How to restart your keto/carnivore diet after the holidays
Tag: Protein
Long-Term Weight Loss: Why So Many Fail
Over fifty years of data have demonstrated that creating energy deficit through the reduction in caloric intake is effective in reducing weight. . . However, it is only for the short term (1, 2). The biggest challenge physicians face in the treatment of obesity is that calorie restriction fails when it comes to long-term weight loss.
Isn’t Fasting Effective in Long-Term Weight Loss?
With the craze and popularity of intermittent fasting, some have claimed that intermittent fasting is more effective in weight reduction. Recent results demonstrate that this may also be incorrect. In the short term evaluation of caloric restriction and intermittent fasting, reduction in 15-20 lbs of weight is effectively seen and the highly publicized Biggest Loser’s losing ~ 120 lbs. Intermittent fasting and alternate day fasting have been shown to be more effective in lowering insulin levels and other inflammatory markers in the short term.
There is, however, controversy over maintaining weight loss beyond 12 months in the calorie restriction, intermittent and alternate day fasting groups. Forty different studies in a recent literature review, thirty-one of those studies looking at forms of intermittent fasting, demonstrate that the majority of people regain the weight within the first 12 months of attempting to maintain weight loss(3, 5). This is, also, what I have seen for over 18 years of medical practice.
Is Calorie Restriction the Only Way to Lose Fat?
Numerous “experts” claim that the only way to reduce fat is “caloric deficit.” Variations through the use of intermittent, long-term or alternate day fasts can be found all over the internet. In regards to calorie restriction, these “experts” with nothing more than a personal experience and a blog to back their claims preach this louder than the “televangelists” preach religion. Based on the faith that many place in this dogma, it could be a religion. What causes belief in this dogma is that weight and fat loss actually does occur with caloric restriction to a point. The average person will lose 20-25 lbs, however, within 12 months of achieving this goal, most people regain all the weight. (No one ever mentions the almost universal problem with long-term weight loss, especially those “experts.”)
Prolonged calorie restricted fasts, intermittent fasts, and alternate day fasts are often grouped together into the fasting approach, causing significant confusion among those that I speak to and counsel in my office. There is great data that alternate day fasts do not have the reduction in resting energy expenditure that prolonged fasting, intermittent fasting and calorie restriction cause. However, none of these approaches appears to solve the problem of weight re-gain after long-term (12-24 months into maintenance) weight loss (3). And, a recent study of 100 men participating in alternate day fasting showed that there was a 38% dropout rate, implying that without close supervision and direction, maintenance of this lifestyle is not feasible for over 1/3rd of those attempting it.
Long-Term Weight Loss Failure Brings Tears
Failure on calorie restricted diets, low fat diets, and intermittent fasting diets with weight regain at twelve to twenty-four months is the most common reason people end up in my office in tears. They’ve fasted, starved themselves, calorie restricted, tried every form of exercise, and still regained the weight. Trainers, coaches and “experts” have belittled them for “cheating” or just not keeping to the diet. Yet, we know that calorie restriction and intermittent fasting cause a rebound in leptin, amilyn, peptid YY, cholecystikinin, insulin, ghrelin, gastric inhibitory peptide and pancreatic poly peptide by twelve months causing ineffective long-term weight loss (6). The dramatic rise in these hormones stimulates tremendous hunger, especially from ghrelin and leptin.
Although less problematic in alternate day fasting, these calorie restricted approaches also cause dramatic slowing of the metabolism at the twelve month mark. In many cases, the metabolic rate never actually returns to baseline, creating even more difficulty in losing further weight or even maintaining weight (6).
Is Gastric Bypass or Gastric Sleeve the Solution?
Gastric bypass and the gastric sleeve procedures have been touted as the solution to this problem, as they decrease ghrelin, however, 5-10 years later, these patients are also back in my office. They find that 5-10 years after these procedures the weight returns, cholesterol and blood pressure rise, and diabetes returns. These hormones kick into high gear, stimulating hunger in the face of a slowed metabolism, that to date, has been the driver for weight regain in the majority of people. People find it nearly impossible to overcome the hunger. You may have experienced this, I know I have.
It’s the Hormones, Baby!
So, what is the answer? It’s the hormones. (WARNING – You’ll hear that when your wife is pregnant, too, gentlemen). We are hormonal beings, both in weight gain, and in pregnancy. Trying to preach calorie control to a hormonal being is like showing up at the brothel to baptize the staff. You might get them into the water, but you’re probably not getting them returning weekly to church or pay a tithe.
So, how do you manipulate the hormones in a way to control the rebounding hunger and suppression of metabolism? This is where we put a bit of twist on the knowledge we’ve gained from alternate day fasting. Recent research shows that “mild” energy deficit in a pulsatile manner, that has the ability to mimicking the body’s normal bio-rhythm’s is dramatically effective in reducing weight and maintaining normal hormonal function without cause of rebound metabolic slowing (4).
Pulsed Mild Energy Restriction
What does this mean in layman’s terms? It means that if we provide a diet that maintains satiety hormones while providing a period of baseline total energy expenditure needs and a period of mildly reduce caloric intake in a pulsed or cyclic manner, greater weight loss occurs and there is no rebound of weight 1-2 years later.
The main reason I’ve not jumped on the intermittent fasting band wagon is the shift in leptin, amylin, ghrelin and GLP-1 signaling that regularly occurs at the 6-12 month mark. The rebound of these hormones causes weight re-gain and is what prevents successful long-term weight loss. A number of people come to my office and tell me they couldn’t follow a ketogenic diet, so they’re doing intermittent fasting and it works . . . for a while. Then, they end up in my office having hit a plateau or fallen off the wagon and regained all the weight. They are completely confused and don’t understand what happned. Most of them are convinced it’s their thyroid or cortisol and they’ve seen every naturopath and functional medicine doctor in town.
What people really need is a simple approach to long-term weight loss without having to spend the night in the physiology lab every two weeks sleeping under a ventilated hood system.
The Ketogenic Lifestyle is a Pulsed Energy Lifestyle
- First, it is essential to turn off the insulin load. Insulin is the master hormone. This is done by a ketogenic lifestyle that restricts carbohydrates.
- Second, providing adequate protein to supply maintenance of muscle and testosterone is key.
- Third, providing adequate fat is the simple way to maintain leptin, ghrelin, amylin, GLP-1 (among the others) and long-term weight loss. Can you eat too much fat? Of course you can. But, because each of us have differing levels of stress and activity each day, this fat intake becomes the lever for hunger control.
- Fourth, the use of exogenous ketones ensures easily accessible ketone (short chain fatty acids) to modulate adipose (white fat) signaling of the liver without large caloric intake through the portal vein by first pass of liver metabolism. The ketones also help stabilize the gut bacteria. The combination of hormone balance between the liver and fat cells and improvement of gut bacteria suppresses key hunger hormones and aids glucose regulation between the fatty tissues and the liver. Ketones, both endogenous and exogenous, suppress production of TNF-alpha, IL-6, resistin, and stabilize production of adiponectin and leptin from the adipose cells (7, 8, 9).
In my office, once we calculate the basic protein needs daily, we start with a 1:1 ratio of protein to fat. Then, the fat is adjusted up or down based on hunger. Remember, hunger occurs, because your body produces hormones. The addition of fat to a diet that is not stimulating large amounts of insulin resets the hormone patterns back to normal without causing weight gain.
Give Obese People Fat Ad Libitum?
“Sure, Dr. Nally, but what about those people who don’t know if they are hungry, bored, stressed or just have a bacon fixation? You can’t just give them all the fat they want?!”
Why not? Implying that people aren’t smart enough to know when they are full is a bit of a fascist philosophy, don’t you think?
Do people over eat? Sure they do. But, I’ve found that when you give people an antidote to hunger (using fat intake in the presence of stabilized insulin levels) over a few months, people begin to recognize true hunger from other forms of cravings. This is especially true when they keep a diet journal. This gives people the ability to begin listening to their own bodies, responding accordingly and governing their stress, eating, exercise and activity. Keeping a diet journal is key to long-term weight loss. And, isn’t helping people use their own agency to improve their health really what we’re trying to do?
Interestingly, doing this over the years seems to line up with the findings of this year’s MATADOR study in the International Journal of Obesity. They found that mild intermittent energy restriction of about 30-33% for two weeks, then interrupting this with two weeks of a diet that was energy balanced for needs improved both short and long-term weight loss efficiency (4). In looking at my, and my patient’s diet journals, this energy restriction of about 1/3 of needed calories cyclically seems to happens naturally with a ketogenic lifestyle, without even counting calories. (Calories are a swear-word in my office).
What does the correct long-term wight loss program look like in a diet or meal plan? Well, you’ll have to join the Ketogenic Lifestyle 101 Course to see what that really means to you individually. I look forward to seeing you there.
Want to find out more about the Ketogenic Lifestyle 101 course? CLICK HERE.
Have you read my book The Keto Cure? Get a signed copy from me by clicking HERE.
References:
- Bronson FH, Marsteller FA. “Effect of short-term food deprivation on reproduction in female mice.” Biol Reprod. Oct 1985; 33(3): 660-7. https://www.ncbi.nlm.nih.gov/pubmed/4052528?dopt=Abstract&holding=npg
- Connors JM, DeVito WJ, Hedge GA. “Effects of food deprivation on the feedback regulation of the hypothalamic-pituitary-thyroid axis of the rat.” Endocrinology. Sep 1985. 117(3): 900-6. https://www.ncbi.nlm.nih.gov/pubmed/3926471?dopt=Abstract&holding=npg
- Seimon RV, Roekenes JA, Zibellini J, Zhu B, Gibson AA, Hills AP, Wood RE, King NA, Byrne NM, Sainsbury A. “Do intermittent diets provide physiological beneftis over continuous diets for weight loss? A systematic review of clinical trials.” Mol Cell Endo. 15 Dec 2015. 418(2): 153-172. https://www.sciencedirect.com/science/article/pii/S0303720715300800
- Byrne NM, Sainsbury A, King NA, Hills AP, Wood RE. “Intermittent energy restriction improves weight loss efficiency in obese men: the MATADOR study.” Int J Obes. 2018. 42:129-138. https://www.nature.com/articles/ijo2017206
- Trepanowski JF, Kroeger CM, Barnosky A. “Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults.” JAMA Intern Med. Jul 2017. 177(7): 930-938. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2623528?redirect=true
- Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, Proietto J. “Long-term persistence of hormonal adaptations to weight loss.” N Engl J Med. 27 Oct 2011. 365: 1597-1604. http://www.nejm.org/doi/full/10.1056/NEJMoa1105816
- Asrih M et al., “Ketogenic diet impairs FGF21 signaling and promotes differential inflammatory responses in the liver and white adipose tissue.” PlosOne. 14 May 2015. Open Access. https://doi.org/10.1371/journal.pone.0126364
- Veniant MM et al. “FGF21 promotes metabolic homeostasis via white adipose and leptin in mice.” PlosOne. Jul 2012. Open access. https://doi.org/10.1371/journal.pone.0040164
- Whittle AJ, “FGF21 conducts a metabolic orchestra and fat is a key player.” Endocrinology. 1 May 2016. 157(5): 1722-1724.
Eight Reasons You Can’t Lose Fat
Inability to lose weight is the most common reason people see me. It’s often a combination of small things of which they are unaware. What simple things are keeping the spare tire inflated around the your waist? I’ve listed the eight most common reasons you can’t lose the fat.
You Eat Too Many Carbohydrates
About 85% of the people that walk through my office doors have some degree of insulin resistance. This means that they produce 2-20 times the normal amount of insulin in response to ANY form of starch or carbohydrate. Insulin is the hormone responsible for letting glucose into the cell to be used as fuel. More importantly, it is the hormone responsible for dampering glucose production in the liver and, it is the primary hormone responsible for pushing triglycerides into the fat cells (essentially, the master hormone for making you FAT). The more insulin you make the more fat you store. Insulin resistance, the inability for insulin to signal glucose dampering at the liver receptors, is the first stage that starts 15-20 years before you become a diabetic.
In order to lose fat, you have to decrease the insulin to a basal level. If you don’t the fat enters the fat cell faster than it exits and the fat cells get bigger. This is RULE number one to weight loss. You gotta turn down the high insulin surge that 85% of us are really good at producing. If you don’t do this, it is almost impossible for many of us to lose weight.
For at least 1/3rd of the people I see, this cannot be accomplished unless TOTAL CARBOHYDRATES are decreased to less than 20 grams per day. Yes, you read that correctly . . . Less that 20 grams per day.
- Your banana contains 30 grams of carbohydrate
- Your yogurt has up to 60 grams of carbohydrate
- That oatmeal you thought was good for you has up to 200 grams of carbohydrate
- The half and half you put in your coffee is half lactose (sugar from milk), 10 grams per cup.
You Eat Too Much Protein
Yes, protein can cause weight gain. And, no, it’s not because gluconeogenesis is on overdrive. There is always a body builder that sends me a nasty message after I say this. But the fact is that it’s true. (I’ll keep an eye on my e-mail).
Five of the ten essential amino acids stimulate an insulin response. Remember why carbohydrates cause weight gain . . . ? (I will give you a hint . . . INSULIN).
Certain amino acids that make up proteins can do the same thing. Arginine, Lycine, Phenylalanine, Leucine & Tyrosine, in that order, stimulate insulin enough to halt weight loss or increase weight gain in a significant way (1). We need protein to stay healthy, but too much of these amino acids in someone who is insulin resistant will inhibit weight loss and stimulate fat gain. I’ve also seen it raise small dense LDL particles in the cholesterol (the heart disease causing particle driven by insulin over production) I’ve seen this time and time again with many people. Simply modulating down the protein to the calculated needs lets the weight start coming off again.
So, what foods contain these in the highest amounts? Sea lion liver (I know, this won’t go over very well with the polar bears), soy protein isolate, crab, shrimp, sesame flour, turkey breast, pork loin (it’s the leanest cut of pork – No. BACON is fine), chicken, pumpkin seeds, soybeans, peanuts, spirulina (blue green alge that is found in the sea).
Yes, I get it. We’ve been told these were the healthy foods for the last 50 years. But, think about it. When did we start gaining weight as a country? 50 years ago.
Too much chicken, shrimp, crab and soy foods will inhibit weight loss in those with insulin resistance. So, consider whether it should be chicken you add to your salad. Consider, instead, bacon or beef as a wonderfully tasty substitute.
How much protein do you need? My formula for calculating your individual amount is here in my blog Calculating Protein Needs.
You Don’t Eat Enough Fat
To successfully lose fat on a ketogenic diet, 30-70% of your caloric intake should come from fat. Yes. You read that correctly. (The definition of a high fat diet is any diet containing more than 30% of fat from calories).
If we limit carbohydrates (which is currently 80% of the body’s fuel on the standard America plate), and moderate excessive protein which also halts weight loss, you have to replace the fuel. That fuel replacement should come from fat. Increasing fat will improve the sensation of fullness, provide all the fat soluble vitamins, and actually makes food taste good again.
As long as you are lowering the insulin to basal levels, you can actually eat all the fat for which you are hungry. Add bacon, butter, coconut oil, avocado, hard cheese, and oh, did I say bacon?
But Dr. Nally, what about all that saturated fat?
The saturated fat is only a problem with vascular disease, cholesterol and heart disease when the insulin level is also high at the same time. It’s the high insulin in the presence of large amounts of fat that drives the risk for atherosclerosis (vascular and heart disease). Instead of cutting out the fat, we’re cutting out the insulin.
How much fat should you be eating? Shoot for 60-70% of your calories from fat for the first 3 months. If your fat grams are slightly higher than or equal to your protein grams, you’re there. Listen to your body and eat fat until you’re full. That’s how most of my patients gauge their need and suppress hunger.
You’re Now Eating Too Much Fat
After the third month, most of us are fat adapted. You may notice your weight loss slows or halts. This means that our ability to absorb fat into the blood stream is dramatically more efficient. It also means that your taking in more fat into the fat cell then you are pulling out of the fat cell. I’ve found this to be the case with people who are loading butter, MCT or heavy whipping cream into their coffee. In this case, back off the “extra fat” your are loading or drinking. It’s not the calories in this case. There are 3-4 hormonal reasons this occurs once you are fat adapted. (We’ll talk about this in another blog post.)
You’re Drinking Tea
I know, I know. Tea is a national pass time in Europe. And, it is deeply embedded in the culture of many other countries. I’m probably not winning any friends across the pond by saying this, and it may bring back memories of the Boston Tea Party. However, the problem is that leaf based teas stimulate a rise in insulin (not taxes). I have had many patients hit a weight loss plateau because of the use of tea, specifically black tea, oolong tea, and green tea (2,3,4).
Yes, I am well aware of the tremendous benefits of the epigallocatechin gallate (ECGC) found in green tea. ECGC, which can be isolated as an extract, improves insulin resistance and improves GLP-1 signaling. ECGC has, also, been show to improve triglycerides (5). For this reason, it is one of the components in the KetoEssentials Multi-Vitamin I developed a few years ago and recommend to all my patients.
It appears, however, that the theaflavin within the leaf of the tea may be playing the offending role in the insulin spike seen with their use (6).
You Don’t Get Enough Sleep
Lack of sleep has been implicated in difficulty with weight loss and weight gain (7). Lack of sleep places the body into a state of chronic stress. This elevates cortisol, lowers testosterone, increases insulin (there’s that insulin problem, again) and increases the other inflammatory hormones. This perfect storm of stress, driven by lack of restful sleep, plays a big role in fat loss.
My average patient needs at a minimum of 6-7 hours of restful sleep to maintain and lose weight.
This is where untreated sleep disorders like sleep apnea play a big role. If you have sleep apnea, get it treated. What else can you do to help improve sleep?
- Remove the computer, iPad and cell phones from the room.
- Lower the room temperature. Men sleep better around 68-70 degrees F and women sleep better when the temperature is <70 degrees F.
- Close the blinds or shades to add or darken the room.
- Don’t study or watch TV in the same room you sleep in. Your body gets used to doing certain activities in certain rooms of the house. The bedroom should be reserved for sleep.
- Go to bed at the same time
- Get up at the same time.
It may take your body and body’s biorhythm 3-4 weeks to adjust to changes you make around sleep habits. Be patient with yourself.
You’re Married to Stress
Just as lack of sleep is stressful, other forms of chronic stress also raise cortisol, insulin and the inflammatory hormones. Chronic stress also lowers testosterone. It, also, has the potential to lower neurosignaling hormones in the brain like serotonin and dopamine, putting you at greater risk for depression and anxiety.
Other forms of chronic stress can occur from poor relationships, chronic pain, stressful employment, unfulfilled expectations, chronic illness and all forms of abuse. If any of these are playing a role in your life, you need to address them, and address them now.
As a physician, my job is stressful. Dealing with life and death issues with multiple people through the day, six or seven days a week, takes it’s toll. I’ve found that weight lifting, horseback riding, and taking care of my animals are my outlets. Find something physical, that takes you outside in the elements and forces you to break a sweat for 15-20 minutes is the key.
Our bodies have a “fight or flight system.” 100 years ago, the stress was fighting or running from the bear that squared off with you when you happened upon him in the woods. Cortisol, adrenaline, epinephrine, insulin, glucose, and inflammatory hormones pour into the blood stream. The heart beats faster, blood flows rapidly to the muscles, sensory awareness is heightened in the brain and increased oxygen flows to the lungs. This lets you fight the bear or run from the bear.
But, you can’t fight or run from your cynical boss. You can’t fight or run from oppressive finances, the person that cuts you off on your one hour commute in traffic, or your coworker who keeps pestering you. However, your body still releases adrenaline, cortisol, epinephrine, insulin and a number of inflammatory hormones prepping you to fight or run. If you don’t burn these hormones off, they halt weight loss, and actually can cause weight gain, increase anxiety and over time disrupt sleep.
So find your favorite way of physically relieving stress, and do it 2-3 times per week. (No, gentlemen, sex doesn’t count).
You Have An MTHFR Deficiency
In the last few years, we’ve been able to identify a number of genetic deficiencies that play a role in weight gain. One of those is an methyl-tetrahydrofolate enzyme deficiency (MTHFR deficiency for short). This is a genetic deficiency in the enzyme that converts adds a methyl ion to the folic acid in the cells of your body.
This is important, because if you can’t methylate folic acid inside the cell, you’ll have difficulty using vitamin B12 and B6 very efficiently to form methionine (a key amino acid in blood vessel and nerve function). There are two genes that encode for the enzyme that does the methylation of folic acid. Deficiency in one or both of these can lead to problems.
In severe cases, it causes homocysteine to build up to unsafe levels in the blood and slow the formation of methionine. It is associated with B12 deficiency, weight gain, fatigue, migraines, depression, anxiety, neuro-developmental disorders like autism, pregnancy loss, blood clots and neuropathy in pre-diabetic and diabetic patients (8, 9, 10).
Giving extra vitamin B12, B6 and folic acid (vitamin B9) doesn’t appear to help. Clinical evidence is pointing to the pre-methylated form of the folic acid. Finding this pre-methylated form has been difficult and notably expensive for patients. I found this deficiency to be so prevalent in my office, I added methylated folic acid to the KetoEssentials Multivitamin.
You Give “Couch Potato” A New Name
We have become a very sedentary people. We have engineered physical activity out of our lives. Remote controls, elevators, escalators, people movers, and automation have made our lives physically easier.
The average office worker burns 300 kcal per day sitting at a desk on a computer. The average farm worker burns 2600 kcal per day. That’s the equivalent of running a marathon every day.
Physical activity doesn’t necessarily cause weight loss. However, physical activity changes the hormones of the body including increasing a hormones like catacholamines, testosterone and a hormone called atrial naturitic peptide (ANP). ANP opens the fat cell, and lets more fat out (11).
When physical activity is paired with the correct diet, the weight come off. This is where exogenous ketones may play a role. The increased presence of ketones in the blood increases the release of ANP helping to activate triglyceride release from the fat cell.
Don’t get me wrong, many of my patients can lose weight with just dietary carbohydrate restriction alone, however, if you’ve hit a stall, you may need to look at your physical activity levels and many people like me, who are notably insulin resistant, benefit greatly with the addition of exogenous ketones.
Kickstart Ketosis over the Plateau
Is your fat loss on a plateau? Knowing that these challenges plague people on and off throughout the year, and, seeing people get hung up on these issues, I’ve created the Ketogenic Lifestyle 101 Course. This program gets you jump-started into ketosis and gives you the tools to overcome the individual hurtles you will experience on your health journey.
If your the really motivated type, and want a true 30 day challenge, then join my Kickstart program.
References:
- Floyd J et al., Stimulation of Insulin Secretion by Amino Acids, Journal of Clinical Investigation. 1966. 45(9).
- Bryans JA et al., Effect of black tea on post-prandial glucose and insulin. Journal Am Coll Nutrition 2007, 25(5): 471-7.
- Store KS & Baer DJ. Tea consumption may improve biomarkers of insulin sensitivity and risk factors for diabetes. The Journal of Nutrition. Aug 2008, 138(8): 1584S-1588S.
- Hosoda K et al., Anti-hyperglycemic effect of oolong tea on type II diabetes. Diabetes Care. Jun 2003. 26(6): 1714-1718.
- Chia-Yu Liu,Chien-Jung Huang, Lin-Huang Huang, I-Ju Chen, Jung-Peng Chiu, Chung-Hua Hsu. Effects of Green Tea Extract on Insulin Resistance and Glucagon-Like Peptide 1 in Patients with Type 2 Diabetes and Lipid Abnormalities: A Randomized, Double-Blinded, and Placebo-Controlled Trial. PLOS one(online). March 10, 2014.
- Cameron, Amy R.; Anton, Siobhan; Melville, Laura; Houston, Nicola P.; Dayal, Saurabh; McDougall, Gordon J.; Stewart, Derek; Rena, Graham (2008). “Black tea polyphenols mimic insulin/insulin-like growth factor-1 signalling to the longevity factor FOXO1a”. Aging Cell. 7(1): 69–77.
- Beccuti, Guglielmo, and Silvana Pannain. “Sleep and Obesity.” Current opinion in clinical nutrition and metabolic care 14.4 (2011): 402–412. PMC. Web. 18 Sept. 2017.
- Divyakolu S, Tejaswini Y, Thomas W, Thumoju S, et al. (2013) Evaluation of C677T Polymorphism of the Methylenetetrahydrofolate Reductase (MTHFR) Gene in various Neurological Disorders. J Neurol Disord 2:142. doi: 10.4172/2329-6895.1000142
- Gilbody, S., Lewis, S. & Lightfoot, T. (2007). Methylenetetrahydrofolate reductase (MTHFR) genetic polymorphisms and psychiatric disorders: A HuGE review. American Journal of Epidemiology, 165(1), 1-13.
- Menon, S., Lea, R., Roy, B., Hanna, M., Wee, S., Haupt, L., & … Griffiths, L. (2012). Genotypes of the MTHFR C677T and MTRR A66G genes act independently to reduce migraine disability in response to vitamin supplementation. Pharmacogenetics And Genomics, 22(10), 741-749.
- Lafontan M et al., Control of lipolysis by natriuretic peptides and cyclic GMP. Trends in Endocrinology and Metabolism. 19(4): 130-137.
So, You Fell Off the Ketosis Wagon . . .
You fell off the ketosis wagon, drug it into the forest, set it on fire, and used the insurance money to buy Twinkies . . .
What do you do when the cravings are bad? Watch this evenings video:
11 Proteins That Spike Insulin
This week on Episode #50 of KetoTalk.com we talked about those proteins highest in arginine and lysine with the greatest potential for spiking your insulin and kicking you out of ketosis. Here is a Graphic to give you a little help:
Take Just A Moment and Admire . . . (Then Calculate Your Ideal Body Weight)
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.
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.
I hope that helps.
DocMusclesScopes: Low-Carb Approach to Scales & Halloween Candy . . .
Click the link below to see this evening’s Periscope (DocMusclesScopes) found on Katch.me:
https://www.katch.me/docmuscles/v/3ff9e94f-c846-3cdb-84fa-081e640b7a6f
Have a great evening!!
Red & Processed Meats . . . The Hidden Agenda
I’ve been hearing it all day. Almost every patient asked me the question: Is red meat really as bad as the World Health Organization is claiming? Multiple articles can be found today in the New York Times, and the Washington Post, and even in Money Magazine today. (Money Magazine . . . really?!)
The World Health Organization (WHO) is claiming that processed meats are cancer causing or carcinogenic on the same level as alcohol and asbestos. They also are claiming that red meat is “probably” carcinogenic. “Probably.” That’s a pretty big hedge for a claim of cancer after years of research was reviewed in meta-analysis. Probably is defined by Merriam-Webster to mean: “as far as one can tell.” Well, I can tell you, as far as I can tell, this is bad science being reported as fact to sway the lay mind in following an agenda.
The real story here is NOT that red meat is bad. The real story, that absolutely no one has mentioned, is the veiled agenda cloaked as blame placed on a source of food. This is the WHO’s first step in advancing the Global Warming Agenda.
“Oh, no, Dr. Nally. Here you go talking all that crazy conspiracy stuff!”
No, let me spell it out in the actual words of the World Health Organization.
First, the WHO Director General has published a Six Point Agenda, this year, specifically outlining her vision for high priority issues. The first point on this list of six is to “drive the global agenda . . . in the context of accelerating progress to the Millennium Development Goals.” (1) What in the world are Millennium Development Goals you may ask?
The Millennium Development Goals were first identified in 2000 at the United Nation’s Sustainable Development Conference and reconfirmed this year. These goals specifically outline a transformational vision of the world. The World Health Organization has taken these 16 goals as their “call to arms.” Goals #12 and #13 specifically discuss “ensuring sustainable food consumption patterns throughout the world” by “doubling agricultural growth” and restricting food production that worsens the “carbon footprint.” (2)
Over the last ten years, multiple progressive groups and sites have made the claim that the greatest threat to Climate Change is the cattle industry. They link cattle, livestock and our consumption of red meats to global warming and have been preaching the politics of nutrition. They claim that the only real way to stop climate change and global warming is to “eat less red meat and dairy products.” (3)
The claim is that if we each reduce the red meat in our diet, it will reduce the number of livestock around the world and decrease methane production . . . that causes global warming. I can personally attest to you, that if you eat a more vegetarian diet including cauliflower, broccoli, eggplant and legumes, you alone will increase the methane production in the atmosphere!
In fact, the Lancet, a well recognized medical journal, has published a series of articles yearly, starting in 2008, calling for the reduction in red meat, pork and livestock to control climate change. (Wait a minute? I thought the Lancet was a journal dedicated to diabetes?) All of their climate change/red meat research is based in meta-analysis consisting of “reported” meals by subjects from memory over a 5 year period. Who can remember what they ate last week? These authors then make claims of conjecture, stating that sources of meat “could be,” “may be,” or “probably are” harmful and “have the potential to” reduce climate change (4).
Second, links to cancer using processed meats are very, very small, . . . like a 0.04% chance of colon cancer if you eat processed meats. You have the same chance of getting hit by lightening in your lifetime – 0.04% chance (5). To liken this level of risk in the main stream media to that of smoking or asbestos exposure is immoral and unethical.
The concern for many regarding processed meats is the nitrate contents from nitrogen byproducts. About 5% of nitrates are converted into nitrites in the gut, and these can affect the oxidation within the colon an the blood stream. However, most of us handle these nitrites and nitrates through the urea cycle without any problem. Third, spinach, lettuce, cabbage, bok choy and carrots have two to five times higher nitrate concentrations than bacon and hot dogs (6). (Hmmm . . . wonder why the WHO didn’t classify spinach and lettuce as carcinogenic?) Fish produce nitrites in their waste and plants absorb the nitrites in the ponds and lakes and bodies of water they live in. (Look up aquaponics). Most of us have the ability to block the conversion and clear any nitrites out of our systems. The problem arises when we ingest foods that are high in nitrates in conjunction with high fructose corn syrup or “sugar,” to be simplistic. The hepatic (liver) metabolism of fructose in the presence of glucose (that’s what happens when we ingest sugar) inhibits endothelial nitric oxide synthase, increases insulin and suppresses the uric acid cycle allowing for build up of nitrites in the system. 
It’s the decreased nitric oxide and the high insulin response most of us get from eating the bread or juice with the bacon or the sausage that inhibits our ability to block the conversion leading to carcinogenic levels. (It ain’t the meat . . . its the sugar and the insuiln!!)
As for me, “pass the pastrami, I’m going to sit on the porch and watch a really amazing lightening storm.”
References:
- WHO Director General Six Point Agenda, Publications. http://www.who.int/nmh/publications/6point_agenda_en.pdf, October 27, 2015.
- United Nations – Sustainable Development Knowledge Platform. Transforming our world: the 2030 Agenda for Sustainable Development. https://sustainabledevelopment.un.org/post2015/transformingourworld, October 27, 2015
- Time For Change. Are cows to blame for global warming? Are cattle the true cause for climate change? http://timeforchange.org/are-cows-cause-of-global-warming-meat-methane-CO2. October 27, 2015.
- Demaio, Alessandro R et al. The Lancet. Human and planetary health: towards a common language. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)61044-3/fulltext#back-bib10. October 27, 2015.
- National Geographic. Flash Facts about Lightening. http://news.nationalgeographic.com/news/2004/06/0623_040623_lightningfacts.html
- NG Hord et. al. American Journal of Clinical Nutrition. Food sources of nitrates and nitrites: the physiologic context for potential health benefits. July 2009, Vol 90, 1-10. http://ajcn.nutrition.org/content/90/1/1.full#cited-by. October 27, 2015.
Nutritional Values of Commonly Used Ketogenic Foods
I’ve had a number of emails and requests from patient’s to locate a source for fat percentages and protein contents of various foods as they prepare and follow a ketogenic lifestyle. I’ve looked all over, however, nothing easy and concise has made itself readily available, and there hasn’t been a simple one page tool at your fingertips . . .
Hopefully, this list will start to fill that gap. Use the list to calculate protein and fat levels as needed. Let me know if I can add to the list or if there are foods you commonly use that I’ve missed. Keep the ketones up and your waistline down!
Nutritional Values of Common Ketogenic Foods:
Food: Protein Contents: Fat Contents:
Steak (Ribeye) – 65 grams per 8 oz. 49%
Steak (Top or Bottom Round) – 23 grams per 3 oz. 33%
Ground Beef (75% Lean) – 22 grams per 3 oz. 55%
Pork Chop (boneless) – 26 grams per 3 oz. 15%
Ham – 17 grams per 3.5 oz. 12%
Bacon (grilled) – 22 grams per 3.5 oz. 75%
Sausage (beef) – 14 grams per 3.5 oz. 79%
Sausage (pork) – 17 grams per 3.5 oz. 75%
Chicken Breast (boneless, skinless) – 24 grams per 3 oz. 18%
Turkey Breast – 24 grams per 3 oz. 15%
Yellowfin Tuna – 25 grams per 3 oz. 10%
Light Tuna – 22 grams per 3 oz. 8%
Halibut – 23 grams per 3 oz. 19%
Sockeye Salmon – 23 grams per 3 oz. 22%
Tilapia – 21 grams per 3 oz. 13%
Deli Meats:
Roast Beef – 18 grams per 3 oz. 16%
Canadian bacon – 15 grams per 3 oz. 33%
Pepperoni – 18 grams per 3 oz. 83%
Roast Turkey Breast – 18 grams per 3 oz. 15%
Snacks:
Beef Jerky (Jack Links) – 13 grams per 1 oz. 9%
Peanut Butter (Peter Pan Crunchy) – 8 grams per 2 tbsp. 76%
Mixed Nuts – 6 grams per 2 oz. 79%
Almonds, raw – 6 grams per 1 oz. 66%
Walnuts, raw – 4 grams per 1 oz. 85%
Sunflower seeds, raw – 6 grams per 1 oz. 76%
Tofu – 12 grams per 3 oz. 30%
Greek Yogurt – 23 grams per 8 oz. 0%
Cheeses:
Swiss Cheese – 24 grams per 3 oz. 66%
Cream Cheese – 11 grams per 3.5 oz. 79%
Ricotta cheese – 10 grams per 3.5 oz. 63%
Cheddar cheese – 24.6 grams per 3.5 oz. 74%
Eggs – 6 grams per 1 large egg 60%
(Adapted from http://www.caloriecount.com)
A printable PDF copy of this information is available here:
Nutritional Value of Common Foods.
To live in the presence of great truths and eternal laws, to be led by permanent ideals – that is what keeps a man patient when the world ignores him, and calm and unspoiled when the world praises him. Hopefully, these posts are adding to your stable ideals.
How Much #Protein is Too Much on a #Ketogenic Low-Carb Diet? #DocMusclesScopes
How much protein should you be using? Watch the periscope below . . . and good morning from Surprise, Arizona!!
I’ve included the calculations you will need to get a ballpark estimate on your protein intake from your ideal body weight
Ideal Body Weight (IBW):
These calculations are estimated ideal body weight in kilograms (kg). You can convert your weight in pounds (lbs) to kilograms (kg) with the following formula:
The average male needs 1.2 mg/kg protein per day. The average female needs 1.0 mg/kg protein per day.
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.
Examples: If I am 6 feet tall, as a male, then I add 50 kg to 27.6 kg ( 6′ tall is 12 inches over 5′ x 2.3 kg) = 77.6 mg of protein requirement per day. That means that if I (a 6′ tall male) ate three times a day, then my protein requirements are 25.9 mg per meal.
So, What is this Ketogenic Thing Again . . . ?
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.
The Perfect BLT
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!