#CholesterolInKetosis #DocMuscles #KetonianKing #Cholesterol #LDL-C

The Ketogenic Cholesterol Quandry

“Won’t my cholesterol get worse and increase my risk of heart disease if I eat more fat?”

I get asked this question at least 3-4 times a day.  The answer is, “NO. Not if you cut out the sugar and starch.”

“But, wait?! What about my heart?  All that fat can’t be good for my heart?” they ask.

Cholesterol Defined

Let’s start with the contents of the standard cholesterol panel or “Lipid Panel.”

For the last 20-30 years the following labs have been looked at as the holy grail of heart disease risk:

  • Total Cholesterol
  • HDL (the measured number for “good” cholesterol)
  • LDL-C (the calculated number for “bad” cholesterol).
  • VLDL-C (the calculated number for very low density cholesterol)
  • Triglycerides

The first problem with this panel is that it makes you believe that there are four different forms of cholesterol.  NOT TRUE!

Actually, cholesterol is a steroid precursor that either makes up a part of the lipoprotein molecule or is transported with the triglycerides as a passenger.   The lipoproteins are just transporters made of lipid that are only slightly different from their passenger load (causing increased or decreased density).  The proteins that are contained within the wall of the lipoprotein transporter is what makes them different.  These lipoprotein particles can be thought of, simplistically as buses, carrying triglyceride passengers.  Here size does matter, and size determines the function of the molecule at that moment in time.

Cholesterol is Really Just a Triglyceride Bus

These buses, big and small, carry the passengers up and down the vascular system of the body.  Glucose can float freely through the blood stream, but the other form of fuel, triglyceride, must be transported via the “lipoprotein bus”.  The triglyceride and cholesterol are actually the passengers inside the bus.   But triglyceride presence in the system seems to change the density of the lipoproteins.  So now picture big, medium and small buses . . . the high density lipoprotein (HDL), intermediate density lipoprotein (IDL) and the low density lipoprotein (LDL) buses.

#Choleserol #Ketosis #KetonianKing #DocMuscles

Triglyceride Changes the Density of Cholesterol

The density of the bus gets lower as triglyceride levels rise and fewer cholesterol esters and proteins are bound.  As HDL goes up, LDL-C goes down (Parker TS et al, Proc Natl Acad Sci USA, Feb 1986)

The second problem is the VLDL-C and LDL-C are actually calculated numbers and don’t actually reflect the true presence of the lipoprotein particles as the triglyceride number rises. For the accountants, mathematicians and engineers reading this that calculation is called the Friedwald Equation and is as follows:

  • LDL-C mmol/L = [Tot Cholesterol (mmol/L)] – [HDL-C (mmol/L)] – [TG (mmol/L) / 2.2]
  • LDL-C mg/dL = [Tot Cholesterol (mg/dL)] – [HDL-C (mg/dL)] – [TG (mg/dL) / 5]
  • VLDL-C = [TG / 5] as a calculated estimate
    • This equation falls apart when the triglyceride level is greater than 400 mg/dL (4.52 mmol/L) or patients with hyperinsulinemia.

Total Cholesterol is the sum of the HDL, LDL, as well as intermediate density lipoprotein (IDL) & very low density lipoprotein (VLDL) which aren’t reported in the “Lipid Panel” above.  So, total cholesterol is basically the sum of all the buses you have driving around.

The third key piece of information that the Lipid Panel above doesn’t tell you is the lipoprotein categories (HDL, LDL, IDL, and VLDL) are actually have three to four sub-types or sub-particles that are further differentiated by weight and size.

#DocMuscles #KetonianKing #BerkleyHeartLabs #CholesterolSubParticles
Image Credit: Berkley Heart Labs, Inc.

Improvement in cardiovascular risk, including improvement in cholesterol, inflammation and plaque formation have been the case with every patient I have used a high fat, low carbohydrate (ketogenic) dietary approach with over the last 12 years.

I’ve had so many people ask me how this works, and then, how to explain the changes to their primary doctors or cardiologist, I decided to write the following article.  My intent is not to point the finger where others are wrong; but to identify how we, myself included, took a misstep along the path of scientific discovery.  This misstep led to guidelines that, for over 45 years, have been accepted by medical students and clinicians as the “gospel truth.”

History of Cholesterol Measurement

The measurement of cholesterol, specifically total cholesterol, started in the 1950’s. There appeared to be a mild correlation of heart disease in countries who’s diets had higher fat intake. Ansel Key’s identified this apparent correlation in his Diet-Heart Hypothesis published in JAMA in 1957.  He stated from his observational work that “the results of a fatty diet are hypercholesterolemia [elevated cholesterol].” A number of studies at the time showed that increasing fat intake in the standard diet increased total cholesterol; however, NO LINK to heart disease was ever proven (Ahrens EH, Jr, Lancet, May 1985).

Studies published by E. H. Ahrens, Jr.  demonstrated that the cholesterol increased because of carbohydrate intake, not fat alone (Ahrens EH Jr, et al., Trans Assoc Am Physicians, 1961).  The actual question, “Does increasing fat alone cause heart disease?” was never answered. The question, as well as known evidence based cholesterol reducing dietary approaches, were ignored in 1984 by the National Institutes of Health (NIH) Consensus Development Conference on Lowering Cholesterol to Prevent Heart Disease that was based heavily on epidemiological data rather than clinical reproducible science (Ahrens EH, Jr, Lancet May 1985).

Despite significant scientific evidence refuting the Diet-Heart Hypothesis, the 1984 NIH decision reflected politics and massive publicity campaigns.

Stop Demonizing My Eggs!

Since 1984, fat and cholesterol containing foods are treated like witches of Salem.  As an example, eggs, specifically the egg yolk.  (To this day, the chef at every breakfast bar I’ve ever visited asks if I want an egg white only omelet.)  Interestingly, there is actually no scientific data association between whole egg consumption and heart disease.  The science simply does not exist. Seriously, check for yourself.

#BaconEggs #DocMuscles #KetonianKing

You can’t extrapolate mortality risk based on a single small study that doesn’t actually identify correlation or causation.  But the AHA did exactly that in 1961, and they are trying to do it again today.   The MR-FIT study, largest study ever completed, is incessantly quoted as the study that demonstrates reduction in cholesterol leads to reduction in cardiovascular disease, but this trial was actually a failure and did not demonstrate improved risk by lowering cholesterol.  In fact, the Director of the study, Dr. William Castelli actually stated, “. . . the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol…”

“We found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories weighed the least, and were the most physically active,” he said.

Diet-Heart Hypothesis Doesn’t Explain the French Paradox

To add to cholesterol confusion, the Diet-Heart Hypothesis does not explain the “European or French Paradox.”  The French prefer cooking in butter instead of vegetable oil.  In fact, the French eat 40% fat in their diet. And, more than 15% of that is saturated fat.

#FrenchParadox #DocMuscles #KetonianKing
The French Paradox

Interestingly, the French and those that eat the most cheese, butter and whole eggs have the lowest rate of coronary vessel calcification and heart disease.  Attempts to explain this away as epidemiological error or diet complexities have been published, but still never answers the underlying question, “Does increasing fat alone cause heart disease?” (Ferrieres J, Heart, Jan 2004).

According to the Diet-Heart Hypothesis, people with familial hypercholesterolemia should have much shorter lifespans and are at increased risk of early mortality or death.  However, there is actually no scientific evidence of this.  In fact, the Honolulu Heart Program study revealed that people with low cholesterol are the ones at significant risk of early mortality or death (Schwartz I, et al., Lancet 2001 Aug). Additionally, higher LDL-C is actually predictive of longer life and has been demonstrated to correlate with longevity (Ravnskov U et al., BMJ Open, 2016 Jun 12;6(6): e010401).

Saturated Fat Isn’t Bad

I hate to burst your bubble, but saturated fat is NOT linked to vascular disease, diabetes or increased mortality (de Souza RJ et al., BMJ 2015,351:h3978).

It is commonly understood that LDL-C will rise as you eat more saturated fat.  This is normal on a ketogenic diet. It has been reported in the scientific literature for over twenty years. It is to be expected, because LDL-C is really a measurement of three different LDL sub-particles (“big fluffy, medium, and small dense”).  Increased saturated fat intake, while at the same time lowering carbohydrate intake, actually causes a shift in these low density particles to a bigger “fluffier” particle conformation (Griffin BA et al., Clin Sci (Lond), 1999 Sep).  We know that the small dense LDL particles are the atherogenic / inflammatory particles participating in the formation of vascular disease and directly correlate with triglyceride levels. We also know the big “fluffy” LDL particles actually reduce the risk of vascular disease  (Griffin BA et al., Clin Sci (Lond), 1999 Sep).

#CholesterolParticleSize #KetonianKing #DocMuscles

Why Do Physicians Still Prescribe STATIN Medications?

So why have clinicians been pushing the use of STATIN medications to reduce risk of coronary heart disease?  It started with the Lipid Research Clinics Coronary Primary Prevention Trial (LRC-CPPT).  This was a study of over 3800 men treated with cholestyramine, a cholesterol lowering medication (JAMA, 1984 Jan. 20;251(3):351-64.).  There was a very slight “absolute reduction” in coronary heart disease risk, 1.6% to be exact.  LDL-C decreased, but there was no reduction in the risk of death.   In fact, there was actually an increase in risk of all cause mortality in the cholestyramine group which was never emphasized.

Overall, cholestyramine reduced non-fatal heart attacks in 60 of the 3,806 men.  In other words, one in 63 men improved with the use of this medication . . . not very impressive.  However, statistics look more impressive expressed in terms of “relative risk.”  Relative risk is the percent increase of those with no treatment from those with treatment.  This is always a bigger number.

When the LRC-CPPT researchers calculated relative risk, the percent change between the treated and non-treated was 19%.  This bigger number was reported as the “risk reduction.”  For those that don’t know the difference between actual risk and relative risk, 19% sounds very impressive! (JAMA. 1984 Jan 20;251(3):351-64.)

False Evidence Emphasized By Relative Risk

This relative risk reduction drove the STATIN era we are well aware of today.  Lipitor (atorvastatin) reduces heart disease risk by only 1%.  However, when you use the term “relative risk reduction,” it has more psychological effect. Relative risk of 36% sells more drugs.

Crestor (rosuvastatin) was show to have an absolute risk reduction in heart disease by 1.2%.  When run through the relative risk reduction statistic it has a claim of 44% relative risk reduction.

These big numbers emphasized false evidences in many clinician’s minds that reducing LDL-C must be really effectively reducing heart disease.

Knowing that the LDL-C doesn’t really give you a clear idea of heart disease risk.  It becomes essential to know which type of LDL lipoprotein particle is the atherogenic or heart disease causing particle. Research now points to the small-dense LDL particle as the atherogenic molecule (Hoogeveen RC et al., Arterioscler Thoromb Vasc Biol, 2014 May; Ivanova EA et al., Oxidative Med Cell Longevity, 2017 Apr).  Studies have identified that elevated small-dense LDL cholesterol correlates much more closely with risk for inflammation, heart disease and vascular disease (Williams PT, et al. Atherosclerosis. 2014 April; 233(2): 713-720.)

A Better Marker for Heart Disease Risk?

Recent research demonstrates that small dense LDL cholesterol is a better marker for prediction of cardiovascular disease than total LDL-C (Hoogeveen RC et al., Arterioscler Thromb Vasc Biol. May 2014, 34(5): 1069-1077l; Ivanova EA et al., Oxidative Med Cell Longev. 2017).

The 2015 British Medical Journal, referenced above, analyzed the relevant 19 peer reviewed medical articles that included over 68,000 participants.  This review showed that there is no association of high LDL-C with mortality (meaning that an elevated LDL-C does not lead to an increased risk of death from heart or vascular disease).

In stark opposition to the landmark evidences above, the American Heart Association’s Presidential Advisory published their position in the June 20, 2017 issue of Circulation.  I am well aware of their position.  They claim that saturated fat is the cause of increased LDL-C.  Further, they extrapolate that elevated LDL-C is associated with increase in cardiovascular disease death.  This boldfaced claim is based on one single small four-year (2009-2013) literature review completed by the World Health Organization.  It looked at very small studies lasting only 3-5 weeks and comprised in total only 2353 participants.  That’s not nearly long enough to see fully effective cholesterol changes.  And, none of the studies had any focus on carbohydrate intake, insulin levels or LDL sub-particle measurement (Mensink RP, Geneva: WHO Library Cataloguing-in-Publication Data, 2016).

Clinical Evidence Is Pointing to Ketogenic Lifestyles as a Key

In my office, I see up to 10% regression in carotid stenosis (blockage in the carotid arteries) each year when following a ketogenic dietary lifestyle.  Evidence points out that higher fat intake and lowering of carbohydrate intake has a regression effect on plaque and thickness of the arterial wall. (Shai I et al., Circulation, Mar 2010.) And, increased small dense LDL cholesterol correlates with thickening of the carotid arterial wall (Gentile M et al., Clinica Chimica Acta,Naples, Italy Division of Cardiology, Nov 2013, DOI: 10.1016 / j.cca.2013.08.010)

Based on the large body of evidence that sits before us today, the use of total cholesterol and LDL-C to determine vascular disease risk are obsolete and ineffective tools.  That’s why we focus on insulin, triglycerides and small dense LDL particles.

Are you worried about your cholesterol?

Is a ketogenic lifestyle right for you?

These are great questions that I hope I can answer.  Check out this month’s Kickstart program if you’re just getting started.  Or, click here to work with me individually on your ketogenic lifestyle and cholesterol.

 

 

8 Reasons You Can't Lose Fat #DocMuscles #KetonianKing DocMuscles.com

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 that they are unaware of that is keeping the spare tire inflated around the waist.  I’ve listed the eight most common reasons you can’t lose fat that are seen in my office.

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.

#DocMuscles #KetonianKing #WeaponOfMassDestructionIn 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. There is always a body builder that sends me a nasty message after I say this, but it is true. (I’ll keep an eye on my e-mail).

#EatMoreChicken #DocMuscles #KetonianKing #TooMuchProtein

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 (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.

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

#Snaccident #DocMuscles #KetonianKing #BaconBoy

To successfully lose fat on a ketogenic diet, 60-70% of your caloric intake should come from fat. Yes. You read that correctly.

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.  If your fat grams are slightly higher than 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 Drinking Tea

Black Tea #KetonianKing #DocMuslces #WeightLoss #KetosisI 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.

#FightOrFlight #DocMuscles #KetonianKing Bear Chasing ManOur 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 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 the addition of exogenous ketones.

Kickstart Ketosis over the Plateau

Is your fat loss on a plateau?  Knowing that these challenges plague people over the coming holidays, and, seeing people get hung up on these issues, I’ve created the Keto Kickstart program for the month of October.  This package provides 30 days of ketogenic essentials including vitamins, exogenous ketones and private interaction with me through the month of October to help you get over the plateau and breeze through the holidays.

Click on Kickstart to find out the details, join me next month and let me help you bridge the weight loss chasm!

References:

  1. Floyd J et al., Stimulation of Insulin Secretion by Amino Acids, Journal of Clinical Investigation. 1966. 45(9).
  2. Bryans JA et al., Effect of black tea on post-prandial glucose and insulin. Journal Am Coll Nutrition 2007, 25(5): 471-7.
  3. 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.
  4. Hosoda K et al., Anti-hyperglycemic effect of oolong tea on type II diabetes. Diabetes Care. Jun 2003. 26(6): 1714-1718.
  5. 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.
  6. 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.
  7. 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.
  8. 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
  9. 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.
  10. 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.
  11. Lafontan M et al., Control of lipolysis by natriuretic peptides and cyclic GMP. Trends in Endocrinology and Metabolism. 19(4): 130-137.
Fixing Habit-Loop Cycle of Weight Gain #DocMuscles #KetonianKing

Fixing the Habit-Loop of Obesity

(Fixing the habit-loop cycle of obesity is the third article in a series on habits relating to obesity and weight gain: Willpower & Self-Discipline and Habit-Loop Cycle of Obesity)

“I want you to increase your fat to 70-80% of your total food intake . . .” I stated, before I was cut off by a loud gasp, followed by a chortle.  The 300 lbs male sitting on the exam table in front of me looked at me with a very skeptical smirk.

“You want me to eat fat to lose weight?!” he said after catching his breath.  “You’re the first doctor who’s openly blown smoke up my a** . . . ,” chided the rotund 42 year old male shaking his index finger at me as we discussed weight loss treatments.

“Although that was standard medical treatment of the Royal Humane Society for drowning victims in 1774, . . . .” I responded.  “No. I’m actually trying to help you lose weight by shifting the hormone signal in your body with food.” I replied as I recalled that the medical thought of the time was that a tobacco enema dried out the insides , warmed the body and increased the heart rate of the drowning patient.  I informed my patient that the use of tobacco smoke enemas fell out of favor around  1811 when its use for drowning, typhoid, headache and stomach cramping was found to actually be cardio-toxic and ineffective.

Tobacco Smoke Enema DocMuscles #KetonianKing

“So, . . . blowing smoke into your rectum won’t help you lose weight, nor will it help you maintain ketosis.  In fact, it might actually kill you.”  I added with a smile.

Eating fat is, however, one of the keys to hormone manipulation used to fix the Habit-Loop Cycle of Obesity.  So, how do we fix or alter the habit-loop of obesity discussed in the last two blog posts?

Four Part Habit-Loop of Obesity

The habit-cycle cycle of obesity consists of four parts:

Habit-Loop of Obesity DocMuscles #KetonianKing Adam Nally @DocMuscles
Habit-loops can be identified by a routine that satisfies a craving
  1. Trigger
  2. Response
  3. Reward
  4. Hormone Response

In my last blog post, we discussed how the trigger and the response are driven by or focused on a craving that may or may not be consciously perceived.  We also learned that breaking this habit-loop cycle takes willpower we talked about in my first article, and willpower can fatigue.  It has a daily shelf-life.

Fixing habits and creating new powerful habits requires identifying the components of your individual habits.  That means, first, identify the routine that occurs in a habit you want to change.  We want to identify a habit that drives you to eat carbohydrates when you really rather wouldn’t.  You’ve tried to stop, but you struggle and when fatigued, ignore your previous thoughts and imbibe on cookies.

Identify the Routine

Weight gain, fat entering and staying in the fat cells, is stimulated by the production of insulin.  Many of us who are insulin resistant, produce 2-15 times the normal amount of insulin when we indulge in carbohydrates.  That’s the master hormone part of weight gain. There are 29 other hormones that play a role in weight gain, however, turning them all on or off is driven by the routine you follow in your daily habits.

In my journey to understand my weight challenges, I found a pattern that was causing my middle to grow.  After a long day at work and returning home to have dinner with the family, I would often sit down to work on my charts, billing codes, labs and dictation from that day.  (Thanks to the wonders of the Affordable Care Act, this immense amount of work added 3-5 hours of “home work” to my already 10 hour day at the office, only to be completed late in the evenings.)

Even though I enjoyed a late low-carb dinner with my family when I got home, I’d find myself getting hungry 2-3 hours later.  While working on charts and trying to “push through” the pile of work in front of me, I’d start getting “hungry” around 10 pm.  I would find myself rummaging through the fridge and freezer looking for something to eat.  The problem was that I would find myself eating things that I normally wouldn’t, and I’d even find myself finishing off the quart of ice-cream in the back of the freezer left over from a birthday.  No matter how much I tried to avoid this behavior, I would frequently cave to cravings between 10 pm and 1 am.  (Yes, I heard the gasps from the ketogenic blogosphere, but I’m human, too.)  I knew that if I, an obesity specialist, was having these challenges, you probably are, too.

So, how does one change this kind of behavior?  The solution is found in the habit-loop cycle.

I started drawing out the loop.  Trigger –> Go to kitchen fridge/freezer —> Reward.

What is the Trigger?

I had to ask myself some questions.  What is the Trigger or Cue?

Was it actually hunger? Boredom? Stress? Fatigue?

What is the Reward?

What was the reward? Was it actually food? Change of scenery?  A temporary distraction? Energy from the food?

So, I had to experiment with my reward to find out.  Rewards are powerful because they satisfy cravings.  However, you and I are often not aware or conscious of the craving that actually drives our behavior or routine.  As Charles Duhigg states, “Most cravings are hiding in plain site. . . They are obvious in retrospect, but incredibly hard to see when we are under their sway” (1).

To figure out which craving drives which reward, I had to run a few experiments on rewards.  I asked my wife to make extra fat bombs and some of her low-carb cheese cake to have in the fridge.

The next few evenings I recorded what happened.  When I felt the urge to get up and go eat, I ate a few fat bombs.  But that didn’t take away the craving.  I tried going out and walking around the back patio and petting the dogs for a bit.  I tried drinking something different instead of my routine water, Diet Dr. Pepper or exogenous ketones.  No matter what I did, some of the evenings I still found myself rummaging the back of the freezer for something sugary.

What Action Eliminated the Craving?

My point here was to see which of these activities took away the cravings.  I wrote down how I felt after each activity, as well as what happened after I’d cheat late at night with ice cream or chocolate.  Just the action of journaling how I felt, my thoughts, emotions or words that came to mind was the key.  After waiting for 15 minutes, I wrote down three words or phrases that came to mind.

I found myself journaling: “Sleepy,” “Anxious,” “Tired,” “Still Hungry”

I found that eating something I should be avoiding, like ice cream, chocolate, or sweets (Even in a low-carb home you can still find some of these things), caused me to feel short term euphoria, more relaxed and suddenly more tired.

The brain will record the scribbled words as recollections attached to emotions.  It is easier to see patterns if you will actually write it down with pen and paper.  The goal is to isolate what you are actually craving.  The words and emotions attached to those words will give you an idea about your cravings and the cue driving it.

Five Categories of Habitual Triggers

Scientists have shown that almost all habitual triggers fit into one of five categories:

  • Location
  • Time
  • Emotional State
  • Other People
  • Immediately Preceding Action

So, in trying to identify the cue driving me to the back of the freezer, I write down five things that happen the moment the urge hits (I’ve included some of my actual notes in bold from my experiment):

  • Where am I? – Sitting in front of my computer at my desk in my home office.
  • What time is it? – 11:32 pm
  • What is my emotional state? – Tired, anxious, and overwhelmed by the volume of work
  • Who else is around? – No, one.  Everyone else is in bed
  • What action preceded the urge? – I looked at the clock while finishing a patient’s chart

I repeated these notes and the repetitive pattern I identified was that it was late (between 10 pm – 1am) and I felt very tired and anxious.

Look at the Pattern

I realized that I wasn’t actually hungry.  I was exhausted, anxious & tired.  My willpower was gone for the day.  Eating the sugary food has always caused me to have a huge insulin surge and when that happened, I always got more sleepy.  When I ate the sugary food, I got more tired – tired enough that I would start falling asleep at my desk and end up going to bed.

I found that the craving was not for sugar at all, but for sleep.  The cue was not hunger or boredom, but for time of day coupled with the emotions of fatigue and stress.  The combination of time of day with these emotions were the trigger that would kick in a routine of rummaging through the pantry or freezer for something sweet, leading to an insulin response (hormone) driving me to bed.  This routine had has a negative aspect, it kicked me out of ketosis causing weight gain and further cravings for the next 72 hours.

Make a Plan

So, I wrote out my plan:  Go to bed at 10 pm.

I actually found that I could get up earlier, exercise and my ability to focus in the morning was much more crisp, alert and I was more effective at getting my charting and labs done in the morning and throughout the day.  I haven’t rummaged the pantry for the last month and I dropped the inch off my waist that had crept back over the last year.

Now, I realize that some habits are much more difficult to break.  I expect that, but hopefully this will be a starting point for you and I to begin looking at some of the hundreds of habit-loops that affect us for good or bad throughout the day.

Sometime New Habits are Required Before Bad Ones Can Be Broken

Your ability to break some of the stronger habits occurs when you set other good habits (2, 3). Habits like regular daily exercise increase the likely-hood of changing or breaking other bad habits.  People get better at regulating impulses and avoiding temptations when they strengthen willpower with habits like exercise. Research shows that simply establishing a habit of exercise actually increased peoples ability to drink less, smoke less, eat better, and learn more effectively (3).

The key to change is repetition of an activity, thought statement associated with physical or emotional feeling.  The repetitive action of exercise 3-6 times per week when willpower is strong increases the emotion of excitement, joy and happiness.  The combination of the repetitive action physically with the emotions experienced by the accomplishment actually strengthens willpower and allows for naturally identifying and changing the triggers and cravings of other habits (3, 4).  It takes at least 3-4 weeks for people to experience the effects of forming a new habit, so be patient with yourself.

Using Hormones and Your Journal to Bridge the Habit-Loop Cycle Faster

This is where journaling and fat come into the equation.  The ingestion of an increased amount of fat in the diet stimulates three hormones: GLP-1, Protein YY, and Oxyntomodulin.  These three hormones suppress hunger cravings by turning down the effects of hunger hormones in the hypothalamus.  When we use fat as a fuel and as a reward, we can change the cravings and the weight at the same time.

We now know that the use of hormone stimulus, emotion and repetition of an action allow for parallel learning about and expecting the reward in the basal ganglia.  The basal ganglia is the region of the brain that streamlines complex learning. It is the part of the brain that allows you back up a car, or riding a bike without deeply thinking about steering, pedaling and balancing.  Shifting the food type to predominantly fat and lowering the carbohydrates changes the hormones in the brain.  When we add journaling, by physically writing and recording our emotions, the basal ganglia learns about this reward system faster (5).

If you are ready to change your life, feel more energy, have improved concentration, better sleep and lose weight, I want to help.  I’ve created a 30 Day Keto Kickstart Challenge Program starting October 1st.   Click on Kickstart Challenge to join this exclusive group of Ketonians as we use the principles in these articles to successfully improve health, lose weight and feel more energy.

And, to answer your burning question, “No! Adding tobacco smoke rectally . . . doesn’t help the habit-loop cycle.”

References:

  1. Duhigg, Charles. The Power of Habit. Random House, New York. 2014. p. 290.
  2. Oaten M, Cheng K. Longitudinal Gains in Self-Regulation from Regular Physical Exercise. Journal of Health Psychology. 2006.; 11: p 717-733.
  3. Baumeister RP, Gailliot M, DeWall CN, Oaten M. Self-regulation and personality: How interventions increase regulatory success, and how depletion moderates the effects of traits on behavior. Journal of Personality2006; 74: p 1773–1801.
  4. Oaten M, Cheng K. “Improvements in Self-Control from Financial Monitoring,” Journal of Economic Psychology. 28 (2007): p 487-501.
  5. Brown J, et al., How the Basal Ganglia Use Parallel Excitatory and Inhibitory Learning Pathways to Selectively Respond to Unexpected Rewarding Cues. Journal of Neuroscience. 1999. Online OpenBU edition: https://open.bu.edu/bitstream/handle/2144/2228/99.011.pdf?sequence=1
Basal Ganglia Fat DocMuscles #KetonianKing Adam Nally

Habit-Loop Cycle of Weight Gain & Obesity

In my last blog post about willpower, I described habits being neural impulse channels in our brain stimulated by a cue following a path leading to the same outcome each and every time – without exerting much effort. Researchers call the formation of these impulse channels habit-loop cycles.  Much of the original obesity research of the 19th century was conducted by psychiatrists and psychologists recognizing that people had habitual eating patterns.  Because of this, gluttony became the perceived influence of obesity.  This underlying philosophy still permeates the obesity research, treatment and low-carb dietary world today.  Yet, over the last 15 years, I’ve found that the habit-loop cycle is tied to powerful hormone responses. These responses to very subtle and often unknown triggers or cues powerfully drive weight gain, obesity and struggles with willpower.   How does the habit-loop cycle effect you?  Before we can change these habit-loop cycles, we have to understand what they are, and how they were created.

It’s All About That Basal Ganglia

All About That Bass (All About That Basal Ganglia) DocMuscles #KetonianKing

Meghan Trainor tells us that “It’s all about that bass . .  .” However, it’s really all about that basal ganglia. Deep inside our brains, close to the brain stem, at the location where the brain meets the spinal cord, is a little “nub” of neurological tissue called the basal ganglia.  This little nubbin of tissues was identified by the really smart scientists at MIT in the 1990’s as the location where habits are formed and executed.  The brain is – to take a quote from my favorite ogre, Shrek – “like an onion – it has layers!”

The Brain Is Like an Onion

If you picture the outer layers of the brain tissue, those closest to the hair and scalp, you can create a mental image of where our most complex thoughts occur.  When you think up a new invention, create a new way to cook with bacon, laugh at a friend’s joke, or link two complex thoughts about how habits form, you are using these outer layers of the brain.

Brain is like and onion DocMuscles #KetonianKing Habit-Loop Cycle
Like an Onion – It Has Layers! (DreamWork’s Shrek, 2001)

However, our interest today is deeper . . . much, much deeper.  Deep within the center of the brain at the basal ganglia is the location where our automatic behavior originates.  Swallowing, breathing and the startle responses are housed in this little nubbin of brain tissue.  It is this area of the brain that learns to recall and record patterns of neurological thought and stimulating action. This part of the brain has the ability, like the water drops on the mound we discussed last week, to record neural pathways and tracks leading to reduced mental effort and habit.  The basal ganglia even has the ability to store habits while the rest of the brain is asleep.  It is in this location, the basal ganglia, where the habit-loop cycle occurs.

Habits Created by Chunking

The habit-loop cycle is the process where the brain converts a sequence of actions into an automatic routine.  The really smart guys at MIT call this “chunking,” and it is the root of habit formation.  There are hundreds of behavioral chunking activities that you and I rely upon every day.  Some of these are as simple as the process you use to squirt toothpaste on your toothbrush before brushing your teeth.  Others are more complex like getting dressed or making a lunch box for the kids.

The Habit-Loop Cycle in Your Car

A habit-loop cycle is performed by this little nubbin of tissue by millions of people every morning.  Take, for example, backing your car out of the garage.  When you first learned to do this, it required huge amounts of concentration – and for very good reason. You’re steering 3000-5000 lbs of steel between a 16 foot garage-door opening into oncoming traffic.  Basal Ganglia DocMuscles #KetonianKing Habit-Loop Cycle

Safely backing your car requires you to open the garage door, unlock the car, adjust the seat, insert the key into the ignition, turn it clockwise, move the rear-view mirror and the side mirrors to visualize any obstacles, put your foot on the brake, put the car into reverse, gently remove your foot from the brake, mentally estimate the distance between the garage and the street while keeping the wheels straight and looking over your shoulder, applying a slight pressure between the gas pedal and the brake, and in some cases, slapping your teenagers hand while they fiddle with the radio dial.

But think about it . . . did you actually put any thought into these actions this morning?  You and I probably did this once or twice today without any additional thought.  It happened because the basal ganglia took over and created a habit-loop out of it.  This routine, repeated hundreds of times, became a habit, requiring very little mental effort.

Your Basal Ganglia Makes You Fat

The habit-loop cycle occurs hundreds and maybe thousands of times throughout our day. It is the cycle that drives hundreds of our activities.  In fact, it is this same cycle, in combination with 30 different hormones, that drives our weight gain or weight loss.  Yes, I said it, your basal ganglia can make you fat.

Habits Make for a Smaller Brain

Your brain will try to turn any regular routine into a habit, because habits allow our minds to slow down and conserve effort, energy and fuel. The efficient brain allows us to stop thinking about basic behaviors like walking, breathing and eating. This effort-saving effect of the brain is a major advantage, otherwise our brains would be huge, requiring heads the size of watermelons, or even the size of a water tower, causing their own weather systems.  Your wife will thank you for an efficient brain that is smaller and requires less room. Can you imaging giving birth to a watermelon or a small Chevy?  (Did you notice the size of Shrek and the Donkey’s head? Just say’n . . . )

Habits Are The Root of Behavior

What all this leads to is this – habits, as much as memory and reason, are the root of our behavior.  We often don’t remember the experiences that create our habits. However, once they are created, they influence our action without our own realization. Charles Duhigg’s book, The Power of Habit is a great resource for further information on how habits drive our behavior.

The Habit-Loop of Obesity

So, how does all this affect obesity and weight gain?  Let’s, first, look at the habit-loop cycle.  Researcher, Larry Squire, documented the habit-loop through three decades of research.  He and others published numerous articles showing that habits have a cue or trigger that stimulates a routine.  The routine leads to an outcome or reward.  The reward usually satisfies a craving.  Cue-> Routine -> Reward.  What we learn through our studies in obesity is that the reward often stimulates a hormonal response of 1-30 different hormones in brain and body leading to repeat cues or triggers.  The cravings are hormonally driven.  I call it the Habit-Loop of Obesity.

Habit-Loop of Obesity DocMuscles #KetonianKing Adam Nally

 

The Craving is the Key

Human psychology and emotion is the key behind habit creation.  First, there must be a trigger or cue.  Second, the trigger is attached to  a previously experienced emotion or craving tied to the cue.  The key to habit formation is the craving.  The craving is what stimulates the physical routine to occur.  It is an emotion or craving that drives the brain to create the habit. Third, there must be a clearly defined outcome or reward that satisfy the emotion or the craving. The emotion or craving doesn’t have to be associated with hormones, however, in the relm of obesity, it is usually tied together.

I am all about making things easier.  Your brain does it. We all do it.   And, I’m all about trying to help you lose fat and get healthy more easily. Let food be your medicine, let medicine be your food. That’s my mantra and that is as easy and natural as it gets.  But, in our day and age, we don’t always have access to growing and raising our own food.  That’s why my second mantra is – better living through chemistry.  So, I created the KetoKart.  Over the last 15 years of medical practice, I’ve found products and supplements that aid in letting food be your medicine, changing triggers, modifying hormones, and help to satisfy cravings in a healthy way to make your decisions easier.  Go to the KetoKart, see which package works for you and order it.  You’ll thank me.

How do  we change our obesity habits?  Stay tuned for the third part in this series: Fixing the Habit-Loop of Obesity.

So, I want to know . . . which package did you choose?

 

Triggers #DocMuscles #KetonianKing Habits Self-Control Self-Discipline

Willpower & Self-Discipline in a Ketogenic Lifestyle

Hundreds of people come to my office each month desiring to lose weight.  Among the challenges they experience is the complaint that they lack willpower and/or self-discipline.  Many people feel they cannot lose weight because they don’t have the self-control to do so. However you define it, willpower, self-discipline, or self-control, is an elusive and mysterious thing.  Scientists have been trying to find out what willpower & self-discipline is and how to improve it since the early 1960’s. “If only I had more self-control,” people lament, “I could . . . lose weight, exercise regularly, eat right, avoid drugs and alcohol, save for retirement, enjoy more bacon, stop procrastinating, . . . . or even achieve the noble peace prize.”  A 2011 American Psychological Association study reveals that almost 30% of those interviewed felt that their lack of willpower was the greatest barrier to making a change in any of these areas.

Excellence Comes From Habit

DocMuscles #KetonianKing Excellence Act Habit ActionExcellence is not an act . . . it is a habit of repetitive action.  To understand willpower & self-discipline, you have to understand habit.  Habits emerge because the brain is constantly looking for ways to save effort or conserve energy.   Left to it’s own devises, your sub-conscious brain will attempt to take any routine and turn it into a habit.  Our brains do this to conserve mental effort and energy. This allows us to stop thinking about basic behaviors like walking and eating, so that we can devote mental fuel to doing important things like making spears, finding bacon, creating irrigation systems, building airplanes and, for some, designing video games.

The brain creates time saving patterns in it’s thought processes in a similar way to what happens when a few drops of water are dropped on the top of a mound of dirt.  As each drop hits the top of the mound, the water runs down the side where it finds the least resistance.  Each drop of water erodes a little channel down the side of the mound of dirt.  The more water drops you release, the deeper the channel is carved in the little hill, and after a while all the water runs down the same path over and over.   To get the water to run down the path, the water has to drop on to the top of the path. This starting point for thought is actually a “cue” or a “trigger.”  Once the water, or in our example the thought, hits the trigger point, it always follows the same path.  Always.

Habits are Repetitive Thought Channels

It takes great effort to turn the water out of the path.  This can be likened to our habits.  Habits are neural impulse channels in our brain that follow a path leading to the same outcome every time without much effort.  All that is necessary is to trigger the neural impulse.  The neural impulse follows the channel in the brain effortlessly causing a mental or physical routine to occur leading to a end point or reward.  Some researchers call this a “habit loop.”  Trigger-Routine-Reward.

What is Willpower?

Image

So what is willpower & self-discipline? It is the ability to resist the unproductive patterns of though and redirect the neural impulse that was triggered down the channel.  Redirecting this habit takes a great deal of mental energy.  The first studies on willpower like Walter Mischel’s famous study of Four Year Olds & Marshmallows gave the impression that willpower was a learned skill.

Henry P Liddon said, “What we do upon some great occasion will probably depend on what we already are; and what we are will be the result of previous years of self-discipline.”  This means that willpower or self-control can be learned or improved.   The more you repeat a task, the easier and less effort it takes to complete it.  Thus, excellence isn’t an act . . . it is a habit of repetitive action.

But, this doesn’t explain why one day you eat healthy, and the next day, when you are tired, you raid the freezer and down the entire quart of ice cream.  You may find that you exercise one day without any problem, but the following day you can’t seem to get yourself off the couch.  If exerting willpower to exercise were a skill, it wouldn’t be so difficult to do it everyday, once the skill is learned.  The problem with the self-discipline theory is that you don’t forget a skill overnight.

Willpower is Like a Muscle

More recently, Mark Muraven found that willpower is actually more like a muscle.   He wondered, as we did above, that if willpower was a skill, then why doesn’t it remain constant from day to day?

Muraven decided to conduct an experiment by placing a bowl of freshly baked chocolate chip cookies next to a bowl of radishes.  The room containing the bowls was a closet with a two-way mirror, a table, a wooden chair, a bell and a toaster oven.   Sixty-seven undergraduate students at Case Western were recruited and told to skip a meal.   One by one, the students filed in and sat in front of the two bowls.  They were told by a researcher that the experiment was about taste perception, which was untrue.   The experiment  was to force half the students to exert their willpower & self-discipline.

DocMuscles #KetonianKing #KetoCookies #ChocolateChipCookie

Half of the students were instructed to eat the cookies and ignore the radishes.  The other half were instructed to eat the radishes, but ignore the cookies. Muraven’s theory was that it was difficult, requiring mental energy and willpower, to ignore the cookies.   Ignoring radishes takes absolutely no energy when there is a full bowl of warm cookies overflowing with chocolate chips.

“Remember,” the researcher instructed, “you can only eat the food that has  been assigned to you.” Then the researcher left the room.

After five minutes, the cookie eaters were in heaven and the radish eaters were experiencing mental agony.

Researchers stated that one of the radish eaters went so far as to pick up a cookie, smell it longingly, and put it back in the bowl.  Another grabbed a few cookies, wolfed them down, and licked the chocolate off of his fingers.  Muraven estimated that after five minutes, the radish eaters willpower would have been fully taxed by eating a bitter vegetable and ignoring treats, where the cookie eaters hardly used any of their self-discipline.

The research then entered the room and asked them to “wait 15 minute for the sensory memory of the food that was eaten to fade.”  To pass the time they were each asked to complete a puzzle that looked fairly simple.  They were to trace a geometric shape without lifting the pencil from the page or going over the same line twice.  If you want to quit, the researcher left a bell to ring. The researcher then implied the puzzle wouldn’t take long.   In truth, the puzzle was impossible to solve.

The puzzle was the most important part of the experiment.   It took enormous willpower to keep working the puzzle. Particularly after each attempt failed.

What they found from behind the two-way mirror was that the cookie eaters with their reserve of will power and self-discipline worked the puzzle even after hitting road block after road block for over 30 minutes.

The radish eaters, with their already depleted willpower, muttered, showed immediate signs of frustration, and complained loudly to themselves.  A few of them even closed their eyes and put their heads on the desk.  One even snapped at the researcher when she walked back into the room.  On average the radish eaters lasted only eight minutes.  When asked how they felt, one complained that he was sick of such a dumb experiment.

Chocolate Chip Cookie Fatigue

By forcing the use of willpower & self-discipline to ignore cookies, it placed the radish eaters into a state of willingness to quit much faster.   More than 200 studies like this have been completed since this test was done.   All of them found the same conclusion – willpower is like a muscle.  It’s not just a skill.  Willpower fatigues.

This may explain why people, who succumb to extramarital affairs, are usually likely to start them late at night, after a long day of work.  It explains why good physicians make dumb mistakes after a long, very complicated task that requires intense focus.  It also points to reasons why people are more likely to lose control over their drinking or cheat on their ketogenic diet.

I meet and work with people every day who feel they have no willpower.  In actuality, will power and self-control are learned behaviors that develop over time, but are greatly effected by fatigue.  Anyone can have willpower, you just have to understand how willpower can be strengthened and what makes it weak.  

Willpower is More Important than IQ

2005 study showed that willpower & self-discipline was more important than IQ in academic successes.  This study also found that increased self-discipline lead to less binge eating, higher self-esteem, higher grade point averages, better relationship skills and less alcoholism. Fascinating isn’t it!?

Willpower strengthens with use, but has a daily “shelf-life.”   It is always greater or stronger in the first part of the day.  Willpower declines over the course of the day as you fatigue.

How Do You Improved the Self-Discipline Muscle?

First, you must establish and write down a reason or motivation for change.  In addition, that change must fulfill a clear goal. Just wanting to lose weight isn’t good enough.  You have to be motivated because of a consequence that arises from the obesity or overweight.  Just “losing weight” isn’t a clear goal.  You must set a (1) specific weight reduction goal. It has to be clearly written down with your (2) motivational reason. “I will lose (1) 30 pounds to prevent (2) diabetes,” is a great written goal.  Willpower or self-control cannot begin to form until these two steps occur. Writing the goal with these two specifics and re-reading the goal regularly is the essence of multiple drops of water running down the hill forming the channel.  This also creates a trigger by setting specifics about the goal.

Second, you must begin to monitor your behavior toward that goal.  When it comes to weight loss, I ask all of my patient’s to keep a diet journal.  In your journal, write down every thing you eat and drink.  This evening, write down your plan for tomorrow’s meals, then the next evening, you account to yourself for your success or failure by journaling on that same page what you actually ate and drank. Tomorrow evening, compare what you did, as you plan for tomorrow and journal why you were successful or why you were not successful.  It’s that last part that is so powerful, a short 3-5 minutes of self-introspection. Self-introspection is the key to behavioral change.  It is the key that allows a person to see their habits, and then make very small changes that break bad habits, solidify good habits and strengthen willpower.  This time of self-introspection is re-enforcing the desired channel of flow.

Third, willpower is developed and strengthened over time.  It is developed by being accountable to ones-self on very little things every single day.  But it MUST be written down. If I planned to eat bacon and eggs for breakfast and I didn’t, why?  When I look at my day, I may realize that I went to bed too late to get up early and cook bacon and eggs. So, instead, I ate a yogurt that was in the fridge. I am accountable to myself.  If I plan to eat bacon and eggs tomorrow, I must either go to bed earlier, prepare them the night before, or throw out the yogurt . . . so not to be a temptation again.  Planning re-enforces the triggers, and takes away the mental energy required to have self-discipline when you lack sleep, are feeling stress from waking up late, or running out of bacon in the fridge.  it also provides more willpower to be available for other decisions later in the day.   Pre-planning by writing down tomorrows tasks provides you strength for future willpower and eliminates fatigue when needing to make a large or small change tomorrow.

kid-musclesOver time, this self-introspection becomes easier and easier, to the point that you do it sub-consciously.  It is this sub-conscious self-introspection and change will be seen by others as self-control or willpower.  Just like exercising or strengthening a muscle, recording short goals and and accounting for them makes your self-discipline stronger.  The self-discipline muscle becomes more powerful. In time, you’ll be able to make a split second decisions about a piece of cake.  Strong willpower will be perceived by those around you. You’ll recognize that it’s just flexing your well rested self-discipline muscle.

Fourth, plan or attack the hardest decisions of your day, those things that require the greatest energy, in the morning when your fresh.  This allows you to have the strength to maintain willpower.  In the evening, when your willpower muscle is the weakest, have rescue foods available so you’re less likely to cheat. Pre-cooked bacon, pork rinds, guacamole, macadamia nuts (the highest in fat), rolled meats and hard cheeses are in my fridge and pantry for this reason. This is where fat bombs in the fridge at the end of a long day allow you to snack when you’re hungry at the time willpower is weakest.

A great way to pre-plan is to go to the KetoKart and order your pre-packaged 1, 3, or 6 month program that will provide you with the supplements necessary to stabilize insulin and ketones on a daily basis.  This is one decision you don’t have to try to make ahead of time.

So, my question for you is which KetoKart package did you choose and . . . where’s your diet journal?

(Stay tuned for the second part of this series: Fixing the Habit Loop Cycle.)