Tag: Testosterone

September 29, 2018

Estrogen Dominance – The Dead Man’s Curve on the Road to Ketogenic Happiness

Over the last 18 years of my practice, I’ve seen tremendous success in helping people improve their health when low-carbohydrate dietary changes are anchored as the foundation of treatment. However, there is still a group of people that struggle with seeing success. Even with the most effective ketogenic dietary control, there are those that see abnormal weight gain, inability to lose weight, poor libido, fatigue, foggy thinking, mood swings, persisting depression, headaches, bloating, breast tenderness, fibro-cystic breast changes, hair loss, and hot flashes. They may not experience all these symptoms, however, many are often present. If you have been following a ketogenic lifestyle and are still experiencing any of these symptoms, you are probably suffering from estrogen dominance.

Estrogen dominance is a condition that elusively effects thousands of women (and men) and your doctor probably doesn’t even know about it. I didn’t know about it. I, like all of my physician colleagues, were trained in school that the symptoms above are related to fluctuations of estrogen as a woman ages (or dropping of testosterone as a man ages). We were, and still are, taught that they are fixed by giving more powerful doses of estrogen or testosterone.

Over the years of my clinical experience, giving more estrogen frequently didn’t work. And, giving men more testosterone didn’t work either. What I found very effective, for many, was changing the diet. And, for about 85% of people, the symptoms list above resolved. However, the cause of the symptoms above in that last 15% of patients I see was still elusive. Examinations, blood tests, and even psychological evaluations never revealed the answer. Giving synthetic estrogen, progestin or testosterone when the blood work showed abnormality partially alleviated some of the symptoms for a few months, but then the patients would end up back in my office with the symptoms having returned.

I’ve found a number of problems following the “standard” medical approach to using synthetic sex hormones.

The first problem is that estrogen, progesterone and testosterone are heavily bound to proteins in the blood. It is only the free component of the three forms of estrogen and progesterone in the body and the free testosterone that acts upon the delicate cells located throughout the body. Blood testing does not account for the levels of free estrogen forms and progesterone effectively. These can only be tested through salivary testing.

The second obstacle is that the synthetic forms of progesterone (progestin), cannot effectively enter the brain. When synthetic forms are used, a person only gets half the benefits of progesterone found in the human body. This is why so many women have depression, anxiety and foggy brain feelings when using the synthetic versions.

The third challenge is that pharmaceutical companies cannot patent a drug that is identical to your human hormones. The chemical structure of the synthetic estrogen, progestin or testosterone must be slightly different. Hormones effectively work on certain aspects of various cells throughout the body, however, progesterone and progestin (the synthetic version found in medroxyProgesterone) DO NOT have the same hormonal effect on each cell. Natural progesterone is broken down by the stomach when ingested. That’s why progestin was invented, however, it doesn’t act the same in the body and only does half the job.

The fourth dilema is that much of our food in the standard American Diet stimulates increased estrogen production or inhibits clearance of estrogen excess through the gut and digestive tract. This happens in men and women. We can get excess estrogen from animals treated with hormones in meats, milk and dairy products. Hydrogenated oils in processed foods change the way estrogen and progesterone are handled in the body. These unstable fats increase the effects of estrogen on the body and amplify the risk for cancers. Excessive omega-6 fatty acids in the diet magnify estrogen receptor response to estrogen.

Estrogen metabolism in the liver and removal in the gut are dependent on vitamins B & E, magnesium and idol-3-carbinol (IC3). Diets without adequate IC3 from glucobrassicin found in leafy green and crucirferous vegetables allow re-uptake of estrogen in the gut leading to high estrogen levels and estrogen dominance. This is where gut health is even more important, and where I see failure in the “carnivore” approach to a ketogenic lifestyle.

The fifth problem is that the more estrogen I give a person, the more estrogen receptors are unregulated to the surfaces of the cells in the body. When that happens, more estrogen is required. Excess estrogen can actually cause many of the same symptoms present in progesterone deficiency including:

Irregular or heavy bleeding
Breast tenderness
Depression
Fatigue
Poor concentration
Fibrocystic breast changes
Decreased libido
Fibroid growth on the uterus
Endometriosis
Water retention and bloating
Fat gain around hips and thighs
Bone mineral loss (osteoporosis)
Hair loss
Skin thinning
Disturbed sleep
Breast and uterine cancer

More estrogen isn’t needed. Balancing natural progesterone with the current estrogen the body is already making is the solution in most cases. This can only be effectively assessed through a salivary hormone test.

In my clinical experience, a ketogenic lifestyle is foundational to balancing these hormones consistently and naturally. Carbohydrate restriction by itself corrects many of the diseases of civilization. I addressed this in my book The Keto Cure. For many, there are few more steps necessary to living a long, happy and healthy life.

The treatment to this issue isn’t difficult. For that reason, much more is to come on this subject. I will address each of the points above in future blogs. However, the first step is get your hormones checked by someone who understand this problem. And, then knows how to interpret it and treat it.

July 31, 2017

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 . . .

When did this become acceptable?

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.

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.

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.

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:

Hamalainen, E., H. Aldercreutz, P. Puska, and P. Pietinen. Diet and serum sex hormones in healthy men. J. Steroid Biochem. 20:459-464, 1984.
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.
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–
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.
Finn, Kevin et al. Factors associated with physical activity in preschool children.J of Ped., Vol 140, Issue 1, 81-85
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.
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.
Valliant GE. Triumphs of Excellence: The Men of the Harvard Grant Study. 1934
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.
DeBenedet A, Cohen LJ. The Art of Roughhousing. 2010. Quirk Books.

July 26, 2017

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

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

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

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

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

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

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

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

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

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

The Fat Lock-Box Keys

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

Insulin

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

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

Picture 1 – Four Key Pathways to Adipocyte Stimulation of Lipolysis

Catecholamines

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

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

Inflammation & Medications

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

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

Naturitic Peptides

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

Hypothalamus-Pituitary-Gonadal (HPG) Axis & Testosterone

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

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

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

What Does This Actually Mean?

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

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

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

References

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

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

June 27, 2017

Why Be In Ketosis – Part XII (Thyroid)

There is a pattern that I’ve noticed on every live-stream that I’ve appeared on talking about ketosis that someone always asks the question: “What about the thyroid?” That’s literally how it’s asked. . . someone I am unfamiliar with keys in the question, “What about the thyroid?”

The blunt sarcastic response in my head is usually, “Well, what about it?”

Buried within the vague periscope or twitter question above is the real question that is on the minds of thousands of people, “Does ketosis effect the thyroid . . . ?”

There’s loads of information about the thyroid on the internet. Much of it is garbage. Seriously. Ask Google about “thyroid,” and you’ll see thousands of articles, posts and comments on WebMD, Women’s Health, and Wikipedia all across the “interwebby.” Everyone, and I mean everyone, seems to have a “thyroid opinion.” Much of the “wikopinion” out there is here-say, conjecture and anecdotal. It doesn’t really give people any foundational understanding of what their thyroid is doing, or more importantly for that matter – what their thyroid isn’t doing.

Of late, the Paleo and Vegetarian thought leaders seem to decry nutritional ketosis because they claim that this dietary approach suppresses thyroid function. This wiki-theory (yes, it is just a theory) was extrapolated from a single study where the T4 level dropped in the first few weeks after ketosis was entered. But just because T4 drops, doesn’t mean the diet suppresses the thyroid. Using T4 as a screening test alone for assessment of thyroid function is 1987 thinking (1987 brought us the Kia Concord and the Subaru Justy just so you get the mental picture). T4 fluctuates with a number of binding proteins and following this number alone is really bad medicine. Taking thyroid advise from the Paleo people is like asking your Fed Ex driver about the correct lift on your 4×4 truck. Really?

Excessive insulin, the hormone produced when you eat sugar, starch and some proteins, actually stimulates thyroid peroxidase antibodies and can cause exacerbation of thyroiditis (causing over-production or under-production of thyroid hormone). Because 85% of the people I see in my office over-produce insulin (this is referred to as insulin-resistance), in response to starches, there is a significant flux in thyroid function due to this pre-diabetes state (insulin over-production) on high carbohydrate based diets.

Leptin, the hormone produced by fats cells when they are “full,” actually stimulates the conversion of T4 to T3. At least 40% of my obese, insulin-resistant patients are also leptin-resistant, meaning they over-produce leptin as well. This has a suppression effect on T4 (by converting it to T3) and is the usual cause of the T4 levels being lower when initially staring a ketogenic diet. It is also the reason that some people feel anxious or “activated” when changing to nutritional ketosis. Leptin-resistance is driven by a high level of fructose in the diet and the presence of high triglycerides, inhibiting the leptin signal from crossing the blood-brain barrier. As a person follows a ketogenic diet and lifestyle, leptin returns to normal over 3-6 months and T4 levels normalize. The Paleo and Vegetarian nay-sayers never mention that . . . do they? What they won’t tell you is that calorie restriction, which is a must for weight loss, on the DASH, Mediterranean, Paleo or Vegetarian diet causes suppression of testosterone, leucine, and thyroid function, causing worsening T4 suppression over time. Hmmm . . . put that in your low-fat green vegetarian taco, and smoke it.

Wait . . . I don’t advocate smoking so, ignore that.

The point is, a ketogenic lifestyle stabilizes thyroid function and improves auto-immune thyroiditis. I’ve seen it happen clinically for over 12 years. It, also, dramatically helps stabilize the other 30 hormones involved with the diseases of civilization including obesity, insulin resistance and diabetes.

Watch my live-stream recording below to find out more about the thyroid.

January 2, 2017

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.

July 24, 2016

Is Your Oatmeal is Killing You?

“Doc, if I don’t get my testosterone up, I’m just going to die!”

I’ve been hearing that statement from men more and more often lately. And, the answer isn’t what you’d think.

If you’ve watched late night TV recently, you’ve probably seen the many advertisements for testosterone supplements for low testosterone in men or what is now being called “Low T” Syndrome. It seems like this is the new advertising trend so much that patient’s use the term “Low T” as part of their conversations.

Watch the four minute short below about how your testosterone and sense of fatigue is being driven by your oatmeal or breakfast cereal . . .

Is it that men have just stopped making testosterone? Suddenly, everyone’s testosterone is low and men are complaining about fatigue, libido, and erectile dysfunction . . . or are they?

It’s actually the oatmeal . . . and the breakfast cereals. Clinically, when a man cuts the cereals and oatmeal out of his diet, he actually increases testosterone by 50-150 points within 1-2 months.

If you practice medicine long enough, you’ll see a trend that seems to have arisen as our waistlines have expanded. About half of the men in my office with insulin resistance, pre-diabetes or diabetes have low testosterone levels. But this shouldn’t be a surprise. Type II diabetes, metabolic syndrome and insulin resistance are all driven by an over production in insulin in response to a carbohydrate load in the meal. Patients with these conditions produce between two to ten times the normal insulin in response to a starchy meal. A number of studies both in animal and human models demonstrate that insulin has a direct correlation on testosterone suppression in the blood. This has been demonstrated in both men and women. In fact, glucose intake has been shown to suppress testosterone and LH in healthy men by suppressing the gonadal hormone axis and more predominant testosterone suppression is seen in patient with insulin resistance or metabolic syndrome.

In fact, to put it simply, insulin increases the conversion (aromitization) of testosterone to estrogen in men (it does the opposite in women by interacting with the hormone FSH). Interestingly, leptin resistance has a similar effect. I tend to see the worst lowering of testosterone in men with both insulin and leptin resistance.

What that basically means is that your breakfast cereal or oatmeal decreases your ability to maintain testosterone by up to 50% (1), lowers your ability to stabilize muscle (2), increases your risk for heart attack and stroke and makes you fat!

Death by oatmeal . . . really?

Yes.

How to you improve your testosterone? Supplemental testosterone has been shown to help, but it comes with some risks, including prostate enlargement and stimulating growth of prostate cancer. The most natural way to improve your testosterone is to change your diet.

A low carbohydrate or ketogenic diet turns down the insulin production and allows the testosterone to be available for use by the body. A ketogenic diet has the effect of reducing leptin resistance as well through weight loss. A simple dietary change of this type is frequently seen in my office to increase testosterone by 100-150 points.

What is a ketogenic diet? It is a diet that restricts carbohydrates to less than 30 grams per day, thereby causing the body to use ketones as the primary fuel source. So, for breakfast tomorrow morning, hold the oatmeal (1/2 cup of Quaker Instant Oatmeal is 31 grams of carbohydrates) and have the bacon and eggs. And, rather than have the cheesecake for desert this evening, have an extra slice of steak butter on your rib-eye and hold the potato.

Or, you might consider using a high fat shake with exogenous ketones. This is my breakfast each morning:

Exogenous ketones mixed in sparkling water, 2 tablespoonfuls of coconut oil and my multi-vitamin and I’m usually full until after noon.

Either way, get rid of your breakfast cereals or oatmeal . . . it’s killing ya!

References:

May 12, 2016

KetoTalk From the Caribbean Sea

Dr. Nally recently spoke about Low-Carbohydrate/Ketogenic Diets on the 2016 Low Carb Cruise to the Eastern Caribbean. While there, he and Jimmy Moore recorded another episode of KetoTalk with Jimmy and the Doc.

Listen in to KetoTalk Episode 20: A LIVE Q&A Session From The 2016 Low-Carb Cruise

Here’s what Jimmy and Dr. Nally talked about in Episode 20:
– We are in front of a LIVE audience of Ketonians
– How long will you experience hair loss when you go ketogenic?
– What role does resistant starch have on the keto diet?
– Is eating high-fat with high-carb harming my boyfriend?
– How does intermittent fasting help with keto?
– Whether to count total vs. net carbohydrates
– Whether you need to cycle carbs when building muscle
– What the best way to test your ketones is
– How to test blood ketones on a budget
– What the difference is between an NMR and basic lipid panel
– The dramatic changes in your cholesterol when going keto
– How long should you be on keto before running blood tests?
– Whether you should cut fat lower on keto to speed up weight loss
– Is having a lower body temperature a bad thing when eating keto?

You can listen at the iTunes page here, or download it for free to your favorite iTunes player.