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

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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.

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“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

 

Men's Hearts Failing Them for Fear

I am always fascinate when religious or spiritual topics collide with medical evidences and/or disease.  I am convinced that “the natural man” has trouble recognizing that all things are spiritual unto God (1 Corinthians 2:14).  Unfortunately, training in medicine often attempts to “educate the spirituality out of you.”

However, this week,and in church today, I’ve been reading about “signs of the times.”  Of interest, and something that I’ve been pondering, is the statement made in Luke 21:25-26 where the Savior, Jesus Christ, specifically foretells the signs of His Second Coming. Among the perplexities and distress outlined, one statement stands out this week and has been the food of much thought, “Men’s hears failing them for fear,…” (Luke 21:26).

heart failure help

This food for thought is actually what directed me to this verse, as I’ve had a number of people express notable fear and worry over whether their diet is correct, because so much miss-information abounds in society today. Argument, stress and fear over diet, apparently, is not new and was something that even Paul noticed and wrote about in his Epistle to the Romans (Romans 14:1-3).

Stress and fear are two of the biggest hindrances to health and weight loss in my office.  The most common non-food cause of failing to maintain ketosis while living a ketogenic lifestyle is stress.   Stress is often due to fear.  Men, and women alike, become fearful because they seem to:

  1. Forget their Purpose
  2. Forget their Identity

When heartache arise from illness, injury, disability, death, divorce, wayward children and the other innumerable causes, stress and fear abound.  Worry about diet and health, in a time when so much contradictory advise is at our fingertips, adds to that fear.

I dont careWhen we forget our purpose and our identity, three symptoms arise both physically and spiritually:

  1. Apathy toward some or all parts of life (“It’s just going to change again so why even care . . ?”)
  2. A mental slumber due to temporal or carnal pacification (“I can just eat and/or drink my problems away”)
  3. Fear of change and the pain or effort it may take to make a change (“I don’t have the will-power to change anymore.”)

The scriptures call this “weak hands & feeble knees” (Isaiah 35:3), and we in medicine refer to this as dysthymia, the first step in progression toward chronic depression and/or anxiety.

These symptoms all increase chronic levels of cortisol and Ponderinginsulin.  Amplified “brain fog,” weight gain, and inflammation are physical responses to the mental fear that is chronically unresolved.  These symptoms just add to the apathy, mental slumber and fear of pain that was already present.

The problem is that over time, this progressive triad lead down the hormonal path to what we now call atherosclerosis, narrowing of the blood vessels, increasing the risk for heart attack, heart failure and stroke.   This was seen in Hippocrates day as “sudden death related to episodes of chest distress” (Leibowitz, 1970).  The Italian anatomist Giovanni Morgagni (1682-1771) described it in his day as “the force of the heart decreases so much more in proportion as the greater number of its parts becomes tendonous instead of being fleshy.”

SO, WHAT DOES ONE DO?

First, realize that the problems you are facing have been faced by millions of human beings and you are not alone.  But, to paraphrase Irene Dunne, if you don’t stand for something, you will fall for anything.

I no longer believe in coincidence.  Whether you have thought about it or not, every interaction you have with others (even our interaction . . . your reading this blog), are not by coincidence. There is a reason.  Whether you believe it or not, everything around us testifies that God exists; the Hand of Providence can be seen from the rotation of the earth, planets and stars, the precision of the seasons, the balance of the atmosphere allowing for the perfect pressures and concentration of elements to sustain a life giving breath, to the perfect replication of DNA within billions of cells throughout the body.

I’m not trying to get religious, and, no, I can’t prove this through the scientific method . . . But, that is just the point.  Hands are weak because of lack of faith.  Faith is the substance of things hoped for, the evidences of which are not yet seen.  Even though we do not see the evidences, we can discern the light and that gives hope.  Hope is a substance that gives purpose.  I can strengthen hands by sharing a little light and stabilize knees through friendship and fellowship (Romans 14:1).

If the Big Bang started the universe, what started the Big Bang?  Where did the first atom or molecule or particle of dust come from?  I have a very difficult time accepting that you and I are here by accident, by a chaotic explosion that created order.  That implies that there must be a plan, and that plan had to have been set in motion by a Creator.  You and I have a place in that plan.  That also implies that that Creator placed solutions to our challenges, including the diseases of civilization, within our grasp and available to those seeking the solutions upon the earth today.

PleasurePrincipleSecond, today’s society teaches the Pleasure Principle.  This is the human instinct to seek pleasure and avoid pain, including avoiding painful recollections.  We often define ourselves by those things that bring us pleasure.  We each go through personal tests, failures and triumphs. Some of us harness all of those experiences for good, others find worsening mental paralysis due to fear of them. We often hide from the painful experiences and attempt to bury or forget them.  Food is often involved with many of the experiences of life, and for a significant number of people, the endorphin release from eating a meal, sometimes just the act of chewing, may be the only pleasure one experience in a day, in a week or a in a year. Many people hide from painful recollections behind the simple pleasure produced by the eating of “comfort foods.”  Food, and our opportunities to experience pleasure from it’s various flavors, textures and physical stimulus, begin to define us.  However, hiding from life’s painful memories with momentary pleasures usually prolongs or makes the problem worse. The ingestion of simple foods containing glucose and fructose, their effect on the liver, and the hedonistic hormonal response is the basis of addiction, and simple carbohydrates provide the perfect fix.

Fascinatingly, when fructose is metabolized in the liver, in the presence of glucose (the basic structure of sugar – one fructose molecule bound to a glucose molecule), the byproduct has a hedonic (pleasure experiencing) effect on the exact same pleasure receptors in the brain that bind to morphine.   Yes, that’s why the M&M’s make you forget your troubles and why the Jolly Rancher is so jolly.  And, its the same reason you crave another do-nut two hours after you ate the entire baker’s dozen.

Healing can only occur when one is willing to confront and talk about the reasons, the real reasons you’d rather experience the endorphins from the do-nuts with your family instead of acknowledge your weakness, stresses, and fears.  Many of us are so afraid of where we might be, we avoid acknowledging where and who we are.  It takes courage not to take the easy path.  And I will be the first to admit, pizza is the easy path and it’s scenic views are decorated with french fry palms and sunset clouds of apple fritters.

Third, many cultures and most forms of religion or spirituality incorporate the use of fasting to one degree or another.  Why fasting?  Well, it removes the effect of the pleasure principle for starters.

Fasting is also a simple and inexpensive method of shifting the body’s metabolism to one of ketosis.  Spiritual, physical and mental clarity are more prominent in the ketotic state.  Finding your identity and purpose are often encouraged while fasting.  In fact, a whole chapter in the Old Testament’s Book of Isaiah is dedicated to the powerful effects of fasting and the ketogenic state it produces (Isaiah 58:3-12).

Your life is never without meaning. Keep it real by recognizing that diet alone may not compete your answer for physical health.  Having courage and faith allow you to see and embrace the truth that is right in front of you. The  Alcoholics Anonymous’ 12 step program only becomes successful when one realistically and courageously applies their faith to align with the truth they have felt all along.  For any long-term lifestyle change to take place, one must connect and live the principles before one truly knows they are true.  In this way the Ketogenic Lifestyle becomes real and men’s hearts are less likely to fail them.  You can start here: The Principle Based KetoDynamic Lifestyle.

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

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

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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

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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 for hypertension, 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 or hypertension 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.