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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

Cheesecake #DocMuscles #KetonianKing

Happy National Cheesecake Day!

Happy National Cheesecake Day!

Yes, you heard me correctly.  It is National Cheesecake Day today.  Today you must eat cheesecake – or you could be considered un-American.

“I can’t eat cheese cake, I’m doing a ketogenic diet!” you exclaim.

“Yes.  So am I.”

Eating cheesecake is actually good for you, (low-carb cheesecake that is) and it’s also good for your family. This is the perfect day for ketogenic cheesecake . . . like my wife Tiffini’s Low-Carb Key Lime & Blueberry Cheesecake and as my gift to you for #NationalCheesecakeDay, you can get the recipe by filling in that pop up box!

And, “NO – I know what you’re thinking,” you can never have too much heavy whipped cream.

So, why am I so excited about National Cheesecake Day?  I love low-carb cheesecake for a number of reasons.

Testosterone & Cheesecake

National Cheesecake Day makes me think of testosterone.

I know. Leave it to a man to start with testosterone, but in the big picture, a man really isn’t a man without testosterone, right?  I mean, it was during the 5th week of embryonic development that my Y chromosome began signaling the differentiation of male fetal growth in-utero.  And like every male, that same hormone, testosterone, continues to differentiate me from the human female counterpart throughout life.  (And, boy am I grateful for that.)

The reason testosterone comes to mind is that I see a large number of men with low testosterone.  Low testosterone has become a significant issue.  20-30% of the men in my practice suffer from some degree of suppression in testosterone when they first present in my office.   In fact, you can’t watch late night TV without being asked if your testosterone is too low (“Do you have Low ‘T’?”).

We know that the primary nutrient shown to affect testosterone to the greatest extent is fat. Studies reveal that diets low in fat and high in carbohydrates are associated with lower testosterone compared to diets high in fat (1, 2).  That begs the question, has 50 years of our low-fat high-carb diets made us less manly?  I am convinced, but I’ll let you be the judge when you look at the pictures below . . .

Manhood #DocMuscles #KetonianKing Cheesecake

When did this become acceptable?

MenThenMenNow #DocMuscles #KetonianKing Lack of Cheesecake

Testosterone is essential in providing energy, muscle mass & growth and actually keeping the waistline down.  Adequate testosterone is one of the key components allowing the man to fill the fatherhood rolls of protector and provider.

Female Brain Has A Testosterone Meter

Interestingly, the female brain is actually subconsciously wired to see the male physique and identify pheromones indicating your testosterone is higher or lower.  Most women won’t admit it, because they probably don’t even recognize it, but studies show that men who lack muscle, have lower testosterone and have a beer belly are actually less attractive to the female sex. Men who produce more testosterone produce androstadienone in their sweat at a greater concentration which can be detected by the female improving her mood, focus and sexual response (9).  If your diet isn’t helping you stimulate testosterone production, you’re less inclined to perform well in areas requiring its presence and you may be seen as less attractive by the women in the room.

That means that, bacon and eggs you craved this morning improve your manliness and actually give you more sex appeal. And, I’m sorry to say, the bagel and orange juice you had this morning are feminizing, they’re turning you into a woman, especially if you are like 85% of other men who over produce insulin because of insulin resistance.

When insulin is high and being over produced, it suppresses Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH), lowering testosterone production.  The high insulin and high fructose of the bagel and orange juice stimulate increased uptake of fat into the fat cells and decreases adiponectin production.  This causes increase in Sex Hormone Binding Globulin (SHBG) which further decreases available testosterone.  High insulin and low adiponectin puts your “man card” through the wash.

Cheesecake and Men’s Muscles

Men need muscles for all sorts of important things.  It’s often Dad who carries the child on his shoulders, or lifts you above his head.  It takes muscles for that.

Father and Child #DocMuscles #KetonianKing Cheesecake makes better fathers

We talked about the importance of testosterone in muscle development.  That that’s not all.  Many men can provide for their families specifically because of their ability to use that muscle.  I’m not saying women can’t use muscle, too.  In fact, muscle is essential for the female body to be healthy. What I’m saying that there are a number of jobs that make our country function that require men who are fit. Jobs like policemen, firefighters, special-ops military teams, construction workers, life-guards & delivery drivers require the strength and power men bring to these fields.  These jobs require muscle, and specifically “manly” muscle from healthy testosterone.

In addition, we know that ketones, the primary fuel in a ketogenic diet, inhibit muscle breakdown by decreasing leucine oxidation and preserving muscle mass (3). Being in ketosis increases testosterone and increases the presence of leucine preserving and allowing for bigger stronger muscles. So, yes, visiting the donut shop actually does make you less manly by allowing the more rapid degradation of your muscles.

“Wasn’t it my muscles that first got your attention when we met and got this whole father thing started in the first place, honey?” I asked my wife in the kitchen.

“What?! No . . .” she responded.

“Oh, . . . never mind.”

Energy & Cheesecake

Whether you have great muscles or not, you need energy for the muscles you have to fill your role as a man.  Work requires energy.  As fat is increasingly used as your primary fuel, instead of sugar, the liver converts it into ketone bodies, or ketones.  The liver itself, doesn’t use the ketones, so they are taken up by the muscles and brain for fuel.  Increased energy, mental clarity and suppression of inflammation are the key findings that are noticed while using fat as your primary fuel.  What man couldn’t us a little more of that?

Health of Family Influenced By Father’s Health

In fact, several studies report that the man in the home has the biggest impact on the overall fitness and on the overall weight of his children. It was found that the father’s, not the mother’s, total and percentage body fat was the best predictor of whether or not the couple’s daughters gained weight as they got older (4).  All the more reason to keep your waistline under control, Dad. And, all the more reason to have low-carb cheesecake today.

Another fascinating study showed fathers’ (again, not the mothers’) body mass index is directly related to a child’s activity level (5).

Cheesecake Helps Rough-Housing

Energy and muscle is essential for “rough-housing” and there is science to prove that “rough-housing” makes your kids awesome!  Psychologist Anthony Pellegrini found that the amount of rough-housing children engage in predicts their achievement in first grade better than their kindergarten test scores do (10). What is it about rough and tumble play that makes kids smarter? Well, a couple things.

OldFasionedRoughHousing #DocMuscles #KetonianKing cheesecake

Rough-housing makes your kids more resilient.  Strengthening resilience is a key in developing children’s intelligence. Resilient kids tend to see failure more as a challenge to overcome rather than an event that defines them.  Intellectual resilience that comes from energetic fathers helps ensure your children bounce back from bad grades and gives them the grit to keep trying until they’ve mastered a topic.

Intelligence From Cheesecake?

Neuroscientists studying animal and human brains have found that bouts of rough-and-tumble play increase the brain’s level of a chemical called brain-derived neurotrophic factor (BDNF). BDNF helps increase neuron growth in the parts of the brain responsible for memory, logic, social intelligence and higher learning–skills necessary for academic success.  We, also, now know that the brain that uses fat, or ketones, as its primary fuel recovers from injury and makes BDNF more effectively (6,7).

So, remember, that rib-eye with steak butter your kids gave you for dinner and the low-carb cheesecake you had for dinner is actually making you and them smarter and more resilient. You could even say that a diet high in fat and low in carbohydrate gives your family more grit.

Overall Happiness from Cheesecake?

The Harvard Grant Study completed in 1934, the longest longitudinal study ever done on the lives of men, found that a man’s father influenced his life in multiple ways exclusive to his relationship with his mother. Loving fathers imparted to their sons:

  • Enhanced capacity to play
  • Greater enjoyment of vacations
  • Increased likelihood of being able to use humor as a healthy coping mechanism
  • Better adjustment to, and contentment with, life after retirement
  • Less anxiety and fewer physical and mental symptoms under stress in young adulthood

It should be noted that “it was not the men with poor mothering but the ones with poor fathering who were significantly more likely to have poor marriages over their lifetimes.” Men who lacked a positive relationship with their fathers were also “much more likely to call themselves pessimists and to report having trouble letting others get close” (8).

You, as a testosterone producing man and father, matter.  And, being in ketosis makes you an even better father! Seriously.

FatherSon #DocMuscles #KetonianKing cheesecake

When all is said and done, a man’s relationship with his father very significantly predicted his overall life satisfaction at age 75 — “a variable not even suggestively associated with the maternal relationship” (8).

So, to circle back, the low-carb key-lime cheese cake just made me more manly. Thanks, Honey!  Happy National Cheesecake Day!

Tiffini’s Low-Carb Cheesecake Recipe:

Crust:

2 1/2 cups macadamia nut flour (salted tastes better)

1/4 cup sweetener (Swerve)

1/2 cup butter melted

In a medium bowl, whisk together flour and sweetener.  Stir in butter until well combined.  Press firmly into bottom and up the sides of a pie pan or spring-form pan.  Bake at 350 degrees for 8 minutes (watch closely so that the crust does not over-brown) 

Filling:

16 oz cream cheese, softened

2 tbsp sour cream

1/4 cup freshly squeezed lime juice with pulp

1 tsp lime zest

3/4 cup sweetener (Swerve or erythritol)

1/2 cup + 2 tbsp heavy whipping cream, divided

1 tbsp gelatin or 1 envelope Knox gelatin

In a large bowl, beat cream cheese, sour cream, lime juice with pulp and zest together until smooth.  Beat in the sweetener until well combined.   In a small bowl, whisk together 2 tbsp of heavy cream and the gelatin.  Stir into the cream cheese until well combined.  

In another bowl, beat whipping cream until it forms stiff peaks.  Gently fold  whipped cream into the cream cheese mixture.

Spread the filling over the cooled prepared crust.  

Refrigerate for a few hours until set and ready to serve with blueberries sprinkled on top.

References:

  1. Hamalainen, E., H. Aldercreutz, P. Puska, and P. Pietinen. Diet and serum sex hormones in healthy men. J. Steroid Biochem. 20:459-464, 1984.
  2. Reed, M.J., R.W. Cheng, M. Simmonds, W. Richmond, and V.H.T. James. Dietary Lipids: an additional regulator of plasma levels of sex hormone binding globulin. J. Clin. Endocrin. Metab. 64:1083-1085, 1987.
  3. Nair KS, Welle SL, Halliday D, Cambell RG. Effect ofβ-hydroxybutyrate on whole-body leucine kinetics and fractional mixed skeletal muscle protein synthesis in humans. J Clin Invest. 1988;82:198–
  4. Figueroa-Colon R, Arani RB, Goran MI, Weinsier RL. Paternal body fat is a longitudinal predictor of changes in body fat in premenarcheal girls. Am J Clin Nutr. 2000 Mar;71(3):829-34.
  5. Finn, Kevin et al. Factors associated with physical activity in preschool children.J of Ped., Vol 140, Issue 1, 81-85
  6. Vizuete AF1, de Souza DF, Guerra MC, Batassini C, Dutra MF, Bernardi C, Costa AP, Gonçalves CA. Brain changes in BDNF and S100B induced by ketogenic diets in Wistar rats. Life Sci. 2013 May 20;92(17-19):923-8.
  7. Masino SA, Rho JM. Mechanisms of Ketogenic Diet Action.  Jasper’s Basic Mechanisms of the Epilepsies [Internet]. 4th edition. Bethesda (MD): National Center for Biotechnology Information (US); 2012.
  8. Valliant GE. Triumphs of Excellence: The Men of the Harvard Grant Study. 1934
  9. Verhaeghe J, Gheysen R, Enzlin P. Pheromones and their effect on women’s mood and sexuality. Facts Views Vis Obgyn. 2013; 5(3): 189-195.
  10. DeBenedet A, Cohen LJ. The Art of Roughhousing. 2010. Quirk Books.

Why Be In Ketosis – Part X: PPAR-alpha

Benefit #10 in my 25 part series on “Why Be In Ketosis?”

This evening we briefly discuss PPAR-α, a powerful hormone that is stimulated by the ketogenic state.  It has a number of known benefits.  A number of great questions also popped up that we answered.  Listen and watch as we discuss them here:

Stay tuned for more great content on Facebook Live, Periscope and Instagram.

Can You Gain Muscle On A Ketogenic Diet?

Build Muscle text

Listen in to Ketotalk Podcast #19 where we talk about inflammatory foods, building muscle with a ketogenic diet & how ketosis affects the Baby Boomer Generation.

Keto Talk is cohosted by 10-year veteran health podcaster and international bestselling author Jimmy Moore from “Livin’ La Vida Low-Carb” and Arizona Osteopath and Board Certified Obesity Medicine physician Dr. Adam Nally from “Doc Muscles” who thoroughly share from their wealth of experience on the ketogenic lifestyle each and every Thursday.

We love hearing from our fabulous Ketonian listeners with new questions–send an email to Jimmy at livinlowcarbman@charter.net. And if you’re not already subscribed to the podcast on iTunes and listened to the past episodes, then you can do that and leave a review HERE. Listen in today as Jimmy and Adam answer more engaging questions about nutritional ketosis from you the listeners.