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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.”


  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?


Why Be In Ketosis – Part XII (Thyroid)

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

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

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

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

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

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

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

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

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

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