What daily rituals are essential to living a happy life? There are six of them.
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Tag: Ketogenic Lifestyle
Doc Holiday Was Right . . .
Toward the end of Tombstone, one of my favorite movies, Wyatt Earp tells his long-time trusted friend, Doc Holiday, that he just wants to live a “normal life.” The doc’s response has resonated with me for years. His answer pierces the façade that society and civilization try to sell each of us.
“There is no such thing as a normal life. There is just life,” Said Doc Holiday.
In my 20+ years of medical practice, and almost 30 years of marriage and family, I have come to realize that the wisdom shared by this young tuberculosis infected physician was correct. What most people mean by a “normal life” is actually a calm, even, unchallenged life with neither great victories or disappointing defeats. This “normality” has a very seductive charm. A life that lacks pains, frights and failures is often dreamed of by the masses and is often portrayed on the big screen. And, in that portrayal, it emphasizes the want of challenge, opportunity and the delight of victory.
Yet, such a “normal life” is simply non-existent. Disruptions, explosions, setbacks, failures combined with celebrations and victories small and large are all part of life. The individual or family that mistakenly believes there is some way to play it safe, some private sanctuary where they can insulate themselves, has failed to take into account the mortality of an aging body, the prevalence’s of cancer, and the imperfect genetic codes we inherited. We fail to consider global financial collapse, war, and the sins and failings of a civilization of humans, each having their own moral agency. That is life. That is “real” life. We live within a test-tube of filth, mire and ever changing chaos.
We even fail to recognize the destruction that good things bring to a “normal life.” Consider an infant. The newborn baby has no respect for “normalcy.” As wonderful as the newborn child is, they seem intent on creating chaos around themselves until their needs are met, destroying the “normal” peaceful life and sleep of it’s parents.
Life Is Life
Life is life. In fact, life frequently sucks, and then we die. However, in between, there are some really joyful and momentous events that make living in this test-tube of filth and mire worth the struggle. This life was never meant to be lollipops, roses and sunshine. Days are hard, Relationships are hard. If they aren’t hard, you’re not growing. (That’s not to say abuse should ever be tolerated).
Take a relationship like marriage. Relationships are made, they don’t just happen. They are made and grow as two people strive for many of the same goals. The problem is most people don’t communicate their expectations, and frequently don’t even know what their expectations from a relationship actually are. Most people are afraid of commitment because they expect that the relationship should provide sunshine on the other side of the wedding ring and yet are shocked when that sunshine leaves a sunburn. Not knowing what their expectations should be, they leave when they don’t feel frequent pleasure and happiness.
The “normal” happy life is a façade. Most people raised on participation trophies misunderstand that the paradox of life is seeking pleasure from a relationship or a job first. That’s the most effective way of missing it. Lasting joy in life, a job, a relationship or a family occurs when one seeks that joy outside of one’s self, daily directing one’s focus on the principle of filling your life with purpose.
So, shall we call Doc Holiday prophetic? I don’t think he was a prophet, but, as a physician suffering from a chronic disease that would eventually end his life, he was correct in his assessment of life in general. The determination to create and cling to a “normal life” will result in frustration, cynicism and even bitterness because it cannot be done. In Doc Holiday’s experience, the brave doctor contracts a terminal illness like tuberculosis in his attempt to help others. The disruptions of “normalcy,” even the good ones, that affect us day to day become obstacles to the “normal.” This can cause resentment of the irritable baby, the spouse, the job, the co-worker, the daily routine and even those we desire to help.
The disruption may become such an obstacle to the facade of normal that a parent, for example, may resent the baby. Seeing that a baby, one of the most noble things a mother can bring into this world, can disrupt and even threaten the ease of someone’s “normal” life, the noble disruption may even lead one to consider aborting it. Society today worships at the alter of “normal.” Hence, the pursuit of the myth of the “normal life” actually allows the horrific to become normal.
Is there an antidote? There is. Life should be meaningful. Life should be purposeful. What brings meaning and purpose in a test-tube of mire and struggle?
All the Things We Experience Make Life Better
The Apostle Paul, in his letters to the Roman saints, gives the most expansive, all-encompassing statement about life in all of the religion and philosophy that I’ve ever read. “All things work together for good to them that love God, to them who are the called according to his purpose” (Romans 8:28).
All things, . . . not just the good stuff -not just the easy, normal stuff work for our good. It is the combination of good and bad that make this life meaningful. Seeing the meaning in your life takes an antidote against the cynicism and and bitter taste that the bad often leaves behind.
The antidote comes in a few steps:
Improve your health
As a doctor, I’m a huge advocate of improving your health which plays a dramatic role in happiness. Losing as little as 10 lbs has been shown to improve energy, decrease your risk for major disease, improve sleep, improve sex life, and decrease inflammation. Improvements in any of those areas will reduce stress and anxiety and increase happiness so you can imagine while improvements in ALL of these areas could dramatically change your life.
As an advocate of the ketogenic lifestyle, I’ve found that the majority of my patients are able to lose 5-15 lbs each month for the first three months using this approach. They average 2-5 lbs pf weight reduction each month there-after while following a ketogenic approach over the long term. Understanding that this is one of the long term keys to success in happiness I want to make sure you know that I’ve developed some custom strategies to help with this and will share them with you below. This lifestyle decreases risk for diabetes by 75%, improves mental clarity, and slows the aging process. (Who wouldn’t want those side effects while eating bacon?)
Use food as an antidote
A number of studies have demonstrated that a ketogenic diet increases gamma-aminobutyric acid (GABA), a key neuro-hormone signaling satiety and pleasure, in the brain. GABA increases sensations of happiness and euphoria. (Yes, this is why eating bacon makes you and I happier. It’s probably why the thought of bacon in the video above made you smile.) Shifting into a ketogenic state at least periodically has the effect of increasing your sense of happiness throughout the day. It is actually the ketone that does this. Whether you get into ketosis through diet alone, or through the use of exogenous ketones, both methods are effective in aiding you in your quest for happiness.
Savor daily experiences and record them
Savor the daily experiences. We live our lives at such a high speed, we often neglect to take time to enjoy the experiences around us. A trip to down town Amarillo, Texas, a few years ago brought me to the front doors of a restaurant that served cream-cheese & sausage stuffed, bacon wrapped, jalapenos (try saying that 5 times fast). I had a bit of time and decided to try them. It was the first time in 3-4 days that I actually had the chance to slow down and savor the place around me, the flavors of the food, and the atmosphere of the restaurant.
Just taking a bit of time to savor these things made this experience a very memorable and happy experience that to this day I have not forgotten.
Take 3-5 minutes today to just think about where you are. Savor the smell of a rose, the color of the sky, the shape of the clouds or the sight of a bird. These sensory images can, and will, leave indelible memories and release dopamine and serotonin naturally in the brain. Savoring the daily experiences of life can be part of the process of meditation we will talk about below.
Volunteer
Doc Holiday could have groveled in the sadness of his illness and pain. But, instead, he risked his life to save the life of Wyatt Earp in Texas. Then, in 1879, he joined Earp in Las Vegas, New Mexico and then rode with him to Prescott, Arizona, and then to Tombstone. In Tombstone, local members of the outlaw Cochise County Cowboys repeatedly threatened Doc Holiday and spread rumors that he had robbed a stage. On October 26, 1881, Holiday was deputized by Tombstone city marshal Virgil Earp. The lawmen attempted to disarm five members of the Cowboys near the O.K. Corral on the west side of town, which resulted in the famous 30-second shootout, and the legendary stories and movie Tombstone.
Get involved and volunteer in meaningful activities around your neighborhood, church & community. Research shows that voluntarily giving of time increases happiness in the giver. It also allows one to see, participate with and help those around you who may be less fortunate. Volunteering your time and energy regularly increases your gratitude we will discuss further below.
Express gratitude
Expressing gratitude daily has been shown to dramatically increase your sense of well-being and happiness. Expressing gratitude requires awareness. It requires you to take inventory of everything around you (something you will already be doing if you are savoring your daily experiences). Gratitude can be expressed in a journal, through prayer & meditation, or directly to those around you. However, expressing gratitude requires effort.
In the Judaeo-Christian view, expressing gratitude is actually a method of expressing faith. The 17th chapter of Luke holds a biblical example of this concept. When the leper returned to express his thanks to Jesus Christ for being healed, he wasn’t told “Your gratitude made you whole.” Christ told him, “Thy faith hath made thee whole.” He implied that the act of expressing gratitude is a demonstration of faith, a necessary and essential process in human development.
Recognize personal value
I’m not talking about your bank statement or personal financial statement. I’m talking about recognizing the value of your soul. The only successful non-medication based program to help people overcome addiction is the 12-Step Program through Alcoholics Anonymous. The essential second step of the twelve is recognition that a power greater than ours is involved in our lives. Whether, you believe in God or a greater universal power, recognition of your value is an essential perspective to gaining happiness. This has been demonstrated thousands of times through the 12-Step Programs.
Often, the feeling we have of our personal worth is based on the love and interest we receive from those around us. Yet, this love is sometimes lacking. The love of men is often imperfect, incomplete, or selfish. What if you looked at yourself with the same benevolence, love, and confidence that God does? Imagine the impact it would have on your life to understand your eternal potential as God understands it. If you could view yourself through His eyes, what influence would that have on your life? Recognition of this principle is essential to making any lasting change.
Look for the growth in who you are
The celebrated Greek poet, Pindar, said, “Become who you are.” This is confusingly paradoxical. How does one become who they already are?
Many of the younger generation grew up to the sounds and images of The Lion King. You probably remember the scene where Simba receives a visit from his father, Mufasa, the deceased king. After his father died, Simba fled from the kingdom because the guilt he felt about his father’s death. He wanted to escape his responsibility as heir to the throne.
His father appears to him and warns him: “You have forgotten who you are and so have forgotten me. Look inside yourself, Simba. You are more than what you have become. You must take your place in the circle of life.” Then this invitation is repeated several times: “Remember who you are. … Remember who you are.”
Simba, completely shaken by this experience, decides to accept his destiny. He confides in his friend, the shaman monkey, that it “looks like the winds are changing.”
The monkey replies, “Change is good.”
And Simba says: “But it’s not easy. I know what I have to do. But going back means I’ll have to face my past. I’ve been running from it for so long.”
Recognizing and accepting our past for what it was brings happiness. Hiding or running from our past prevents us from experiencing true joy.
Meditate
Meditation and prayer have been shown to actually change areas of the brain that relate to stress management and mood regulation. People who meditate regularly over long periods of time have better ability to find and maintain positive states like joy and compassion. Richard Davidson and his colleagues found that meditation increases brain activity in areas related to happiness as well.
The ability for a person to access the subconscious mind and to address aberrant thinking errors attached to powerful emotions confers advantages that cannot be acquired through any other medical medium. Wholeness of the mind, body and spirit are ultimately the goal. Meditation & hypnotherapy change fragmented, unhappy people into integrated, happy people by simply helping people to identify and repair the broken subconscious thought patterns that can occur in all of our day to day lives. Check out Dr. Nally’s information on mind-body medicine here.
Improve the quality of your relationships
Happiness has been linked to quality relationships as well. Robert Wallinger, psychiatrist at Harvard University, conducted a 75 year multi-generational study on happiness. He found that the quality of the relationships was powerfully connected to happiness. Lonely people were less happy and had poorer health. People with higher-quality relationship or social ties were the happiest.
However, it wasn’t just having a relationship, but having one with a stable and consistently caring person that made the difference. Having lots of acquaintances or being in a relationship with an unreliable or abusive partner did not make people happier. Amazingly, listening (savoring shared experiences) and complimenting (expressing gratitude) improve the quality of relationships. (
Don’t know where to start? Start by sharing some bacon . . .
Allow others to help
I know you are probably familiar with the phrase “it is better to give than receive,” but did you know there is evidence to support the reverse mantra is also true? Happiness also comes from allowing others to help. Think about it. When you are helping others, especially when they appreciate it, you feel happiness or joy. Others experience those same feelings when they are able to help you. Think of a child that wants to make you a meal. No matter what it looks like when it gets to you, you smile and feel happy at the effort, the child smiles back proud at their success. There is happiness in giving and receiving.
So today’s your chance to receive. As a doctor, I find myself shying away from sharing this information with you directly because I never want anyone to feel like my efforts are about me. I’ve spent years learning and understanding the benefits of a Ketogenic lifestyle and spent additional years researching products that work and my local patients are experiencing tremendous results! A friend told me that not sharing this information with people directly was actually being selfish. (Ouch!) “When you know someone has a problem that you can solve, shouldn’t you share it and then let them make their own decisions?”
Although that was painful to hear, it helped me commit to being more direct about how I can help all of you to feel better. If you are ready to change the way you feel and want to live a happier, healthier life, the time is NOW. Put these 10 steps in action, click the link and get a copy of my diet. Then, enjoy the benefits of a Ketogenic or Carnivorous Lifestyle.
If you want to know more about what I do, keep reading my blog, join my weekly newsletter by signing up below. Then, watch my videos every week on YouTube and listen to my Podcast giving you free tips and tricks to stay healthier. I even developed my own line of vitamins and supplements specifically for myself and my patients. If you know you are ready for a change, and you want to see how I can help, check out the variety of Ketogenic programs I offer to help you find the meaning in your life.
16 Years of Keto/Carnivore . . .
No, it’s not sustainable at all. What do you think?
Keto Approved Foods
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:
- “What foods are ketogenic lifestyle approved?”
- “Can you just give me a list of approved keto foods?”
- “But, can’t I just have some oatmeal?”
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.
Carbohydrates
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
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.
- Egg protein utilization – 50%
- Meat protein utilization – 40%
- Cheese protein utilization – 40%
- Whey protein utilization – 18%
- Vegetable protein utilization – 14%
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.
What’s the One Difference that Increases Likelyhood of COVID-19 Survival?
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.
Why is this a problem?
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.
Insulin Raises Cytokine Levels
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.
C-Reactive Protein
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.
Interleukins (1,6, & 33)
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.
Risk of Death
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?
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 you and I do?
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.
Additional Measures
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:
- Follow good hand washing practices
- Limit exposure to those who may be carrying this illness through social distancing. If you have a fever, stay home. If you are ill, wear a mask out in public.
- Get good sleep (six or more hours of restful sleep)
- Use a complete pharmaceutical grade vitamin
- Spend 20-30 minutes outside
- Do something physical for 20-30 minutes 5-6 days per week
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:
What Can You & I Do To Prevent Viral Infections?
The following general measures are recommended to reduce transmission of infection:
- Diligent hand washing, particularly after touching surfaces in public. Use of hand sanitizer that contains at least 60 percent alcohol is a reasonable alternative if the hands are not visibly dirty.
- Respiratory hygiene (for example – covering the cough or sneeze).
- Avoiding touching the face (in particular eyes, nose, and mouth).
- Avoiding crowds (particularly in poorly ventilated spaces) if possible and avoiding close contact with ill individuals.
- Cleaning and disinfecting objects and surfaces that are frequently touched. The CDC has issued guidance on disinfection in the home setting; a list of EPA-registered products can be found here.
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:
#JustKeepEsterifying #LeadFolloworGetOutOrMyWay.
#Ketogenic #Keto #KetogenicLifestyle #Carnivore #DrAdamNally #DocMuscles #DocMusclesLive #DocTalk #DocsWhoLift #LiftRunShoot #DocMusclesLife YouTube.com/drnally/.
Dr Nallys Lasers: #PicoSure #Icon #SculpSure #TempSure
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Food Storage, Emergency Preparedness & The Ketogenic Lifestyle
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.
Principles of Food Storage
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:
- Food Supply
- Start with a three-month supply that is easy to rotate through your daily meals
- Expand as you can to a year’s supply of food
- Rotate through these foods using some of them regularly in your meal preparation and replacing them as you go along.
- Water Supply
- Storage
- Filtration
- Financial Reserves
- Essential (A whole topic for a different blog post and we won’t delve into it here)
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.
So, how does one build a long-term food supply and rotation without resorting to carbs?
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.
How much food do I actually need?
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.
Where do I store all this food & water?
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.
Start with Canned Foods
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.
Dry Goods
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.
Storing Your Own Seeds & Simple Garden Growbeds
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.
Designer Dry Goods
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
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.
Medications & Supplements
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.
Other Considerations
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.
My Feet Are Tingling (Polyneuropathy and Hyperinsulinemia)
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.
Definitions
- Polyneuropathy is a specific term that refers to a generalized sensation of tingling or numbness that uniformly affects many nerves at the peripheral sites (ends of the extremities like hands, fingers, lower legs, feet and toes).
- Peripheral neuropathy is a less precise term. It is frequently used synonymously with polyneuropathy, but can also refer to any disorder of the peripheral nervous system. However, this term includes pain or numbness that radiates from nerve roots like “sciatica” of the leg and “brachial plexopathy” causing symptoms in one hand and/or arm (mononeuropathies).
- Neuropathy, which again is frequently used interchangeably with peripheral neuropathy and/or polyneuropathy, can refer even more generally to disorders of the central (brain & spinal cord) and peripheral nervous system (nerves of the arms and legs) and their connections to sensory organs, such as the eye and ear, and to other organs of the body, muscles, blood vessels, and glands.
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.
- Mononeuropathy refers to focused involvement of a single nerve, usually due to a localized trauma, compression, or nerve entrapment. Carpal tunnel syndrome is a common example of a mononeuropathy. Sciatica due to a lumbar disc bulge is another form of mononeuropathy.
- Mononeuropathy multiplex refers to simultaneous involvement of non-adjoining sections of nerve trunks. Used loosely, this term can refer to multiple compressive mononeuropathies. However, in its more specific meaning, it identifies trauma, infection, auto-immunity or damage to multiple nerves outside the central nervous system. This is often due to lack of blood supply due to disease based inflammation of blood vessels supplying blood to these peripheral nerves.
- Diseases of the central nervous system such as a brain tumor, stroke, or spinal cord lesion occasionally present with symptoms that are difficult to distinguish from polyneuropathy.
Insulin Resistance and Neuropathy
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.
What Causes Polyneuropathy?
The mechanism of polyneuropathy damage in the patient with hyperinsulinemia three-fold.
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- The presence of high insulin stimulates increased fat storage. As fat cells begin to get filled, they begin to over-produce a number of inflammatory hormones including TNF-alpha, IL-6, IL-1, Adiponectin, Leptin and Resistin. These inflammatory hormones turn on auto-immunities and abnormal immune system function.
- At the same time, the high insulin levels suppress appropriate testosterone and estrogen production causing microscopic damage to the lining of the smallest arteries and capillaries of the body (found predominantly at the extremities, kidneys and back of the eyes).
- 65% of patients with insulin resistance (hyperinsulinemia) have a malformation of one or both genes that encode the MTHFR enzyme (methylenetetrahydrofolate reductase) that uses folic acid (Vitamin B9) inside the cells of the body. Because this is genetic and is a process occurring inside the cell, it has been difficult to identify until recent advances in measuring genetic SNPs. Single nucleotide polymorphisms, frequently called SNPs (pronounced “snips”), are the most common type of genetic variation among people.
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.
What Can I Do To Treat Polyneuropathy?
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!
References:
- Yigit, Serbulent et al. “Association of MTHFR gene C677T mutation with diabetic peripheral neuropathy and diabetic retinopathy.” Molecular vision 19 1626-30. 25 Jul. 2013.
- Wan, Lin et al. “Methylenetetrahydrofolate reductase and psychiatric diseases.” Translational psychiatry 8,1 242. 5 Nov. 2018, doi:10.1038/s41398-018-0276-6.
- Shelton, Richard C et al. “Assessing Effects of l-Methylfolate in Depression Management: Results of a Real-World Patient Experience Trial.” The primary care companion for CNS disorders 15,4 (2013): PCC.13m01520. doi:10.4088/PCC.13m01520.
- Hughes R. Investigation of peripheral neuropathy. BMJ 2010; 341:c6100.
- Morrison B, Chaudhry V. Medication, toxic, and vitamin-related neuropathies. Continuum (Minneap Minn) 2012; 18:139.
- Pareyson D, Piscosquito G, Moroni I, et al. Peripheral neuropathy in mitochondrial disorders. Lancet Neurol 2013; 12:1011.
- Rutkove SB, et al., Overview of Polyneuropathy. UpToDate.com. Online Jan 2020, https://www.uptodate.com/contents/overview-of-polyneuropathy?search=neuropathy&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
Just Keep Esterifying
I’ve had many of my patients and followers on social media ask about my continued use of the hashtag #JustKeepEsterifying. Well, here is the answer. Check out the short 4 minute video below to get the answer:
“Keep the carbs low and the fat high.”
#DrAdamNally #DocMuscles #DocMusclesLive #DocTalk #DocsWhoLift #LiftRunShoot #DocMusclesLife #PicoSure #Icon #SculpSure #TempSure
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Exogenous Ketone Manufacturers:
Great Info on Starting a keto diet: https://www.docmuscles.com/principle-based-ketodynamic-lifestyle/
What You MUST Know about Total Cholesterol & LDL-C on a Ketogenic Diet
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.
Estrogen Dominance – The Dead Man’s Curve on the Road to Ketogenic Happiness
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.
The Shovel will Fail You in Obesity, Finances & Life
A few years ago, my family and I set out to build a pond.
I have always loved Koi and the serenity of a Koi pond in my own back yard was very enticing. I spent about a year planning my design and the location. I dreamed of a serene evening after a very long, hectic day seeing patients relaxing beside the pond. The sound of trickling water, the occasional splash from fish, the cool breeze passing over the mist from a water-fall would sooth my soul after a busy day in the office.
I envisioned the perfect area. An unused access path, previously worn by the previous owner with truck and trailer traffic, beside my now expanded patio. Twenty feet wide, thirty feet long and four feet deep. . . that seems just perfect.
I pulled out my shovel and set about digging. Eager to begin and filled with the energy of the final product, I set to digging. What could be so hard about digging my own pond? Think of the exercise I will be getting. Thoughts spurred me on.
Minutes later, chest heaving, face glistening with sweat, I stared in dismay at the ground. All I had to show for my wild digging was a small 1/2 inch dent in the dusty Arizona top soil.
Sonoran Clay
Over time, calcium-carbonate, along with other minerals, accumulates and dissolves into the topsoil of the very arid regions of Arizona Sonoran Desert. It forms a two to three-foot layer of soil called “caliche.” Periodic rains carry the calcium as far as three feet down into the soil, then the water rapidly evaporates in the blistering Arizona heat. This often forms two to three feet of soil that is “literally” harder than concrete.
With tremendous zeal, a great deal of sweat and a round of painful blisters, I broke my third shovel on this impenetrable ground. I realized this was much more difficult than I thought. I pulled out the back-hoe attachment for my small farm tractor. After a few hours and few gallons of diesel fuel later, still very little progress occurred.
Multiple weekends and evenings of digging in the Arizona caliche left me with three broken shovels, a ruptured hydrolic line in my tractor, anger that my expensive back-hoe attachment didn’t work, and only a small dent in the ground near my patio. Even the brute force from the tractor would not budge the clay. I wondered if dynamite would be effective? (My wife would have none of this idea).
With my exuberance quashed, I concluded that this would require much more measured exhuming.
Escape From the Prison
We often imagine, with great delight, the removal or destruction of that which enslaves or imprisons us. We dream that just a little sweat, exertion of a few shovel scoops of dirt and the foundation to our prison of obesity, addiction, debt, and depression are exposed. A few extra scoops and we imagine freedom from that prison cell.
If only I had a jack hammer and a bigger, more powerful scoop, I imagine . . . I could make short work of these manacles that bind me.
But, our manacles and prison cells do not so easily give way.
The failings of our sharpened spades and powerful back-hoes form a new, even stronger fetter – the belief that our prison cell is unbreakable, that our challenge is just too great. These failings usually leave a person cured of any further desire to break free. It quashs the dream and solidifying the depression of stagnation.
The in-fecundity of my shovel, no matter the strength and effort put behind it, was not cause to quit. It was life’s lesson that prisons and shackles often only need a simple tool.
Enter the pick-axe. During this process my wife said, “Honey, why don’t you use the pick in the garage?”
“If my shovel and the back-hoe didn’t work, there was no way I was going to break through this clay with a pick axe.” That was absurd, I thought.
Yet when I humbled myself to try, it was simple. The pick-axe was unpretentious. This simple tool allowed for an almost effortless stroke to a small area of weakness in the caliche. A large flake of soil would pop free with each stroke. The process was repeated.
Scale by scale, the dragon’s flank was exposed. Careful work of the pick-axe began to loosen layer after layer, section after section, pellicle after pellicle. Yes, it was slow work. But, each swing was a small victory.
At each little victory, my heart would leap, the dream would become ever clearer.
Working this magic again and again until finally the specter was weakened enough to pull out the shovel. And, further work, allowed for bringing back the powerful back-hoe, in gratifying scoops.
The excavation that I thought would take two months took me fourteen. But, it was gratifying.
I learned a powerful lesson. Wherever life has pinned you, fettered you or barred you in, put down the shovel, and pick up the pick-axe. Second, if you really listen, your spouse may point out the tool you really need. Don’t be afraid to chip away at it a piece at a time.
Finances
Stop waiting for the sharper shovel or the bigger back-hoe to dig yourself out of your harrowing debt, mega mortgage, or your income dwarfing spending. The jackpot or financial windfall won’t come. While others await the jackpot, put down your shovel and shoulder your pick-axe.
- Pick one small debt and begin to pick at it by applying just a little extra each month until it is gone.
- Cancel your extra cable, sell the motorcycle and payoff the 21% interest credit card.
- If you must, pick up a side-hustle for extra to sharpen the pick.
Once you’ve lifted one flake, chip away at the next. Making progress will make it easier to continue. It doesn’t matter how long it takes, just keep at it.
Marriage
You long for resolution of the apathy, progressive resentment and mutual stalemate that permeates your relationship. You look in vain for the bigger shovel that will uncover the treasure that years of apathy have buried. You long to uncover your dreams and needs that have been covered and hardened under the clay of resentment. The shovel and the back-hoe won’t help you here.
Drop the shovel. Shoulder your pick-axe.
- Kiss your wife every time you leave, even if it’s just for a ten minutes to run to the convenience store.
- Hold her for five seconds longer every time you hug.
- Find a gift you can give her once a week, just because.
- Put down your phone and look her in the eyes when she talks to you and listen. Really listen and the flakes of hard clay will unveil the beauty of her soul.
- Find a way to praise her every day, even if it is through a simple text.
Health
You long to rid yourself of your addiction to sugar, bread, stress, and sleep deprivation. You’ve tried to scoop them out of your life. You even hired a trainer with some muscle to force you to change. You’ve tried in vain to save yourself from yourself.
Trying to use the shovel here is like trying to use the shovel on steel forged walls of your life’s prison fortress. Forget the shovel. Shoulder your pick-axe.
- Start with one meal and make some substitutions. My dietary plan can help you with this.
- Go to bed an hour earlier. Really, you’ll be surprised that the focus you have will more than compensate for the hour of lost time in the evening.
- Add a quality vitamin to your morning routine.
- Take ten minutes and do 20 push-ups and 20 sit-ups, then take a 10-minute walk.
- Simply remove the “white stuff” from your meals. You will be amazed at the results.
- Put down your phone for 30 minutes and read that book you’ve been meaning to read, instead of surfing Facebook.
Grand-standing with your back-hoe doesn’t help you. Just swing the pick-axe once or twice. Simple daily picking with the sharp point weakens the hardest of ground and the prison walls in our lives. It takes time, so be patient.
Find the weak point, apply the pick. Day by day, little by little you will be free.
I’ve been there. I’m with you. Keep me posted on your journey.
If you’re looking for a program that teaches you how to do this, check out my membership site.
Is Keto For Everyone? Dr. Nally’s Three Principles of Health
Is a Ketogenic Lifestyle What Everyone Needs?
“Do I really need to be doing that ‘Keto Thing’?”
I get asked this question all the time. And, my answer is that 85% of the people that walk through the doors of my clinic will not be fully successful in weight loss, reversal of diabetes, normalization of blood pressure and reversal of heart disease and/or vascular disease without it.
I am frequently asked, “Is Keto for everyone?” Does everyone need to follow a ketogenic lifestyle? The answer is “No.” 15% of the population will be able to maintain great health with calorie restriction and exercise. However, the principles that provide a successful ketogenic lifestyle are easily understood and incorporated by anyone looking for improved health, energy and weight control.
Principle #1 – Insulin is the Master Hormone
Insulin is the master hormone when it comes to weight loss and the diseases of civilization. Whether you are insulin resistant or not, insulin is essential for life and proper function of the cells of the body, but too much insulin production in response to sugars, starches or complex carbohydrates causes disease.
How do you know if you are insulin resistant (producing too much insulin)?
Skin tags are pathognomonic (a characteristic indicative of the presence of disease) for insulin resistance. If you have skin tags, you may want to focus your diet on increased carbohydrate restriction.
You may not need to completely remove carbohydrate from your diet, however, recognizing that not all carbohydrates are created equal and avoiding those with higher carbohydrate content will help many improve weight and halt the progression of disease. I have many patients that with just partial carbohydrate restriction they are able to lose 20-30 lbs, improve their cholesterol profiles and improve their blood pressure.
There are sixteen different diseases that respond very effectively to carbohydrate restriction. You can read about them and how the ketogenic lifestyle effectively reverses them in The Keto Cure.
Principle #2 – Saturated Fat & Cholesterol Aren’t the Demons We’ve Made Them Out to Be
Saturated Fat and cholesterol aren’t the demons we’ve made them out to be. Another way to put it is: “Don’t blame the butter for what the bread did.”
Since 1984, nutrition experts treat fat and cholesterol containing foods like the witches of Salem. Experts castigate their use as if they were the “Avada Kedavra“ curse of the fantasy world.
As an example, eggs, specifically the egg yolk (the part of the egg containing all the cholesterol and saturated fat), have been demonized by just about every health magazine I’ve ever read. (To this day, the chef at every breakfast bar I’ve ever visited asks if I want an ‘egg white only’ omelet.) Interestingly, there is actually no scientific data association between whole egg consumption and heart disease. The science simply does not exist. Seriously, check for yourself.
I personally eat 6-8 eggs a day and my cholesterol is perfect. Back 1000 years ago, only the aristocrats at the chickens. All laborers and serfs ate the eggs . . . who would be dumb enough to eat your food source? (Don’t answer that.)
For example, the MR-FIT study, the largest cholesterol study ever completed, is incessantly quoted as the study that demonstrates reduction in cholesterol leads to reduction in cardiovascular disease, but this trial was actually a failure and did not demonstrate improved risk by lowering cholesterol. In fact, the Director of the study, Dr. William Castelli stated, “. . . the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol…”
Researchers found that people who ate the most cholesterol, including the most saturated fat, weighed the least. They were also the most physically active. In fact, the British Medical Journal published a 2015 study demonstrating that saturated fat is NOT linked to vascular disease, diabetes or increased mortality (de Souza RJ et al., BMJ 2015,351:h3978).
In my clinic, the basis of appetite suppression is eating adequate protein that includes saturated fat and cholesterol. This is the most powerful tool in my clinical approach to the treatment of weight loss. I can use foods like red meat, bacon, butter and coconut oil without concern or worry of heart disease as long as you are keeping your carbohydrate intake less than 20 grams per day.
Baseline insulin levels allow for peace of mind about heart disease risk. Heart disease risk goes down when insulin levels are maintained at normal baseline levels. Increasing saturated fat, while at the same time lowering carbohydrate intake has been demonstrated to shift the cholesterol to a more heart protective form (Griffin BA et al., Clin Sci [Lond], 1999 Sep).
Principle #3 – Nutritional Ketosis Has Anti-Inflammatory & Age Slowing Effects On the Body
Ketones in the blood at a nutritional level (0.5-4 mmol/L) have tremendous anti-inflammatory and age slowing effects on the body. Even having them present intermittently has dramatic improvement on overall inflammatory changes and disease in the body.
Ketones are the usable fuel of the body when the liver breaks down fat for energy. They suppress the NLRP3 inflammasome in every cell in the body. This is important because it allows for more rapid recovery from exercise. It also dramatically decreases pain and fatigue that comes from diseases like arthritis, rheumatoid arthritis, multiple sclerosis and auto-immune disease (Y.H. Youm, et al., Nature Medicine, vol. 21, no. 3, pp. 263–269, 2015.)
If full blown ketosis isn’t for you, partially restrict starch and carbohydrates for a mild to moderate benefit. Even small amounts of ketones in the blood are helpful. This provides increased recovery time, and improved inflammation control.
So, even if you don’t follow a strict ketogenic lifestyle, the principles above are powerful. These three principles make this dietary approach universally effective for weight loss. They are also very powerful for disease management. Even partial application of carbohydrate restriction can benefit just about everyone.
You can learn much much more about the Ketogenic Lifestyle as a member of DocMuscles.com. Click the link and sign up now.
And, don’t forget to get your signed copy of my book, The Keto Cure.
What Blood Tests are Important In a Ketogenic Lifestyle?
So, you’ve started a ketogenic lifestyle and you’re a few months in . . . but, is it really working? How do you know? You should be seeing your waist shrink. But, is all that butter really good for my cholesterol? What about my blood tests?
I commonly get these questions over the last 12-13 years of using a low-carbohydrate or ketogenic lifestyle approach in the treatment of obesity, diabetes, cholesterol and high blood pressure. We can determine the effectiveness of the diet on your metabolism with some simple blood testing.
What Lab Tests Do You Need?
Watch the video below to find out what tests are right for you:
Why don’t you check all the other inflammatory markers like HS-CRP, Lp(a), etc? Because, I know that these test will be elevated if insulin is > 5 mmol/L and if sdLDL particle is > 500 nmol/L.
Check out our membership site and the benefits that come with it.
Long-Term Weight Loss: Why So Many Fail
Over fifty years of data have demonstrated that creating energy deficit through the reduction in caloric intake is effective in reducing weight. . . However, it is only for the short term (1, 2). The biggest challenge physicians face in the treatment of obesity is that calorie restriction fails when it comes to long-term weight loss.
Isn’t Fasting Effective in Long-Term Weight Loss?
With the craze and popularity of intermittent fasting, some have claimed that intermittent fasting is more effective in weight reduction. Recent results demonstrate that this may also be incorrect. In the short term evaluation of caloric restriction and intermittent fasting, reduction in 15-20 lbs of weight is effectively seen and the highly publicized Biggest Loser’s losing ~ 120 lbs. Intermittent fasting and alternate day fasting have been shown to be more effective in lowering insulin levels and other inflammatory markers in the short term.
There is, however, controversy over maintaining weight loss beyond 12 months in the calorie restriction, intermittent and alternate day fasting groups. Forty different studies in a recent literature review, thirty-one of those studies looking at forms of intermittent fasting, demonstrate that the majority of people regain the weight within the first 12 months of attempting to maintain weight loss(3, 5). This is, also, what I have seen for over 18 years of medical practice.
Is Calorie Restriction the Only Way to Lose Fat?
Numerous “experts” claim that the only way to reduce fat is “caloric deficit.” Variations through the use of intermittent, long-term or alternate day fasts can be found all over the internet. In regards to calorie restriction, these “experts” with nothing more than a personal experience and a blog to back their claims preach this louder than the “televangelists” preach religion. Based on the faith that many place in this dogma, it could be a religion. What causes belief in this dogma is that weight and fat loss actually does occur with caloric restriction to a point. The average person will lose 20-25 lbs, however, within 12 months of achieving this goal, most people regain all the weight. (No one ever mentions the almost universal problem with long-term weight loss, especially those “experts.”)
Prolonged calorie restricted fasts, intermittent fasts, and alternate day fasts are often grouped together into the fasting approach, causing significant confusion among those that I speak to and counsel in my office. There is great data that alternate day fasts do not have the reduction in resting energy expenditure that prolonged fasting, intermittent fasting and calorie restriction cause. However, none of these approaches appears to solve the problem of weight re-gain after long-term (12-24 months into maintenance) weight loss (3). And, a recent study of 100 men participating in alternate day fasting showed that there was a 38% dropout rate, implying that without close supervision and direction, maintenance of this lifestyle is not feasible for over 1/3rd of those attempting it.
Long-Term Weight Loss Failure Brings Tears
Failure on calorie restricted diets, low fat diets, and intermittent fasting diets with weight regain at twelve to twenty-four months is the most common reason people end up in my office in tears. They’ve fasted, starved themselves, calorie restricted, tried every form of exercise, and still regained the weight. Trainers, coaches and “experts” have belittled them for “cheating” or just not keeping to the diet. Yet, we know that calorie restriction and intermittent fasting cause a rebound in leptin, amilyn, peptid YY, cholecystikinin, insulin, ghrelin, gastric inhibitory peptide and pancreatic poly peptide by twelve months causing ineffective long-term weight loss (6). The dramatic rise in these hormones stimulates tremendous hunger, especially from ghrelin and leptin.
Although less problematic in alternate day fasting, these calorie restricted approaches also cause dramatic slowing of the metabolism at the twelve month mark. In many cases, the metabolic rate never actually returns to baseline, creating even more difficulty in losing further weight or even maintaining weight (6).
Is Gastric Bypass or Gastric Sleeve the Solution?
Gastric bypass and the gastric sleeve procedures have been touted as the solution to this problem, as they decrease ghrelin, however, 5-10 years later, these patients are also back in my office. They find that 5-10 years after these procedures the weight returns, cholesterol and blood pressure rise, and diabetes returns. These hormones kick into high gear, stimulating hunger in the face of a slowed metabolism, that to date, has been the driver for weight regain in the majority of people. People find it nearly impossible to overcome the hunger. You may have experienced this, I know I have.
It’s the Hormones, Baby!
So, what is the answer? It’s the hormones. (WARNING – You’ll hear that when your wife is pregnant, too, gentlemen). We are hormonal beings, both in weight gain, and in pregnancy. Trying to preach calorie control to a hormonal being is like showing up at the brothel to baptize the staff. You might get them into the water, but you’re probably not getting them returning weekly to church or pay a tithe.
So, how do you manipulate the hormones in a way to control the rebounding hunger and suppression of metabolism? This is where we put a bit of twist on the knowledge we’ve gained from alternate day fasting. Recent research shows that “mild” energy deficit in a pulsatile manner, that has the ability to mimicking the body’s normal bio-rhythm’s is dramatically effective in reducing weight and maintaining normal hormonal function without cause of rebound metabolic slowing (4).
Pulsed Mild Energy Restriction
What does this mean in layman’s terms? It means that if we provide a diet that maintains satiety hormones while providing a period of baseline total energy expenditure needs and a period of mildly reduce caloric intake in a pulsed or cyclic manner, greater weight loss occurs and there is no rebound of weight 1-2 years later.
The main reason I’ve not jumped on the intermittent fasting band wagon is the shift in leptin, amylin, ghrelin and GLP-1 signaling that regularly occurs at the 6-12 month mark. The rebound of these hormones causes weight re-gain and is what prevents successful long-term weight loss. A number of people come to my office and tell me they couldn’t follow a ketogenic diet, so they’re doing intermittent fasting and it works . . . for a while. Then, they end up in my office having hit a plateau or fallen off the wagon and regained all the weight. They are completely confused and don’t understand what happned. Most of them are convinced it’s their thyroid or cortisol and they’ve seen every naturopath and functional medicine doctor in town.
What people really need is a simple approach to long-term weight loss without having to spend the night in the physiology lab every two weeks sleeping under a ventilated hood system.
The Ketogenic Lifestyle is a Pulsed Energy Lifestyle
- First, it is essential to turn off the insulin load. Insulin is the master hormone. This is done by a ketogenic lifestyle that restricts carbohydrates.
- Second, providing adequate protein to supply maintenance of muscle and testosterone is key.
- Third, providing adequate fat is the simple way to maintain leptin, ghrelin, amylin, GLP-1 (among the others) and long-term weight loss. Can you eat too much fat? Of course you can. But, because each of us have differing levels of stress and activity each day, this fat intake becomes the lever for hunger control.
- Fourth, the use of exogenous ketones ensures easily accessible ketone (short chain fatty acids) to modulate adipose (white fat) signaling of the liver without large caloric intake through the portal vein by first pass of liver metabolism. The ketones also help stabilize the gut bacteria. The combination of hormone balance between the liver and fat cells and improvement of gut bacteria suppresses key hunger hormones and aids glucose regulation between the fatty tissues and the liver. Ketones, both endogenous and exogenous, suppress production of TNF-alpha, IL-6, resistin, and stabilize production of adiponectin and leptin from the adipose cells (7, 8, 9).
In my office, once we calculate the basic protein needs daily, we start with a 1:1 ratio of protein to fat. Then, the fat is adjusted up or down based on hunger. Remember, hunger occurs, because your body produces hormones. The addition of fat to a diet that is not stimulating large amounts of insulin resets the hormone patterns back to normal without causing weight gain.
Give Obese People Fat Ad Libitum?
“Sure, Dr. Nally, but what about those people who don’t know if they are hungry, bored, stressed or just have a bacon fixation? You can’t just give them all the fat they want?!”
Why not? Implying that people aren’t smart enough to know when they are full is a bit of a fascist philosophy, don’t you think?
Do people over eat? Sure they do. But, I’ve found that when you give people an antidote to hunger (using fat intake in the presence of stabilized insulin levels) over a few months, people begin to recognize true hunger from other forms of cravings. This is especially true when they keep a diet journal. This gives people the ability to begin listening to their own bodies, responding accordingly and governing their stress, eating, exercise and activity. Keeping a diet journal is key to long-term weight loss. And, isn’t helping people use their own agency to improve their health really what we’re trying to do?
Interestingly, doing this over the years seems to line up with the findings of this year’s MATADOR study in the International Journal of Obesity. They found that mild intermittent energy restriction of about 30-33% for two weeks, then interrupting this with two weeks of a diet that was energy balanced for needs improved both short and long-term weight loss efficiency (4). In looking at my, and my patient’s diet journals, this energy restriction of about 1/3 of needed calories cyclically seems to happens naturally with a ketogenic lifestyle, without even counting calories. (Calories are a swear-word in my office).
What does the correct long-term wight loss program look like in a diet or meal plan? Well, you’ll have to join the Ketogenic Lifestyle 101 Course to see what that really means to you individually. I look forward to seeing you there.
Want to find out more about the Ketogenic Lifestyle 101 course? CLICK HERE.
Have you read my book The Keto Cure? Get a signed copy from me by clicking HERE.
References:
- Bronson FH, Marsteller FA. “Effect of short-term food deprivation on reproduction in female mice.” Biol Reprod. Oct 1985; 33(3): 660-7. https://www.ncbi.nlm.nih.gov/pubmed/4052528?dopt=Abstract&holding=npg
- Connors JM, DeVito WJ, Hedge GA. “Effects of food deprivation on the feedback regulation of the hypothalamic-pituitary-thyroid axis of the rat.” Endocrinology. Sep 1985. 117(3): 900-6. https://www.ncbi.nlm.nih.gov/pubmed/3926471?dopt=Abstract&holding=npg
- Seimon RV, Roekenes JA, Zibellini J, Zhu B, Gibson AA, Hills AP, Wood RE, King NA, Byrne NM, Sainsbury A. “Do intermittent diets provide physiological beneftis over continuous diets for weight loss? A systematic review of clinical trials.” Mol Cell Endo. 15 Dec 2015. 418(2): 153-172. https://www.sciencedirect.com/science/article/pii/S0303720715300800
- Byrne NM, Sainsbury A, King NA, Hills AP, Wood RE. “Intermittent energy restriction improves weight loss efficiency in obese men: the MATADOR study.” Int J Obes. 2018. 42:129-138. https://www.nature.com/articles/ijo2017206
- Trepanowski JF, Kroeger CM, Barnosky A. “Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults.” JAMA Intern Med. Jul 2017. 177(7): 930-938. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2623528?redirect=true
- Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, Proietto J. “Long-term persistence of hormonal adaptations to weight loss.” N Engl J Med. 27 Oct 2011. 365: 1597-1604. http://www.nejm.org/doi/full/10.1056/NEJMoa1105816
- Asrih M et al., “Ketogenic diet impairs FGF21 signaling and promotes differential inflammatory responses in the liver and white adipose tissue.” PlosOne. 14 May 2015. Open Access. https://doi.org/10.1371/journal.pone.0126364
- Veniant MM et al. “FGF21 promotes metabolic homeostasis via white adipose and leptin in mice.” PlosOne. Jul 2012. Open access. https://doi.org/10.1371/journal.pone.0040164
- Whittle AJ, “FGF21 conducts a metabolic orchestra and fat is a key player.” Endocrinology. 1 May 2016. 157(5): 1722-1724.
Dr. Nally’s Twenty Two Tough Truth’s
Sunday’s are my day of rest, . . . if a physician ever really rests? I’m sitting out under the stars very late on this Sunday evening, into the wee hours of Monday morning. (It’s our turn for flood irrigation at 2 o’clock in the morning). But, I appreciate these times of solitude. It is on Sunday’s that I’ve been able to work on twenty two life lessons (tough truths) that make life better. I do my best to treat Sundays as a “sacred” or “holy day,” a day of rest from my temporal labor, to contemplate the word of God, to pray & meditate, to participate in public worship and focus on where I am at in my personal spiritual development.
Yes, I know. I’m a physician; and yet, I believe in God.
No, it is not a contradiction. (I can already see my in-box filling up with agnostic castigation.) Friends of mine claim atheism or agnosticism. Yet in the day to day trenches of life, I find there is no real atheism. There is no such thing as not worshiping. When it comes down to it, we all worship something. We each have the choice of what we worship. Worship being defined as giving adoration, reverence or homage to someone or something.
We have the choice of worshiping the God, a god (however you may define god), spiritualism, truth, ethical principles, nature, football, money, your body, someone else’s body, power, fame, etc. You and I know this on a basic level, we just have to come to grips with what it is we hold on a pedestal, and to which we “pay homage.”
There comes a point, when one deals with life and death on a daily basis, that a person must question the very existence of God, and come to terms with who or what we actually pay homage. I’ve sincerely asked that question . . . I’ll leave that story for another time.
It’s during my Sunday afternoons, that I’ve been able to contemplate and attempt to re-apply the “tough truths” of life that seem to challenge me. So, instead of sharing some bacon with you this evening, I thought I’d share twenty two of the truths that I am working on improving in my life. (Though . . . they’re almost as good as bacon!)
Twenty Two Tough Truth’s that I’ve Learned & Had to Re-Learn in Life:
- There is much about life over which we have absolutely no control. You cannot control everything that happens in life, but you can control how you respond. Your response is your greatest power. “The joy we feel has little to do with the circumstances of our lives, and everything to do with the focus of our lives.” (Russel Nelson)
- It’s not about the cards you’ve been dealt, it’s about how you play the hand. (Randy Pausch)
- W. C. Fields said, “Smile first thing in the morning and get it over with.” My expectations often make me utterly unhappy. Happiness is letting go of what you assume your life is supposed to be like right now, and sincerely appreciating it for everything that it actually is.
- In mortality, we will always be incredibly imperfect. If you wait until you’re perfect before you share your stories, ideas, talents and gifts with the world, no one will ever hear from you.
- A moment spent worrying is a moment wasted. Worrying will NEVER change the outcome. Do more, worry less. Train your mind to see the lesson in EVERY situation, and then make the very best of it. Liberating ourselves from our fears, automatically gives people the ability to do the same around you.
- The best lessons often come from the very hardest days. If you are having a hard day, stand strong, there is a lesson here. Sometimes you have to experience a low point in life to learn a good lesson you couldn’t have learned any other way.
- Success easily gets to our heads, and failure easily gets to our hearts. Our true character is usually revealed at our highs and lows. Be humble at the mountain top, steadfast in the valley’s and faithful in between.
- We often confuse being busy with being productive. What you pay attention to grows. So, focus on what truly matters and let go of what does not. “You are the average of the five people you spend the most time with.” (Jim Rohn)
- More money left un-managed just creates more problem. Yes, we need money to live. Earn it. Save it. Invest it. But, avoid spending money you haven’t earned, to buy things you don’t need, to impress folks you don’t even know. Manage your money so it doesn’t end up managing you.
- Most of us don’t need more to be happy – we need less. When things aren’t adding up in life, begin subtracting. Life gets much simpler when you clear away the physical and mental clutter that makes it complicated.
- Our fancy gadgets (phones, computers, tablets, radios, etc.) often get in our way and dehumanize us. We all need to learn to be more human again. Don’t avoid eye contact. Don’t hide behind the gadgets. Smile often. Ask about people’s stories . . . And, then, listen.
- We don’t always get what we give. You will end up sadly disappointed if you expect people will always do for you as you do for them. Not everyone has the same heart you do.
- Most arguments we have with one another are pointless. Be selective in your battles. Peace in this moment may be better than being right. You actually don’t need to attend every argument into which you’ve been invited. “You will never reach your destination if you stop and throw stones at every barking dog.” (Winston Churchill)
- I’ve never met a strong and confident person with an easy past. Be grateful for your scars. Be thankful for the emotional muscle and physical strength you gain from standing against the winds of life.
- The only way to completely avoid pissing people off is to do nothing of importance.
- The true definition of “Hell” is to meet the person you could have become on your last day on earth.
- Just because you fell off the ketogenic wagon today, doesn’t give you license to drag it into the woods, set it on fire and use the insurance money to buy Twinkies.
- “You only live once, but if you do it right, once is enough.” (Mae West)
- Ignoring your passion in life creates anxiety. Ignoring the anxiety, creates panic and hopelessness. Never ignore what moves you. Mold your work around the lifestyle that brings you passion, don’t mold your passion around your career.
- The human body tends to move more or less in the direction of your expectations. This is why it is so important to know that the attitudes of confidence and determination you feel and hold are just as much a part of your treatment program as medical science and technology.
- The hottest places in Hell are reserved for those, who in times of great moral crises, maintained their neutrality. (paraphrased from Dante Alighieri)
- A man would do well to carry a pencil in his pocket, and write down the thoughts of the moment. Those thoughts that come unsought after in the moment are commonly the most valuable, and should be secured by recording them, . . . because they seldom return. (Brigham Young)
Over the years, I’ve carried a leatherbound little notebook with me and I write down thoughts or quotes I hear into that little note book. Among these thoughts and quotes I’ve collected, I’ve found that on Sundays, I can let my mind chew on them.
One of the things that I’ve learned over the years is that observing a weekly “day of rest,” or “holy day,” is that this behavior is one of the most important safeguards to health and wellness. I’ve learned this from my personal experiences during periods when I didn’t observe the “day of rest” and periods where I have closely guarded that “day of rest.” I’ve found that observing the Sabbath has truly become a “delight” as spoken of by the Old Testament prophet, Isaiah.
Science Demonstrates Importance of Day of Rest
What is fascinating, is that science has recently demonstrated how this works. In early 2000, Marcus Raichle from Washington University demonstrated that the human brain demands 20 percent of the body’s energy and uses only 5-10 percent more when solving calculus problems, reading a book (or this blog post, for that matter) or writing a letter. However, they noticed that some areas of the brain became notably less active when concentrating on a mental challenge, but fired synchronously when laying flat in an MRI scanner, allowing their thoughts to wander (1).
This was confirmed by a number of other researchers who noted that there was a coordinated communication between diverse areas of the brain when people were “resting.” This mysterious coordination between different parts of the brain during “daydreaming” has become known as the default mode network (DMN). In the last few years, we’ve learned there are actually five different “resting state networks” that coordinate vision, hearing, movement, attention & memory. However, the DMN is the most researched and appears to be the most important.
Dr. Immordino-Yang reviewed the research on the DMN and found that downtime is an opportunity for the brain to make sense of what it has recently learned. It is during this “day of rest” that the mind coordinates unresolved tensions, conversations we had earlier in the week, re-writing verbal blunders, and practicing standing up to those that intimidate us. Our minds shuffle through the neglected to-do lists and post-it notes on the mental refrigerator of our brain, searching for solutions and answers. It moves back and forth through childhood scenes and futuristic adult hopes and dreams. It is during this time that our brain looks at the moral connotations of our performance with others (3).
Other research demonstrates that the mind solves very tough problems during this period of rest and day-dreaming. You may have experienced something like this when you solve a problem while in the shower. (I hate to admit it, but many of my problems get solved in the shower.) When the mind isn’t actively working or learning something new, it can accumulate, memorize and rehearse recently learned skills, actually transcribing them onto new brain matter (4). Recent research demonstrates that this recording of new memory and skill, called “sharp-wave ripples” actually occurs more often during “rest periods” than during sleep (5).
Meditation and the Day of Rest
Meditation and/or prayer have been shown to strengthen connections between regions of the DMN. Those that observe a day of rest with meditation develop a more intricate wrinkled cortex, the outer layer of the brain that gives us the ability to perform abstract thought and introspection. Meditation appears to increased both the volume and density of the hippocampus, the area of the brain essential for memory storage and the frontal cortex that allows us to control or rein in emotions. Fascinatingly, meditation and observance of a “day of rest” slows the natural “wilting” of the brain regions required for sustained attention that normally withers as we age (6, 7, 8, 9).
How soon does observing a rest day or “keeping the Sabbath” become effective? A number of studies show that noticeable changes occur within a couple of weeks. More importantly, daily meditation has been show to be more effective in the long run than the total hours of meditation over one’s lifetime (10,11).
As a physician and a clinical hypnotherapist, I personally use and recommend daily meditation. If you want a free copy of my self-guided meditation program for relaxation and weight loss, CLICK HERE.
Now, what I want to know, is does bacon intake during the rest day have any effect on the hippocampus, frontal cortex or wrinkle cortex? I guess we’ll have to wait for that research to be completed. In the mean time, check out my membership page to see what we do know about the use of fat and cholesterol does to help attention and energy.
References:
1. Raichle ME, MacLeod AM, Snyder AZ, Powers WJ, Gusnard DA, Shulman GL. “The maturing architecture of the brains default network.” Proc Natl Acad Sci U S A. 2001 Jan 16; 98(2):676-82.
2. Moussa MN, Steen MR, Laurienti PJ, Hayasaka S. “Consistency of Network Modules in Resting-State fMRI Connectome Data” PLOSone. 31 Aug, 2012. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0044428.
3. Immordino-Yang MH, Christodoulou JA, Singh V. “Implications of the Brain’s Default Mode for Human Development and Education.” Perspectives on Psychological Science. 29 Jun, 2012. 7(4): 352-364.
4. Payne, JD. “Learning, Memory, and Sleep in Humans.” Sleep Medicine Clinics. Mar 2011. 6(1):15-30. https://www.sciencedirect.com/science/article/pii/S1556407X10001220.
5. Perlow LA, Porter JL. “Making Time Off Predictable – and Required.” Harvard Business Review. Oct 2009. https://hbr.org/2009/10/making-time-off-predictable-and-required.
6. Zeidan F, Johnson SK, Diamond BJ, David Z, Goolkasian P. Mindfulness meditation improves cognition: Evidence of brief mental training.” Consciousness and Cognition. Jun 2010. 19(2): 597-605. https://www.sciencedirect.com/science/article/pii/S1053810010000681#]
7. Luders E, Kurth R, Mayer EA, Toga AW, Narr KL, Gaser C. “The unique brain anatomy of medication practitioners: alterations in cortical gyrification.” Front Hum Neurosci. 29 Feb, 2012. online. https://www.frontiersin.org/articles/10.3389/fnhum.2012.00034/full
8. Pagnoni G, Cekic M. “Age effects on gray matter volume and attentional performance in Zen meditation.” Neurobiology of Aging. 28(10): 1623-1627. https://www.sciencedirect.com/science/article/pii/S0197458007002436
9. Luders E, Toga AW, Lepore N, Gaser C. “The underlying anatomical correlates of long-term meditation: Larger hippocampal and frontal volumes of gray matter.” Neuroimage. 15 Apr 2009. 45(3) 672-678. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3184843/
10. Chiesa A, Clati R, Serretti A. “Does mindfulness training improve cognitive abilities? A systematic review of neurpsychological findings.” Clinical Psychology Review. 1 Dec 2010. 31: 449-464. http://psy.fgu.edu.tw/web/wlchou/perceptual_psychology/class_pdf/Advanced%20Perceptual/2011/2011week15_HaoChen_paper.pdf
11. Chan D, Woollacott M. “Effects of level of meditation on experience on attentional focus: is the efficiency of executive or orientation networks improved?” J Altern Complement Med. 2007. Jul-Aug. 13(6): 651-657. https://www.ncbi.nlm.nih.gov/pubmed/17718648.
Eight Reasons You Can’t Lose Fat
Inability to lose weight is the most common reason people see me. It’s often a combination of small things of which they are unaware. What simple things are keeping the spare tire inflated around the your waist? I’ve listed the eight most common reasons you can’t lose the fat.
You Eat Too Many Carbohydrates
About 85% of the people that walk through my office doors have some degree of insulin resistance. This means that they produce 2-20 times the normal amount of insulin in response to ANY form of starch or carbohydrate. Insulin is the hormone responsible for letting glucose into the cell to be used as fuel. More importantly, it is the hormone responsible for dampering glucose production in the liver and, it is the primary hormone responsible for pushing triglycerides into the fat cells (essentially, the master hormone for making you FAT). The more insulin you make the more fat you store. Insulin resistance, the inability for insulin to signal glucose dampering at the liver receptors, is the first stage that starts 15-20 years before you become a diabetic.
In order to lose fat, you have to decrease the insulin to a basal level. If you don’t the fat enters the fat cell faster than it exits and the fat cells get bigger. This is RULE number one to weight loss. You gotta turn down the high insulin surge that 85% of us are really good at producing. If you don’t do this, it is almost impossible for many of us to lose weight.
For at least 1/3rd of the people I see, this cannot be accomplished unless TOTAL CARBOHYDRATES are decreased to less than 20 grams per day. Yes, you read that correctly . . . Less that 20 grams per day.
- Your banana contains 30 grams of carbohydrate
- Your yogurt has up to 60 grams of carbohydrate
- That oatmeal you thought was good for you has up to 200 grams of carbohydrate
- The half and half you put in your coffee is half lactose (sugar from milk), 10 grams per cup.
You Eat Too Much Protein
Yes, protein can cause weight gain. And, no, it’s not because gluconeogenesis is on overdrive. There is always a body builder that sends me a nasty message after I say this. But the fact is that it’s true. (I’ll keep an eye on my e-mail).
Five of the ten essential amino acids stimulate an insulin response. Remember why carbohydrates cause weight gain . . . ? (I will give you a hint . . . INSULIN).
Certain amino acids that make up proteins can do the same thing. Arginine, Lycine, Phenylalanine, Leucine & Tyrosine, in that order, stimulate insulin enough to halt weight loss or increase weight gain in a significant way (1). We need protein to stay healthy, but too much of these amino acids in someone who is insulin resistant will inhibit weight loss and stimulate fat gain. I’ve also seen it raise small dense LDL particles in the cholesterol (the heart disease causing particle driven by insulin over production) I’ve seen this time and time again with many people. Simply modulating down the protein to the calculated needs lets the weight start coming off again.
So, what foods contain these in the highest amounts? Sea lion liver (I know, this won’t go over very well with the polar bears), soy protein isolate, crab, shrimp, sesame flour, turkey breast, pork loin (it’s the leanest cut of pork – No. BACON is fine), chicken, pumpkin seeds, soybeans, peanuts, spirulina (blue green alge that is found in the sea).
Yes, I get it. We’ve been told these were the healthy foods for the last 50 years. But, think about it. When did we start gaining weight as a country? 50 years ago.
Too much chicken, shrimp, crab and soy foods will inhibit weight loss in those with insulin resistance. So, consider whether it should be chicken you add to your salad. Consider, instead, bacon or beef as a wonderfully tasty substitute.
How much protein do you need? My formula for calculating your individual amount is here in my blog Calculating Protein Needs.
You Don’t Eat Enough Fat
To successfully lose fat on a ketogenic diet, 30-70% of your caloric intake should come from fat. Yes. You read that correctly. (The definition of a high fat diet is any diet containing more than 30% of fat from calories).
If we limit carbohydrates (which is currently 80% of the body’s fuel on the standard America plate), and moderate excessive protein which also halts weight loss, you have to replace the fuel. That fuel replacement should come from fat. Increasing fat will improve the sensation of fullness, provide all the fat soluble vitamins, and actually makes food taste good again.
As long as you are lowering the insulin to basal levels, you can actually eat all the fat for which you are hungry. Add bacon, butter, coconut oil, avocado, hard cheese, and oh, did I say bacon?
But Dr. Nally, what about all that saturated fat?
The saturated fat is only a problem with vascular disease, cholesterol and heart disease when the insulin level is also high at the same time. It’s the high insulin in the presence of large amounts of fat that drives the risk for atherosclerosis (vascular and heart disease). Instead of cutting out the fat, we’re cutting out the insulin.
How much fat should you be eating? Shoot for 60-70% of your calories from fat for the first 3 months. If your fat grams are slightly higher than or equal to your protein grams, you’re there. Listen to your body and eat fat until you’re full. That’s how most of my patients gauge their need and suppress hunger.
You’re Now Eating Too Much Fat
After the third month, most of us are fat adapted. You may notice your weight loss slows or halts. This means that our ability to absorb fat into the blood stream is dramatically more efficient. It also means that your taking in more fat into the fat cell then you are pulling out of the fat cell. I’ve found this to be the case with people who are loading butter, MCT or heavy whipping cream into their coffee. In this case, back off the “extra fat” your are loading or drinking. It’s not the calories in this case. There are 3-4 hormonal reasons this occurs once you are fat adapted. (We’ll talk about this in another blog post.)
You’re Drinking Tea
I know, I know. Tea is a national pass time in Europe. And, it is deeply embedded in the culture of many other countries. I’m probably not winning any friends across the pond by saying this, and it may bring back memories of the Boston Tea Party. However, the problem is that leaf based teas stimulate a rise in insulin (not taxes). I have had many patients hit a weight loss plateau because of the use of tea, specifically black tea, oolong tea, and green tea (2,3,4).
Yes, I am well aware of the tremendous benefits of the epigallocatechin gallate (ECGC) found in green tea. ECGC, which can be isolated as an extract, improves insulin resistance and improves GLP-1 signaling. ECGC has, also, been show to improve triglycerides (5). For this reason, it is one of the components in the KetoEssentials Multi-Vitamin I developed a few years ago and recommend to all my patients.
It appears, however, that the theaflavin within the leaf of the tea may be playing the offending role in the insulin spike seen with their use (6).
You Don’t Get Enough Sleep
Lack of sleep has been implicated in difficulty with weight loss and weight gain (7). Lack of sleep places the body into a state of chronic stress. This elevates cortisol, lowers testosterone, increases insulin (there’s that insulin problem, again) and increases the other inflammatory hormones. This perfect storm of stress, driven by lack of restful sleep, plays a big role in fat loss.
My average patient needs at a minimum of 6-7 hours of restful sleep to maintain and lose weight.
This is where untreated sleep disorders like sleep apnea play a big role. If you have sleep apnea, get it treated. What else can you do to help improve sleep?
- Remove the computer, iPad and cell phones from the room.
- Lower the room temperature. Men sleep better around 68-70 degrees F and women sleep better when the temperature is <70 degrees F.
- Close the blinds or shades to add or darken the room.
- Don’t study or watch TV in the same room you sleep in. Your body gets used to doing certain activities in certain rooms of the house. The bedroom should be reserved for sleep.
- Go to bed at the same time
- Get up at the same time.
It may take your body and body’s biorhythm 3-4 weeks to adjust to changes you make around sleep habits. Be patient with yourself.
You’re Married to Stress
Just as lack of sleep is stressful, other forms of chronic stress also raise cortisol, insulin and the inflammatory hormones. Chronic stress also lowers testosterone. It, also, has the potential to lower neurosignaling hormones in the brain like serotonin and dopamine, putting you at greater risk for depression and anxiety.
Other forms of chronic stress can occur from poor relationships, chronic pain, stressful employment, unfulfilled expectations, chronic illness and all forms of abuse. If any of these are playing a role in your life, you need to address them, and address them now.
As a physician, my job is stressful. Dealing with life and death issues with multiple people through the day, six or seven days a week, takes it’s toll. I’ve found that weight lifting, horseback riding, and taking care of my animals are my outlets. Find something physical, that takes you outside in the elements and forces you to break a sweat for 15-20 minutes is the key.
Our bodies have a “fight or flight system.” 100 years ago, the stress was fighting or running from the bear that squared off with you when you happened upon him in the woods. Cortisol, adrenaline, epinephrine, insulin, glucose, and inflammatory hormones pour into the blood stream. The heart beats faster, blood flows rapidly to the muscles, sensory awareness is heightened in the brain and increased oxygen flows to the lungs. This lets you fight the bear or run from the bear.
But, you can’t fight or run from your cynical boss. You can’t fight or run from oppressive finances, the person that cuts you off on your one hour commute in traffic, or your coworker who keeps pestering you. However, your body still releases adrenaline, cortisol, epinephrine, insulin and a number of inflammatory hormones prepping you to fight or run. If you don’t burn these hormones off, they halt weight loss, and actually can cause weight gain, increase anxiety and over time disrupt sleep.
So find your favorite way of physically relieving stress, and do it 2-3 times per week. (No, gentlemen, sex doesn’t count).
You Have An MTHFR Deficiency
In the last few years, we’ve been able to identify a number of genetic deficiencies that play a role in weight gain. One of those is an methyl-tetrahydrofolate enzyme deficiency (MTHFR deficiency for short). This is a genetic deficiency in the enzyme that converts adds a methyl ion to the folic acid in the cells of your body.
This is important, because if you can’t methylate folic acid inside the cell, you’ll have difficulty using vitamin B12 and B6 very efficiently to form methionine (a key amino acid in blood vessel and nerve function). There are two genes that encode for the enzyme that does the methylation of folic acid. Deficiency in one or both of these can lead to problems.
In severe cases, it causes homocysteine to build up to unsafe levels in the blood and slow the formation of methionine. It is associated with B12 deficiency, weight gain, fatigue, migraines, depression, anxiety, neuro-developmental disorders like autism, pregnancy loss, blood clots and neuropathy in pre-diabetic and diabetic patients (8, 9, 10).
Giving extra vitamin B12, B6 and folic acid (vitamin B9) doesn’t appear to help. Clinical evidence is pointing to the pre-methylated form of the folic acid. Finding this pre-methylated form has been difficult and notably expensive for patients. I found this deficiency to be so prevalent in my office, I added methylated folic acid to the KetoEssentials Multivitamin.
You Give “Couch Potato” A New Name
We have become a very sedentary people. We have engineered physical activity out of our lives. Remote controls, elevators, escalators, people movers, and automation have made our lives physically easier.
The average office worker burns 300 kcal per day sitting at a desk on a computer. The average farm worker burns 2600 kcal per day. That’s the equivalent of running a marathon every day.
Physical activity doesn’t necessarily cause weight loss. However, physical activity changes the hormones of the body including increasing a hormones like catacholamines, testosterone and a hormone called atrial naturitic peptide (ANP). ANP opens the fat cell, and lets more fat out (11).
When physical activity is paired with the correct diet, the weight come off. This is where exogenous ketones may play a role. The increased presence of ketones in the blood increases the release of ANP helping to activate triglyceride release from the fat cell.
Don’t get me wrong, many of my patients can lose weight with just dietary carbohydrate restriction alone, however, if you’ve hit a stall, you may need to look at your physical activity levels and many people like me, who are notably insulin resistant, benefit greatly with the addition of exogenous ketones.
Kickstart Ketosis over the Plateau
Is your fat loss on a plateau? Knowing that these challenges plague people on and off throughout the year, and, seeing people get hung up on these issues, I’ve created the Ketogenic Lifestyle 101 Course. This program gets you jump-started into ketosis and gives you the tools to overcome the individual hurtles you will experience on your health journey.
If your the really motivated type, and want a true 30 day challenge, then join my Kickstart program.
References:
- Floyd J et al., Stimulation of Insulin Secretion by Amino Acids, Journal of Clinical Investigation. 1966. 45(9).
- Bryans JA et al., Effect of black tea on post-prandial glucose and insulin. Journal Am Coll Nutrition 2007, 25(5): 471-7.
- Store KS & Baer DJ. Tea consumption may improve biomarkers of insulin sensitivity and risk factors for diabetes. The Journal of Nutrition. Aug 2008, 138(8): 1584S-1588S.
- Hosoda K et al., Anti-hyperglycemic effect of oolong tea on type II diabetes. Diabetes Care. Jun 2003. 26(6): 1714-1718.
- Chia-Yu Liu,Chien-Jung Huang, Lin-Huang Huang, I-Ju Chen, Jung-Peng Chiu, Chung-Hua Hsu. Effects of Green Tea Extract on Insulin Resistance and Glucagon-Like Peptide 1 in Patients with Type 2 Diabetes and Lipid Abnormalities: A Randomized, Double-Blinded, and Placebo-Controlled Trial. PLOS one(online). March 10, 2014.
- Cameron, Amy R.; Anton, Siobhan; Melville, Laura; Houston, Nicola P.; Dayal, Saurabh; McDougall, Gordon J.; Stewart, Derek; Rena, Graham (2008). “Black tea polyphenols mimic insulin/insulin-like growth factor-1 signalling to the longevity factor FOXO1a”. Aging Cell. 7(1): 69–77.
- Beccuti, Guglielmo, and Silvana Pannain. “Sleep and Obesity.” Current opinion in clinical nutrition and metabolic care 14.4 (2011): 402–412. PMC. Web. 18 Sept. 2017.
- Divyakolu S, Tejaswini Y, Thomas W, Thumoju S, et al. (2013) Evaluation of C677T Polymorphism of the Methylenetetrahydrofolate Reductase (MTHFR) Gene in various Neurological Disorders. J Neurol Disord 2:142. doi: 10.4172/2329-6895.1000142
- Gilbody, S., Lewis, S. & Lightfoot, T. (2007). Methylenetetrahydrofolate reductase (MTHFR) genetic polymorphisms and psychiatric disorders: A HuGE review. American Journal of Epidemiology, 165(1), 1-13.
- Menon, S., Lea, R., Roy, B., Hanna, M., Wee, S., Haupt, L., & … Griffiths, L. (2012). Genotypes of the MTHFR C677T and MTRR A66G genes act independently to reduce migraine disability in response to vitamin supplementation. Pharmacogenetics And Genomics, 22(10), 741-749.
- Lafontan M et al., Control of lipolysis by natriuretic peptides and cyclic GMP. Trends in Endocrinology and Metabolism. 19(4): 130-137.
Habit-Loop Cycle of Weight Gain & Obesity
In my last blog post about willpower, I described habits being neural impulse channels in our brain stimulated by a cue following a path leading to the same outcome each and every time – without exerting much effort. Researchers call the formation of these impulse channels habit-loop cycles. Much of the original obesity research of the 19th century was conducted by psychiatrists and psychologists recognizing that people had habitual eating patterns. Because of this, gluttony became the perceived influence of obesity. This underlying philosophy still permeates the obesity research, treatment and low-carb dietary world today. Yet, over the last 15 years, I’ve found that the habit-loop cycle is tied to powerful hormone responses. These responses to very subtle and often unknown triggers or cues powerfully drive weight gain, obesity and struggles with willpower. How does the habit-loop cycle effect you? Before we can change these habit-loop cycles, we have to understand what they are, and how they were created.
It’s All About That Basal Ganglia
Meghan Trainor tells us that “It’s all about that bass . . .” However, it’s really all about that basal ganglia. Deep inside our brains, close to the brain stem, at the location where the brain meets the spinal cord, is a little “nub” of neurological tissue called the basal ganglia. This little nubbin of tissues was identified by the really smart scientists at MIT in the 1990’s as the location where habits are formed and executed. The brain is – to take a quote from my favorite ogre, Shrek – “like an onion – it has layers!”
The Brain Is Like an Onion
If you picture the outer layers of the brain tissue, those closest to the hair and scalp, you can create a mental image of where our most complex thoughts occur. When you think up a new invention, create a new way to cook with bacon, laugh at a friend’s joke, or link two complex thoughts about how habits form, you are using these outer layers of the brain.
However, our interest today is deeper . . . much, much deeper. Deep within the center of the brain at the basal ganglia is the location where our automatic behavior originates. Swallowing, breathing and the startle responses are housed in this little nubbin of brain tissue. It is this area of the brain that learns to recall and record patterns of neurological thought and stimulating action. This part of the brain has the ability, like the water drops on the mound we discussed last week, to record neural pathways and tracks leading to reduced mental effort and habit. The basal ganglia even has the ability to store habits while the rest of the brain is asleep. It is in this location, the basal ganglia, where the habit-loop cycle occurs.
Habits Created by Chunking
The habit-loop cycle is the process where the brain converts a sequence of actions into an automatic routine. The really smart guys at MIT call this “chunking,” and it is the root of habit formation. There are hundreds of behavioral chunking activities that you and I rely upon every day. Some of these are as simple as the process you use to squirt toothpaste on your toothbrush before brushing your teeth. Others are more complex like getting dressed or making a lunch box for the kids.
The Habit-Loop Cycle in Your Car
A habit-loop cycle is performed by this little nubbin of tissue by millions of people every morning. Take, for example, backing your car out of the garage. When you first learned to do this, it required huge amounts of concentration – and for very good reason. You’re steering 3000-5000 lbs of steel between a 16 foot garage-door opening into oncoming traffic. 
Safely backing your car requires you to open the garage door, unlock the car, adjust the seat, insert the key into the ignition, turn it clockwise, move the rear-view mirror and the side mirrors to visualize any obstacles, put your foot on the brake, put the car into reverse, gently remove your foot from the brake, mentally estimate the distance between the garage and the street while keeping the wheels straight and looking over your shoulder, applying a slight pressure between the gas pedal and the brake, and in some cases, slapping your teenagers hand while they fiddle with the radio dial.
But think about it . . . did you actually put any thought into these actions this morning? You and I probably did this once or twice today without any additional thought. It happened because the basal ganglia took over and created a habit-loop out of it. This routine, repeated hundreds of times, became a habit, requiring very little mental effort.
Your Basal Ganglia Makes You Fat
The habit-loop cycle occurs hundreds and maybe thousands of times throughout our day. It is the cycle that drives hundreds of our activities. In fact, it is this same cycle, in combination with 30 different hormones, that drives our weight gain or weight loss. Yes, I said it, your basal ganglia can make you fat.
Habits Make for a Smaller Brain
Your brain will try to turn any regular routine into a habit, because habits allow our minds to slow down and conserve effort, energy and fuel. The efficient brain allows us to stop thinking about basic behaviors like walking, breathing and eating. This effort-saving effect of the brain is a major advantage, otherwise our brains would be huge, requiring heads the size of watermelons, or even the size of a water tower, causing their own weather systems. Your wife will thank you for an efficient brain that is smaller and requires less room. Can you imaging giving birth to a watermelon or a small Chevy? (Did you notice the size of Shrek and the Donkey’s head? Just say’n . . . )
Habits Are The Root of Behavior
What all this leads to is this – habits, as much as memory and reason, are the root of our behavior. We often don’t remember the experiences that create our habits. However, once they are created, they influence our action without our own realization. Charles Duhigg’s book, The Power of Habit is a great resource for further information on how habits drive our behavior.
The Habit-Loop of Obesity
So, how does all this affect obesity and weight gain? Let’s, first, look at the habit-loop cycle. Researcher, Larry Squire, documented the habit-loop through three decades of research. He and others published numerous articles showing that habits have a cue or trigger that stimulates a routine. The routine leads to an outcome or reward. The reward usually satisfies a craving. Cue-> Routine -> Reward. What we learn through our studies in obesity is that the reward often stimulates a hormonal response of 1-30 different hormones in brain and body leading to repeat cues or triggers. The cravings are hormonally driven. I call it the Habit-Loop of Obesity.
The Craving is the Key
Human psychology and emotion is the key behind habit creation. First, there must be a trigger or cue. Second, the trigger is attached to a previously experienced emotion or craving tied to the cue. The key to habit formation is the craving. The craving is what stimulates the physical routine to occur. It is an emotion or craving that drives the brain to create the habit. Third, there must be a clearly defined outcome or reward that satisfy the emotion or the craving. The emotion or craving doesn’t have to be associated with hormones, however, in the relm of obesity, it is usually tied together.
I am all about making things easier. Your brain does it. We all do it. And, I’m all about trying to help you lose fat and get healthy more easily. Let food be your medicine, let medicine be your food. That’s my mantra and that is as easy and natural as it gets. But, in our day and age, we don’t always have access to growing and raising our own food. That’s why my second mantra is – better living through chemistry. So, I created the KetoKart. Over the last 15 years of medical practice, I’ve found products and supplements that aid in letting food be your medicine, changing triggers, modifying hormones, and help to satisfy cravings in a healthy way to make your decisions easier. Go to the KetoKart, see which package works for you and order it. You’ll thank me.
How do we change our obesity habits? Stay tuned for the third part in this series: Fixing the Habit-Loop of Obesity.
So, I want to know . . . which package did you choose?
Willpower & Self-Discipline in a Ketogenic Lifestyle
Hundreds of people come to my office each month desiring to lose weight. Among the challenges they experience is the complaint that they lack willpower and/or self-discipline. Many people feel they cannot lose weight because they don’t have the self-control to do so. However you define it, willpower, self-discipline, or self-control, is an elusive and mysterious thing. Scientists have been trying to find out what willpower & self-discipline is and how to improve it since the early 1960’s. “If only I had more self-control,” people lament, “I could . . . lose weight, exercise regularly, eat right, avoid drugs and alcohol, save for retirement, enjoy more bacon, stop procrastinating, . . . . or even achieve the noble peace prize.” A 2011 American Psychological Association study reveals that almost 30% of those interviewed felt that their lack of willpower was the greatest barrier to making a change in any of these areas.
Excellence Comes From Habit
Excellence is not an act . . . it is a habit of repetitive action. To understand willpower & self-discipline, you have to understand habit. Habits emerge because the brain is constantly looking for ways to save effort or conserve energy. Left to it’s own devises, your sub-conscious brain will attempt to take any routine and turn it into a habit. Our brains do this to conserve mental effort and energy. This allows us to stop thinking about basic behaviors like walking and eating, so that we can devote mental fuel to doing important things like making spears, finding bacon, creating irrigation systems, building airplanes and, for some, designing video games.
The brain creates time saving patterns in it’s thought processes in a similar way to what happens when a few drops of water are dropped on the top of a mound of dirt. As each drop hits the top of the mound, the water runs down the side where it finds the least resistance. Each drop of water erodes a little channel down the side of the mound of dirt. The more water drops you release, the deeper the channel is carved in the little hill, and after a while all the water runs down the same path over and over. To get the water to run down the path, the water has to drop on to the top of the path. This starting point for thought is actually a “cue” or a “trigger.” Once the water, or in our example the thought, hits the trigger point, it always follows the same path. Always.
Habits are Repetitive Thought Channels
It takes great effort to turn the water out of the path. This can be likened to our habits. Habits are neural impulse channels in our brain that follow a path leading to the same outcome every time without much effort. All that is necessary is to trigger the neural impulse. The neural impulse follows the channel in the brain effortlessly causing a mental or physical routine to occur leading to a end point or reward. Some researchers call this a “habit loop.” Trigger-Routine-Reward.
What is Willpower?
So what is willpower & self-discipline? It is the ability to resist the unproductive patterns of though and redirect the neural impulse that was triggered down the channel. Redirecting this habit takes a great deal of mental energy. The first studies on willpower like Walter Mischel’s famous study of Four Year Olds & Marshmallows gave the impression that willpower was a learned skill.
Henry P Liddon said, “What we do upon some great occasion will probably depend on what we already are; and what we are will be the result of previous years of self-discipline.” This means that willpower or self-control can be learned or improved. The more you repeat a task, the easier and less effort it takes to complete it. Thus, excellence isn’t an act . . . it is a habit of repetitive action.
But, this doesn’t explain why one day you eat healthy, and the next day, when you are tired, you raid the freezer and down the entire quart of ice cream. You may find that you exercise one day without any problem, but the following day you can’t seem to get yourself off the couch. If exerting willpower to exercise were a skill, it wouldn’t be so difficult to do it everyday, once the skill is learned. The problem with the self-discipline theory is that you don’t forget a skill overnight.
Willpower is Like a Muscle
More recently, Mark Muraven found that willpower is actually more like a muscle. He wondered, as we did above, that if willpower was a skill, then why doesn’t it remain constant from day to day?
Muraven decided to conduct an experiment by placing a bowl of freshly baked chocolate chip cookies next to a bowl of radishes. The room containing the bowls was a closet with a two-way mirror, a table, a wooden chair, a bell and a toaster oven. Sixty-seven undergraduate students at Case Western were recruited and told to skip a meal. One by one, the students filed in and sat in front of the two bowls. They were told by a researcher that the experiment was about taste perception, which was untrue. The experiment was to force half the students to exert their willpower & self-discipline.
Half of the students were instructed to eat the cookies and ignore the radishes. The other half were instructed to eat the radishes, but ignore the cookies. Muraven’s theory was that it was difficult, requiring mental energy and willpower, to ignore the cookies. Ignoring radishes takes absolutely no energy when there is a full bowl of warm cookies overflowing with chocolate chips.
“Remember,” the researcher instructed, “you can only eat the food that has been assigned to you.” Then the researcher left the room.
After five minutes, the cookie eaters were in heaven and the radish eaters were experiencing mental agony.
Researchers stated that one of the radish eaters went so far as to pick up a cookie, smell it longingly, and put it back in the bowl. Another grabbed a few cookies, wolfed them down, and licked the chocolate off of his fingers. Muraven estimated that after five minutes, the radish eaters willpower would have been fully taxed by eating a bitter vegetable and ignoring treats, where the cookie eaters hardly used any of their self-discipline.
The research then entered the room and asked them to “wait 15 minute for the sensory memory of the food that was eaten to fade.” To pass the time they were each asked to complete a puzzle that looked fairly simple. They were to trace a geometric shape without lifting the pencil from the page or going over the same line twice. If you want to quit, the researcher left a bell to ring. The researcher then implied the puzzle wouldn’t take long. In truth, the puzzle was impossible to solve.
The puzzle was the most important part of the experiment. It took enormous willpower to keep working the puzzle. Particularly after each attempt failed.
What they found from behind the two-way mirror was that the cookie eaters with their reserve of will power and self-discipline worked the puzzle even after hitting road block after road block for over 30 minutes.
The radish eaters, with their already depleted willpower, muttered, showed immediate signs of frustration, and complained loudly to themselves. A few of them even closed their eyes and put their heads on the desk. One even snapped at the researcher when she walked back into the room. On average the radish eaters lasted only eight minutes. When asked how they felt, one complained that he was sick of such a dumb experiment.
Chocolate Chip Cookie Fatigue
By forcing the use of willpower & self-discipline to ignore cookies, it placed the radish eaters into a state of willingness to quit much faster. More than 200 studies like this have been completed since this test was done. All of them found the same conclusion – willpower is like a muscle. It’s not just a skill. Willpower fatigues.
This may explain why people, who succumb to extramarital affairs, are usually likely to start them late at night, after a long day of work. It explains why good physicians make dumb mistakes after a long, very complicated task that requires intense focus. It also points to reasons why people are more likely to lose control over their drinking or cheat on their ketogenic diet.
I meet and work with people every day who feel they have no willpower. In actuality, will power and self-control are learned behaviors that develop over time, but are greatly effected by fatigue. Anyone can have willpower, you just have to understand how willpower can be strengthened and what makes it weak.
Willpower is More Important than IQ
A 2005 study showed that willpower & self-discipline was more important than IQ in academic successes. This study also found that increased self-discipline lead to less binge eating, higher self-esteem, higher grade point averages, better relationship skills and less alcoholism. Fascinating isn’t it!?
Willpower strengthens with use, but has a daily “shelf-life.” It is always greater or stronger in the first part of the day. Willpower declines over the course of the day as you fatigue.
How Do You Improved the Self-Discipline Muscle?
First, you must establish and write down a reason or motivation for change. In addition, that change must fulfill a clear goal. Just wanting to lose weight isn’t good enough. You have to be motivated because of a consequence that arises from the obesity or overweight. Just “losing weight” isn’t a clear goal. You must set a (1) specific weight reduction goal. It has to be clearly written down with your (2) motivational reason. “I will lose (1) 30 pounds to prevent (2) diabetes,” is a great written goal. Willpower or self-control cannot begin to form until these two steps occur. Writing the goal with these two specifics and re-reading the goal regularly is the essence of multiple drops of water running down the hill forming the channel. This also creates a trigger by setting specifics about the goal.
Second, you must begin to monitor your behavior toward that goal. When it comes to weight loss, I ask all of my patient’s to keep a diet journal. In your journal, write down every thing you eat and drink. This evening, write down your plan for tomorrow’s meals, then the next evening, you account to yourself for your success or failure by journaling on that same page what you actually ate and drank. Tomorrow evening, compare what you did, as you plan for tomorrow and journal why you were successful or why you were not successful. It’s that last part that is so powerful, a short 3-5 minutes of self-introspection. Self-introspection is the key to behavioral change. It is the key that allows a person to see their habits, and then make very small changes that break bad habits, solidify good habits and strengthen willpower. This time of self-introspection is re-enforcing the desired channel of flow.
Third, willpower is developed and strengthened over time. It is developed by being accountable to ones-self on very little things every single day. But it MUST be written down. If I planned to eat bacon and eggs for breakfast and I didn’t, why? When I look at my day, I may realize that I went to bed too late to get up early and cook bacon and eggs. So, instead, I ate a yogurt that was in the fridge. I am accountable to myself. If I plan to eat bacon and eggs tomorrow, I must either go to bed earlier, prepare them the night before, or throw out the yogurt . . . so not to be a temptation again. Planning re-enforces the triggers, and takes away the mental energy required to have self-discipline when you lack sleep, are feeling stress from waking up late, or running out of bacon in the fridge. it also provides more willpower to be available for other decisions later in the day. Pre-planning by writing down tomorrows tasks provides you strength for future willpower and eliminates fatigue when needing to make a large or small change tomorrow.
Over time, this self-introspection becomes easier and easier, to the point that you do it sub-consciously. It is this sub-conscious self-introspection and change will be seen by others as self-control or willpower. Just like exercising or strengthening a muscle, recording short goals and and accounting for them makes your self-discipline stronger. The self-discipline muscle becomes more powerful. In time, you’ll be able to make a split second decisions about a piece of cake. Strong willpower will be perceived by those around you. You’ll recognize that it’s just flexing your well rested self-discipline muscle.
Fourth, plan or attack the hardest decisions of your day, those things that require the greatest energy, in the morning when your fresh. This allows you to have the strength to maintain willpower. In the evening, when your willpower muscle is the weakest, have rescue foods available so you’re less likely to cheat. Pre-cooked bacon, pork rinds, guacamole, macadamia nuts (the highest in fat), rolled meats and hard cheeses are in my fridge and pantry for this reason. This is where fat bombs in the fridge at the end of a long day allow you to snack when you’re hungry at the time willpower is weakest.
A great way to pre-plan is to go to the KetoKart and order your pre-packaged 1, 3, or 6 month program that will provide you with the supplements necessary to stabilize insulin and ketones on a daily basis. This is one decision you don’t have to try to make ahead of time.
So, my question for you is which KetoKart package did you choose and . . . where’s your diet journal?
(Stay tuned for the second part of this series: Fixing the Habit Loop Cycle.)
Why Be In Ketosis – Part XII (Thyroid)
There is a pattern that I’ve noticed on every live-stream that I’ve appeared on talking about ketosis that someone always asks the question: “What about the thyroid?” That’s literally how it’s asked. . . someone I am unfamiliar with keys in the question, “What about the thyroid?”
The blunt sarcastic response in my head is usually, “Well, what about it?”
Buried within the vague periscope or twitter question above is the real question that is on the minds of thousands of people, “Does ketosis effect the thyroid . . . ?”
There’s loads of information about the thyroid on the internet. Much of it is garbage. Seriously. Ask Google about “thyroid,” and you’ll see thousands of articles, posts and comments on WebMD, Women’s Health, and Wikipedia all across the “interwebby.” Everyone, and I mean everyone, seems to have a “thyroid opinion.” Much of the “wikopinion” out there is here-say, conjecture and anecdotal. It doesn’t really give people any foundational understanding of what their thyroid is doing, or more importantly for that matter – what their thyroid isn’t doing.
Of late, the Paleo and Vegetarian thought leaders seem to decry nutritional ketosis because they claim that this dietary approach suppresses thyroid function. This wiki-theory (yes, it is just a theory) was extrapolated from a single study where the T4 level dropped in the first few weeks after ketosis was entered. But just because T4 drops, doesn’t mean the diet suppresses the thyroid. Using T4 as a screening test alone for assessment of thyroid function is 1987 thinking (1987 brought us the Kia Concord and the Subaru Justy just so you get the mental picture). T4 fluctuates with a number of binding proteins and following this number alone is really bad medicine. Taking thyroid advise from the Paleo people is like asking your Fed Ex driver about the correct lift on your 4×4 truck. Really?
Excessive insulin, the hormone produced when you eat sugar, starch and some proteins, actually stimulates thyroid peroxidase antibodies and can cause exacerbation of thyroiditis (causing over-production or under-production of thyroid hormone). Because 85% of the people I see in my office over-produce insulin (this is referred to as insulin-resistance), in response to starches, there is a significant flux in thyroid function due to this pre-diabetes state (insulin over-production) on high carbohydrate based diets.
Leptin, the hormone produced by fats cells when they are “full,” actually stimulates the conversion of T4 to T3. At least 40% of my obese, insulin-resistant patients are also leptin-resistant, meaning they over-produce leptin as well. This has a suppression effect on T4 (by converting it to T3) and is the usual cause of the T4 levels being lower when initially staring a ketogenic diet. It is also the reason that some people feel anxious or “activated” when changing to nutritional ketosis. Leptin-resistance is driven by a high level of fructose in the diet and the presence of high triglycerides, inhibiting the leptin signal from crossing the blood-brain barrier. As a person follows a ketogenic diet and lifestyle, leptin returns to normal over 3-6 months and T4 levels normalize. The Paleo and Vegetarian nay-sayers never mention that . . . do they? What they won’t tell you is that calorie restriction, which is a must for weight loss, on the DASH, Mediterranean, Paleo or Vegetarian diet causes suppression of testosterone, leucine, and thyroid function, causing worsening T4 suppression over time. Hmmm . . . put that in your low-fat green vegetarian taco, and smoke it.
Wait . . . I don’t advocate smoking so, ignore that.
The point is, a ketogenic lifestyle stabilizes thyroid function and improves auto-immune thyroiditis. I’ve seen it happen clinically for over 12 years. It, also, dramatically helps stabilize the other 30 hormones involved with the diseases of civilization including obesity, insulin resistance and diabetes.
Watch my live-stream recording below to find out more about the thyroid.
PeriScope: Weight Loss, Gut Health & Pond Scum…In The New Year
Good morning from Arizona. I’ve had a few people ask about how gut health relates to a ketogenic diet. This is a great question and one that I think can be answered best by taking a closer look at my natural koi pond and learning a little about pond scum.
So, sit back and look at the similaries between your gut and how nature balances a pond system: Katch.me
Or you can watch the video below:
The four tenets of health that we touch on above that are essential to understand before you can understand gut health:
- The body is a unit and works as such with all parts enhancing the whole
- The body is capable of self-regulation, self-healing, and health-maintenance
- Structure & function are reciprocally interrelated
- Rational treatment of the body must be based upon understanding the principles above and assisting or augmenting those principles
Keys to gut health and pond balancing that we touch on:
- Remove the toxins from entering the system like:
- Antibiotic overuse
- Caffeine
- Artificial Fat
- Artificial Sweeteners
- Repair the system and it’s ability to balance the system
- Takes time
- Provide structure for the bacteria to which it can bind
- Provide essential vitamins and minerals like KetoEnhance & Omega-3 fatty acids
- Periodic Fasting
- Restore the bacteria or flora of the system
- Prebiotics (fermented foods like sauerkraut, kimchi, Japanese natto, etc.)
- Probiotics like Dietary KetoBalance (can be purchased in the office)
- Replace the salts and pH balance where necessary
- Replace electrolytes
- Limit things that shift the pH balance
Hope this gives you a starting point for your New Year!!
Santa's Gone . . . Low Carb
It appears that Santa reviewed the low-carbohydrate, ketogenic science and while vacationing in South Africa, was introduced to Banting (the South African term for carbohydrate restriction).
Four Most Common Weight Loss Mistakes that Halt Your Weight Loss
What are the four most common mistakes I see in the office when it comes to weight loss? Watch Dr. Nally on today’s PeriScope as he answers that question and many others. You can see it here with the live stream comments on: https://www.katch.me/docmuscles/v/392e5d3e-bb28-3176-a03a-83433878a5ce
Or see the video below:
Nutritional Values of Commonly Used Ketogenic Foods
I’ve had a number of emails and requests from patient’s to locate a source for fat percentages and protein contents of various foods as they prepare and follow a ketogenic lifestyle. I’ve looked all over, however, nothing easy and concise has made itself readily available, and there hasn’t been a simple one page tool at your fingertips . . .
Hopefully, this list will start to fill that gap. Use the list to calculate protein and fat levels as needed. Let me know if I can add to the list or if there are foods you commonly use that I’ve missed. Keep the ketones up and your waistline down!
Nutritional Values of Common Ketogenic Foods:
Food: Protein Contents: Fat Contents:
Steak (Ribeye) – 65 grams per 8 oz. 49%
Steak (Top or Bottom Round) – 23 grams per 3 oz. 33%
Ground Beef (75% Lean) – 22 grams per 3 oz. 55%
Pork Chop (boneless) – 26 grams per 3 oz. 15%
Ham – 17 grams per 3.5 oz. 12%
Bacon (grilled) – 22 grams per 3.5 oz. 75%
Sausage (beef) – 14 grams per 3.5 oz. 79%
Sausage (pork) – 17 grams per 3.5 oz. 75%
Chicken Breast (boneless, skinless) – 24 grams per 3 oz. 18%
Turkey Breast – 24 grams per 3 oz. 15%
Yellowfin Tuna – 25 grams per 3 oz. 10%
Light Tuna – 22 grams per 3 oz. 8%
Halibut – 23 grams per 3 oz. 19%
Sockeye Salmon – 23 grams per 3 oz. 22%
Tilapia – 21 grams per 3 oz. 13%
Deli Meats:
Roast Beef – 18 grams per 3 oz. 16%
Canadian bacon – 15 grams per 3 oz. 33%
Pepperoni – 18 grams per 3 oz. 83%
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%
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:
Swiss Cheese – 24 grams per 3 oz. 66%
Cream Cheese – 11 grams per 3.5 oz. 79%
Ricotta cheese – 10 grams per 3.5 oz. 63%
Cheddar cheese – 24.6 grams per 3.5 oz. 74%
Eggs – 6 grams per 1 large egg 60%
(Adapted from http://www.caloriecount.com)
A printable PDF copy of this information is available here:
Nutritional Value of Common Foods.
To live in the presence of great truths and eternal laws, to be led by permanent ideals – that is what keeps a man patient when the world ignores him, and calm and unspoiled when the world praises him. Hopefully, these posts are adding to your stable ideals.
The Simple Effects of Ponderizing . . . The First Step in a Principle Based Ketogenic Lifestyle
I have found, over time, that happiness in life seems to be the greatest when I strive for balance in the three basic aspects of life: Mind, Body & Spirit. Yes, I am a physician, and I spend the majority of my day applying advise and treatment plans that have been demonstrated to be effective through the tried and true scientific method. However, I know from personal experience, and from working closely with patients for over 15 years, that science alone, does not bring fullness and happiness to life. Truth and learning can be found through study and also by faith. Finding balance and peace physically is important, but finding that balance emotionally and spiritually are often essential. Being able to follow a Ketogenic Lifestyle effectively over the long term (longer than 6 months) actually requires understanding of some basic principles. This is the first in a series of articles regarding The Principle Based Ketogenic Lifestyle.
I treat patients with obesity, one of the most difficult diseases to address in the medical office. I find that just applying diet alone doesn’t always solve the problem. If the patient’s life is out of balance emotionally or spiritually, the stress this causes often halts effective weight loss and metabolic healing. You may disagree with me on political or religious issues, but healing is not about politics nor is it about religious doctrine – it is about understanding where we are, the path forward, and our potential to get there. The mind, body and spirit are deeply interconnected. Often, until we recognize and treat those connections, true healing cannot occur.
The first step in treating any illness, including weight, is recognition of the problem. The Medical Community has recognized Obesity as a disease, but obesity is also a symptom of underlying physical metabolic dysfunction that may be tied to the mind and spirit. Daily journaling is the tool that lets one see if the dysfunction is tied to mind or spirit. I ask my patients to keep a daily food journal. This is very important in looking at the patterns of macro-nutrient intake. But the more powerful effect of journaling allows one to see how food is tied to emotion – mentally and spiritually.
Simply writing down what you eat each day, when you eat it, and how you felt after you at it is actually quite profound. The patterns that emerge are usually seen and identified by the patient long before I ever see them. In fact, patient’s often bring those patterns up before ever showing me their food journals.
I’ve found, in keeping a food journal myself, that combining my journaling with other other daily goals, uplifting thoughts and reminders was even more helpful and powerful. This can be done on paper, a notebook, a planner or even on the computer. (I have a few patients who are accountants or engineers – they bring in complex spread sheets). What is important is daily consistency. It takes about 3-4 weeks of journaling to begin to see patterns.
I have taken the advise of one of the leaders of my church to “ponderize” a scripture, meaningful poetic verse or truth filled quote each week as part of the journaling process. He defined “ponderizing” as the act of pondering and memorizing a scripture or a favorite uplifting poem or verse each week. This is done by writing the verse on a written card or note in a place that you will see it frequently each day during the week. When you see it, read it and ponder it. Just the process of frequently reading it will lead to memorization each week. I have found that reading and pondering a verse 3-4 times a day for a week, lends itself to easy memorization. Each time you read the verse, think about it and ponder it for a moment, then go on with your day. This will give you a brief opportunity to elevate your thoughts each day, and will give you a place your mind can go and think when you don’t have to think. It gives your subconscious mind the ability to solve complex patterns at a higher level.
Said David O. McKay, “Tell me what you think about when you don’t have to think, and I’ll tell you what you are.” “As a man thinketh in his heart, so is he . . . ” (Proverbs 23:7).
For some reason, with all the cares of the day, work, family and the challenges of life, I have fallen out of this habit for some time. When this leader mentioned this process in his comments, I was reminded of the peace and balance I used to feel each week when doing this simple activity. I have recommitted myself to restart this activity and I invite you to do the same. This time to ponder opens your mind and allows you access the deeper worries and fears holding you from what you what to accomplish. It takes great courage to make permanent lifestyle and dietary changes. When someone can’t clearly see what lies ahead, it fills them with fear, doubt or both. But journaling, even in its simplest form, gives a person the ability to resist and then master the patterns that have kept them from change. As Mark Twain said, “Courage is resistance to fear, mastery of fear – not absence of fear.”
Courage is tested when we purse difficult goals, fight against disease with unknown outcomes, or work to regain health. The testing can be painful. Journaling, and ponderizing in the process, gives courage to take small steps, one day at a time. Admitting to, journaling when we fail or make mistakes, fear of failure or feeling unsure actually increases our courage. Being given a week to ponderize an uplifting scripture or verse enhances that courage . Journaling successes and failures empowers us individually. The psychiatrist Carl Jung wrote:
“There appears to be a conscience in mankind which severely punishes the man who does not somehow and at some time, at whatever cost to his pride, cease to defend and assert himself, and instead confess himself fallible and human. Until he can do this, an impenetrable wall shuts him out from the living experience of felling himself a man among men. Here we find a key to the great significance of true unstereotyped confession – a significance known in all the initiation and mystery cults of the ancient world, as is shown by a saying from the Greek mysteries: ‘Give up what thou hast, and thou will receive.'”
Journaling and ponderizing allows one a form of confession and renewal. It gives one courage that you have survived today’s challenges and seen the pattern of fallibility in them. It is actually energizing. And, the path to healing begins to become clear.
Journaling also is a great way to outline side effects from carbohydrate withdrawl that will last for 2-4 weeks (That’s for another blog post, however).
Feel free to ask me about the verse that I am ponderizing each week. I will happily tell you which verse I am pondering and memorizing; but, I will in tern, ask you which verse you are ponderizing.
This week, the verse I am ponderizing comes from the Bible – Genesis 35:2-3:
“Then Jacob said unto his household, and to all that were with him, Put away the strange gods that are among you, and be clean, and change your garments: And let us arise, and go up to Beth-el; and I will make there an altar unto God, who answered me in the day of my distress, and was with me in the way which I went.”
Did you begin your food journal? And, what verse are you going to ponderize this week?