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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
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?


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.)

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.

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
Bacon Grease DocMuscles #KetonianKing

Bacon Grease – The Healthy Essential Oil

Bacon Grease Is the Healthy Oil

Is bacon grease really healthy? People in my office stress out about getting all the healthy fats and the right amino acids.  I am asked all the time, which protein powder they should be taking?  Do I prefer fish oil or krill oil?  My answer to this is simple.

“Bacon grease.”

Disbelief Bacon DocMuscles

I know, I can see it on your face now. . . the blank stare of disbelief.

Yes, I said “bacon grease.”

If you are following a low carbohydrate or ketogenic diet, bacon grease is your essential oil. Let me explain why:

Bacon Contains All The Essential Amino Acids

Bacon, and the grease it creates, contains all the essential amino acids.  Yes, even the coveted branched chain amino acids (BCAAs).  Go ahead, have 3-5 slices for breakfast, but keep the grease and re-use it to cook with.  Because your saving yourself from having to buy expensive protein powders and less tasty versions of these essential muscle building blocks.

Bacon Is A Great Source of Choline

Bacon grease is a great source of choline, an essential nutrient for stabilizing cell membranes and making the neurotransmitter acetylcholine.  Acetylcholine is one of the neurotransmitters absent in memory disorders and muscle disease.  Fascinatingly, choline helps in the prevention of fatty liver disease, a disease caused by the standard American diet that often progresses to non-alcoholic liver disease.

Choline has also been shown in a number of studies to help ward off Alzheimer’s Disease.

Bacon Grease Contains All The B-Vitamins

Bacon fat is a superb source of all of the necessary B vitamins.  It is also a superb source of Vitamin D, phosphorus, magnesium and iron.  In fact all of the fat soluble vitamins – any vitamin that sounds like a letter of the alphabet: A, B, C, D, etc.- are found in animal fat.

Veggies Bacon Superpower DocMuscles

Bacon Grease Suppresses Appetite

Long-Chain fatty acids are satiating.  Bacon grease is a great source of the longer chain fatty acids and has a wonderful effect on suppressing your appetite.  That’s why Dr. Nally talks about it so often.  Bacon is the duct tape of the culinary world, and acts to suppress the cravings for the pie that might arise 30-60 minutes later.

Bacon Brings Happiness

When have you ever felt a frown after eating bacon?  That’s my point . . . you just smiled when that thought crossed your mind.  Seriously, don’t deny it . . .

Put a piece of bacon in your mouth, and it doesn’t really matter who the president is, what Kim Kardashian recently posted, or that you’re late for work . . . seriously.  Bacon in your mouth reminds you how good life really is.  If I die while eating a plate of bacon, my life will be complete.

My wife fries eggs in bacon grease for breakfast when she cooks.  I tell you . . . it’s edible love.

Bacon Stimulates the Heart

Bacon grease also contains a significant amount of medium chain triglycerides (caproic, caprylic, capric, and lauric acids).  These medium chain triglycerides (MCTs) are all the rage in helping to maintain a ketogenic diet.  MCTs convert rapidly into ketones after absorption into the liver from the gut.  Rapid conversion of fat into ketones stimulate more effective contraction of the heart.  When the heart contracts more effectively, it releases atrial-naturitic peptide (ANP), that opens the “back door” in the fat cell allowing for more efficient fat burning and maintenance of ketosis.

Bacon Smells So Good

Many people us essential oils for the aromatic effect they produce on mood and anxiety.  Next time you cook bacon, check your mood.  Never has there been an aroma that is so inviting and calming.  Very few other aromas actually bring people to a dinner table.  And for you men out there, bacon grease improves your manhood.  Increased presence of ketones, and the appetite suppressing effect of bacon grease helps to stabilize testosterone and leucine.  This improves muscle development, enhances libedo, and prevents the progressive decline in testosterone leading to the “girly-man” status that occurs with so many men eating the standard American diet.

Let me leave you with one last question.  When is the last time you saw left-over bacon?

Exactly – the same time you saw leprechauns riding unicorns down your street after a rain storm.

So, cook that bacon . . . and save the grease.  Use it to cook your eggs or bake with it.  You’ll thank me later.