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Dietary Counseling Tantrums

I am a Family Practice Physician.  I spent eleven years of my life training to become a physician certified in Family Medicine.  But, I found this wasn’t enough.  I struggled to treat the “diseases of civilization” that arise from society, our Western diet and lifestyle.

I, also, specialize in dietary weight/obesity management and low-carbohydrate/ketogenic diets.  I actually spent an additional three years obtaining specialized training and board certification in this field.   When you add all the training and my years of experience in practice together, I’ve spent over 25 years perfecting this art of medicine.

Because of this training, I have been very blessed that people from all over the world travel to Surprise, Arizona, to see me for weight management, dietary advise, and counseling on the diseases of civilization.  I’ve been amazed that simple changes in diet halt and reverse obesity, arthritis, diabetes, cholesterol, high blood pressure, etc.  The list goes on and on …

But I find a disturbing mindset pervasive through the community and the nation:


After listening to an number of people get angry over this issue in the last few weeks, I began wondering to myself…

“Who ties your shoelaces for you?”

Podcast #32: Hereditary Angioedema, Lower Blood Ketones, Statins, Healthy Keto Lifestyle

Hereditary AngioEdema.jpg
Stomach Pain & Swelling with Hereditary Angio-Edema (HAE)

Listen to KetoTalk Podcast #32 where we talk about hereditary angio-edema, adequate ketone ranges, statin use while in ketosis and healthy keto questions.  You can listen in by going to KetoTalk.com or you can listen in on iTunes.


“About 40 percent of my older patient population who take statins while eating ketogenic experience some form of myalgia they didn’t have before. And there’s an amplified side effect profile: muscle ache, joint pain, generalized fatigue, liver enzyme elevation, and cloudy headed.” — Dr. Adam Nally


KetoTalk: Episode 27 -Mailbox Blitz, Low Energy, Headache, Stomach-Ache, Breast-Feeding While On Keto

Mailbox desert

Listen in today as Jimmy and Adam blaze through a bunch of listener questions in Episode 27 of KetoTalk with Jimmy and the Doc!


KEY QUOTE: “Children are born in ketosis, so ketones are perfect for babies. The level of fat in breast-milk is essential for them to maintain their health and their growth.” — Dr. Adam Nally

Here’s are the 12 questions Jimmy and Adam answered in this special Keto Talk Mailbox Blitz extended podcast today:

– Testimonial from someone who learned his lesson why it’s important to stay ketogenic all the time
– Three-decade study confirms saturated fats are bad for health
– Is increased testosterone from a ketogenic diet a bad thing for women?
– Why am I still struggling with low energy and low ketones after months of being in ketosis?
– Can being in nutritional ketosis above 1.0 mmol cause painful headaches?
– Do artificial sweeteners and stevia raise insulin?
– Is my ketogenic diet causing me to cramp up before and during my half marathon racing?
– Is MCT oil a better fat to use on a ketogenic diet than other fats like coconut oil, cream, or butter?
– Why do I have a constant stomachache while I’m on a ketogenic diet?
– Do you have to be in ketosis to burn fat?
– Does being in ketosis lead to daily spotting and extended periods?
– Are ketones in my baby’s breastmilk safe for her to consume? And why did my milk supply drop when I went keto?
– What is the impact of the supplement creatine on ketones, blood sugar, and insulin levels?
– Can I ease into ketosis as a way to avoid the dreaded “keto flu?”

KEY QUOTE: “If you’re not feeling energy after that adaptation period of 2-4 weeks at the very most, then you’re doing something wrong. Let that be your wakeup call to change something.” — Jimmy Moore


Listen in here at KetoTalk.com or you can download the episode for free on iTunes.

How Fat Lowers Your Blood Pressure

Hypertension (elevated blood pressure) is one of the triad symptoms of metabolic syndrome.  Most of the hypertension that I see clinically is driven by insulin resistance as Blood Pressure Surprisethe underlying cause.  I see this problem in a very large majority of the people in my office and I am seeing people younger and younger show up with continually increasing blood pressure.
In medical school, we were taught to treat “borderline” or “slightly elevated blood pressure,” through “lifestyle changes” which was another way of saying exercise, caloric restriction  & hold the salt.  But most physicians today will tell you that exercise, salt & caloric restriction doesn’t work.  When asked why the 34 year old male in my office suddenly has elevated blood pressure, the only explanation we had was it is a “genetic problem,” or “blood pressure naturally goes up as we get older,” or “you’ve been eating too much salt,” and they are started on blood pressure medication and sent on their way. But, as time went on, I found that I had to keep adding more and more blood pressure medication to control the continually rising blood pressure of the patients in my practice.

Most of these people will have a progressive elevation in blood pressure over time, and these blood pressure (anti-hypertensive) medications are/were continually raised until the person is on four or five different blood pressure pills at maximal doses.  Again, when questioned why, their genetics are blamed and that is the end of it.  Or is it?!Time Changes Everything

What shocked me was that when I took patients off of salt & caloric restriction, and placed them on low carbohydrate high fat diets (and yes, I gave them back their salt), their blood pressure normalized. I noticed that as their fasting insulin levels began to fall, their blood pressure began to return to normal.

What?!  Blood pressure rise is caused by insulin?!

Ummm . . . Yes!

I am a prime example.  During the first few years of my medical practice and reserve military service, we had routine vitals checkups. I was working out 3-5 days a week with weights and running 3-5 miles 2-3 times a week and restricting my calories to 1500 per day.  So, I thought I was in pretty good shape.  However, it was not uncommon for for the nurse to raise her eyebrows at my blood pressure readings in the 140-160 systolic and 85-98 range diastolic.  “Oh, it’s the lack of sleep last night,” or “it’s the caffeine I had this morning,” would be my excuse.  But I was making a lot of excuses, and in light of those excuses, my caloric restriction, exercise and salt restriction, I was also still gaining weight.

Nally 1998 Expanding Waist


By the 5th year of my medical practice, I weighed 60 lbs heavier than I do today and I struggled to keep my blood pressure under 150/95.  I was violating my own counsel . . . don’t trust a fat doctor for nutritional advise. (Or, was that advise from Dr.House?)

Nally 2016
A much slimmer, healthier and happier Dr. Nally (center) in 2016

After cutting out the carbohydrates (I’ve kept my carbohydrate intake < 20 grams per day), moderating my protein intake and eating all the fat I am hungry for each day, my recent physical examination at the beginning of June 2016 revealed my blood pressure at 112/64.  I don’t remember ever having blood pressure that low. And to be honest, I didn’t sleep well the night before my exam due to a number of middle of the night patient calls.

Loegolas Blood Pressure

When I first started treating the insulin resistance problem in the human, rather than the blood pressure problem, I began to see immediate reductions in blood pressure within one to two weeks.  So much of a reduction that if I didn’t warn the patient that they should Himalayan Saltbegin to back down their blood pressure medications, they would experience symptoms of dizziness, light-headedness, headache and a few patient’s nearly passing out.   On a low-carbohydrate, high-fat (ketogenic) diet you need salt (sodium, potassium, & magnesium).
The process of burning fat as fuel causes you to lose increased amounts of sodium & potassium, and you have to replace these electrolytes.  A number of my patients begin a low-carbohydrate, high-fat diet and are afraid of increasing their salt intake.  Not replacing these electrolytes while on a ketogenic diet can also lead to low blood pressure, dehydrate and dizziness.


I often wondered why applying a ketogenic diet had such a profound effect on blood pressure so quickly.  Dr. Robert Lustig helped answer that question for me.

In order to understand how the Standard American Diet (we call it the SAD diet in my office) raises your blood pressure, it is important to understand how the body processes the basic sugar molecule.  Sugar is one glucose molecule bound to a fructose molecule.  This is broken down in the body and 20% of the glucose is metabolized in the liver, the other 80% is sent on to be used as fuel throughout the body. Fructose, however, is where the problems arise.  100% of the fructose is metabolized in the liver, and the by product of fructose metabolism is increasing the liver’s production of MORE glucose and the byproduct of uric acid. Uric acid is produced and this inhibits the production of nitric oxide. The diminished nitric oxide in the presence of an increased level of glucose (stimulating increased insulin production due to eating starches) constricts the blood vessels and raises blood pressure.   Yes, that donut you just ate raised your blood pressure for the next 12 hours. GetAdaptBars

The mechanism that fructose containing carbohydrates, sugars and starches raise blood pressure, cholesterol and cause weight gain can be seen in the really complex diagram found in Dr. Lustig’s 2010 article:

Metabolism of Fructose


So, how do you lower your blood pressure through diet?

First, cut out all the simple sugars. These include anything with table sugar, high fructose corn syrup and corn syrup.  (This is why people with any change in diet see some improvement in weight and blood pressure as they remove the simple sugars like candy, sugared drinks and pastries from their diet.)

Second, limit your overall intake of other sources of carbohydrates including any type of bread, rice, pasta, tortilla, potato, corn and carrots.  Realize that carbohydrate in fruit is fructose, and when taken with other forms of glucose can have the same effect as table sugar – it can and will raise your blood pressure, as well as halt or cause weight gain.

Third, if you are taking blood pressure medications, see your doctor about close monitoring of your blood pressure as it can and will drop within 2-4 weeks of making these dietary changes.

Maintaining ketosis is really important for weight loss and blood pressure control. I am very much an advocate of using real food for this process, but I have also found that the use of exogenous ketone salts aid significantly in maintaining ketosis.  I have found that exogenous ketones are the next step in bridging the difficulty of day to day maintenance of ketosis.

It isn’t making the mistakes that’s critical; it’s correcting them and getting on with the task that’s important.  If you’ve been calorie restricting and exercising to lower you blood pressure, don’t fret.  A simple change in your diet focused on restricting starches and carbohydrates has been demonstrated in my office to be more powerful than many of the blood pressure medications we’ve used for years.

You can find out how to get started on a low carbohydrate, high fat (ketogenic) diet in my recent articles  The Principle Based Ketogenic Lifestyle – Part I and Ketogenic Principles – Part II.

Two Most Common Elements in the Universe: Hydrogen & Moronium . . . Maybe, Not In That Order

Over the last few months, I’ve found myself amid the center of vehement nutritional arguments about fat, carbohydrates, calories and diet.  I have found it fascinating that very intelligent men and women, over the last 50 years, have accepted, without reservation, a dogma taught them by their eighth grade nutrition teachers.  This dogma is interlaced and interwoven throughout the textbooks, manuals, and college cafeterias throughout the world.

Low-carb is bad

Very few souls have questioned this dogma, and even in light of it’s utter failure to improve one’s health, it becomes the fall back point upon which millions have accepted nutritional disease and defeat.  It makes no sense that a dogma of this nature, without anything more than a scientific corellation in the 1960’s, could sway the minds of intelligent researchers, physicians and scholars for over 50 years.

It is a well known fact, however, that hydrogen is the most common element in the universe and is used as a basic building block for most molecular structures.  What many don’t realize is there exists another element yet to be added to the periodic table that is almost as prevalent called moronium (pending symbol approval  – Mu).  It fills the blank space on the table of elements between Hydrogen and Helium.   I, and those who have been able to identify this element, suspect that moronium is a gas at room temperature and has some affinity to binding the white matter of the brain responsible for catechol-O-methyltransferase (COMT) gene regulation of the prefrontal cortex.  It is suspected by some that when it is inhaled by a person of low intellect, it has only a mild effect. However, when combined with either oxygen (O), hydrogen (H) or Helium (He)  and inhaled by those of higher intelligence, it has a much wider, more potent and even stupefying diffusion effect, that is quite surprising to witness.


Moronium reacts adversely when diffused into blood with a higher alcohol concentration and seems to spontaneously combust when it is exposed to old paper and libraries. Moronium is very difficult and very expensive to isolate.  Moronium seems to be more prevalent during the summer and winter solstices, which may be why moronium intoxication seems to appear around holidays.  Recent attempts in a nearby lab to synthetically create even small crystals of moronium cause an explosion, physically and psychologically stupefying all of the researchers involved and inducing them to leave the study of science and pursue individual careers as drummers.

The presence of moronium seems to be higher in those that do not read, or have an aversion to reading.  There is some correlation that moronium drops in proportion to listening to iTunes podcasts, however, follow-up reading does appear to have a potential lowering affect on the moronium levels within the brain.

Why do I bring this up?

I suspect that this little known element may be responsible for intelligent men and women introducing questionable theoretical science as incontrovertible truth.  Those with suppressed COMT regulation seem to have a propensity to accept theoretical science because it sounds good,  even when there’s really no way to actually prove the theory at the time, or when colleagues have accepted the theory in a peer-pressure instead of peer-review situation.

The stupefying effect of moronium bound COMT produces dogma like:

The amazing thing about science is that it is self-correcting (at least it used to be). A scientist makes a set of observations about nature, and then identifies a plausible theory within the laws of nature to fit those observations. Then, researchers take that theory and test it in as many ways as possible, attempting to disprove the theory and isolate the cause of the observation.  If the theory withstands scrutiny it becomes widely accepted.

At any given point in the future, if contradicting evidence emerges, the original theory is discarded and a new theory is then identified.  In essence, this is the simple scientific method, however, in modern day application, it has become a great deal more messy than you’d think.

This approach (application of “the scientific method”) was skirted during the 1960’s and 1970’s regarding the “fat causes heart disease” theoretical proposition.  Interestingly, there was also a notable increase in the number drummers and musicians during the 1980’s Hair Bands era.   This begs the questions, which I wholly agree needs further study: Does moronium exist? and . . . . Did levels of moronium actually increase between 1960 and 1990 causing a surge in the presence and popularity of Hair Bands?


It only took us 20 years to get past the Era of the HairBands, hopefully we can turn the nutritional ship around and recognize the real culprit causing the Diseases of Civilization.



Ketosis in 60 minutes . . .


The Multi-Vitamin Dr. Nally Personally Uses

(Author’s Note: For those who may possibly be under the influence of moronium toxicity, the post above is written in sarcastic jest, and to be clear, there IS NOT an element currently under investigation called moronium!)