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Myokines and Weight Loss

Since the very first muscle derived myostatin protein was identified as a myokine in 1997, over 600 myokines have been identified to date (Gorgens et al., 2015).  However, the majority of these myokines are still not sufficiently characterized.

Why is this important? This frequently neglected topic plays a central roll in diet and exercise in those people trying to lose or maintain their weight. Myokines are the key actors in muscle development and size, and and they influence weight gain or loss in a pretty dramatic way.

Myokines Produced In Skeletal Muscle

The myokines are a subclass of interlukins. Interlukins are a group of naturally occurring proteins that mediate communication between cells. They are like the rapid text messages between teenagers in the same room communicating with each other. Interleukins regulate cell growth, differentiation, and motility. They are particularly important in stimulating immune responses, such as inflammation.

Muscles Make Their Own Interlukins

A few years ago, research demonstrated in the Journal of Experimental Biology that there is a notable increase in the plasma concentration of IL-6 during exercise (Pedersen and Febbraio, 2008). This is followed by the appearance of IL-1 receptor antagonist (IL-1ra) and the anti-inflammatory cytokine IL-10. Concentrations of the these cytokines, IL-8, macrophage inflammatory protein 1a (MIP-1a) and MIP-1b are elevated after strenuous exercise.

Thus, the cytokine response to exercise is not preceded by an increase in plasma TNF-a. Even though there may be a moderate increase in the systemic concentration of these cytokines, the underlying fact is that the appearance of IL-6 in the circulation is by far the most marked and precedes that of the other cytokines (Pedersen and Febbraio, 2008).

Muscle Interlukins Create Good Inflammation

When IL-6 is produced by macrophages, it leads to an inflammatory response, whereas muscle cells produce and release IL-6 without activating classical pro-inflammatory pathways. The fact that IL-6 can sometimes act as a pro-inflammatory and sometimes as an anti-inflammatory agent appears to be more dependent on the environment (muscle versus immune cell) than on whether IL-6 is activated in an acute or chronic fashion (Pedersen and Febbraio, 2008). This essentially means that strenuous exercise is a good form of stress, stabilizing the muscle, causing growth and not adversely affecting the immune system.

Interlukins From Muscles Talk to Fat Cells

At the same time, IL-15 is expressed in human skeletal muscle (Pedersen et al., 2007). C2C12 tubule contraction in the muscle stimulates the IL-15 release. It possesses anabolic effects on skeletal muscle in vitro and in vivo and may also take part in reducing adipose tissue mass (Pedersen et al., 2007). Therefore, IL-15 has been suggested to be involved in muscle–fat crosstalk. Recently, we demonstrated that IL-15 mRNA levels were upregulated in human skeletal muscle following a bout of strength training (Nielsen et al., 2007), suggesting that IL-15 may accumulate within the muscle as a consequence of regular training.

What is fascinating is that there is a negative relationship between IL-15 and truncal fat mass, but not limb fat mass. That means that the more resistance exercise you participate in regularly, the lower your truncal fat becomes.

BDNF Stays Active Even After Exercise

Another cytokine actor in this opera of human metabolism is Brain Derived Neurotrophic Factor (BDNF). BDNF is a fascinating hormone produced in the brain. In humans, a BDNF release from the brain was observed at rest and increased 2- to 3-fold during exercise. Both at rest and during exercise, the brain contributed 70–80% of the circulating BDNF, while this contribution decreased following 1h of recovery. In mice, exercise induced a 3- to 5-fold increase in BDNF mRNA expression in the hippocampus and cortex, peaking 2h after the termination of exercise.

Matthews and colleagues studied whether skeletal muscle would produce BDNF in response to exercise (Matthews et al., 2009) and found that BDNF mRNA and protein expression were increased in human skeletal muscle after exercise. However. muscle-derived BDNF appeared not to be released into the circulation. BDNF mRNA and protein expression were increased in muscle cells that were electrically stimulated.

You can augment the presence of BDNF with curcuminCurcumin is a natural isolate derived from turmeric an has been show to have anti-inflammatory, anti-oxidant and anti-depressant properties through its ability to raise BDNF.  Using curcumin daily with a regular exercise program helps to improve brain function and reduce mental and physical stress (4, 5)

How HIFEM Exercise Is Effective

Why is this important? Because, BDNF increased phosphorylation of AMPK and acetyl-CoA carboxylase (ACC) and enhanced fat oxidation both in vitro and ex vivo. In layman’s terms, that means that regular exercise stimulates the burning of fat for 1-2 hours after exercise. This can be exercise from resistance training or from HIFEM like EMSculpt or electromagnetic stimulus.

What is the take home message from all this geeky science stuff?

Resistance exercise improves muscle regeneration, fatty acid oxidation, fat metabolism, muscle repair, mitochondrial biogenesis (increasing numbers of mitochondria). So if you are not participating in at least 3 days of resistance exercise per week, I’d encourage you to do so.

If you are looking for a simple body weight exercise program that can be done at home. I’ll send you my program for free. Go to docmuscles.com/exercise and sign up.

References:

  1. Pedersen BK. Muscles and their myokines. J Exper Biol. 2011. 214:337-346. doi:10.1242/jeb.048074.
  2. Furuichi Y, Manabe Y, Takagi M, Aoki M, Fujii NL (2018) Evidence for acute contraction induced myokine secretion by C2C12 myotubes. PLoS ONE 13(10): e0206146. https://doi.org/ 10.1371/journal.pone.0206146.
  3. Han LJ & Hee-Sook J. Role of Myokines in Regulating Skeletal Muscle Mass and Function. Frontiers in Physiology. Jan 2019. Vol 10:1-9. doi: 10.3389/fphys.2019.00042
  4. Ga-Young Choi, Hyun-Bum Kim, Eun-Sang Hwang, Seok Lee, Min-Ji Kim, Ji-Young Choi, Sung-Ok Lee, Sang-Seong Kim, Ji-Ho Park, “Curcumin Alters Neural Plasticity and Viability of Intact Hippocampal Circuits and Attenuates Behavioral Despair and COX-2 Expression in Chronically Stressed Rats”, Mediators of Inflammation, vol. 2017, Article ID 6280925, 9 pages, 2017. https://doi.org/10.1155/2017/6280925
  5. Hurley LL, Akinfiresoye L, Nwulia E, Kamiya A, Kulkarni AA, Tizabi Y. Antidepressant-like effects of curcumin in WKY rat model of depression is associated with an increase in hippocampal BDNF, Behavioral Brain Research. 2013(239):27-30. ISSN 0166-4328, https://doi.org/10.1016/j.bbr.2012.10.049.

What Does a Strong Core Do for You?

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I am amazed after just two treatments.

100 percent of the muscle contracts with this amazing technology. Nothing else does that like EMSculptNEO.

I am personally amazed at how much better my motorcycle riding, fencing and sword-fighting has improved with just two core treatments. He is absolutely correct. It’s amazing what you can do when you strengthen your core.

4-6 treatments one week apart. HIFEM + RF gives you 20,000 crunches in 30 minutes while burning fat through a patented radiofrequency wavelength between contractions. I cannot tell you how amazed I am by this technology.

30% more muscle and 25% fat reduction – you can’t beat that.

When combined with a daily exercise program, and a ketogenic diet, you will see AMAZING results. Cut your carbohydrates back to less than 20 grams per day. For women, I recommend 90 grams of protein or more daily. For men, I recommend 150 grams of protein daily or more to see the best results.

Call the office and schedule your consultation with me today!!

Office Number: (623) 584-7805.


#LeadFolloworGetOutOrMyWay #JustKeepEsterifying #Ketogenic #Keto #KetogenicLifestyle #Carnivore #DrAdamNally #DocMuscles #DocMusclesLive #DocTalk #DocsWhoLift #LiftRunShoot #DocMusclesLife #PlantBasedDietsSuck YouTube.com/drnally/.
Dr Nallys Lasers: #PicoSure #Icon #SculpSure #TempSure #EMScuptNeo #EMSella #EMFace

Dr. Nally’s Keto/Carnivore LiveStream Video Topics

I will be starting a twice weekly exclusive live-stream here for my amazing online followers and patient who are participating in the KetoClan Group on the following sixteen topics next week. Will be sharing the basics and my 22 years of clinical experience with each of these topics as it relates to health and weight management. These topics will take 10-30 minutes, then giving the remainder of the hour to you to ask questions.

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The topics we will cover over the next 8 weeks are listed below:
1. Insulin
2. Monitoring Glucose – CGMs
3. Fat Adaptation
4. Things that make insulin go “bump in the night (or the day)” – (sweeteners, creamers, teas, Resveratrol, nuts, etc)
5. Protein
6. Basic Thyroid Function
7. Female Hormones
8. Male Hormones
9. Testing Ketones in Urine, Breath, Blood
10. Ketoacidosis
11. Medications and ketogenic diets (Metformin, DPP4s, GLP-1, SLT-2s, sulfonoureas, Berberine)
12. Stress – Cortisol & DHEA
13. Exercise – Cardiovascular and Resistance Exercise
14. Sleep
15. Food Cravings and the Subconscious Mind
16. Keto, Carnivore or Fasting – What should I be doing?

Not a member yet? Sign up here.

2022 Keto Awards

I’ve been told that many of you have nominated me. Thank you!!!

Every year Ketogenic.com hosts the Keto Awards with Metabolic Health Summit to highlight some of the best and brightest in our community.


There are five unique categories in which you can nominate and it would be an honor to me for you to add your vote:
Top Keto Educator
Top Keto Book
Top Keto Podcast
Top Keto Researcher
Making Positivity Louder

I’ll be sure to let you know who is selected.
Please take a minute to cast your vote for me.
Vote Here:

https://ketogenic.com/keto-awards-2022/

How Do You Use Exogenous Ketones (BHB)?

BHB stands for beta-hydroxybutyrate. This is one of three naturally occurring ketones formed in the body when metabolizing fat.

I’ve been asked what they are and how to use them quite a few times in the last week, so I thought I’d answer it here. . .

BHB can be used for a number of things:

1) to push you into a ketogenic state for 1-6 hours – I use them to jumpstart keto in people just starting a ketogenic diet (however, if BHB is being used while cheating on carbs at the same time, they often halt weight loss and in some cases can allow for weight gain).

2) I use it as a pre-workout drink for increased energy and stronger muscle contraction (I use them prior to sword fighting and it allows me more energy and endurance.)

3) For appetite suppression when the “munchies” try to kick in due to stress or anxiety.

4) To help enhance cognition in patients with Alzheimer’s dementia and Parkinson’s disease.

5) To improve mental clarity and focus in those with ADD/ADHD.

6) I also use them as a meal replacement while traveling.

7) I use them to help people who are morbidly obese experience a ketogenic state when they have never restricted carbohydrates before.

8) And, to prevent seizures when scuba diving with re-breather type equipment (bubble-less SCUBA).

You can find my exogenous ketones (BHB) at http://www.ketoliving.com

High Fat? High Protein? Low Protein? What is really ketogenic?

The daily question that I get asked by my patients, and from those around the internet, relates to burning one’s own fat. “Don’t you have to limit the calories and limit fat you eat to burn your own body fat?

It seems everyone has a differing opinion on this question and a few of them have two opinions (you know who you are).  Very few of these opinions are grounded in the actual science of weight loss.

I hear coaches, trainers and even a number physicians argue, name call and rant about the need to cut calories to lose fat.  Yet, most of my patients “cut their calories” 200-1000 per day without successful fat reduction.  They may increase their exercise by 400-600 calories per day and still no weight loss.  This is the same crazy ineffective instruction we’ve been given for the last 50 years.

To be honest, there is a percentage of those in the fitness and modeling worlds upon which this dogma is effective and that is because of normal insulin levels and significant exercise. However, for the other 85% of the world who work over 40-80 hours a week, have children and families, serve in our churches and occasionally have a social life, myself included, it doesn’t work.  If we were all paid to exercise 2 hours a day and take “butt selfies” on Instagram, it might be easier.

Yes, you will probably lose 20 lbs. with calorie restriction, but your testosterone will drop by up to 50%, sex hormone binding globulin will double, and over time your basal metabolic rate will slow due to dramatic and often permeant reduction in thyroid function.  This makes it nearly impossible to lose more than that 20 lbs, and then you will regain the weight once calorie levels return to normal within 18-24 months.  (No one ever talks about that little problem, do they?)

For those of you that want to see success in weight loss, let’s outline a few essential principles that the trainers, keto-coaches and social media talking heads aren’t mentioning.

First, insulin has to be kept at a baseline.  The reason that 85% of people don’t, won’t and can’t see effective weight loss beyond 20-30 lbs long term (greater than 2 years) with calorie restriction is that 85% of the population has some degree of insulin resistance.  It’s not a disease, it’s a syndrome associated with the effect of the standard American diet.  I wrote a whole book about it called The Keto Cure.  We know that insulin and catecholamines increase the rate by which fat is stored.

Second, glucacon is a counter active hormone to keep your blood sugar from bottoming out.  The presence of glucagon stimulates fat burningIntermittent fasting and ketogenic dietary intake allow blood sugar to drop below 70 mg/dL (3.9 mmol/L) causing glucagon release and stimulate increased release of free fatty acids from the fat cells.

Third, two hormones, epinephrine and norepinephrine, are produced when blood sugar drops below 67 mg/dL (3.7 mmol/L).  Exercise lowers blood sugar to this level and stimulates additional burning of fat by engaging the release of glucagon and epinephrine and norepinephrine.  Exercise, also, has three other myokine hormonal effects making weight loss more successful when the diet is correctly balanced.

The fourth principle that is essential to understand relates to growth hormone.  Growth hormone stimulates and preserves muscle tissue, has a suppressive effect on insulin. Growth hormone increases with exercise, sleep, intermittent fasting and when protein intake is at least greater than 90 grams per day in women and around 1 gram of protein per body weight in men.  This is notably higher than previous calculations on protein that I have written about in the past.  Recent research, also found here, here and here, demonstrates that increased protein above 90-100 grams per day enhances muscle growth and stabilization and further suppresses insulin production beyond what we previously understood.
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Contrary to what the media has been saying about protein sources, not all protein is absorbed in the same way.  When it comes to absorption in the human gut and use by the human metabolism, protein sources differ in their effectiveness:

    • Egg protein utilization – 50%
    • Meat protein utilization – 40%
    • Cheese protein utilization 35-40%
    • Whey protein utilization – 18%
    • Vegetable protein utilization – 14%

Lastly, release of fat from the fat cell is mediated by natriuretic peptides and cGMP through the release of catecholamines, prostaglandins and nicotinic acid.  Interestingly, the major positive regulators of human lipolysis are catecholamines and natriuretic peptides (NPs). Fatty acid release from fat cells triples when catecholamines and natriuretic peptides are released.  Catecholamines are produced by exercise, stimulants and stress, and natriuretic peptides are stimulated by short change fatty acids (ketones).

For the science geeks in who follow my blog, I’ve included the following picture that summarizes the effects of these hormones on the fat cell.  The figure below shows the major pathways by which insulin, thyroid, catecholamines, testosterone and sympathomimetics effect fatty acid release from adipose tissue.

Primary signaling pathways in human lipolysis. Black and red lines indicate pro-lipolytic and anti-lipolytic signaling events, respectively. Arrows indicate stimulation and/or translocation and blunt lines indicate inhibition. Stimulation of lipolysis is dependent on PKA- or PKG-mediated phosphorylation of HSL and PLIN1. PKG is activated by cGMP, which is increased in response to activation of the GC-coupled NPR-A. Similarly, stimulation of the Gs-protein-coupled β1/2-ARs activates AC, which generates cAMP and activates PKA. Conversely, activation of Gi-protein-coupled α2-ARs inhibits AC and thereby reduces cAMP-dependent signaling to lipolysis. Stimulation of the insulin signaling pathway through the IR increases the activity of PDE3B, which converts cAMP to 5′-AMP, thus decreasing PKA activity and suppressing lipolysis. PKG activity is reduced by PDE5-mediated conversion of cGMP to 5′-GMP, although the upstream signals regulating this process are currently unknown. The dashed line indicates a putative Akt-independent insulin pathway acting selectively on PLIN1. α2-ARs, α2-adrenergic receptors; AC, adenylyl cyclase; TG, triglyceride; ATGL, adipose TG lipase; β1/2-ARs, β1- and β2-adrenergic receptors; CGI-58, comparative gene identification-58; DG, diacylglycerol; FFA, free fatty acid; GC, guanylyl cyclase; HSL, hormone-sensitive lipase; IR, insulin receptor; IRS1/2, IR substrates 1 and 2; MG, monoacylglycerol; MGL, monoglyceride lipase; NPR-A, type-A natriuretic peptide receptor; PDE3B, phosphodiesterase 3B; PDK, phosphoinositide-dependent kinase; PI3K, phosphatidylinositol 3-kinase; PKA, protein kinase A; PKB/Akt, protein kinase B; PLIN1, perilipin 1. (Journal of Molecular Endocrinology 52, 3; 10.1530/JME-13-0277)

The take home message from this information is this, effective long term weight loss cannot be achieved by calorie restriction.  Effective weight loss (specifically fat loss and muscle gain) is most effectively achieved when carbohydrates are restricted, protein is optimized, and proper exercise adequately triggers the release of fat burning hormones.

Click HERE and get a copy of my ketogenic diet.

Get a copy of my diet and 13 learning modules with coaching and online assistance by becoming a member of Dr. Nally’s KetoClan.

I’d like to know, what combination has been most effective for you?

Have a great day!

Adam (eat your bacon) Nally, DO

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.

    1. 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.
    2. 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).
    3. 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

All About Fat on a Ketogenic Diet (Can You Eat Too Much Fat?)

Catch my new video. I go into depth regarding why the type of fat you eat is very important on a ketogenic lifestyle. I reviews the effects of short, medium and long chain fats and how they are absorbed and used. We talk about starting a ketogenic diet and answer multiple viewer questions. Check it out!

 

Dr. Nally’s Favorite Low-Carb Peanut Butter Bars

My son was craving Reese’s Peanut Butter Eggs during the Easter holiday.  My wife came up with these peanut butter bars and I think this is now one of my favorite low-carb treats.   Be aware, you have to restrict portion sizes.  Too much peanut butter and peanut flour can kick me out of ketosis.  But if you are looking for something to satisfy a craving, this will do it and you can still maintain ketosis with two servings.

 

Peanut Butter Bar Recipe: 

Peanut Butter Bar Base
1/2 cup butter
3/4 cup Confectioner’s Swerve
1 tsp liquid sucralose
1 cup peanut butter
1 scoop Iso-100 vanilla protein powder
1/2 cup peanut flour
Stir in all ingredients into pan on medium heat on stove-top. Once mixed, press onto half-sized cookie sheet. (caution it is hot)
Chocolate Topping
4 oz unsweetened baking chocolate
1/2 cup cream
3/4 cup Confectioner’s Swerve
1 tsp liquid sucralose
1/2 tsp vanilla.
Wisc together in pan on medium heat.  Once mixed, pour over the peanut butter bar base in the cookie sheet.
Refrigerate until solid.
One serving is approximately a 2 inch x 2 inch square.
Enjoy.

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.

  1. Pick one small debt and begin to pick at it by applying just a little extra each month until it is gone.
  2. Cancel your extra cable, sell the motorcycle and payoff the 21% interest credit card.
  3. 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.

  1. Kiss your wife every time you leave, even if it’s just for a ten minutes to run to the convenience store.
  2. Hold her for five seconds longer every time you hug.
  3. Find a gift you can give her once a week, just because.
  4. 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.
  5. 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.

  1. Start with one meal and make some substitutions.  My dietary plan can help you with this.
  2. 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.
  3. Add a quality vitamin to your morning routine.
  4. Take ten minutes and do 20 push-ups and 20 sit-ups, then take a 10-minute walk.
  5. Simply remove the “white stuff” from your meals. You will be amazed at the results.
  6. 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

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.

Hormones after weight loss
N Eng J Med 27 Oct 2011. Mean (±SE) Fasting and Postprandial Levels of Ghrelin, Peptide YY, Amylin, and Cholecystokinin (CCK) at Baseline, 10 Weeks, and 62 Weeks.

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).

Weight rebound after loss
N Engl J Med 27 Oct 2011. Mean changes is weight from 0 – 62 weeks.

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.

Respect My HormonesSo, 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:

  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. Whittle AJ, “FGF21 conducts a metabolic orchestra and fat is a key player.” Endocrinology. 1 May 2016. 157(5): 1722-1724.
Fixing Habit-Loop Cycle of Weight Gain #DocMuscles #KetonianKing

Fixing the Habit-Loop of Obesity

(Fixing the habit-loop cycle of obesity is the third article in a series on habits relating to obesity and weight gain: Willpower & Self-Discipline and Habit-Loop Cycle of Obesity)

“I want you to increase your fat to 70-80% of your total food intake . . .” I stated, before I was cut off by a loud gasp, followed by a chortle.  The 300 lbs male sitting on the exam table in front of me looked at me with a very skeptical smirk.

“You want me to eat fat to lose weight?!” he said after catching his breath.  “You’re the first doctor who’s openly blown smoke up my a** . . . ,” chided the rotund 42 year old male shaking his index finger at me as we discussed weight loss treatments.

“Although that was standard medical treatment of the Royal Humane Society for drowning victims in 1774, . . . .” I responded.  “No. I’m actually trying to help you lose weight by shifting the hormone signal in your body with food.” I replied as I recalled that the medical thought of the time was that a tobacco enema dried out the insides , warmed the body and increased the heart rate of the drowning patient.  I informed my patient that the use of tobacco smoke enemas fell out of favor around  1811 when its use for drowning, typhoid, headache and stomach cramping was found to actually be cardio-toxic and ineffective.

Tobacco Smoke Enema DocMuscles #KetonianKing

“So, . . . blowing smoke into your rectum won’t help you lose weight, nor will it help you maintain ketosis.  In fact, it might actually kill you.”  I added with a smile.

Eating fat is, however, one of the keys to hormone manipulation used to fix the Habit-Loop Cycle of Obesity.  So, how do we fix or alter the habit-loop of obesity discussed in the last two blog posts?

Four Part Habit-Loop of Obesity

The habit-cycle cycle of obesity consists of four parts:

Habit-Loop of Obesity DocMuscles #KetonianKing Adam Nally @DocMuscles
Habit-loops can be identified by a routine that satisfies a craving

  1. Trigger
  2. Response
  3. Reward
  4. Hormone Response

In my last blog post, we discussed how the trigger and the response are driven by or focused on a craving that may or may not be consciously perceived.  We also learned that breaking this habit-loop cycle takes willpower we talked about in my first article, and willpower can fatigue.  It has a daily shelf-life.

Fixing habits and creating new powerful habits requires identifying the components of your individual habits.  That means, first, identify the routine that occurs in a habit you want to change.  We want to identify a habit that drives you to eat carbohydrates when you really rather wouldn’t.  You’ve tried to stop, but you struggle and when fatigued, ignore your previous thoughts and imbibe on cookies.

Identify the Routine

Weight gain, fat entering and staying in the fat cells, is stimulated by the production of insulin.  Many of us who are insulin resistant, produce 2-15 times the normal amount of insulin when we indulge in carbohydrates.  That’s the master hormone part of weight gain. There are 29 other hormones that play a role in weight gain, however, turning them all on or off is driven by the routine you follow in your daily habits.

In my journey to understand my weight challenges, I found a pattern that was causing my middle to grow.  After a long day at work and returning home to have dinner with the family, I would often sit down to work on my charts, billing codes, labs and dictation from that day.  (Thanks to the wonders of the Affordable Care Act, this immense amount of work added 3-5 hours of “home work” to my already 10 hour day at the office, only to be completed late in the evenings.)

Even though I enjoyed a late low-carb dinner with my family when I got home, I’d find myself getting hungry 2-3 hours later.  While working on charts and trying to “push through” the pile of work in front of me, I’d start getting “hungry” around 10 pm.  I would find myself rummaging through the fridge and freezer looking for something to eat.  The problem was that I would find myself eating things that I normally wouldn’t, and I’d even find myself finishing off the quart of ice-cream in the back of the freezer left over from a birthday.  No matter how much I tried to avoid this behavior, I would frequently cave to cravings between 10 pm and 1 am.  (Yes, I heard the gasps from the ketogenic blogosphere, but I’m human, too.)  I knew that if I, an obesity specialist, was having these challenges, you probably are, too.

So, how does one change this kind of behavior?  The solution is found in the habit-loop cycle.

I started drawing out the loop.  Trigger –> Go to kitchen fridge/freezer —> Reward.

What is the Trigger?

I had to ask myself some questions.  What is the Trigger or Cue?

Was it actually hunger? Boredom? Stress? Fatigue?

What is the Reward?

What was the reward? Was it actually food? Change of scenery?  A temporary distraction? Energy from the food?

So, I had to experiment with my reward to find out.  Rewards are powerful because they satisfy cravings.  However, you and I are often not aware or conscious of the craving that actually drives our behavior or routine.  As Charles Duhigg states, “Most cravings are hiding in plain site. . . They are obvious in retrospect, but incredibly hard to see when we are under their sway” (1).

To figure out which craving drives which reward, I had to run a few experiments on rewards.  I asked my wife to make extra fat bombs and some of her low-carb cheese cake to have in the fridge.

The next few evenings I recorded what happened.  When I felt the urge to get up and go eat, I ate a few fat bombs.  But that didn’t take away the craving.  I tried going out and walking around the back patio and petting the dogs for a bit.  I tried drinking something different instead of my routine water, Diet Dr. Pepper or exogenous ketones.  No matter what I did, some of the evenings I still found myself rummaging the back of the freezer for something sugary.

What Action Eliminated the Craving?

My point here was to see which of these activities took away the cravings.  I wrote down how I felt after each activity, as well as what happened after I’d cheat late at night with ice cream or chocolate.  Just the action of journaling how I felt, my thoughts, emotions or words that came to mind was the key.  After waiting for 15 minutes, I wrote down three words or phrases that came to mind.

I found myself journaling: “Sleepy,” “Anxious,” “Tired,” “Still Hungry”

I found that eating something I should be avoiding, like ice cream, chocolate, or sweets (Even in a low-carb home you can still find some of these things), caused me to feel short term euphoria, more relaxed and suddenly more tired.

The brain will record the scribbled words as recollections attached to emotions.  It is easier to see patterns if you will actually write it down with pen and paper.  The goal is to isolate what you are actually craving.  The words and emotions attached to those words will give you an idea about your cravings and the cue driving it.

Five Categories of Habitual Triggers

Scientists have shown that almost all habitual triggers fit into one of five categories:

  • Location
  • Time
  • Emotional State
  • Other People
  • Immediately Preceding Action

So, in trying to identify the cue driving me to the back of the freezer, I write down five things that happen the moment the urge hits (I’ve included some of my actual notes in bold from my experiment):

  • Where am I? – Sitting in front of my computer at my desk in my home office.
  • What time is it? – 11:32 pm
  • What is my emotional state? – Tired, anxious, and overwhelmed by the volume of work
  • Who else is around? – No, one.  Everyone else is in bed
  • What action preceded the urge? – I looked at the clock while finishing a patient’s chart

I repeated these notes and the repetitive pattern I identified was that it was late (between 10 pm – 1am) and I felt very tired and anxious.

Look at the Pattern

I realized that I wasn’t actually hungry.  I was exhausted, anxious & tired.  My willpower was gone for the day.  Eating the sugary food has always caused me to have a huge insulin surge and when that happened, I always got more sleepy.  When I ate the sugary food, I got more tired – tired enough that I would start falling asleep at my desk and end up going to bed.

I found that the craving was not for sugar at all, but for sleep.  The cue was not hunger or boredom, but for time of day coupled with the emotions of fatigue and stress.  The combination of time of day with these emotions were the trigger that would kick in a routine of rummaging through the pantry or freezer for something sweet, leading to an insulin response (hormone) driving me to bed.  This routine had has a negative aspect, it kicked me out of ketosis causing weight gain and further cravings for the next 72 hours.

Make a Plan

So, I wrote out my plan:  Go to bed at 10 pm.

I actually found that I could get up earlier, exercise and my ability to focus in the morning was much more crisp, alert and I was more effective at getting my charting and labs done in the morning and throughout the day.  I haven’t rummaged the pantry for the last month and I dropped the inch off my waist that had crept back over the last year.

Now, I realize that some habits are much more difficult to break.  I expect that, but hopefully this will be a starting point for you and I to begin looking at some of the hundreds of habit-loops that affect us for good or bad throughout the day.

Sometime New Habits are Required Before Bad Ones Can Be Broken

Your ability to break some of the stronger habits occurs when you set other good habits (2, 3). Habits like regular daily exercise increase the likely-hood of changing or breaking other bad habits.  People get better at regulating impulses and avoiding temptations when they strengthen willpower with habits like exercise. Research shows that simply establishing a habit of exercise actually increased peoples ability to drink less, smoke less, eat better, and learn more effectively (3).

The key to change is repetition of an activity, thought statement associated with physical or emotional feeling.  The repetitive action of exercise 3-6 times per week when willpower is strong increases the emotion of excitement, joy and happiness.  The combination of the repetitive action physically with the emotions experienced by the accomplishment actually strengthens willpower and allows for naturally identifying and changing the triggers and cravings of other habits (3, 4).  It takes at least 3-4 weeks for people to experience the effects of forming a new habit, so be patient with yourself.

Using Hormones and Your Journal to Bridge the Habit-Loop Cycle Faster

This is where journaling and fat come into the equation.  The ingestion of an increased amount of fat in the diet stimulates three hormones: GLP-1, Protein YY, and Oxyntomodulin.  These three hormones suppress hunger cravings by turning down the effects of hunger hormones in the hypothalamus.  When we use fat as a fuel and as a reward, we can change the cravings and the weight at the same time.

We now know that the use of hormone stimulus, emotion and repetition of an action allow for parallel learning about and expecting the reward in the basal ganglia.  The basal ganglia is the region of the brain that streamlines complex learning. It is the part of the brain that allows you back up a car, or riding a bike without deeply thinking about steering, pedaling and balancing.  Shifting the food type to predominantly fat and lowering the carbohydrates changes the hormones in the brain.  When we add journaling, by physically writing and recording our emotions, the basal ganglia learns about this reward system faster (5).

If you are ready to change your life, feel more energy, have improved concentration, better sleep and lose weight, I want to help.  I’ve created a 30 Day Keto Kickstart Challenge Program starting October 1st.   Click on Kickstart Challenge to join this exclusive group of Ketonians as we use the principles in these articles to successfully improve health, lose weight and feel more energy.

And, to answer your burning question, “No! Adding tobacco smoke rectally . . . doesn’t help the habit-loop cycle.”

References:

  1. Duhigg, Charles. The Power of Habit. Random House, New York. 2014. p. 290.
  2. Oaten M, Cheng K. Longitudinal Gains in Self-Regulation from Regular Physical Exercise. Journal of Health Psychology. 2006.; 11: p 717-733.
  3. Baumeister RP, Gailliot M, DeWall CN, Oaten M. Self-regulation and personality: How interventions increase regulatory success, and how depletion moderates the effects of traits on behavior. Journal of Personality2006; 74: p 1773–1801.
  4. Oaten M, Cheng K. “Improvements in Self-Control from Financial Monitoring,” Journal of Economic Psychology. 28 (2007): p 487-501.
  5. Brown J, et al., How the Basal Ganglia Use Parallel Excitatory and Inhibitory Learning Pathways to Selectively Respond to Unexpected Rewarding Cues. Journal of Neuroscience. 1999. Online OpenBU edition: https://open.bu.edu/bitstream/handle/2144/2228/99.011.pdf?sequence=1
Triggers #DocMuscles #KetonianKing Habits Self-Control Self-Discipline

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

DocMuscles #KetonianKing Excellence Act Habit ActionExcellence 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?

Image

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.

DocMuscles #KetonianKing #KetoCookies #ChocolateChipCookie

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

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.

kid-musclesOver 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.)

Quest for Life of Happiness #DocMuscles #KetonianKing #BaconBoy

Keto Happy – Do You Live A Life of Happiness?

Founded by the Secret Society of Happy People in 1999, August 8th was officially named the National Day of Happiness.  It was a day created to recognize and express happiness.  (I personally think it should involve the sharing of bacon, but some may disagree.)  Most people, whether they admit it or not, are searching for happiness.  (Most people are searching for bacon, too, . . . but that is for another article.)  We hope for happiness, we aim for happiness,  and we wish happiness upon our family, friends and neighbors at holidays and birthdays.  It appears to be a desired condition of the soul.

In medical school, we learn that the body is almost 80% water.  One of my professors intelligently quipped, “if you’re unhappy all day, that means you are essentially a cucumber with anxiety.”  For many people, happiness is really hard to find.  Money is hard to find . . . but, that’s because it gets wasted by people trying to find happiness

What exactly is happiness?  It is a transient condition or state of cheerfulness, contentment, satisfaction or pleasure.  Many people mistake meaningfulness as happiness.  Meaningfulness to one’s life is more enduring.  For example, suddenly having a wind-fall of cash may make you happy for the short term.  However, what you actually do with that cash over the next few days, months and years is what brings degrees of meaning to your life.

Basics of Happiness

Happiness is based upon your emotional & spiritual vision, and how living your life aligns with the principles you hold most valuable.  You can’t control all of the circumstances of your life. Things both good and challenging will happen to you that you never expected. However, you have control of your own happiness. You and I are the architects of it.

In working with a majority of patients who are over 65 years old, I have found that the older we get, the more we look back and realize that external circumstances don’t really matter or determine our happiness. We determine our happiness.

How do we increase our level of happiness?  There are 10 Simple Steps to Happiness:

1. Improving 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?)

2. Savor Daily Experience

BaconWrappedJalapeno #DocMuscles #KetonianKing
Bacon Wrapped Jalapenos

First, 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 recent trip in down town Amarillo, Texas, 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.

BaconWrappedJalapeno #DocMuscles #KetonianKing
Bacon Wrapped Jalapeno’s & Happiness

Just taking a bit of time to savor these things made this experience a very memorable and happy experience that I probably won’t soon forget.

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.

3. Volunteer

Volunteer #DocMuscles #KetonianKing HappinessGet 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.

4. 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.Christ Leper #DocMuscles #KetonianKing

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.

5. Recognition of 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.

6. Become Who You Are

The celebrated Greek poet, Pindar, said, “Become who you are.”  Isn’t this a paradox?  How does one become who they already are?

Many of my and the younger generations 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.

Lion King #DocMuscles #KetonianKingHis 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.”

“Where are you going?” the monkey asks him.

“I’m going back!” cries Simba.

(This is also a great movie because of the “bacon references:”)

YouTube player

Admit it. You smiled didn’t you!

7. Meditation

Meditation Grand Canyon #DocMuscles #KetonianKingMeditation 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.

8. 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.  (Sharing your bacon improves relationships as well.)

9. Food

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.

10. Allow Others to Help

I know you are probably familiar with the term it is better to give than receive but did you know there is evidence to support the reverse is true too?  That 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 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 and enjoy the benefits of a KetoLifestyle. If you want to know more about what I do, keep reading my blog, join my weekly newsletter and watch me Live Stream every week on Facebook Live & Periscope giving you free tips and tricks to stay healthier. 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 Happiness inside You! Because we all love gifts and they make us Happy, in honor of #NationalHappinessDay, you should see a pop up here for something special!  ] Be sure to click here to go to the Keto Kart and cash in on better health!

However you decide to approach your day today, choose to be happy.  It really is up to you.

Fat Lock Box #DocMuscles #KetonianKing

Ketones – One of the Keys to the Fat Lock-Box

Do you have the keys to your “fat lock-box?”

Lock-boxes have always fascinated me.  Lock-boxes with special keys are even more fascinating.  The more I’ve learned about fat cells (adipocytes), the more I think about them as special fuel depositories or fat lock-boxes.  Before the invention of refrigerators, fast-food, Bisquick and beer, our bodies preserved and reserved fat as a precious commodity.

The body, when given fat with carbohydrates or excess protein, quickly places the fat into a lock-box for safe keeping.  It does this for two reasons. First, the body can store fat very efficiently. Second, hormone signals stimulate fat storage when other fuel sources (carbohydrate & protein) are present in excess. The body can access this stored fuel only when the right presentation of hormonal keys are present.  Fascinatingly, we now know from recent research, there are actually three types of lock-boxes for fat in the human body (white adipose tissue, brown adipose tissue, and tan adipose tissue).

The greatest challenge for the obesity doctor is getting into the fat lock-box.  Some people’s boxes are like the “Jack-in-the-Box” you had as a child – just add a little exercise spinning the handle and the box pops open (These are those people that say, “Oh, just eat less and exercise and you’ll lose weight.”)  For the majority of the people I see, it’s more like the lock above with a four or five part key required to turn the gears just right.  (And, that key often only seems available on a quarter moon at midnight when the temperature is 72 degrees.)  Fat cells, called adipocytes, require four, and possibly more, keys to open them up and access the fuel inside.  Exercise is only one of those keys.  However, exercise alone often fails.

Over the last 18 months, I have been surprisingly impressed with the results patients have by the addition of both medium chain triglycerides and exogenous ketones.   A number of people have asked me, “Why do you encourage the addition of exogenous ketones to a person already following a ketogenic diet?”

Others just accuse me of self promotion, saying, “You’re just trying to sell a product!”

Or they exclaim, “Giving more ketones is just a waste of time and money.”

A few of the uneducated holler from across cyberspace, “You’re just going to cause ketoacidosis!”

Believe me, I’ve heard it all.  And, the skepticism is understandable.  I work with people every day, looking closely at weight gain/loss, metabolism, cholesterol, blood pressure, inflammation, etc.  With any “low-carb” or “ketogenic product,” I test it out on myself and my family, before I offer it to my patients or even consider encouraging its use in my practice.  I have this desire to understand “the how” and “the why” before I prescribe the who and when.

The Fat Lock-Box Keys

First , let’s talk about the adipocyte as a fat lock-box – and where you find the keys. Then, we’ll discuss how products may or may not help.

Insulin

There is only one door INTO the adipocyte for the fat, and the key to that door is insulin.   Insulin stimulates an enzyme called lipoprotein lipase that essentially pulls the fat from the cholesterol molecule into the fat cell.  Without insulin, fat doesn’t enter the fat cell.  As a result, type I diabetics (those that make absolutely no insulin) look anorexic if they don’t take their needed insulin.   Insulin is also the first key to the back door on the adipocyte.  Actually, if there is too much insulin in the system, fat enters easily through the front door but cannot exit the back door (Picture 1). Insulin seals up the back door so that fat cannot exit very effectively.

That’s why insulin is the master hormone when it comes to obesity.  You’ve got to lower the over-all insulin load to get the adipocyte slowing fat entry and increasing fat exit.  If you don’t do that, I don’t care how much you exercise, 85% of the population will struggle with weight loss.  Hmmm, seems kind a familiar to the last 50 years of our obesity epidemic, No?

Stimulation Lipolysis #DocMuscles #KetonianKing
Picture 1 – Four Key Pathways to Adipocyte Stimulation of Lipolysis

Catecholamines

The second key to the back door of the fat cells are the catecholamines.  These are adrenaline (epinephrine), norepinephrine, adrenocorticotropic hormone (ACTH) and even serotonin.  These hormones are produced in the adrenal glands through exercise, fear and even recollection of powerful memories. Medications can also stimulate production of these hormones.  The catecholamines stimulate cAMP.  cAMP opens the fat cell, releasing fatty acids for fuel.

#WhereIsBaconBoy #DocMuscles #KetonianKing

The thyroid hormone conversion of T4 to T3 also plays a role in uptake of the catecholamines by adnylyl cyclase (AC).  Low levels of T3 (like those seen in hypothyroidism or in cases of thyroiditis) also inhibit unlocking of the fat lock-box.  Conversion of T4 to T3 is driven by the presence of bile salts in the gut.  Increase fat intake increases the presence of the bile salts which naturally leads to better T3 conversion.  Hence my constant references to eating more fat and bacon. .

Inflammation & Medications

The third key is an inhibitory effect on adenylyl cyclase (AC) activity by alpha and beta adrenoreceptors, adenosine, prostaglandins, neuropeptide Y, peptide YY, HM74-R & nicotinic acid.  These inhibitory and inflammatory hormones produced in the brain, gut and other areas decrease cAMP activity in the fat cell and slow fat loss.  The fancy long names are all hormones causing inflammation.  Of note, many are also stimulated by medications including blood pressure lowering drugs. Check with your doctor if the medications you are taking may be causing weight gain, or halting your weight loss.

Please note that the first three keys have effect on the cAMP pathway for release of fat from the adipocyte.  These three keys turn on or off effective function of cAMP leading release of fatty acids from the fat cell.

Naturitic Peptides

The fourth key follows a separate pathway.  This is why I’ve clinically seen patients experience weight loss even in the presence of higher insulin, inflammatory disease or hypothyroidism. This key activates release of the naturitic peptides (ANP, BNP).  These hormones are released from the heart when it squeezes more powerfully.  As the cardiac muscle contracts, it releases ANP & BNP hormones.  These hormones stimulate the cGMP pathway in the adipocyte.   It then activates hormone sensitive lipase (HSL) and perilipin to release free fatty acids.  Again, this pathway is separate from the pathway by which the first three keys released fat.   Exercise increases heart contractility, but is inhibited by high insulin levels.  However, ketones themselves also stimulate this increased contractile effect.

Hypothalamus-Pituitary-Gonadal (HPG) Axis & Testosterone

There actually is a fifth key not referenced above.  The fifth key to the fat lock-box amplifies testosterone’s presence through the HPG axis.  Insulin resistance and leptin resistance lower testosterone in men and raise it in women, causing poly-cystic ovarian syndrome (PCOS).   Normalizing insulin levels (with a ketogenic diet) while at the same time increasing ketones as the primary fuel powerfully resets the HPG axis through a complex series of hormonal reactions.  Growth hormone is balanced and testosterone returns to a normal range.

Clinically, 60% of the people I see in the office have abnormal testosterone due to insulin resistance. This leads to hypogonadism in men and PCOS (abnormal periods, facial hair growth and/or infertility) in women.  Restricting carbohydrates and maintaining nutritional ketosis by diet and/or addition of exogenous ketones has a powerful corrective factor in these people.

Testosterone influences the up-regulation of the alpha & beta adrenergic receptors (the 2nd & 3rd key above).  Hence, if your testosterone is low, it has a suppression on the way that the catecholamines influence fatty acid release from the fat cells.  If your testosterone and growth hormone are normal, muscle development and adrenaline stimulus from exercise helps amplify the use and mobilization of fat from the fat cell.  In people with insulin resistance and leptin resistance, exercise and the catecholamines don’t have the same fat burning effect.

What Does This Actually Mean?

Yes, I have greatly simplified a series of very complex hormonal pathways in the explanation of the keys above.  Why do you think understanding obesity has been so difficult?  Think of your adipocytes as a fat lock-box.

What’s even more important is the knowledge that the fat cell DOES NOT open or close because of calories.  There is no dogmatic calorie-meter on the wall of the fat cell.  There is no calorie key to the fat lock-box.  Really, . . . in the 50 years of studying fat, researchers haven’t found one.  (Prove me wrong when you show me an electron micro-graph of a calorie-meter in the wall of a cell).  Science has demonstrated multiple times that the lack of food from starvation or excessive fasting suppresses thyroid function (an inhibitory effect on key #3).  Restricting calories actually inhibits fat loss in many people.

The fat lock-box keys I refer to above are hormone responses to the presence of macro-nutrients (food).  That means, first reduce your carbohydrate intake by eating real food from good sources. You can learn how to get started by registering for my FREE six part weight loss mini-course.  Second, be as active as you can. Third, reduce stress and medications that have inhibitory effect on catacholamines. Fourth, balance your thyroid. And, fifth, get into ketosis and consider adding exogenous ketones to your dietary regimen.  It really is that simple.

References

(For those of you that still believe there is a calorie key – or just need something to do while in the bathroom):

  1. Lafontan et al. Arterioscler Thromb Vasc Biol. 2005
  2. Lenard NR, Obesity, 2008
  3. Li XF et al, Endo (April 2004) Vol 145
  4. Liu YY& Brent GA, Trends Endocrinol Metab. 2010 Mar; 21(3): 166–173
  5. Max Lafontan et al. Arterioscler Thromb Vasc Biol. 2005;25:2032-2042
  6. Skorupskaite K et al, Hum Rep Update, Mar 2014, vol 20
Bacon Grease DocMuscles #KetonianKing

Bacon Grease – The Healthy Essential Oil

Bacon Grease Is the Healthy Oil

Is bacon grease really healthy? People in my office stress out about getting all the healthy fats and the right amino acids.  I am asked all the time, which protein powder they should be taking?  Do I prefer fish oil or krill oil?  My answer to this is simple.

“Bacon grease.”

Disbelief Bacon DocMuscles

I know, I can see it on your face now. . . the blank stare of disbelief.

Yes, I said “bacon grease.”

If you are following a low carbohydrate or ketogenic diet, bacon grease is your essential oil. Let me explain why:

Bacon Contains All The Essential Amino Acids

Bacon, and the grease it creates, contains all the essential amino acids.  Yes, even the coveted branched chain amino acids (BCAAs).  Go ahead, have 3-5 slices for breakfast, but keep the grease and re-use it to cook with.  Because your saving yourself from having to buy expensive protein powders and less tasty versions of these essential muscle building blocks.

Bacon Is A Great Source of Choline

Bacon grease is a great source of choline, an essential nutrient for stabilizing cell membranes and making the neurotransmitter acetylcholine.  Acetylcholine is one of the neurotransmitters absent in memory disorders and muscle disease.  Fascinatingly, choline helps in the prevention of fatty liver disease, a disease caused by the standard American diet that often progresses to non-alcoholic liver disease.

Choline has also been shown in a number of studies to help ward off Alzheimer’s Disease.

Bacon Grease Contains All The B-Vitamins

Bacon fat is a superb source of all of the necessary B vitamins.  It is also a superb source of Vitamin D, phosphorus, magnesium and iron.  In fact all of the fat soluble vitamins – any vitamin that sounds like a letter of the alphabet: A, B, C, D, etc.- are found in animal fat.

Veggies Bacon Superpower DocMuscles

Bacon Grease Suppresses Appetite

Long-Chain fatty acids are satiating.  Bacon grease is a great source of the longer chain fatty acids and has a wonderful effect on suppressing your appetite.  That’s why Dr. Nally talks about it so often.  Bacon is the duct tape of the culinary world, and acts to suppress the cravings for the pie that might arise 30-60 minutes later.

Bacon Brings Happiness

When have you ever felt a frown after eating bacon?  That’s my point . . . you just smiled when that thought crossed your mind.  Seriously, don’t deny it . . .

Put a piece of bacon in your mouth, and it doesn’t really matter who the president is, what Kim Kardashian recently posted, or that you’re late for work . . . seriously.  Bacon in your mouth reminds you how good life really is.  If I die while eating a plate of bacon, my life will be complete.

My wife fries eggs in bacon grease for breakfast when she cooks.  I tell you . . . it’s edible love.

Bacon Stimulates the Heart

Bacon grease also contains a significant amount of medium chain triglycerides (caproic, caprylic, capric, and lauric acids).  These medium chain triglycerides (MCTs) are all the rage in helping to maintain a ketogenic diet.  MCTs convert rapidly into ketones after absorption into the liver from the gut.  Rapid conversion of fat into ketones stimulate more effective contraction of the heart.  When the heart contracts more effectively, it releases atrial-naturitic peptide (ANP), that opens the “back door” in the fat cell allowing for more efficient fat burning and maintenance of ketosis.

Bacon Smells So Good

Many people us essential oils for the aromatic effect they produce on mood and anxiety.  Next time you cook bacon, check your mood.  Never has there been an aroma that is so inviting and calming.  Very few other aromas actually bring people to a dinner table.  And for you men out there, bacon grease improves your manhood.  Increased presence of ketones, and the appetite suppressing effect of bacon grease helps to stabilize testosterone and leucine.  This improves muscle development, enhances libedo, and prevents the progressive decline in testosterone leading to the “girly-man” status that occurs with so many men eating the standard American diet.

Let me leave you with one last question.  When is the last time you saw left-over bacon?

Exactly – the same time you saw leprechauns riding unicorns down your street after a rain storm.

So, cook that bacon . . . and save the grease.  Use it to cook your eggs or bake with it.  You’ll thank me later.

Why Be In Ketosis? Part XIII: How Ketones Modulate Pain

DocMuscles in Downtown Denver

I traveled to downtown Denver, Colorado, this week.  It gave me the opportunity to talk to a number of really great people.  A number of those people that I chatted with were searching for relief from pain and other aliments.  Not surprisingly, being in the mile-high city, many of those were using derivatives of marijuana (pun not intended).  I was actually surprised at the number of people who spontaneously admitted to using tetrahydrocannabinol (THC) or cannabinol (CBD).  They use it in various forms to treat their pain or other complaints.  Only a handful of those that I had the pleasure of talking to had ever heard of nutritional ketosis as an approach to pain control. This got me thinking about my patients and their pain control.  Many of them have had significant improvement in pain using a ketogenic diet and exogenous ketones.

Nutritional Ketosis as a Method of Pain Treatment

I started using nutritional ketosis as an adjunctive treatment to disease twelve years ago. Quite a few of my patients reported improvements in their overall pain using this approach.  I started to see 50-60% improvement in the inflammatory types of pain, and 40-50% improvement in neuropathic pain.

Ketosis and Forms of Pain

There are a number of forms of pain: thermal, inflammatory, and neuropathic. Looking over the scientific literature, there is no strong data showing that ketogenic diets reduce thermal pain, however, there is data showing improvement in inflammatory pain.  Within two days of dietary changes, inflammatory pain and secondary swelling, as well as plasma extravasation (excess fluid accumulation around the area of swelling) show measured improvement.

Watch my four minute vlog below about pain control being one of the twenty-five reasons to use nutritional ketosis (This video has a mic problem, so turn your sound all the way up):

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Even though the published science has not caught up to fully clarified what we are seeing clinically, evidence demonstrates that ketones improve nerve pain. When ketones are present in increased amounts in the blood stream, the current evidence points to a number of poorly understood mechanisms.  Ketones compete with chloride ions in the peripheral nerve cells.  When ketones bind instead of chloride, there is a decrease in glutamate production, a key amino acid necessary in the signaling of pain fibers.  The lower glutamate level causes a rise in gama-aminobutyric acid (GABA). . . leading to decreased sensation of pain.

This is the same pathway that stops intractable seizures and may play a very significant role in dietary treatment of autism.

Denver is ranked No. 3 by Zagat on the list of “Foodie Capitals” of America. And, the downtown scene is absolutely beautiful, but I walked by eight different restaurants specializing in “carbage” while walking just two blocks.  Encouraging cities to eat less bread may be a challenge.   But, hey, you get to eat more bacon!  And, bacon is the duct tape of the culinary world.

Bacon Boy loves to travel. Click Here to take him on your next photo opportunity.

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.

 

Coconut Oil – Duct Tape for the Broken Metabolism

Coconut oil can be found in just about every grocery store, health food store and coffee shop near you.  It was made popular in the last few years by the highly advertised Bullet Proof Coffee claims of health and taste over the last few years.  But in the last few days, the news outlets through video and print have made it clear that the American Heart Association (AHA) isn’t happy with our use of this “duct tape for one’s metabolism.” The AHA has long been a proponent of education against activities increasing the risk of heart disease.  Since 1961 the AHA has decried the use of saturated fat, based on their support of Ansel Key’s diet heart hypothesis, and leading to over 60 years of preaching against the use of saturated fats from the pulpits of science.  The claim is that 85% of coconut oil is saturated fat (this is the fat deemed “evil” by those “disciples of the low-fat cloth”).   Yes, coconut oil is predominantly a saturated fat.  And approximately 75% of that is medium chain triglycerides, the form that converts most efficiently into ketones, for those of us using ketogenic nutritional approaches to health.  But is coconut oil really bad for your heart health?

Those of us using ketogenic diets know that LDL-C will commonly rise with increased saturated fat intake.  And, we’ve know this for over twenty years. This is to be expected, because LDL-C is really comprised of three different LDL sub-particles (big fluffy, medium, and small dense).  We’ve known for the last twenty years that increased saturated fat actually causes a shift in these particles to bigger “fluffier” particles.  We also know that it’s the small dense LDL particles are the atherogenic/inflammatory particles participating in the formation of vascular disease (arterial blockage) and their presence in the blood is directly correlated with the level of triglyceride, and that the big “fluffy” particles actually reduce the risk of vascular disease. Those of us following ketogenic lifestyles and treating disease with these protocols also know that triglycerides levels are increased directly by increasing levels of insulin.

The 2015 British Medical Journal published a study reviewing 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 (a calculated value of all the LDL sub-particles) with mortality (meaning that an elevated LDL-C does not lead to an increased risk of death from heart disease).  In stark contrast to this landmark review, The American Heart Association’s Presidential Advisory published this week in the June 20, 2017 issue of Circulation states that saturated fat is the cause of increased LDL-C and elevated LDL-C is associated with an increase in death by cardiovascular disease.  This boldfaced claim is based on a single small 4 year (2009-2013) literature review completed by the World Health Organization with a whopping 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.  From this singular study, the AHA concludes that elevated LDL-C is an indicator of increased cardiovascular mortality.  That’s the equivalent of saying, “you know cars drive on the roads and cause pot holes, so we should all STOP driving cars because it is causing our freeway system to have increased pot holes.”

You can’t extrapolate mortality risk based on a single small study that doesn’t actually identify correlation or causation.  But the AHA did exactly that in 1961, and they are trying to do it again today.   The MR-FIT study, largest 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 actually stated, “. . . the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol…”

“We found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories weighed the least and were the most physically active,” he said.

Isn’t that interesting?

So, is coconut oil, or any other food high in saturated fat to blame?  Absolutely not!  There is no solid evidence to support these facts and there hasn’t been in over 65 years.   In fact, clinically, I find that the addition of coconut oil lowers triglycerides, decreases appetite, improves energy, improves skin tone, and plays a huge role in shifting the Omega 3/6 ratios to a more normal 2:1 level.

[clickToTweet tweet=”Is coconut oil, or any other food high in saturated fat to blame?  Absolutely not! #docmuscles” quote=”Is coconut oil, or any other food high in saturated fat to blame?  Absolutely not!  There is no solid evidence to support these facts and there hasn’t been in over 65 years. #docmuscles”]

So, how does coconut oil help the broken metabolism?  The majority of people I see in my office have insulin resistance to some degree.  Insulin resistance is an over production of insulin in response to any form of carbohydrate or starch.  Increasing your saturated fat, does two things.  It provides a fantastic form of fuel, one your body can use very easily.  And second, it will decrease your craving for starches and carbohydrates, naturally decreasing production of insulin and helping to improve insulin resistance over time.

If you want to learn more about using fat and improving insulin resistance, see my previous blog post here.

You can learn more about how our acceptance of bad science has lead to an obesity and diabetes epidemic in our country over the last 65 years by reading these books below:

 

SculpSure Non-Invasive Fat Reduction

I am excited to announce that we just added the SculpSure Laser to our treatment offerings at Nally Family Practice.   Many of my patient’s have very successfully lost weight with a ketogenic lifestyle; and I am still a strong advocate of a ketogenic lifestyle for maintenance of health, weight and over-all wellness.

After years of carrying extra weight, a number of my patients still struggle with that last stubborn problem areas like the belly and love handles.  I’ve been waiting for over 15 years for technology to catch up to treat theses areas, . . .  and now it has. 20160811-CYN-9

Introducing SculptSure, the non-invasive fat reduction laser that can customize fat reduction in the problem spots.

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Call our office today to schedule your consultation with Dr. Nally and his staff to find out if SculpSure is right for you!

(623) 584-7805

KetoTalk LIVE on the Boat: Episode #69

KetotalkEpisode69

Listen in to our live audience recording of KetoTalk Episode #69 while cruising around Alaska!

Questions You Can Find Answers to On This Podcast:

– Can your fasting blood sugar creep up if you’ve been low carb for a long time?
– What combination of electrolytes do you need to prevent leg cramps while keto?
– Should I use a keto diet to treat an immunosuppressed system?
– How does a keto diet effect someone with low stomach acid levels?
– Does plaque leave your arteries when you go keto, or do you have it forever?
– What is the best time to test blood sugar?
– Why does some bacon have sugar, and should I be eating it? What about nitrates?
– How do you account for the variations in home glucose meter readings?
– Why are most artificial sweeteners not a good idea?
– Can keto help Reynaud’s Syndrome?
– Is there a role for energy balance on keto specifically after hormones have been normalized?
– Why do some people get keto rash?
– Is my raised blood sugar levels telling me that I am still healing?
– Stalled weight loss after gastric band
– Why do you sometimes go out of ketosis after exercise?
– What is the difference in using MCT oil vs coconut oil?
– What is the proper timing of supplementing with bone broth and other electrolytes?
– Are food sensitivity tests a good idea?
– If calories don’t matter, why do things like the rice diet work?
– Why do I wake up hungry in the middle of the night?

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Dr. Nally’s KetoLiving Muti-Vitamin Formulation