/carnivore diet, where my children are following lower carbohydrate diets. The information I list below are there to help you come up with ideas that may fit your personal needs and dietary requirements.
Start simply. Begin with a week’s supply of food. I am always amazed at how many people have less than two days of food in their homes.
The amount of food you would need to purchase to feed your family for a day multiplied by seven is the amount of food you need for a one-week supply. Once you have a week’s supply, you can gradually expand that to a month, then three months. Eventually, that will expand to a year’s supply.
Dry & canned foods need to be stored in cool dry places. Short term perishables will need refrigeration or freezing.
If you have water from a good, pre-treated source, then no purification will be needed. Otherwise, water will need to be purified before you can use it. Store water in sturdy, leak proof, breakage resistant containers. Keep water away from heat sources and direct sunlight. Water storage and purification is a whole topic in and of itself. You can find simple straight forward information about water storage and purification here.
We don’t use a large amount of canned foods in our current day-to-day diet, but we do have a fairly large selection of canned foods in our storage. These range from canned proteins like beef, chicken, seafood, freshwater fish and Vienna sausages to Spam and canned bacon (Yes, I love a good slice of fried spam. Seriously. My wife will vehemently disagree.) You may want to learn to do some home canning and stock preparation. It’s pretty invigorating when you know how to store and preserve your own food. 
Lower carbohydrate canned vegetables can also be used. Artichoke hearts, asparagus, spinach, mushrooms, green chilies, and even canned tomatoes could be used to stretch protein and fat stores. These can also be used to add variety to meals.
Canned cream and coconut milk can also be an important piece of your food storage. These can be found at any grocery store. Though, they may be a little more expensive, we’ve found that picking up a can or two when we are at the grocery store allows one to build a supply over time that doesn’t break the budget.
When people think about dry goods, they often think of only jerky, trail mix and nuts. These are nice to have, but they don’t store for long periods of time and they shouldn’t be the basis of a food storage plan. Carbs in trail mix and nuts add up really fast. And the oils in the nuts expire quickly. If you ever eaten a old rancid nut, you’ll know why this can be a problem. My brilliant wife actually keeps all of our stores of nuts in the freezer. They actually preserve longer that way.
Don’t forget salt, sea salt, pink salts (like Redmond Salt), pepper & peppercorns, other herbs & spices, and chocolate are other essential dry goods you will want to include on your list.
Powdered creams and fats are also an option that can be stored; however, you’ll want to look closely at how long these can be adequately stored. These are also a little more expensive and do have a little more bulk in regards to meal preparation. Also, be mindful that many “powdered fats” use maltodextrin or dextrose to powder them. These “covert sugars” are not keto friendly so beware.
There are some great keto bars made by Quest Nutrition and KetoBrick. These have a 1-2 year shelf life, and would work well for shorter-term food storage. Remember that these dry goods may have different storage lives, so adequately planning storage rotation is something you will need to keep your eye on.
If you are able to stay around your home in an emergency, the ability to plant your own lettuce or kale can be pretty handy. Having the seeds to do this is an essential part of a good food storage program. You don’t have to have a large space or garden to do it either. There are many companies offering seeds for storage; however, be aware that heirloom seeds are necessary to be regenerative and not genetically modified.
Alfalfa sprouts will grow in 5-7 days. Having something fresh in an emergency can be a game changer for morale.
I’ve been experimenting with aquaponics systems for years. We were able to live off of our own lettuce, kale and strawberries for a full year using three 4’x4’ grow beds and a 50-gallon water-trough with our own koi. If you haven’t looked into aquaponics, this is a great way to provide the leafy greens you need and a great source of live fish.
I’ve since expanded this to a 14,000 gallon pond with 20 + koi.
Freeze dried eggs, meat and vegetables are available, and we use these for backpacking and short term camping. However, they are expensive. These work well in a three-day emergency kit or pack as well, but you’ll need to see if they fit into your budget.
Fats are usually what we worry about most when following a ketogenic diet. Many people following a ketogenic lifestyle use butter, A LOT of butter. However, butter doesn’t last indefinitely at room temperature. Canned butter does exist, but it is really expensive.
There are other options. MCT oil, coconut oil, ghee, lard, avocado oil and olive oil are used in my home regularly and are on a regular rotation with the butter in the refrigerator. Avocado oil is higher in omega-6 fatty acids and can be inflammatory for some people, and it is also more fragile, meaning it doesn’t store as long as other oils. Olive oil also has a shorter preservation life. We have some stored coconut oil that has been good for 8-9 years. Others have shared with me that they have MCT oil that stored for 7-8 years without problem. Your nose will know.
I could go on and on about medications, but that could be a whole article in itself. So, I just want to remind you that planning on having medications, supplements and electrolytes (sodium, potassium, magnesium and zinc) are essential to surviving physically and mentally stressful calamities.
Emergencies may necessitate periods of fasting. Getting used to fasting and feeling comfortable that you could go 24-48 hours without food is very confidence building. Planned fasting periodically will help with stress, recovery and healing in many cases. Don’t be afraid to experiment with 24-72 hour fasts so that you know how your body responds during these types of experiences.
Though, as I’ve told my patients in the past, frequent fasting longer that 24 hours has a suppressive effect on testosterone (lowering it by 50%) and suppressing thyroid function that can be permanent. This is how your body protects itself in a real famine.
Remember, preparation is the key to success. An hour of planning and preparation can save you ten hours of doing. And if you are living your plan, a crisis won’t set you back. Failing to plan is just planning to fail.
There has been very little dialogue in the keto/carnivore community about following this lifestyle in a crisis or natural disaster. My hope, here, is to begin that dialogue, get you thinking about the possibilities and then planning and doing what actually matters.
One of the common complaints that I see in my office is chronic numbness and tingling of the hands, fingers, feet & toes. There are multiple causes of these symptoms, but by far the most common cause in my practice is polyneuropathy caused by insulin resistance (hyperinsulinemia).
Before we dive into this particular type of nephropathy, it is important that we define a few terms. The terms “polyneuropathy,” “peripheral neuropathy,” and “neuropathy” are frequently used interchangeably, and although they can be easily confused, they are distinctly different.
Why spend time defining all this? Because, neuropathy can be very confusing, even for the experienced physician. And, because I am seeing, more and more frequently, cases of insulin resistance induced polyneuropathy. The polyneuropathies must be distinguished from other diseases of the peripheral nervous system, including the mononeuropathies and mononeuropathy multiplex (multifocal neuropathy), and from disorders of the central nervous system.
Insulin resistance, or better defined hyperinsulinemia, begins 10-15 years before a person is considered “pre-diabetic” and 20 years before the onset of type II diabetes. This “over production of insulin” in response to carbohydrates, starches and sugars causes a subtle and progressive form of inflammation. This excessive production of insulin will damage the smallest arteries (capillaries) carrying oxygen and fuel to the back of the eyes, the kidneys and the peripheral nerves of the hands, fingers, lower legs, feet and toes.
Often not identified until a person is actually diabetic, the mechanism underlying the development of this type of neuropathy is extremely complex. It is driven by years of subtle and progressive damage to the blood vessels, and inability of the nerves to use essential B vitamins damaging the genetics of the cell. This leads to inflammatory, metabolic, and ischemic effects causing the nerves to function poorly over time.
The mechanism of polyneuropathy damage in the patient with hyperinsulinemia three-fold.
Interestingly, MTHFR deficiencies are also strongly correlated with depression, anxiety and other forms of mental illness. MTHFR is a SNP that can easily be tested through a simple blood sample at your local lab or doctors office. And, nerve testing can be done through a simple sudomotor function test in the doctors office. In fact, Medicare encourages this testing yearly through part of the Annual Wellness Exam.
The polyneuropathy that I see most commonly in my office can and will improve. In fact, polyneuropathy will completely resolve if you catch it early enough. We treat it in two ways.
First, restrict carbohydrate intake. A ketogenic or carnivore diet is the perfect approach to this. If you don’t have a copy of my book, The KetoCure, please pick one up on my website or on Amazon. if you are just looking to fine tune the nuts and bolts of your diet, you can get a copy of my diet recommendations here. Carbohydrate restriction corrects the high insulin levels. Within a few weeks, people start seeing improvement in inflammation, testosterone, estrogen and leptin resistance.
Second, get your MTHFR SNPs tested. This can be ordered through a simple blood test through your doctor or nearby lab. If you have one or both MTHFR mutations, treatment is simple. A mutation of the MTHFR SNP directly causes polyneuropathy, anxiety, depression and in severe cases, schizophrenia. It can also cause significant problems with homocysteine metabolism and is a significant risk factor in heart disease.
Third, use the correct form of folic acid. If you have the MTHFR mutation, regular folic acid is ineffective. Instead of using regular folic acid (Vitamin B9), 1000-5000mcg per day of L-methyl folate (premethylated Vitamin B9) solves the problem. Within 90 days, over 50% of my patients feel dramatic improvement in their neuropathy and many have compete resolution of the numbness and tingling. I see this so frequently, that a few years ago I had my multivitamins designed to include L-methyl folate instead of regular folic acid. You can find them here at Ketoliving. com. If you want more information on why I designed my own vitamin supplement a few years ago, you can read about them here.
So, restrict your carbs, use the appropriate form of folic acid for you, and pass the bacon!
If you are interested in getting more help on this issue, schedule an appointment with me in my office. Or, consider one of my membership options if seeing me in my office isn’t convenient for you. Sign up today!
Our celebration of Independence Day is a deception.
Laying beneath the fireworks, barbecue and fun is the hard to swallow truth . . . It’s all a sham.
Are you and I really independent anymore? No. Not anymore.
243 years ago, the British oppression was a threat. It was singular, visible and involuntary.
Now, the threat we face daily is an entirely new form of tyranny, infinitely more complex.
The scary thing is that oppression is now:
Slavery has changed. The oppressor previously owned the slave individually. However, with time we learned that when there are multiple owners, the burden of ownership is lessened. Joint ownership became the norm. Now we have joint ownership of our condos, boats, and jets. The burden of slave ownership was the risk of revolt and revolution.
If ownership of debt can be spread among the masses, the individual risk is mitigated.
Our fractional oppression is spread throughout the legion, and the tyranny is masked as a principle of the great “free market.”
BIG FOOD sells cancer, diabetes, heart disease and fatigue through the FOMO of fake food.
BIG MEDIA sprinkles us with malaise, despair, anxiety and post-traumatic stress with lurid half-truths, click-bait shock value, and salty emotion all with the intent to sell us more advertisement.
BIG PHARMA peddles side-effects, addiction and false hope convincing the feeble mind, created by BIG FOOD, that a pill is necessary to prevent us from experiencing the pain, emotion and struggle of life – that same life that BIG MEDIA keeps ever present in the palms of our hands. In bed with BIG GOVERNMENT, their evangelism recommends medicating instead the more difficult learning from struggle and failure.
BIG GOVERNMENT covers us with red tape to stop the financial bleeding and hemorrhaging of the tumor’s growth it stimulates, through greed and invasion of individual inalienable right.
BIG MONEY circles us on wings of dread and fear singing a song of doom, all the while sampling emotional cookies and Danishes of immediate gratification, while slipping the “plastic card with a security chip” shackles over the wrists of the enslaved.
BIG EDUCATION preys upon our children with glib platitudes, group-think, and participation trophies. It teaches the weakened minds to prize test-taking, rote memorization, and fact regurgitation above problem-solving, creative thinking, and learning from failure. They prepare our children to work as drones on the factory floor of cyberspace instead of art and enterprise.
And, that’s just the beginning.
Look no further than your bank statement to see how the oppression is itemized. Each line item takes it’s pound of flesh round the clock each month.
“None are more hopelessly enslaved than those who falsely believe that they are free.” -Goethe-
200 years ago, the shackles were visible.
Today the shackles are disguised. Independence is a deception.
We are smarter than an outright shackle. So, they were re-tooled, re-imagined, re-formed, and hidden like landmines in cyberspace:
These are just grease on the slaughterhouse chute.
Forced slavery is no longer acceptable in our “free society.” The dark genius of modern oppression is the creation of cultural norms, rituals and addiction that invite us to PUT ON OUR OWN CHAINS.
Modern slavery is now VOLUNTARY.
“No one put a gun to your head or forced you to buy our product or service,” is the mantra of the oppressor while billions are spent on engineering conditions that make the shackles look like icing on your cyberspace cake.
But there is an escape . . .
Massive in scale, fractional, and nearly invisible, there is still a choice.
So, this evening, as the cardboard tubes of fireworks lay discarded in the park grass, and the toy flags lay rolled up on top of the fridge, awaiting their return to the attic for storage, let your Independence Day celebration be much deeper. Choose.
Let your Independence Day stir the same indignation for oppression that our fore-fathers felt.
Cultivate within yourself the desire to fight and win a second Independence Day.
You will need every ounce of resolve and strength you can muster.
Today, there are no chains, hangman’s noose or firing squads, there is but chemistry, habit, choice and instinct. The Oppressor will attempt to use it against you. You can still see it if you look. You can still choose.
Have the courage to flip them the bird of indignation as they present you the “standard American prepackaged life.”
Reject the drama and depletion of paycheck-to-paycheck living . . . instead, create wealth. Save a few dollars each day.
Reject the cardboard food in the grocery store and eat real food: bloody, fresh and wild. It will re-energize you.
Reject the FOMO of the dutiful consumer and become a CREATOR. Create the world you dream of by small and simple daily choices.
Reject the fake new, fake government, fake food, fake medicine, fake success, fake friendships, and fake happiness that encircles us. Create a life that is REAL. You’ll know it’s real because you can feel it, beyond the pain of trial and error and failure, REAL encompasses heart, mind, body and soul at the same time.
Take off the blinders so that you may see the leeches and parasites sticking to you. Rip them from your body and warm yourself as you burn them in the fire.
Only then will you escape the clutches of the modern tyrant.
Only then will you be free.
[Adapted from Bryan Ward and his “Third Way Man” series]
Adam S. Nally, D.O. (aka DocMuscles)
If you enjoy my content, please checkout the links below:
Is following your Total Cholesterol and LDL-C really that important?
You may be quite surprised.
Watch as we discuss the important markers of heart disease and vascular disease risk. We will talk about how these markers can help you understand what your body is doing in the process of making or reversing atherosclerosis (plaque in the vessels). And, should you really be taking that STATIN (cholesterol lowering) drug? Get the scoop here as Dr. Nally very simply points out how the right diet can and will lower your cholesterol without the use of medications.
Research in the last 10 years points to the small-dense LDL particle as the atherogenic component of cholesterol (Hoogeveen RC et al., Arterioscler Thoromb Vasc Biol, 2014 May; Ivanova EA et al., Oxidative Med Cell Longevity, 2017 Apr). Studies in the last five years have identified that elevated small-dense LDL cholesterol correlates much more closely with risk for inflammation, heart disease and vascular disease (Williams PT, et al. Atherosclerosis. 2014 April; 233(2): 713-720.)
Recent research in the last three years demonstrates that small dense LDL cholesterol is a better marker for prediction of cardiovascular disease than total LDL-C (Hoogeveen RC et al., Arterioscler Thromb Vasc Biol. May 2014, 34(5): 1069-1077l; Ivanova EA et al., Oxidative Med Cell Longev. 2017).
Additionally, higher LDL-C is actually predictive of longer life and has been demonstrated to correlate with longevity (Ravnskov U et al., BMJ Open, 2016 Jun 12;6(6): e010401). And, a low LDL-C actually increases risk of early mortality (Schwartz I et al., Lancet 2001, 358: 351-55).
It is commonly understood that LDL-C will rise with increased saturated fat intake on a ketogenic diet. This has been know and reported in the scientific literature for over twenty years. This is to be expected, because LDL-C is really a measurement of three different LDL sub-particles (“big fluffy, medium, and small dense”). Increased saturated fat intake, while at the same time lowering carbohydrate intake, actually causes a shift in these low density particles to a bigger “fluffier” particle conformation (Griffin BA et al., Clin Sci (Lond), 1999 Sep).
The 2015 British Medical Journal, referenced above, analyzed the relevant 19 peer reviewed medical articles that included over 68,000 participants. This review showed that there is no association of high LDL-C with mortality (meaning that an elevated LDL-C does not lead to an increased risk of death from heart or vascular disease). I realize that, in stark opposition to the landmark review above, The American Heart Association’s Presidential Advisory published their position in the June 20, 2017 issue of Circulation. They stated that saturated fat is the cause of increased LDL-C and they further extrapolated that elevated LDL-C is associated with an increase in death by cardiovascular disease. This boldfaced claim is only based on one single small four year (2009-2013) literature review completed by the World Health Organization with a total of only 2353 participants, most of these studies only lasting 3-5 weeks (not nearly long enough to see fully effective cholesterol changes) and none of which had any focus on carbohydrate intake, insulin levels or LDL sub-particle measurement (Mensink RP, Geneva: WHO Library Cataloguing-in-Publication Data, 2016).
Based upon the most current scientific evidence above and my clinical experience, the large body of evidence above demonstrates the use of total cholesterol and LDL-C to determine vascular disease risk to be ineffective tools. A low carbohydrate/ketogenic diet lowers small dense LDL cholesterol, triglycerides and blood sugar and in many cases, the use of cholesterol drug (STATIN) therapy is not needed and ineffective in comparison with a ketogenic/carbohydrate restricted lifestyle.
The most common complaint that I get in my office when someone has started a ketogenic diet is, “Doc, I feel fatigued. Will this ever go away?”
That feeling of fatigue, some refer to as the “keto-flu,” is usually due to a couple of things. First, you may not be eating enough fat (I recommend a 1 gram to 1 gram ratio of protein to fat when getting started). Second, you’re not taking in enough salt (specifically sodium, potassium, magnesium and/or zinc). These four salts are essential electrolytes our body requires for proper function.
If salt is the problem, the you will be experiencing leg cramps. Cramps during daytime activity are usually due to low sodium or potassium levels. Cramps that wake you up at night are usually due to low magnesium or zinc. Leg cramps can also be due to hypothyroidism or significant blood sugar swings. Dr. Nally will usually check for this during your visit with him.
“But isn’t too much salt bad for you?” I am frequently asked.
Too much salt is only bad for you if you’re eating a “low-fat” diet.
What if increasing salt intake actually lowered your blood pressure?
Did you know that increasing your salt intake can actually improve your diabetic blood sugar if you are following a correct diet? Could it be that easy?
Almost every patient that I see in the office has a significant worry about salt intake, some greater than others. In fact, some people are so fearful about salt that when I initially began encouraging its use, they told me that I was crazy, and they left my practice.
Has restricting salt over the last 50 years really worked, or is it doing more damage than we think?
That was the question that was asked by Dr. Ames in the American Journal of Hypertension 17 years ago. However, his answer never got a mention. In fact, I’ve been in practice for almost 20 years, and incidentally stumbled upon this article when it was mentioned by a colleague of mine. Granted, the study is a small sample size of people, only twenty-one. However, the results are profound.
Twenty-one patients with hypertension were randomized to periods of no salt (placebo) and periods of 2 grams (2000 mg) of sodium chloride four times a day (a total of 8 grams of salt per day). Glucose tolerance tests were completed with insulin levels at the end of each intervention period.
Insulin Resistance and Hypertension Improve by Adding Salt
Three very noteworthy results happened. First, those patients with insulin resistance and diabetes had improvement in their glucose levels while on 2 grams of sodium supplementation.
Second, those with hypertension also, shockingly, showed improvement in their blood pressure while on the 2 grams of sodium supplementation.
Third, those with insulin resistance had a lowering of their insulin levels during the period of increased sodium intake. These findings fly in the face of the dogma that’s been drilled into our heads that “salt is bad!”
“But, Dr. Nally, you can’t base your findings on a small group of 21 people,” the experts say.
Yes, it is a small study group. However, these findings are identical to what I, also, see clinically every day in my practice for over 20 years.
We know that the average human needs at a minimum 3 grams of sodium per day and 3 grams of potassium per day. The standard American diet (SAD diet) including processed foods contains 2-3 grams per day of sodium and potassium. In fact, the CDC claims the worst salt containing meals for you are:
Insulin also stimulates additional retention of sodium at the kidney level. If you are insulin resistant, producing excess insulin in response to starches or sugars, you retain notably larger amounts of salt when eating the standard American diet (SAD diet) or a “low-fat” diet. However, if your following a low-carbohydrate or ketogenic lifestyle, you won’t be eating the meals above and you’re probably not getting near enough salt.
Salts, or electrolytes, are essential in normal cellular function. Low salt in the body is like running your car without oil. It will run, but not very efficiently and over the long term will cause problems. This is the cause of the keto-flu I wrote about previously. And, according to the study above, it is a potential driver of our persisting insulin resistance, diabetes and hypertension.
How Much Salt Should I Use?
In my office, I encourage use of 3-4 grams of sodium and 3-4 grams of potassium daily when using a ketogenic lifestyle. That’s approximately 1 ½ – 2 teaspoons of salt per day. I like the Redmond’s RealSalt or pink Himalayan salt because these products contains all four types of salt (sodium, potassium, magnesium and zinc).
It is probably that your salt restrictions is making your insulin resistance and blood pressure worse. That’s what the clinical evidences are pointing toward, and it is what I see every day in my office.
Want to know more about a ketogenic life-style? Click the KetoLife link to get some basics.
If you’re already following a ketogenic lifestyle, then let me help you navigate the bumps and turns by going to the KetoKart and checking out the products I recommend to jump-start ketosis DocMuscles-style!
Until then, I’ll have another piece of bacon, please . . . and, oh, pass the salt!
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.
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.
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.
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).
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.
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).
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.
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.
“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.
