Diseases seem to arrive in three’s each day in my office. Today I had three different patients with cholesterol concerns who were notably confused about what actually makes the cholesterol worse, and what causes weight gain. Each of them, like many patients that I see, were stuck in a state of confusion between low fat and low carbohydrate lifestyle change. My hope is to give my patients and anyone reading this blog a little more clarity regarding what cholesterol is, how it is influenced and how it affect our individual health.
First, the standard cholesterol profile does not give us a true picture of what is occurring at a cellular level. The standard cholesterol panel includes: total cholesterol (all the forms of cholesterol), HDL (the good stuff), LDL-C (the “bad” stuff) and triglycerides. It is important to recognize that the “-C” in these measurements stands for “a calculation” usually completed by the lab, and not an actual measurement. Total cholesterol, HDL-C and triglycerides are usually measured and LDL-C is calculated using the Friedewald equation [LDL = total cholesterol – HDL – (triglycerides/5)]. (No, there won’t be a quiz on this at the end . . . so relax.)
However, an ever increasing body evidence reveals that the concentration and size of the LDL particles correlates much more powerfully to the degree of atherosclerosis progression (arterial blockage) than the calculated LDL concentration or weight (1, 2, 3).
There are three sub-types of LDL that we each need to be aware of: Large “fluffy” LDL particles (type I), medium LDL particles (type II & III), and small dense LDL particles (type IV).
Weight & Size of VLDL, LDL & HDL
Why LDL-C is misleading: Identical LDL-C of 130 mg/dL can have a low risk (Pattern A) with a few “big fluffy LDL particles or high risk (Pattern B) with many small dense LDL particles.
Second, it is important to realize that HDL and LDL types are actually transport molecules for triglyceride – they are essentially buses for the triglycerides (the passengers). HDL can be simplistically thought of as taking triglycerides to the fat cells and LDL can be thought of as taking triglycerides from the fat cells to the muscles and other organs for use as fuel.
Third, it is the small dense LDL particles that are more easily oxidized and because of their size, are more likely to cause damage to the lining of the blood vessel leading to damage and blockage. The large boyant LDL (“big fluffy LDL particles”) contain more Vitamin E and are much less susceptible to oxidation and vascular wall damage.
Eating more fat or cholesterol DOES NOT raise small dense LDL particle number. Eating eggs, bacon and cheese does not raise your cholesterol! What increases small dense LDL particles then? It is the presence of higher levels of insulin. Insulin is increased because of carbohydrate (sugars, starches or fruits) ingestion. It is the bread or the oatmeal you eat with the bacon that is the culprit. The bread or starch stimulates and insulin response. Insulin stimulates the production of triglycerides and “calls out more small buses” to transport the increased triglyceride to the fat cells (4, 5, 6, 7).
Fourth, following a very low carbohydrate diet or ketogenic diet has been demonstrated to decreased small dense LDL particle number and correlates with a regression in vascular blockage (8, 9). So, what does this really mean to you and me? It means that the low-fat diet dogma that that has been touted from the rooftops and plastered across the cover of every magazine and health journal for the last 50 years is wrong. . . absolutely wrong.
I talk about this and answers questions on today’s Periscope. You can see the recording on Katch.me with the comments in real time here:
Superko HR, Gadesam RR. Is it LDL particle size or number that correlates with risk for cardiovascular disease? Curr Atheroscler Rep. 2008 Oct;10(5):377-85. PMID: 18706278
Rizzo M, Berneis K. Low-density lipoprotein size and cardiovascular risk assessment. QJM. 2006 Jan;99(1):1-14. PMID: 16371404
Rizzo M, Berneis K, Corrado E, Novo S. The significance of low-density-lipoproteins size in vascular diseases. Int Angiol. 2006 Mar;25(1):4-9. PMID:16520717
Howard BV, Wylie-Rosett J. Sugar and cardiovascular disease: A statement for healthcare professionals from the Committee on Nutrition of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation. 2002 Jul 23;106(4):523-7. PMID: 12135957
Elkeles RS. Blood glucose and coronary heart disease. European Heart Journal (2000) 21, 1735–1737 doi:10.1053/euhj.2000.2331
Stanhope KL, Bremer AA, Medici V, et al. Consumption of Fructose and High Fructose Corn Syrup Increase Postprandial Triglycerides, LDL-Cholesterol, and Apolipoprotein-B in Young Men and Women. The Journal of Clinical Endocrinology and Metabolism. 2011;96(10):E1596-E1605.
Shai I et al. Cirulation. 2010; 121:1200-1208
Krauss RM, et al. Prevalence of LDL subclass pattern B as a function of dietary carbohydrate content for each experimental diet before and after weight loss and stabilization with the diets. American Journal of Clinical Nutrition. 2006; 83:1025-1031
Gentile M, Panico S, et al., Clinica Chimica Acta, 2013, Association between small dense LDL and early atherosclerosis in a sample of menopausal women, Department of Clinical Medicine and Surgery, University “Federico II” Medical School, Naples, Italy Division of Cardiology, Moscati Hospital, Aversa, Italy A. Cardarelli Hospital, Naples, Italy
I have been using PeriScope as a fun method of staying in touch with each of you, my fantastic patients, and people all over the world. If you’re interested in seeing me live, you can down-load the PeriScope app onto your iPhone, iPad or Android phone through the App Store.
You can see this mornings PeriScope (with the rolling comments and hearts on the screen) with Dr Nally here on Katch.me/docmuscles. Katch is a great site that holds a record of all my recent PeriScopes.
Or you can watch the video stream (without comment stream) below:
If you have a question you’d like me to address on PeriScope, please let me know.
I found these charts to be very helpful when trying to calculate your fat intake with a meal. Fish can be challenging in calculating fat content. After reading these charts, I’m craving some sashimi’ed mackerel and salmon.
I’ve personally been following and prescribing ketogenic diets to my patients since 2005. When I started on my ketogenic journey, it was called a “Low Carbohydrate Diet.” Over the last 5-10 years, we’ve learned a thing or two about how the body processes carbohydrate, protein and fat. Specifically, it’s not just the restriction of the carbohydrates that leads to metabolic health, but appropriate protein intake and significant emphasis on the level and type of fat intake as well. The majority of people who cut out carbohydrates will initially see successful weight loss, but to maintain that weight loss and see significant metabolic changes that reverse the diseases of civilization, an understanding of protein and fat needs are essential.
It’s Not Necessarily a High Protein Diet
Most people, when they hear you’re following a “Low-Carb” diet . . . respond with, “Oh, you are on that high protein, Adkins’ thing, . . . right?!”
Well, not really. A true ketogenic diet is NOT a “high protein diet.” However, you must be ingesting enough protein to maintain muscle, hair growth and energy levels. Most people, having been brainwashed in grade school and middle school about the horrors of fat in the diet, assume that if you’re not eating carbohydrates, then you must be eating extra protein to stay satiated. (No one would ever intentionally increase the fat in their diet, right?!!) However, remember that protein and fat usually come together in the sources that the Good Lord put them in.
That’s the impression that most people in my office get when I mention the words “Low-Carb” or “Adkins.” And, before I have a chance to explain that I’m not recommending that you race home to eat three large turkey legs and a pound of turkey bacon, the vegetarians gather their things to leave and the former home economics teachers begin to get chest pain at the mental picture in their heads.
How Are Ketones Made?
A ketogenic diet is one which allows your body to use ketones as it’s primary fuel source. Ketones are produced from the breakdown of triglyceride and free fatty acids. Ketones are essentially produced by two distinctly different events:
1) Starvation caused by prolonged periods without food (which is essentially what happens to type I diabetics when they have no insulin at all in their systems)
2) When fat is ingested as the primary fuel, and very low levels of insulin are concurrently produced, primarily when the diet has minimal to no carbohydrate present (allowing the body to activate its free fatty acid reserves found within in the adipose cells).
The body is an amazing machine. It was designed to take any of the three main macro-nutrients (carbohydrate, protein or fat) as fuel and function quite well. It’s like a futuristic car that can run on unleaded gasoline, oil, or diesel fuel. It is able to recognize which fuel is present and run quite well off of any of the three. The amazing thing about the body is that we mix up all three fuel types and just pour them into the tank. Impressively, the body can separate them out and run very well in the short term on any combination of mixes. We don’t have cars or trucks that do that today . . . maybe in the future . . .?
We have Two Fuel Systems
I like to equate carbohydrates to unleaded fuel. These are clean burning, easy to access and cheap. However, the body requires the production of insulin to use this “unleaded” type of fuel. When carbohydrates are identified to be present in the liver and pancreas, insulin is released so that the rest of the cells throughout the body can “open the tank” and let the carbohydrate into the cell to be used as fuel. The challenge is that carbohydrates don’t store very well in the form they are supplied in, so, as a protective mechanism against starvation and famine, if excess carbohydrate is found in the system, it is converted into triglyceride. Insulin is required for this. Interestingly, when your insulin levels rise, the signal to the body is that “unleaded fuel” is in the system, so it stores any fats and excess carbohydrates in the form of free fatty acid and triglyceride. Carbohydrate stimulate an insulin response and cause fat storage. It is the same reason we give corn to cattle — to plump them up before taking them to market.
Fat then is the “diesel fuel” of macro-nutrients. It burns well, can be stored very easily, and provides over twice the energy to the body when measured in the form of k-cal per gram. Fat is used preferentially when there is limited or no insulin floating around the blood stream and is quickly and efficiency stored when other forms of fuel are available. (Insulin being the key hormone signaling that other fuel is around.)
Nutritional Ketosis is Using Fat as Your Optimum Fuel
So what is this “ketosis thing?” It is a method of dietary change (a lifestyle) that intentionally focuses the body’s metabolism to use fat (in the form of triglyceride & free fatty acid) as its primary fuel. Leading to weight loss, dramatically improved blood sugars, significantly improved cholesterol and triglyceride levels, and notably improved inflammatory markers.
“But don’t you end up eating a lot more protein on your weight loss program?” I frequently get asked.
Honestly, No.
Protein and fat are both very filling, and most people find that limiting the carbohydrates actually causes less hunger and diminishes the rebound carbohydrate cravings often stimulated by the two or three slices of bread, pasta or that potato often occurring 2-3 hours later. Interestingly, most people don’t eat that much more and the protein levels remain fairly constant. Because fat and protein come together in meats, eggs, fish, etc., satiation occurs with just minor increases in dietary intake real animal food. I don’t recommend increase the fat alone. I recommend increasing the amount of real animal protein until you are full. This is even more satiating and many people find themselves eating only twice a day when they are hungry.
Excessive protein in those who are morbidly obese with severe overproduction of insulin can experience a spike the insulin levels further with large amounts of protein. Protein can be equated to the oil you put in your car. Protein is a building block used for muscle, connective tissue and some essential metabolic functions. When too much protein, in this group is ingested, it spikes the insulin. (See my article on Why Your Chicken Salad is Making you Fat)
Most people have problems when they start supplementing with protein shakes. These often contain sweeteners that raise insulin and consequently halts your weight loss – or even causing weight gain.
I recently read a blog post decrying anyone that would recommend a low carbohydrate / ketogenic diet to their patients.
What?!
In fact, this particular blog outlined a number of “adverse reactions” to a ketogenic diet, and based upon these perceived reactions, the writer advised severe caution with its use in just about anyone. It is important to note at the outset that most of the data this blogger quotes are from older studies completed in children for the treatment of epilepsy with specific liquid ketogenic dietary meal replacements. (Not what you’d expect in a low-carb / ketogenic diet for the average obese adult today.)
Diet Confusion
Thanks to recent misinformation by a number of medical professionals, including the person writing the blog referenced above, a poor understanding of fatty acid metabolism by the general community, and a distinct lack of understanding of human adaptability recorded over the last 5,000-6,000 years, there is still significant confusion about ketogenic diets.
It is important to recognize the crucial fact that the human body is designed to function quite well when supplied any of three macronutrients: carbohydrates, proteins or fats. It does so through an amazing series of enzymatic reactions referred to as the Krebs (tricarboxylic acid) cycle, producing needed ATP (adenosine triphosphate) required for our muscles to contract, our heart to beat and our diaphragm to expand our lungs. What’s even more amazing that that the body was designed to recognize the season we are in based up on the food we eat. That is, until we invented refrigerators in 1913. (Now our bodies think it’s year round summer time . . . wait . . . I live in Arizona where it is year round summer time.)
No, this is not a post about unplugging your refrigerator, living on solar, getting off the grid and saving energy.
Our bodies recognize the seasons we are in based upon inherent hormone release. The key hormone is insulin. Insulin can be looked at as the seasonal indicator to our bodies. Insulin production rises and falls based on our intake of carbohydrates (sugar, starches, some fibers). Insulin, essentially, tells our bodies when it is a “time of plenty” and when it was a “time of famine.” Why? You ask. We didn’t have refrigerators 100 years ago and you were lucky if you had a root cellar. The body needs to know when to store for the famine (the winter) that was around the corner. Insulin is that signal.
During the summer, potatoes, carrots, corn and other fruits are readily available. These are all starchy carbohydrates and they all require the body to stimulate an insulin response so that they can be absorbed. Insulin stimulates fat storage (J Clin Invest. 2000;106(4):473-481. doi:10.1172/JCI10842). Just like bears, our bodies were designed to store for the winter.
If you think back in history, your grandparents probably used stored meats & cheeses that could be salted or smoked for preserving during this time of year. Those crossing the plains were commonly found with pemmican, a concentration of fat and protein used as a portable nutrition source in the absence of other food. (Chapter VIII. Narrative of the Life of David Crockett, of The State of Tennessee, Written by Himself, Sixth Edition [E.L. Carey and A. Hart:Philadelphia] 1834, 1837; Marcy, The Prairie Traveler, p. 31.) Think about conversations you may have had with your grandmother when she told you that for Christmas, she received an orange. A single orange for a gift?! Many of my patients drink 12-15 of them in a glass every morning. The winter diets of our grandparents were very low in starches and carbohydrates. When carbohydrate intake is low, little insulin is produced.
Again, insulin is the hormone that tells you that you’re in “a time of plenty” and stimulates weight gain and cholesterol production to prepare for winter. Those prescribing the use of ketogenic diets understand this innate human adaptive trait, and use it to effect changes in weight, cholesterol and other desired metabolic changes.
Three types of ketones. Uptodate.com, May 2015
Now, let’s define the difference between ketosis and keto-acidosis and try to clarify the misinformation that is being spread around the blogosphere.
A ketone is a molecule the body produces from the breakdown of fat and some proteins (amino acids). There are specifically three types of ketones: beta-hydroxybutyric acid, acetoacetic acid and acetone. If ketosis was “bad,” then why would our bodies produce these molecules? They are not bad, and in fact, multiple studies show that the body is often more efficient and effective when it functions on ketones rather than glucose as its primary fuel source. The body can only supply a limited amount of sugar or glucose for fuel. If you talk to runners, marathoners or triathletes, they will tell you that after about 45-90 minutes of continuous endurance exercise the glucose supply runs out and they will experience what is termed a “bonk” (have a low-blood sugar or hypoglycemic episode). Unfortunately, our bodies can only store about 18-24 hours of glucose.
Metobolic Changes of Ketogenic Diet (American Journal of Physiology – Endocrinology and Metabolism Published 1 June 2007 Vol. 292 no. 6, E1724-E1739 DOI: 10.1152/ajpendo.00717.2006)
However, the body can store days upon days of fat in the form of triglyceride in the fat cells. Triglyceride is broken down into ketones. If glucose is the “unleaded” fuel, you can think of ketones as the “diesel fuel” that is easier to store and runs longer.
The average body functioning on ketones as the primary fuel will have a ketone level measured in the blood somewhere between 0.4 and 4 mmol/L. Because of a balance that is created by the use of ketones and a feedback mechanism that kicks in when the ketone level rises, the body will maintain a pH of around 7.4.
Ketoacidosis is dramatically different. If you are a type I diabetic, you don’t produce any insulin. The feedback mechanism regulating ketone use is broken and the ketone levels and triglyceride breakdown speeds up because the body can’t access glucose and can’t produce insulin. The ketone levels spike and the level can rise to > 25 mmol/L. In the presence of a high blood sugar and high ketone level, the acid level in the blood shifts to a pH of less than 7.3. This is referred to as metabolic acidosis and can be life threatening as the low pH shuts down the bodies’ enzymatic processes and a person becomes critically ill and without treatment, can die. (Kitabchi AE et al., Clinical features and diagnosis of diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults. www.uptodate.com, May 2015.)
If you’re not a type I diabetic, you have nothing to worry about. Regardless of what the “ketogenic nay-sayers” blog about, your liver makes approximately 240g of glucose per day, this stimulates a basal release of insulin which keeps the pH in check. It’s also what keeps weight loss at a consistent pace of around 2-10 lbs per month.
If you are a type I diabetic, don’t fret. Carbohydrate restriction can still be used very effectively. It just takes some balancing and understanding of your individual metabolism. Talk to your physician and/or medical bariatrician about how to follow a carbohydrate restricted diet while using insulin.
What about all the other “adverse effects” the blogosphere and other so-called experts claim about ketogenic diets?
Let’s take them on one by one. Are you ready?
Gastrointestinal (GI) disturbances – Yes. Any time you change your diet you may experience diarrhea, constipation or gassiness. Most of the time, this is because you are either 1) not eating enough leafy greens (fiber) or 2) you’re using a supplement that contains an artificial sweetener. Most of the studies on ketogenic diets did not incorporate fiber and the studies used to make this point were on children who used a ketogenic fat supplement shake or liquid preparations containing these artificial sweeteners to make them palatable. If you have spoken to any bariatrician, they will tell you, the best way to follow a ketogenic diet is to eat real food. If you want to read about the anecdotal GI effects of sweeteners, read the comment section in Amazon about the Haribo Sugar Free Gummy Bears.
Inflammation Risk – In every patient that I have placed on a ketogenic diet in the last 8 years, all inflammatory markers including CRP, Sedimentation Rate and Uric Acid have all decreased. Inflammation gets better on an appropriately formulated ketogenic diet. The older studies of ketogenic diets in children contain most of their fat from Omega-6 fatty acids from vegetable oil which will increase inflammation and oxidative stress, spike the cortisol levels and have the secondary effect of actually raising the triglycerides. (Simopoulos AP,The importance of the ratio of omega-6/omega-3 essential fatty acids, Biomed Pharmacother., 2002 Oct;56(8):365-79.)
Muscle Cramps/Weakness – The process of weight loss occurs by burning fat into CO2 and water. We breathe the CO2 out, but the water produced has to follow salts out through the kidneys. Hence, we lose salts. This can cause weakness and muscle cramps. The solution? Stop restricting salt on a low carbohydrate diet. We are the only mammal that restricts salt and we do it because low-fat diets cause us to retain water. Low carbohydrate diets do the opposite. Use sea salt or sip beef or chicken bouillon broth with your dinner. The use of yellow mustard also helps (the small amount of quinine in yellow mustard stops the cramping). If you have congestive heart failure, talk to your doctor about monitoring your salt intake in balance with your diuretic or water pill.
Hypoglycemia – If you read the ketogenic diet research, most of it was done on epileptic children. The diets called for a period of starvation, then the use of a ketogenic liquid based on the John’s Hopkin’s protocol. It is a well-known fact in medicine that starvation in children can frequently cause hypoglycemia, especially in children with other genetic or congenital defects leading to forms of epilepsy. In clinical practice, with ketogenic diet use in adults, hypoglycemia is rare.
Low Platelet Count (Thrombocytopenia) – Again, this was seen in the epileptic children who were placed into starvation first, then introduced a liquid fat replacement shake to stop intractable seizures. These liquids or shakes were often nutrient deficient in other essentials. Folic acid, B12 and copper deficiency can occur when not eating “real food.” Low platelet counts are rarely seen on ketogenic diets based around “real food.” Many children in the ketogenic studies had been on or were concomitantly on valproic acid for their seizures. Valproic acid is commonly known to cause thrombocytopenia (Barry-Kravis E et al, Bruising and the ketogenic diet: evidence for diet-induced changes in platelet function. Ann Neurol. 2001 Jan;49(1):98-103.; Kraut E, Easy Bruising, http://www.uptodate.com, May 2015.)
Easy Bruising – This is usually due to inadequate protein supplementation as was the case in much of the ketogenic literature where protein levels were also restricted. (Kraut E, Easy Bruising, http://www.uptodate.com, May 2015.)
Pancreatitis – Patients who are insulin resistant or have impaired fasting glucose commonly have high triglycerides. Elevation in triglycerides itself is a cause of pancreatitis. Ketogenic diets lower the triglycerides. However, if a patient has not been following their diet as directed, spikes in the triglycerides can occur placing the person at risk for pancreatitis.
Long QT Intervals/Heart Arrhythmias – The list of things causing Long QT intervals and abnormal heart rhythms is long and variable (Acquired Long QT Syndrome. Berul C et al. www.uptodate.com, May 2015). It is well know that starvation, rapid weight loss and liquid protein diets can cause a delay in the conduction signal in the heart. Anyone wishing to start any diet should have an electrocardiogram (EKG) through their doctor to ensure that the diet (of any type) doesn’t exacerbate a prolonged QT interval.
Three year weight loss and metabolic improvement in a patient on a Low-Carb / Ketogenic diet. Note: Patient admits to not following ketogenic diet during holidays from Nov 2013 – Feb 2014 (see the dramatic changes to the body when cheating happens)
Cardiomyopathy – Prolonged QT intervals have been associated with cardiomyopathy and the former can stimulate the later. Any diet that has the potential to prolong a QT interval has the potential to cause cardiomyopathy. Hence the need for regular EKG monitoring on any diet (Acquired Long QT Syndrome. Berul C et al. www.uptodate.com, May 2015).
Lipid/Cholesterol Changes – In the 8 years I have been applying ketogenic diets to patients, I have seen dramatic improvement in the triglycerides and HDL levels. The only time triglycerides rise over 100 is if the patient is using artificial sweeteners or is cheating on the carbohydrate restriction. Total cholesterol commonly rises, however, this is indicative of the fact that there is a shift in the LDL particle size and this affects the calculation of both total cholesterol and LDL-C. In light of this, most of my patients have dramatic improvement in triglycerides and small dense LDL particle number. I’ve included the common cholesterol changes I seen in my office as a few case reports to demonstrate the effectiveness of a ketogenic diet:
2 year ketogenic dietary labs and weight loss
Myocardial Infarction – It is interesting that one blogger includes this on the list of adverse reactions, however, when you actually read the study, the author of the paper make an “assumption” that there was potential for heart attack due to an elevated total cholesterol, however, a correlation was never made. Again, in the 8 years I have been using ketogenic diets, I have seen dramatic improvement in cholesterol profiles, inflammatory markers, atherosclerosis and carotid intimal studies (Shai I et al, Circulation 2010; 121:1200-1208).
Three year metabolic history of a Low-Carbohydrate / Ketogenic diet
Menstrual Irregularities / Amenorrhea – It is well known that any diet causing protein or other nutritional deficiency will affect the menstrual cycle first and growth second. The only time menstrual irregularities occur with a ketogenic or Low-Carb diet is when a patient is not taking in enough protein or is not eating real food. What amazes me is that a properly applied ketogenic diet causes normalization of the menstrual cycle, and in my practice, I’ve had a number of women successfully be able to conceive after making a ketogenic dietary change.
For more details on the nutrient content of a ketogenic diet, see the recent article by a friend of mine, Maria Emmerich. She’s been creating ketogenic diets for years and has a number of fantastic books my wife and I have been using in our home over the last nine years. She is one among many that can give you some direction on how to devise a healthy, real food based ketogenic diet. See the page on my website here that will give you some direction in formulating your Ketogenic Lifestyle.
Nally Family Low-Carb / Ketogenic Cheese Cake
So, to celebrate Mother’s Day, today, with my family, I am going to indulge in some Low-Carb / Ketogenic Cheese Cake!! Happy Mother’s Day, to all of you and especially to all you mothers out there making a healthy difference in the lives of your families! (You can find the recipe for this delicious cheese cake here)
In the words of Sir William Ostler, “If it were not for the great variability among individuals, medicine might well be a science and not an art.”
A number of patients come in to the office struggling with loosing weight. When I review their dietary journals with them, I notice that many of them never stop eating fruit (because, fruit is good for you, right?!). Well, lets put it this way:
One banana for breakfast is equal to . . .
. . . just over seven (7) teaspoons of sugar.
Count them . . . seven (7) teaspoons.
If your eating a banana for breakfast, it is halting your weight loss for up to 12 hours. Give the banana’s to the monkeys and cook up some sausage and eggs for breakfast tomorrow.
A few of my patients have come in struggling with their weight this week, following what they assumed to be a low carbohydrate diet. They were eating yogurt for breakfast, a chicken salad for lunch, and chicken and vegetables for dinner. A true low carbohydrate diet is ketogenic (it derives fuel from ketones) and is the byproduct of fatty acid metabolism. That means your fuel is coming from fat, not protein or carbohydrate. The presence of glucose, fructose, lactose or other sugars (or many sugar alcohols) shut fatty acid metabolism down and halt the process of weight loss and frequently increase weight gain. Too much protein does the same thing. A chicken salad is not ketogenic. It may be low carb, but without adequate fat, the absence of glucose drives the body to use protein as it’s primary fuel source. It is essential to maintain ketosis that a low carbohydrate diet moderate the protein and increase the fats to upwards of 60-70% of the total caloric intake.
Bacon is a 50/50 food. (I’m not talking about turkey bacon . . . that’s not real bacon). Each slice of real bacon is at a minimum 3 grams (50%) fat, and 3 grams (50%) protein. No carbs there, either.
So, if you’re struggling with your weight loss on a low carb diet . . . your first step should be “BLT” it!
Weight loss, better put as “fat loss,” is a journey. A journey brought you to where you stand today, and it will be an even more exciting journey getting back to that size you’ve been daydreaming about. So, how do you most effectively start down the path of this journey? That is the great question. It is the most important question I get asked every day. In the words of Napoleon Hill, “Desire is the starting point of all achievement, not a hope, not a wish, but a keen pulsating desire which transcends everything.”
First, Know Where You Are Coming From. A journey requires knowing where you were, were you are today and where you want to go. Get a journal and weight yourself. Write it down and then check your weight every 3-5 days. DO NOT weigh yourself every day. I repeat DO NOT weight yourself every day. This can be discouraging because is is normal to fluctuate 2-5 lbs every day based on meals and water intake. Many people see this fluctuation and thing they are failing, then give up. The journal helps this. Recording your weight helps you see the progress.
The journal is also to help you record what you eat. Plan and record your meals IN YOUR JOURNAL. If you are being followed by a weight loss specialist, they will want to see your journal. If you are seeing me in my office, bring the journal with you to EVERY visit. Record every thing you eat. And, record your water intake. I am amazed at how many of my patient’s are dehydrated and just putting water back into their systems help them loose weight.
Second, Plan Your Day. Planning is the key to weight loss on any program. You should plan your exercise and plan your meals the night before. Failing to plan is really just planning to fail. Your plan should include 1) keeping carbohydrate intake less than 20 grams per day and 2) getting adequate proteins to match your goals.
Third, What’s the Underlying Cause of Your Weight Struggles?
You can’t effectively lose weight unless you understand why you are gaining weight. Two thirds of my patients are hyperinslinemic – they produce too much insulin in response to any sugar, starch or carbohydrate. This is also called “insulin resistance.” This is the primary cause of weight gain in 85% of the population. People produce between two to thirty times the normal amount of insulin in response to a piece of bread or a bowl of cereal. When they eat a single piece of bread, their bodies respond as if they ate the whole loaf. If they eat a bowl of cereal, their bodies respond as if they ate the whole box of Captain Crunch.
This variable over production of insulin is why some patient’s gain more weight than others eating and exercising the same way. Your doctor can easily identify this through blood work. For starters, if your waist circumference is larger than 40 inches as a male or larger than 35 inches as a female, you’re probably insulin resistant. Most men complain they don’t have a tape measure to measure their belly, so I tell them if they walk toward the wall and the first thing that touches the wall is their belly, “you’re insulin resistant.”
Skin Tags
Skin tags or the presence of thickened browning skin at areas of skin folds (acanthosis nigricans) are classic signs of insulin resistant.
Acanthosis Nigricans of the Neck-line
Hypoglycemia or low blood sugar is another sign of hyperinsulinemia or insulin resistance. This is where a person gets light headed or dizzy 2-5 hours after eating a meal that contains mainly starch or sugar.
Insulin resistance requires a dramatically different dietary approach than the standard diets we’ve been taught all our lives. The “heart healthy” diet, DASH diet, vegetarian/vegan diet, low fat diet or calorie restricted diet just don’t work with hyperinsulinemia or insulin resistance. If you are insulin resistant, a low fat/calorie restricted diet will not be very effective, and you may even gain weight with this approach as many of my patients have experienced.
If you have any of these symptoms, you need to follow up with your doctor or weight management specialist. Find out where your insulin levels are in relationship to your diet. Losing weight is possible. You can get started here with my ketogenic dietary program.
As this is a journey, it will probably have a number of twists and turns that are often made easier with a road map. Getting checked out with your doctor, and evaluating your metabolic status is your road map. Check out the health programs I offer to my patients to get this road map. I’ve also produced hundreds of videos on YouTube and DocMuscles.Locals.com to help you down the road. Either way, enjoy the journey!!
And, record your water intake. I am amazed at how many of my patient’s are dehydrated and just putting water back into their systems help them loose weight.
