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!!
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.
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?
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:
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).
Twice a week I join up with my HEMA (Historical European Martial Arts) group and sword fight. My wife and I participated with group sparing yesterday. It is a wonderful group of peeps.
We all live very stressful lives. Stresses come in the form of phone calls, getting cut off in traffic, and angry outbursts from people around us. These short bursts of stress act like a bear chasing you through the woods. Every time that “fight or flight” signal kicks in, it is the physiological equivalent of eating a donut. Literally.
If you don’t already, you need a physical release valve. You must have a physical outlet 3-6 days per week to burn off the accumulating adrenalin and cortisol or your anxiety, depression and fatigue will overwhelm you. Research shows that progressive repetitive daily bouts of stress that aren’t physically dissipated leads to weight gain, anxiety and depression.
(After 50 years, I’ve finally figured out how to relax . . .)
The most common complaint that I get in my office when someone has started a ketogenic diet is, “Doc, I feel fatigued. Will this ever go away?”
That feeling of fatigue, some refer to as the “keto-flu,” is usually due to a couple of things. First, you may not be eating enough fat (I recommend a 1 gram to 1 gram ratio of protein to fat when getting started). Second, you’re not taking in enough salt (specifically sodium, potassium, magnesium and/or zinc). These four salts are essential electrolytes our body requires for proper function.
If salt is the problem, the you will be experiencing leg cramps. Cramps during daytime activity are usually due to low sodium or potassium levels. Cramps that wake you up at night are usually due to low magnesium or zinc. Leg cramps can also be due to hypothyroidism or significant blood sugar swings. Dr. Nally will usually check for this during your visit with him.
“But isn’t too much salt bad for you?” I am frequently asked.
Too much salt is only bad for you if you’re eating a “low-fat” diet.
What if increasing salt intake actually lowered your blood pressure?
Did you know that increasing your salt intake can actually improve your diabetic blood sugar if you are following a correct diet? Could it be that easy?
Almost every patient that I see in the office has a significant worry about salt intake, some greater than others. In fact, some people are so fearful about salt that when I initially began encouraging its use, they told me that I was crazy, and they left my practice.
Has restricting salt over the last 50 years really worked, or is it doing more damage than we think?
That was the question that was asked by Dr. Ames in the American Journal of Hypertension 17 years ago. However, his answer never got a mention. In fact, I’ve been in practice for almost 20 years, and incidentally stumbled upon this article when it was mentioned by a colleague of mine. Granted, the study is a small sample size of people, only twenty-one. However, the results are profound.
Twenty-one patients with hypertension were randomized to periods of no salt (placebo) and periods of 2 grams (2000 mg) of sodium chloride four times a day (a total of 8 grams of salt per day). Glucose tolerance tests were completed with insulin levels at the end of each intervention period.
Insulin Resistance and Hypertension Improve by Adding Salt
Three very noteworthy results happened. First, those patients with insulin resistance and diabetes had improvement in their glucose levels while on 2 grams of sodium supplementation.
Second, those with hypertension also, shockingly, showed improvement in their blood pressure while on the 2 grams of sodium supplementation.
Third, those with insulin resistance had a lowering of their insulin levels during the period of increased sodium intake. These findings fly in the face of the dogma that’s been drilled into our heads that “salt is bad!”
“But, Dr. Nally, you can’t base your findings on a small group of 21 people,” the experts say.
Yes, it is a small study group. However, these findings are identical to what I, also, see clinically every day in my practice for over 20 years.
We know that the average human needs at a minimum 3 grams of sodium per day and 3 grams of potassium per day. The standard American diet (SAD diet) including processed foods contains 2-3 grams per day of sodium and potassium. In fact, the CDC claims the worst salt containing meals for you are:
Bread
Processed chicken dinners
Pizza
Pasta
Insulin also stimulates additional retention of sodium at the kidney level. If you are insulin resistant, producing excess insulin in response to starches or sugars, you retain notably larger amounts of salt when eating the standard American diet (SAD diet) or a “low-fat” diet. However, if your following a low-carbohydrate or ketogenic lifestyle, you won’t be eating the meals above and you’re probably not getting near enough salt.
Salts, or electrolytes, are essential in normal cellular function. Low salt in the body is like running your car without oil. It will run, but not very efficiently and over the long term will cause problems. This is the cause of the keto-flu I wrote about previously. And, according to the study above, it is a potential driver of our persisting insulin resistance, diabetes and hypertension.
How Much Salt Should I Use?
In my office, I encourage use of 3-4 grams of sodium and 3-4 grams of potassium daily when using a ketogenic lifestyle. That’s approximately 1 ½ – 2 teaspoons of salt per day. I like the Redmond’s RealSalt or pink Himalayan salt because these products contains all four types of salt (sodium, potassium, magnesium and zinc).
It is probably that your salt restrictions is making your insulin resistance and blood pressure worse. That’s what the clinical evidences are pointing toward, and it is what I see every day in my office.
Want to know more about a ketogenic life-style? Click the KetoLife link to get some basics.
If you’re already following a ketogenic lifestyle, then let me help you navigate the bumps and turns by going to the KetoKart and checking out the products I recommend to jump-start ketosis DocMuscles-style!
Until then, I’ll have another piece of bacon, please . . . and, oh, pass the salt!
While at a medical conference in Tampa, Florida, I started thinking about uric acid. This lead to remembering the story of a patient who was passing a kidney stone . . . watch to find out what she said.
Kidney stones are really just gout’s wicked step-child and both are usually found in the insulin resistant patient. Learn why as we spend a short 10 minutes talking about how both types of kidney stones are formed and why. Uric acid stones & calcium oxalate stones are siblings with different mechanisms of formation but, oh, how they love hanging out in your kidney.
Listen and watch as we talk about how ketosis, or the absence thereof plays a role in the formation of the Diseases of Civilization (It’s not rocket science, or maybe it is?)
We touch on non-alcoholic fatty liver disease, carbohydrate restriction, the use of protein and even exercise (Did you say “eggs are sides . . .” or exercise?). So pull up a piece of string cheese and spend 20 minutes that may just change your life.
You can find the vitamin supplements that Dr Nally developed and uses himself and with his patients at KetoLiving.com.
You can find exogenous ketones referenced in the video at DynamicKetones.com
Stomach Pain & Swelling with Hereditary Angio-Edema (HAE)
Listen to KetoTalk Podcast #32 where we talk about hereditary angio-edema, adequate ketone ranges, statin use while in ketosis and healthy keto questions. You can listen in by going to KetoTalk.com or you can listen in on iTunes.
“About 40 percent of my older patient population who take statins while eating ketogenic experience some form of myalgia they didn’t have before. And there’s an amplified side effect profile: muscle ache, joint pain, generalized fatigue, liver enzyme elevation, and cloudy headed.” — Dr. Adam Nally
I am frequently asked about the sweeteners that can be used with a low carbohydrate diet. There are a number of sweeteners available that are used in “LowCarb” pre-processed foods like shakes or bars, or in cooking as alternatives to sugar. However, most of them raise insulin levels without raising blood sugar and are not appropriate for use with a true low-carbohydrate/ketogenic diet. You can see and print the article I published clarifying which sweeteners you can use and which ones to avoid here:
Of recent note, I’ve been asked about the insulin response that occurs in the study found here quoted by Dr. Jason Fung in his wonderful book, The Obesity Code.
First, it is essential to note that both the crystalline form of Stevia and the aspartame used in the form of Equal, also a crystal, contain either dextrose or malto-dextrin as the crystallizing agent. Both dextrose and malto-dextrin have a known insulin spike equal to table sugar. You can see that in my article link above. Watch the video and we’ll discuss which forms of Stevia and aspartame don’t raise insulin in myself or my patients.
Aspartame has been effective in appetite suppression in many obesity patients clinically. However, recent studies have demonstrated that aspartame does have a negative effect on gut flora, has potential to cause insulin resistance to persist when used long term (seen in animal studies) and has been shown to damage the mitochondria of brain cells (also animal studies). I now caution my patients with its use. We will keep a very close eye on all these sweeteners.
I want you to think about bacon for a minute . . . here are some images to help:
Now admit it . . . your problems went away for just a moment . . . didn’t they!? That’s the power and influence of ketones on your brain.
See, your brain loves ketones. Bacon is the bearer of ketones. Bacon contains saturated, polyunsaturated and monounsaturated fat. Fats that have the ability to be converted to ketones in the short run, in a couple of hours and 4-5 hours from now. Isn’t that exciting?
I know my brain feels a little kick start just thinking about it.
As long as you are putting that bacon into the system without the stimulus due to an insulin surge from carbohydrates, you’ll do fantastic.
This is the same feeling I get when I use exogenous ketones like Keto//OS. If you haven’t tried them, you’re missing out.
So, if your feeling a little foggy today, stop and think about bacon wrapped avocado fried to a crispy golden brown in coconut oil for a moment, and while you’re making them . . . drink a Keto//OS . . .
There . . . doesn’t that feel better?
(Yes, I just used pictures of bacon to advertise for exogenous ketones, but really, . . . . you feel better don’t you!?)
KEY QUOTE: “Children are born in ketosis, so ketones are perfect for babies. The level of fat in breast-milk is essential for them to maintain their health and their growth.” — Dr. Adam Nally
Here’s are the 12 questions Jimmy and Adam answered in this special Keto Talk Mailbox Blitz extended podcast today:
– Testimonial from someone who learned his lesson why it’s important to stay ketogenic all the time
– Three-decade study confirms saturated fats are bad for health
– Is increased testosterone from a ketogenic diet a bad thing for women?
– Why am I still struggling with low energy and low ketones after months of being in ketosis?
– Can being in nutritional ketosis above 1.0 mmol cause painful headaches?
– Do artificial sweeteners and stevia raise insulin?
– Is my ketogenic diet causing me to cramp up before and during my half marathon racing?
– Is MCT oil a better fat to use on a ketogenic diet than other fats like coconut oil, cream, or butter?
– Why do I have a constant stomachache while I’m on a ketogenic diet?
– Do you have to be in ketosis to burn fat?
– Does being in ketosis lead to daily spotting and extended periods?
– Are ketones in my baby’s breastmilk safe for her to consume? And why did my milk supply drop when I went keto?
– What is the impact of the supplement creatine on ketones, blood sugar, and insulin levels?
– Can I ease into ketosis as a way to avoid the dreaded “keto flu?”
KEY QUOTE: “If you’re not feeling energy after that adaptation period of 2-4 weeks at the very most, then you’re doing something wrong. Let that be your wakeup call to change something.” — Jimmy Moore
Hypertension (elevated blood pressure) is one of the triad symptoms of metabolic syndrome. Most of the hypertension that I see clinically is driven by insulin resistance as the underlying cause. I see this problem in a very large majority of the people in my office and I am seeing people younger and younger show up with continually increasing blood pressure.
In medical school, we were taught to treat “borderline” or “slightly elevated blood pressure,” through “lifestyle changes” which was another way of saying exercise, caloric restriction & hold the salt. But most physicians today will tell you that exercise, salt & caloric restriction doesn’t work. When asked why the 34 year old male in my office suddenly has elevated blood pressure, the only explanation we had was it is a “genetic problem,” or “blood pressure naturally goes up as we get older,” or “you’ve been eating too much salt,” and they are started on blood pressure medication and sent on their way. But, as time went on, I found that I had to keep adding more and more blood pressure medication to control the continually rising blood pressure of the patients in my practice.
Most of these people will have a progressive elevation in blood pressure over time, and these blood pressure (anti-hypertensive) medications are/were continually raised until the person is on four or five different blood pressure pills at maximal doses. Again, when questioned why, their genetics are blamed and that is the end of it. Or is it?!
What shocked me was that when I took patients off of salt & caloric restriction, and placed them on low carbohydrate high fat diets (and yes, I gave them back their salt), their blood pressure normalized. I noticed that as their fasting insulin levels began to fall, their blood pressure began to return to normal.
What?! Blood pressure rise is caused by insulin?!
Ummm . . . Yes!
I am a prime example. During the first few years of my medical practice and reserve military service, we had routine vitals checkups. I was working out 3-5 days a week with weights and running 3-5 miles 2-3 times a week and restricting my calories to 1500 per day. So, I thought I was in pretty good shape. However, it was not uncommon for for the nurse to raise her eyebrows at my blood pressure readings in the 140-160 systolic and 85-98 range diastolic. “Oh, it’s the lack of sleep last night,” or “it’s the caffeine I had this morning,” would be my excuse. But I was making a lot of excuses, and in light of those excuses, my caloric restriction, exercise and salt restriction, I was also still gaining weight.
By the 5th year of my medical practice, I weighed 60 lbs heavier than I do today and I struggled to keep my blood pressure under 150/95. I was violating my own counsel . . . don’t trust a fat doctor for nutritional advise. (Or, was that advise from Dr.House?)
A much slimmer, healthier and happier Dr. Nally (center) in 2016
After cutting out the carbohydrates (I’ve kept my carbohydrate intake < 20 grams per day), moderating my protein intake and eating all the fat I am hungry for each day, my recent physical examination at the beginning of June 2016 revealed my blood pressure at 112/64. I don’t remember ever having blood pressure that low. And to be honest, I didn’t sleep well the night before my exam due to a number of middle of the night patient calls.
When I first started treating the insulin resistance problem in the human, rather than the blood pressure problem, I began to see immediate reductions in blood pressure within one to two weeks. So much of a reduction that if I didn’t warn the patient that they should begin to back down their blood pressure medications, they would experience symptoms of dizziness, light-headedness, headache and a few patient’s nearly passing out. On a low-carbohydrate, high-fat (ketogenic) diet you need salt (sodium, potassium, & magnesium). The process of burning fat as fuel causes you to lose increased amounts of sodium & potassium, and you have to replace these electrolytes. A number of my patients begin a low-carbohydrate, high-fat diet and are afraid of increasing their salt intake. Not replacing these electrolytes while on a ketogenic diet can also lead to low blood pressure, dehydrate and dizziness.
I often wondered why applying a ketogenic diet had such a profound effect on blood pressure so quickly. Dr. Robert Lustig helped answer that question for me.
In order to understand how the Standard American Diet (we call it the SAD diet in my office) raises your blood pressure, it is important to understand how the body processes the basic sugar molecule. Sugar is one glucose molecule bound to a fructose molecule. This is broken down in the body and 20% of the glucose is metabolized in the liver, the other 80% is sent on to be used as fuel throughout the body. Fructose, however, is where the problems arise. 100% of the fructose is metabolized in the liver, and the by product of fructose metabolism is increasing the liver’s production of MORE glucose and the byproduct of uric acid. Uric acid is produced and this inhibits the production of nitric oxide. The diminished nitric oxide in the presence of an increased level of glucose (stimulating increased insulin production due to eating starches) constricts the blood vessels and raises blood pressure. Yes, that donut you just ate raised your blood pressure for the next 12 hours.
The mechanism that fructose containing carbohydrates, sugars and starches raise blood pressure, cholesterol and cause weight gain can be seen in the really complex diagram found in Dr. Lustig’s 2010 article:
So, how do you lower your blood pressure through diet?
First, cut out all the simple sugars. These include anything with table sugar, high fructose corn syrup and corn syrup. (This is why people with any change in diet see some improvement in weight and blood pressure as they remove the simple sugars like candy, sugared drinks and pastries from their diet.)
Second, limit your overall intake of other sources of carbohydrates including any type of bread, rice, pasta, tortilla, potato, corn and carrots. Realize that carbohydrate in fruit is fructose, and when taken with other forms of glucose can have the same effect as table sugar – it can and will raise your blood pressure, as well as halt or cause weight gain.
Third, if you are taking blood pressure medications for hypertension, see your doctor about close monitoring of your blood pressure as it can and will drop within 2-4 weeks of making these dietary changes.
Maintaining ketosis is really important for weight loss and blood pressure or hypertension control. I am very much an advocate of using real food for this process, but I have also found that the use of exogenous ketone salts aid significantly in maintaining ketosis. I have found that exogenous ketones are the next step in bridging the difficulty of day to day maintenance of ketosis.
It isn’t making the mistakes that’s critical; it’s correcting them and getting on with the task that’s important. If you’ve been calorie restricting and exercising to lower you blood pressure, don’t fret. A simple change in your diet focused on restricting starches and carbohydrates has been demonstrated in my office to be more powerful than many of the blood pressure medications we’ve used for years.
The health podcast legend, Jimmy Moore, and I talk about how much fat is too much. Or, is it? What’s the deal with Zero-carb ketogenic diets? We answer your questions and try to give you the most up-to-date knowlege regarding the ketogenic lifestyle and how it affects your metabolism. We zero in exclusively on all the questions people have about how being in a state of nutritional ketosis and the effects it has on your health.
There are a lot of myths about “keto” floating around out there and we shoot them down one at a time.
You can down-load it for free on iTunesor listen to KetoTalk.com on your computer.
Does your diet really reverse vascular disease? I mean, will the diet you’re following ACTUALLY reverse the plaque burden that has occurred over the years of eating the SAD diet (Standard American Diet)?
It appears that the ketogenic diet does. At least that’s what research is showing, and that’s what I am seeing clinically. Let me give you an example. Reversal of vascular disease is what I saw last week in this patient case study in my office.
Meet “Mrs. Plaque” (name has been changed to protect her identity). She is a very pleasant 78 year old female who has been seeing me as a patient for the last 10 years. We identified worsening cholesterol and hyperinsulinemia in this patient a few years ago, and last year, she finally decided to go on a ketogenic diet after we noted slight worsening blood sugar (HbA1c increased to 6.1%), worsening cholesterol and a recent TIA (transient ischemic attack or “mini stroke”). We identified a 44% blockage in her left internal carotid artery and a 21% blockage in the right internal carotid artery putting her at risk for further cerebral ischemic events like a stroke and/or other vascular events like a possible heart attack down the road. She refused STATIN therapy as she had previous myalgia and side effects with their use in the past.
Past Medical History: Hyperlipidemia, Impaired Fasting Glucose (Pre-Diabetes),.Asthma, GERD, Irritable Bowel, Generalized Anxiety, Idiopathic Peripheral Neuropathy, Surgical Menopause (Hysterectomy) with Secondary Atrophic Vaginitis, Recent TIA, Cataracts, Appendectomy
Medications: Plavix 75mg one daily, Premarin Cream 0.635mg every other day, Xanax 0.5mg at bedtime for anxiety, Lyrica 50mg one nightly for neuropathy, Vitamin D 2000 IU daily , TUMS 750mg twice a day.
Her carotid ultrasound and carotid medial intimal thickness (CIMT) study completed April 1, 2015 is present below. You can see that her intimal thickness is only slightly higher than the average female her age, however, she has notable internal carotid artery blockage in both the right and the left sides.
The “mini stroke” and the report above, convinced her that she needed to tighten up her diet. The patient’s husband was also a diabetic and the patient had been “partially” restricting sugar in her diet up to this point in time, however, she had not fully jumped on the ketogenic band wagon. At this point she decided to change her diet.
She was placed on a ketogenic diet, restricting her carbohydrates to no more than 20 grams per day and increasing total fat to >50-60% of her total calories. Nothing else changed including her medications. She followed this program for the next year and this is the blood work that she had while following this program:
4/2/2015
8/4/2015
11/6/2015
5/12/2016
HbA1c (%)
6.1
5.8
5.2
Tot Chol (mg/dL)
224
156
230
233
HDL (mg/dL)
76
76
87
96
LDL-C (mg/dL)
134
65
128
123
Small Dense LDL-P (nmol/L)
481
150
222
217
Triglycerides (mg/dL)
72
76
74
68
Fasting Insulin (uIU/mL)
12
Glucose (mg/dL)
91
95
92
85
Because she was already partially restricting her sugar intake, her triglycerides and small dense LDL particle number was not bad, however, her average blood sugars were still significantly elevated. Weight decreased from 127 lbs to 119 lbs in August. She admits to slightly increased protein intake over the holidays and her weight increased back up to 125 lbs as of her last visit.
These labs also demonstrate that Total Cholesterol and LDL-C don’t appear to correlate with regression of plaque.
The image below is the patient’s repeat CIMT and carotid ultrasound 13 months later through the same lab. What is dramatic is that she has had over 10% regression in the plaque in both internal carotid arteries and a return of her carotid intimal thickness to the average female in her age bracket.
This case study is consistent with the findings of Dr.Shai and his group when they did a two year comparative dietary intervention study of Low Fat – Group 1, Mediterranean Diet – Group 2, and a Ketogenic Diet – Group 3 on vessel wall volume and CIMT.
Carotid IMT changed by −1.1% from 0.816 mm at baseline to 0.808 mm after 2 years (P=0.18), with no significant difference between diet groups (P=0.91). There was a trend toward significant correlation between the 2-year changes in carotid IMT and VWV (r=0.173, P=0.056).
So, does your diet reverse vascular disease? Evidence is pointing to the fact that the ketogenic diet does. I return to the statement Hippocrates made over 2000 years ago, “Let food be thy medicine, and let medicine be thy food.”
It has long been understood that tumor cells of any kind require high levels of glucose to grow and spread (1,2). It is also recognized that higher levels of insulin, commonly found in patients with insulin resistance or type II diabetes, are 2.4 times more likely to stimulate the development of breast cancer (3). A diet low in glucose has thereby been theorized to be an adjunct to cancer treatment.
Ketogenic diets have been demonstrated to be therapeutically useful in the treatments of epilepsy and cardiovascular disease (4). A ketogenic diet is one in which carbohydrate levels are kept below 50 grams per day and fat intake is increased to the point that the body shifts its metabolism to use triglycerides, and the ketones derived from triglycerides, as the primary fuel source for the majority of the cells within the body. With this understanding in mind, the application of a ketogenic diet, one high in fat and protein with limited carbohydrate or glucose has been suggested as a adjunct to cancer treatments (5).
KetoOS – Drinkable Exogenous Ketones
A recent study (6) in the Oncology Letters evaluated the benefits of a ketogenic diet in 78 cancer patients in clinical practice. A novel marker measuring the tumor cells use of glucose called transketolase-like-1 (TKTL1) was closely monitored, as was each of the 78 patients adherence to a ketogenic diet. Increased TKTL1 was noted in more aggressively active and growing tumors (7,8).
Among the 43 males and 35 females, 7 patients agree to and followed a fully ketogenic diet and 6 of them followed a partially ketogenic diet. Ketogenic meals were provided by a German company called Tavarlin that would prepare and mail ketogenic meals including oil, fat, snacks, bread, protein and energy drinks. Dietary journals were reviewed every three months over a period of about 10 months.
40 % of these patients experienced a halting of the tumor progression and 60% experienced improvement noted by normalization of TKTL1 or reduction in TKTL1, respectively. Those on a ketogenic diet demonstrated an average reduction of TKTL1 by approximately 50%.
This is the first study of its kind and has significant potential. Could dietary carbohydrate restriction be an effective cancer treatment or adjunct to cancer treatment?
Because the food diaries were based on reporting only, the sample study was very small, and patients treated in the outpatient setting have the possibility of variability in the standard oncologic treatments, the results must be interpreted with caution. However, the data is very promising. This study is one in which I have great interest as I have seen similar results in my clinic on a case by case basis.
Based on the limitations noted above, rigorous randomized control studies are needed, but this is an exciting an promising first step. Additionally, the presence of a marker for tumor growth that correlates with diet is remarkable. And, it provides the ketogenic specialist a possible measurement tool that could be used clinically.
References:
Klement RJ and Kämmerer U: Is there a role for carbohydrate restriction in the treatment and prevention of cancer? Nutr Metab (Lond) 8: 75, 2011
Vaughn AE and Deshmukh M: Glucose metabolism inhibits apoptosis in neurons and cancer cells by redox inactivation of cytochrome c. Nat Cell Biol 10: 1477-1483, 2008.
Gunter MJ, Hoover DR, Yu H, Wassertheil-Smoller S, Rohan TE, Manson JE, Li J, Ho GY, Xue X, Anderson GL, et al: Insulin, insulin-like growth factor-I, and risk of breast cancer in postmenopausal women. J Natl Cancer Inst 101: 48-60, 2009.
Paoli A, Rubini A, Volek JS and GrimaldiKA: Beyond weight loss: A review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr 67: 789-796, 2013.
Ruskin DN and Masino SA: The nervous system and metabolic dysregulation: Emerging evidence converges on ketogenic diet therapy. Front Neurosci 6: 33, 2012.
Jansen, N., Walach, H.”The development of tumours under a ketogenic diet in association with the novel tumour marker TKTL1: A case series in general practice”. Oncology Letters 11.1 (2016): 584-592.
. Schwaab J, Horisberger K, Ströbel P, Bohn B, Gencer D, Kähler G, Kienle P, Post S, Wenz F, Hofmann WK, et al: Expression of Transketolase like gene 1 (TKTL1) predicts disease-free survival in patients with locally advanced rectal cancer receiving neoadjuvant chemoradiotherapy. BMC Cancer 11: 363, 2011.
Zhang S, Yang JH, Guo CK and Cai PC: Gene silencing of TKTL1 by RNAi inhibits cell proliferation in human hepatoma cells. Cancer Lett 253: 108-114, 2007
Good morning from Arizona. I’ve had a few people ask about how gut health relates to a ketogenic diet. This is a great question and one that I think can be answered best by taking a closer look at my natural koi pond and learning a little about pond scum.
So, sit back and look at the similaries between your gut and how nature balances a pond system: Katch.me
Or you can watch the video below:
The four tenets of health that we touch on above that are essential to understand before you can understand gut health:
The body is a unit and works as such with all parts enhancing the whole
The body is capable of self-regulation, self-healing, and health-maintenance
Structure & function are reciprocally interrelated
Rational treatment of the body must be based upon understanding the principles above and assisting or augmenting those principles
Keys to gut health and pond balancing that we touch on:
Remove the toxins from entering the system like:
Antibiotic overuse
Caffeine
Artificial Fat
Artificial Sweeteners
Repair the system and it’s ability to balance the system
Takes time
Provide structure for the bacteria to which it can bind
Provide essential vitamins and minerals like KetoEnhance & Omega-3 fatty acids
Periodic Fasting
Restore the bacteria or flora of the system
Prebiotics (fermented foods like sauerkraut, kimchi, Japanese natto, etc.)
Probiotics like Dietary KetoBalance (can be purchased in the office)
Replace the salts and pH balance where necessary
Replace electrolytes
Limit things that shift the pH balance
Hope this gives you a starting point for your New Year!!
Our intelligent and beautiful physician assistant, Jenna Lightfoot, PA-C, is in the running for a co-host position with Jimmy Moore on LowCarbConversations.com you can hear her on today’s podcast with Jimmy Moore and cast your vote here: Round 2 Co-host Contest.
How do you know if you're insulin resistant? What questions need to be asked? What should your numbers be? And, many other great ketosis questions. Also, why does Dr. Nally look like he has dirt on his chin? See it here . . .
This evening we covered the 5 myths of weight loss identified through the National Weight Control Registry’s research findings. What causes “wrinkle face” for Dr. Nally? We also talked about & answered 20 minutes of rapid fire questions ranging from the amount of protein you need daily to the likelihood a human could be a bomb calorimeter . . . exciting stuff!!
You can watch the video stream below. Or you can Katch the replay with the rapid stream of exciting comments here at Katch.me/docmuscles.
What laboratory testing is necessary when you start your weight loss journey on a Ketogenic, Low-Carbohydrate, Paleolithic or any other dietary changes? Why do you need them and what are you looking for? We discuss these questions and others on today’s PeriScope. Lots of questions from around the world to day . . . this one lasted a bit longer than normal . . . 45 minutes to be specific. But it’s a good one because of all of your fantastic questions! You really don’t want to miss this one.
You can see the video below or watch the video combined with the rolling comments here on Katch.me/docmuscles.
A list of the labs that we discussed are listed below:
Fasting insulin with 100 gram 2 or 3 hour glucose tolerance test with insulin assay every hour
CMP
CBC
HbA1c
Leptin
Adiponectin
C-Peptid
NMR Liprofile or Cardio IQ test
Lipid Panel
Urinalysis
Microalbumin
Apo B
C-reactive protein
TSH
Thyroid panel
Thyroid antibodies
AM Cortisol
This list will at least get one started, provide the screening necessary to identify insulin resistance (Diabetes In-Situ), Impaired fasting glucose, diabetes and allow for screening for a number of the less common causes of obesity.
I would highly recommend that you get these through your physician’s office so that appropriate follow up can be completed. These labs will need to be interpreted by your physician, someone who understands and is familiar with various causes of obesity.
I just completed my reading of Dr. Joseph Kraft’s Diabetes Epidemic & You. This text originally printed in 2008 and was re-published in 2011. I am not really sure why I have never seen this book until now, but I could not put it down. I know, I am a real life medical geek. But seriously, you should only read this book if you are concerned about your health in the future. Otherwise, don’t read it.
For the first time in 15 years, someone has published and validated what I have been seeing clinically in my office throughout my career. Dr. Kraft is a pathologist that began measuring both glucose and insulin levels through a three hour glucose tolerance blood test at the University of Illinois, St. Joseph Hospital in Chicago. This test consists of checking blood sugar and insulin in a fasted state, and then drinking a 100 gram glucose load followed by checking blood sugar and insulin at the 30, 60, 120 and 180 minute marks (a total of three hours).
Dr. Kraft completed and recorded this test over a period of almost 30 years on 14,384 patients between 1972 and 1998. His findings are landmark and both confirm and clarify the results that I have seen and suspected for years.
I am convinced that our problem with treating obesity, diabetes and the diseases of civilization has been that we defined diabetes as a “disease” based on a lab value and a threshold instead of identifying the underlying disease process. We have been treating the symptoms of the late stage of a disease that started 15 to 20 years before it is ever actually diagnosed. Diabetes is defined as two fasting BS >126, any random blood sugar >200, or a HbA1c >6.5%. (Interestingly this “disease” has been a moving target. When I graduated from medical school it was two fasting blood sugars >140 and the test called hemoglobin A1c (HbA1c) that we use today for diagnosis didn’t even exist). The semantics associated with this problem is that many of us recognize that the disease is not actually diabetes. The disease is (as far as we understand it today) insulin resistance or hyperinsulinemia. This is where Dr. Kraft’s data is so useful. Diabetes, as it is defined above, is really the fourth stage of insulin resistance progression over a 15-20 year period and Dr. Kraft’s data presents enormous and very clear evidence to that effect.
When I first entered private practice 15 years ago, I noticed a correlation and a very scary trend that patients would present with symptoms including elevated triglycerides, elevated fasting blood sugar, neuropathy, microalbuminuria, gout, kidney stones, polycystic ovarian disease, coronary artery disease and hypertension that were frequently associated with diabetes 5-15 years before I ever made the diagnosis of diabetes mellitus. I began doing 2 hour glucose tolerance tests with insulin levels and was shocked to find that 80-85% of those people were actually diabetic or very near diabetic in their numbers. The problem with a 2 hour glucose tolerance test, is that if you are diabetic or pre-diabetic, you feel miserable due to the very profound insulin spike that occurs. A few patients actually got quite upset with me for ordering the test, both because of how they felt after the test, and the fact that I was the only physician in town ordering it. So, in an attempt to find an easier way, I found that the use of fasting insulin > 5 nU/dl, triglycerides > 100 mg/dl and small dense LDL particle number > 500 correlated quite closely clinically with those patients that had positive glucose tolerance tests in my office. There is absolutely no data in the literature about the use of this triangulation, but I found it to be consistent clinically.
I was ecstatic to see that Dr. Kraft plowed through 30 years and over 14,000 patients with an unpleasant glucose tolerance test and provided the data that many of us have had to clinically triangulate. (I’m a conservative straight white male, but if Dr. Kraft would have been sitting next to me when I finished the book this afternoon, I was so excited that I probably would have kissed him.)
Insulin resistance or hyperinsulinemia (the over production of insulin between 2-10 times the normal amount after eating carbohydrates) is defined as a “syndrome” not a disease. What Dr. Kraft points out so clearly is that huge spikes in insulin occur at 1-2 hours after ingestion of carbohydrates 15-20 years prior to blood sugar levels falling into the “diabetic range.” He also demonstrates, consistently, the pattern that occurs in the normal non-insulin resistant patient and in each stage of insulin resistance progression.
The information extrapolated from Dr. Kraft’s research give the following stages:
Stages of insulin resistance by 3 hr OGTT extrapolated from “Diabetes Epidemic & You”
From the table above, you can see that the current definition of diabetes is actually the fourth and most prolifically damaging stage of diabetes. From the data gathered in Dr. Kraft’s population, it is apparent that hyperinsulinemia (insulin resistance) is really the underlying disease and that diabetes mellitus type II should be based upon an insulin assay instead of an arbitrary blood sugar number. This would allow us to catch and treat diabetes 10-15 years prior to it’s becoming a problem. In looking at the percentages of these 14,384 patient, Dr. Kraft’s data also implies that 50-85% of people in the US are hyperinsuliemic, or have diabetes mellitus “in-situ” (1). This means that up to 85% of the population in the U.S. is in the early stages of diabetes and is the reason 2050 projections state that 1 in 3 Americans will be diabetic by 2050 (2).
Insulin resistance is a genetically inherited syndrome, and as demonstrated by the data above has a pattern to its progression. It is my professional opinion that this “syndrome” was, and actually is, the protective genetic mechanism that protected groups of people and kept them alive during famine or harsh winter when no other method of food preservation was available. It is most likely what kept the Pima Indians of Arizona, and other similar groups, alive while living for hundreds of years in the arid desert. This syndrome didn’t become an issue among these populations until we introduced them to Bisquick and Beer.
The very fascinating and notably exciting aspect of this whole issue is that insulin resistance is made worse by diet and it is completely treatable with diet. This is where the low carbohydrate diet, and even more effective ketogenic diet or lifestyle becomes the powerful tool available. Simple carbohydrate restriction reverses the insulin spiking and response. In fact, I witness clinical improvement in the insulin resistance in patients in my office over 18-24 months every day. You can get a copy of my Ketogenic Diet here in addition to video based low carbohydrate dietary instruction.
Until we are all on the same page and acknowledge that diabetes is really the fourth stage of progression on the insulin resistance slippery slope, confusion and arguments about treatment approaches will continue to be ineffective in reducing the diseases of civilization.
This evening on PeriScope, we talked about the 10 things you can do to stay motivated on your low-carb lifestyle. A number of great questions were asked including:
How much carbohydrate should be restricted?
What labs should you be monitoring regularly?
What’s a normal blood sugar?
Why is Dr. Nally freezing in Denver?
Is fermented food good for you?
Why should you eat pickles and kimchi even when you’re not pregnant?
And, much much more . . . It’s like a college ketogenic course on overdrive . . . for FREE!!!
You can see the PeriScope with the comments rolling in real-time here: katch.me/docmuscles
Join me as we chew the phat of ketogenic lifestyles PeriScope style and answer many questions like, “Why do I get ‘hangry’?” What causes hypoglycemia? How many times a day should I eat? and many more . . .
We talk briefly about why 60% of people with insulin resistance may need methylated folic acid to help with B vitamin absorption/use and where it can be found. (See me recent article about this called The Power of a Good Vitamin.)
You can see the whole PeriScope conversation on Katch.me/docmuscles with the comments scrolling or you can see the video stream below:
A patient just sent this picture to me this evening. I got a good laugh out of it.
It brought up a couple of principles. So, Seriously, take just a moment and admire this pile of bacon. . .
First, it’s important that we take a moment and think about what is important in life. What really makes you tick? To those of us following a ketogenic lifestyle (low carb, moderate protein & high fat living), this represents food, fuel, taste and a great conversation tool. This pile of bacon forces one to think about what is really important in ones life.
This pile of bacon represents 2-3 weeks of breakfasts.
It represents wonderful flavor for a salad.
It becomes something wonderful to dip in guacamole.
Second, how much of this bacon can one following a ketogenic lifestyle have at a meal? That depends upon your need of protein. We base our basic protein need on a persons calculated ideal body weight. (No, your ideal body weight is not the weight you’re supposed to reach! It is a calculation based on height that gives us a starting point fro protein needs).
Many people have asked me how to calculate ideal body weight this week. I’ve provided the calculation below:
Ideal Body Weight (IBW) – Estimated in (kg) Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet.
Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet.
The average female needs 1.0 g of protein per kg of ideal body weight per day.
The average male needs 1.2 g protein per kg of ideal body weight per day.
If you are exercising more than 60 minutes 5 days per week then those values increase to 1.4 grams per kg for females and 1.6 grams per kg for males.
Example:
A 6 foot male’s IBW would be 50 kg + (2.3kg x 12 inches) = 77.6 kg
A 5 foot 4 inch females IBW would be 45.5 kg + (2.3kg x 4 inches) = 54.7 kg.
If you eat three times per day, then simply divide your IBW by 3 to get the maximum protein you need per meal.
Yes, your fruit makes you fat just like your beer gives you a beer belly. . .
It is fascinating how similarly fructose (the sugar in fruit) and alcohol are processed through the liver. Both of them increase insulin and both increase triglyceride production as a byproduct of their metabolism. This is clearly pointed out in Robert Lustig’s paper published in the Journal of the American Dietetic Association in 2010.
The metabolic pathways are very clearly outlined below:
You can Katch my PeriScope conversation about this below or with the comments and hearts included at Katch.me/docmuscles.
raise insulin levels without raising blood sugar and are not appropriate for use with a true low-carbohydrate/ketogenic diet. You can see and print the article I published clarifying which sweeteners you can use and which ones to avoid here:
the underlying cause. I see this problem in a very large majority of the people in my office and I am seeing people younger and younger show up with continually increasing blood pressure.
begin to back down their blood pressure medications, they would experience symptoms of dizziness, light-headedness, headache and a few patient’s nearly passing out. On a low-carbohydrate, high-fat (ketogenic) diet you need salt (sodium, potassium, & magnesium).
