Quest for Life of Happiness #DocMuscles #KetonianKing #BaconBoy

Keto Happy – Do You Live A Life of Happiness?

Founded by the Secret Society of Happy People in 1999, August 8th was officially named the National Day of Happiness.  It was a day created to recognize and express happiness.  (I personally think it should involve the sharing of bacon, but some may disagree.)  Most people, whether they admit it or not, are searching for happiness.  (Most people are searching for bacon, too, . . . but that is for another article.)  We hope for happiness, we aim for happiness,  and we wish happiness upon our family, friends and neighbors at holidays and birthdays.  It appears to be a desired condition of the soul.

In medical school, we learn that the body is almost 80% water.  One of my professors intelligently quipped, “if you’re unhappy all day, that means you are essentially a cucumber with anxiety.”  For many people, happiness is really hard to find.  Money is hard to find . . . but, that’s because it gets wasted by people trying to find happiness

What exactly is happiness?  It is a transient condition or state of cheerfulness, contentment, satisfaction or pleasure.  Many people mistake meaningfulness as happiness.  Meaningfulness to one’s life is more enduring.  For example, suddenly having a wind-fall of cash may make you happy for the short term.  However, what you actually do with that cash over the next few days, months and years is what brings degrees of meaning to your life.

Basics of Happiness

Happiness is based upon your emotional & spiritual vision, and how living your life aligns with the principles you hold most valuable.  You can’t control all of the circumstances of your life. Things both good and challenging will happen to you that you never expected. However, you have control of your own happiness. You and I are the architects of it.

In working with a majority of patients who are over 65 years old, I have found that the older we get, the more we look back and realize that external circumstances don’t really matter or determine our happiness. We determine our happiness.

How do we increase our level of happiness?  There are 10 Simple Steps to Happiness:

1. Improving Health

As a doctor, I’m a huge advocate of improving your health which plays a dramatic role in happiness.  Losing as little as 10 lbs has been shown to improve energy, decrease your risk for major disease, improve sleep, improve sex life, and decrease inflammation.  Improvements in any of those areas will reduce stress and anxiety and increase happiness so you can imagine while improvements in ALL of these areas could dramatically change your life.

As an advocate of the ketogenic lifestyle, I’ve found that the majority of my patients are able to lose 5-15 lbs each month for the first three months using this approach.  They average 2-5 lbs pf weight reduction each month there-after while following a ketogenic approach over the long term.  Understanding that this is one of the long term keys to success in happiness I want to make sure you know that I’ve developed some custom strategies to help with this and will share them with you below.  This lifestyle decreases risk for diabetes by 75%, improves mental clarity, and slows the aging process. (Who wouldn’t want those side effects while eating bacon?)

2. Savor Daily Experience

BaconWrappedJalapeno #DocMuscles #KetonianKing
Bacon Wrapped Jalapenos

First, savor the daily experiences.  We live our lives at such a high speed, we often neglect to take time to enjoy the experiences around us.  A recent trip in down town Amarillo, Texas, brought me to the front doors of a restaurant that served cream-cheese & sausage stuffed, bacon wrapped, jalapenos (try saying that 5 times fast).  I had a bit of time and decided to try them.  It was the first time in 3-4 days that I actually had the chance to slow down and savor the place around me, the flavors of the food, and the atmosphere of the restaurant.

BaconWrappedJalapeno #DocMuscles #KetonianKing
Bacon Wrapped Jalapeno’s & Happiness

Just taking a bit of time to savor these things made this experience a very memorable and happy experience that I probably won’t soon forget.

Take 3-5 minutes today to just think about where you are.  Savor the smell of a rose, the color of the sky, the shape of the clouds or the sight of a bird. These sensory images can, and will, leave indelible memories and release dopamine and serotonin naturally in the brain.  Savoring the daily experiences of life can be part of the process of meditation we will talk about below.

3. Volunteer

Volunteer #DocMuscles #KetonianKing HappinessGet involved and volunteer in meaningful activities around your neighborhood, church & community.  Research shows that voluntarily giving of time increases happiness in the giver.  It also allows one to see, participate with and help those around you who may be less fortunate.  Volunteering your time and energy regularly increases your gratitude we will discuss further below.

4. Express Gratitude

Expressing gratitude daily has been shown to dramatically increase your sense of well-being and happiness.  Expressing gratitude requires awareness.  It requires you to take inventory of everything around you (something you will already be doing if you are savoring your daily experiences).  Gratitude can be expressed in a journal, through prayer & meditation, or directly to those around you.  However, expressing gratitude requires effort.Christ Leper #DocMuscles #KetonianKing

In the Judaeo-Christian view, expressing gratitude is actually a method of expressing faith.  The 17th chapter of Luke holds a biblical example of this concept. When the leper returned to express his thanks to Jesus Christ for being healed, he wasn’t told “Your gratitude made you whole.”  Christ told him, “Thy faith hath made thee whole.”  He implied that the act of expressing gratitude is a demonstration of faith, a necessary and essential process in human development.

5. Recognition of Personal Value

I’m not talking about your bank statement or personal financial statement.  I’m talking about recognizing the value of your soul.  The only successful non-medication based program to help people overcome addiction is the 12-Step Program through Alcoholics Anonymous.  The essential second step of the twelve is recognition that a power greater than ours is involved in our lives.  Whether, you believe in God or a greater universal power, recognition of your value is an essential perspective to gaining happiness.  This has been demonstrated thousands of times through the 12-Step Programs.

Often, the feeling we have of our personal worth is based on the love and interest we receive from those around us. Yet, this love is sometimes lacking. The love of men is often imperfect, incomplete, or selfish. What if you looked at yourself with the same benevolence, love, and confidence that God does? Imagine the impact it would have on your life to understand your eternal potential as God understands it. If you could view yourself through His eyes, what influence would that have on your life?  Recognition of this principle is essential to making any lasting change.

6. Become Who You Are

The celebrated Greek poet, Pindar, said, “Become who you are.”  Isn’t this a paradox?  How does one become who they already are?

Many of my and the younger generations grew up to the sounds and images of The Lion King. You probably remember the scene where Simba receives a visit from his father, Mufasa, the deceased king. After his father died, Simba fled from the kingdom because the guilt he felt about his father’s death. He wanted to escape his responsibility as heir to the throne.

Lion King #DocMuscles #KetonianKingHis father appears to him and warns him: “You have forgotten who you are and so have forgotten me. Look inside yourself, Simba. You are more than what you have become. You must take your place in the circle of life.” Then this invitation is repeated several times: “Remember who you are. … Remember who you are.

Simba, completely shaken by this experience, decides to accept his destiny. He confides in his friend, the shaman monkey, that it “looks like the winds are changing.”

The monkey replies, “Change is good.”

And Simba says: “But it’s not easy. I know what I have to do. But going back means I’ll have to face my past. I’ve been running from it for so long.”

“Where are you going?” the monkey asks him.

“I’m going back!” cries Simba.

(This is also a great movie because of the “bacon references:”)

Admit it. You smiled didn’t you!

7. Meditation

Meditation Grand Canyon #DocMuscles #KetonianKingMeditation and prayer have been shown to actually change areas of the brain that relate to stress management and mood regulation.  People who meditate regularly over long periods of time have better ability to find and maintain positive states like joy and compassion. Richard Davidson and his colleagues found that meditation increases brain activity in areas related to happiness as well.

8. Relationships

Happiness has been linked to quality relationships as well.  Robert Wallinger, psychiatrist at Harvard University, conducted a 75 year multi-generational study on happiness.  He found that the quality of the relationships was powerfully connected to happiness. Lonely people were less happy and had poorer health.  People with higher-quality relationship or social ties were the happiest.

However, it wasn’t just having a relationship, but having one with a stable and consistently caring person that made the difference. Having lots of acquaintances or being in a relationship with an unreliable or abusive partner did not make people happier.  Amazingly, listening (savoring shared experiences) and complimenting (expressing gratitude) improve the quality of relationships.  (Sharing your bacon improves relationships as well.)

9. Food

A number of studies have demonstrated that a ketogenic diet increases gamma-aminobutyric acid (GABA), a key neuro-hormone signaling satiety and pleasure, in the brain.  GABA increases sensations of happiness and euphoria.  (Yes, this is why eating bacon makes you and I happier.  It’s probably why the thought of bacon in the video above made you smile.)  Shifting into a ketogenic state at least periodically has the effect of increasing your sense of happiness throughout the day.   It is actually the ketone that does this.  Whether you get into ketosis through diet alone, or through the use of exogenous ketones, both methods are effective in aiding you in your quest for happiness.

10. Allow Others to Help

I know you are probably familiar with the term it is better to give than receive but did you know there is evidence to support the reverse is true too?  That happiness also comes from allowing others to help? Think about it. When you are helping others, especially when they appreciate it, you feel happiness or joy. Others experience those same feelings when they are able to help you. Think of a child that wants to make you a meal. No matter what it looks like when it gets to you, you smile and feel happy at the effort, the child smiles back proud at their success. There is happiness in giving and receiving. 


So today’s your chance to receive.  As a doctor, I find myself shying away from sharing this information with you directly because I never want anyone to feel like my efforts are about me. I’ve spent years learning and understanding the benefits of a Ketogenic lifestyle and spent additional years researching products that work and my local patients are experiencing tremendous results! A friend told me that not sharing this information with people directly was actually being selfish. (Ouch!) “When you know someone has a problem that you can solve, shouldn’t you share it and let them make their own decisions?”

Although that was painful to hear, it helped me commit to being more direct about how I can help all of you to feel better. If you are ready to change the way you feel and want to live a happier, healthier life, the time is NOW.  Put these 10 steps in action and enjoy the benefits of a KetoLifestyle. If you want to know more about what I do, keep reading my blog, join my weekly newsletter and watch me Live Stream every week on Facebook Live & Periscope giving you free tips and tricks to stay healthier. If you know you are ready for a change, and you want to see how I can help, check out the variety of Ketogenic programs I offer to help you find the Happiness inside You! Because we all love gifts and they make us Happy, in honor of #NationalHappinessDay, you should see a pop up here for something special!  ] Be sure to click here to go to the Keto Kart and cash in on better health!

However you decide to approach your day today, choose to be happy.  It really is up to you.

Cheesecake #DocMuscles #KetonianKing

Happy National Cheesecake Day!

Happy National Cheesecake Day!

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

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

“Yes.  So am I.”

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

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

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

Testosterone & Cheesecake

National Cheesecake Day makes me think of testosterone.

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

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

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

Manhood #DocMuscles #KetonianKing Cheesecake

When did this become acceptable?

MenThenMenNow #DocMuscles #KetonianKing Lack of Cheesecake

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

Female Brain Has A Testosterone Meter

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

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

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

Cheesecake and Men’s Muscles

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

Father and Child #DocMuscles #KetonianKing Cheesecake makes better fathers

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

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

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

“What?! No . . .” she responded.

“Oh, . . . never mind.”

Energy & Cheesecake

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

Health of Family Influenced By Father’s Health

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

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

Cheesecake Helps Rough-Housing

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

OldFasionedRoughHousing #DocMuscles #KetonianKing cheesecake

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

Intelligence From Cheesecake?

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

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

Overall Happiness from Cheesecake?

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

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

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

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

FatherSon #DocMuscles #KetonianKing cheesecake

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

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

Tiffini’s Low-Carb Cheesecake Recipe:


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) 


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.


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

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.


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?

Stimulation Lipolysis #DocMuscles #KetonianKing
Picture 1 – Four Key Pathways to Adipocyte Stimulation of Lipolysis


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.

#WhereIsBaconBoy #DocMuscles #KetonianKing

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.


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

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

National Day of the Cowboy – Why DocMuscles Wears A Cowboy Hat

Happy National Day of the Cowboy!  I love beef and a good cowboy hat as much as I love bacon.  And, the one thing that I think about when I cut into my ribeye steak is the cowboy that helped put it on my plate. Starting in 2005, National Day of the Cowboy is observed annually on the fourth Saturday in July.

The cowboy era and legends began after the Civil War in the heart of Texas and the southern states West of the Mississippi. Cattle were herded long before this time, but in Texas, they grew wild and unchecked. As the country grew, and populations moved West, the demand for beef (my favorite ketogenic food) in the Northern territories and Northwestern states increased.  Cowboys moved 5 million head of cattle  each year by cowboys pushing their herds on long Northward drives to where profits could be made selling the beef.

The draw of wealth and adventure, mixed with stories of a rough wilderness set on the backdrop of the Great Plains, gave way to the mythological image of the cowboy.  Where the dust settles out reveals the truth of the American cowboy and cowgirl. The life of a cowboy required a particular ability to live in a frontier world.  It required respect, loyalty and a willingness to work hard.

Former President Bush said of this day, “We celebrate the Cowboy as a symbol of the grand history of the American West. The Cowboy’s love of the land and love of the country are examples for all Americans.”


Celebrate with a cowboy you know and post on social media using #NationalDayOfTheCowboy. Enjoy a western novel or movie, attend a rodeo and embrace the cowboy way of life.  Or just pull out your cowboy hat and wear it, thinking about the men and women who tamed the West.

You can see how I observed this special day (Do you like my new hat?)

#NatonalDayofTheCowboy #KetonianKing Why does DocMuscles wear a cowboy hat?

Posted by Dr. Adam Nally on Saturday, July 22, 2017

The Cowboy Hat – Most Recognized Symbol of the West

The cowboy hat is a defining piece of attire that has carried over from the Old West.  Originally defined by J.B. Stetson in 1865, it is one article of clothing that has essentially remained unchanged.  It is a welcome addition to the Nally home as an essential part of our little ranch’s attire because of shade it provides in the hot Arizona sun, the fitted sweatband inside,  and the durability in the rain.

The durability and water-resistance of the original Stetson obtained additional publicity in 1912, when the battleship USS Maine was raised from Havana harbor, where it had sunk in 1898. A Stetson hat was found in the wreck, which had been submerged in seawater for 14 years. The hat had been exposed to ooze, mud, and plant growth. However, the hat was cleaned off, and appeared to be undamaged. (John B. Stetson Company. “Stetson Hats the World Over. The Story of 50 Years of Stetson Foreign Business.” 1927. Philadelphia, Pennsylvania)

Cowboy Hat Design

Ornamentation, like bows and buckles, are usually attached on the left side. This had a practical purpose. Because the majority of people are right-handed, in the absence of a wide brim, bows or feathers on the right side of the hat would interfere with the use of weapons and lassos.

Inside the cowboy hat you’ll find a small memorial bow to past hatters.  In the early 1900’s hatters developed brain damage from treating felt with mercury (which gave rise to the expression “Mad as a hatter“). “Early hatters used mercury in the making of their felt hats. Their bodies absorbed mercury, and after several years of making hats, the hatters developed violent and uncontrollable muscle twitching. The ignorance of the times caused people to attribute these seizure like convulsions to madness, not mercury.” The bow on the inside hatband at the rear of the hat often resembles a skull and crossbones.

Meaning of The Cowboy Hat Crease

Today’s cowboy hat has remained essentially unchanged in construction and design since the first Stetson creation. The cowboy hat quickly developed the capability, even in the early years, to identify its wearer as someone associated with the West.  “Within a decade the name “John B. Stetson” became synonymous with the word “hat” in every corner and culture West of the Mississippi.” The shape of the hat’s crown and brim were often modified by the wearer for fashion and to protect against weather by being softened in hot steam, shaped, and allowed to dry and cool. Felt tends to stay in the shape that it dries. Because of the ease of personalization, it was often possible to tell where a cowboy hat was from, right down to which ranch, simply by looking at the crease in the crown.

#DocMuscles Cowboy Hat Crease

The mystique of the “Wild West” was popularized by entertainers such as Buffalo Bill Cody and western movies starring actors such as Tom Mix, the Cowboy hat came to symbolize the American West.  John Wayne christened them “the hat that won the West”.  The “Boss of the Plains” design influenced various wide-brimmed hats worn by farmers and ranchers all over the United States.  Later designs were customized for law enforcement, military and motion pictures.

Murphy Elliot #DocMuscles Famous Cowboys
Murphy Elliot’s Sketches of Famous Cowboys and Their Hats
Life-Balance Myth #DocMuscles #KetonianKing

Don’t Cry When It’s Over, Smile Because It Happened

Sometimes We Have To Let Things Go

Sometimes we have to let things go.  Not because we want to, but because life changes and some responsibilities become too heavy to carry. Sometimes we have the strength to carry the weight. But, the work of carrying offsets our balance. Balancing objects can occur when the foundation is stable and boundaries are secure.  Balance is the act of putting an object in a steady state of motion so that it does not fall or shift out of balance. Instability is the opposite of balance. Frequent attention must be given to the motion of the object to maintain stability.  This applies to objects, responsibilities, actions and even health.  But, balance in life is a myth.

Think about the Chinese acrobat. She balances on one arm, . . . then slowly adds a plate that is spinning on a stick. Then another stick, and another plate . . . However, the plates don’t keep spinning on their own.  Even though the plates appear perfectly balanced, she must periodically spin them to maintain balance.

There comes a point where more than three or four plates is too much to manage. Many of us live our lives afraid to add a plate, and on the flip side, many of us try to spin too many plates. The stress of too little or too much interferes with relationships, sleep, health and sense of well-being.

Chinese Acrobat #DocMuscles

Life-Balance Is A Myth

Our lives consist of attempting to balance multiple “plates” in the form of responsibilities or activities around us.  Attention is taken from one activity and focused on another until that responsibility or activity is back in balance.  This is why balance in life is a myth.  We move from object to object, responsibility to responsibility.  None of those objects ever remains completely balanced at the same time.  As we focus on re-balancing one task, the others slow and begin to fall out of balance.  As a husband, father, physician, speaker, entrepreneur and son of God, I wear many hats. I’ve frequently felt like a lone fireman, running from fire to fire with a garden hose, attempting to reset the balance in my responsibilities and put out fires.  I know you do too. We’ve had these conversations in my office.

Life-balance is a myth I bought into. It was placed on sale by life’s “well meaning middle-managers” in school and business. I kept thinking that at some point I could attain a perfect balance in all of my care-giving, parenting and relationship activities. Recognizing this myth has helped me make some very important decisions.

Learn To Say “NO”

I am a recovering “nice guy” and part of the “nice guy syndrome” involves understanding the myth of life-balance. Learning to say “no” is not easy.  I am learning to set boundaries. I am learning to stabilize foundations.  As a healer, I have an innate desire to help everyone, literally everyone.  This desire to help frequently comes at the detriment of family and those close to me.  The work of healing is seen as a “noble calling” in our society.  Because of this, I justified the need to help everyone with large amounts of time at my own expense.  I’ve spend hundreds of hours answering questions about health and weight at the expense and burden of myself and my family.  Saying “No,” even when an activity offsets needed balance is not easy for some of us.

Good, Better & Best

Part of that boundary setting is looking at those things that are “good, better and best.”  It requires looking at the objects, responsibilities and warming fires around us and deciding which ones are good, which ones are better and which ones are best. Balancing some objects and responsibilities are good, but may actually be taking time away from some of the better or best things we could be doing.  As we consider various choices in our lives, we need to remember that it is not enough that something is good. Other choices are better, and still others are best. Even though a particular choice may be more costly, the much greater value may make it the best choice of all.  I’ve had to sit down with myself and my family, and make some challenging decisions.

I am learning to set boundaries.  Looking at what is most important in my life at this time isn’t easy.  However, it’s been made loud and clear to me that we must be able to forgo “good things” to do those things that are better or best.  In medical speak, continually fixing and fine tuning the thyroid hormones doesn’t help when leptin is out of balance.

How Many Psychological Carbs Are In Your Life?

Many of us must realize that many of the good things are “psychological carbohydrates.”  The carbs smell good . . . And they taste great.  But, forgoing the carbs brings the greatest return in areas of our lives that are most important. Those things that are better or best are more effective at strengthening our lives and those of our families.

Pick The Best Things In Your Life To Balance

One of those decisions is to leave  The choice to leave relates specifically to selecting the best things that allow me to focus my time, energy and skills on being a good husband, father, physician and entrepreneur.  I’m sure the rumors will surge, and cyberspace will fill with speculation.  The truth is that I still have a wonderful relationship with Jimmy Moore, that has not changed.  He and I are still great friends.  Leaving KetoTalk was a very difficult decision.  I will continue working with him on my upcoming book The KetoCure, and we will still be working together on the line of supplements.  Non-of that will change.  What will change is my focus on activities that bring the best value to my patients and my practice while at the same time bringing the greatest value to me and my family.

I love people. I love to help people. Working with thousands of amazing souls in this ketogenic journey, is an immense blessing.  Unless I am assasinated by a rogue high-velocity vegan cucumber, I’m not going anywhere. You can find me and work with me here at

How many plates are you spinning?  Do you need to let something go?  Is the good in your life keeping you from the better or the best?

So, don’t cry because it’s over, smile because it happened and we became great friends.