A recent article in the January 9th edition of the Archives of Internal Medicine (1) found that post menopausal women had a 48% increased risk of getting diabetes if they used any of the STATIN type cholesterol medications. The Women's Health Initiative, an observational study of over 153,000 post menopausal women found this increased risk. This is a significant finding and a worrisome claim.
In a time when STATIN medications like Crestor, Lipitor, Zocor, and Pravachol are being used more frequently to decrease risk of coronary heart and vascular disease, this poses a significant risk and raises a number of questions. Is the increased risk actually due to the cholesterol lowering medication, or is the progression to diabetes a component of the patient's heart disease risk due to other genetic factors? Is the mechanism of action in these cholesterol medications contributing to diabetes risk or are these patients already in the progression to diabetes and cardiovascular changes were identified and treated prior to progression to diabetes.
What should you and I make of this data? Well, first, don't stop your cholesterol medication. Talk to your doctor about this study and your risk of diabetes. Second, realize that cardiovascular changes and elevation in cholesterol starts up to 20 years before diabetes is diagnosed in many patients with insulin resistance and metabolic syndrome. Third, further evaluation and research needs to be done and we shouldn't base our decisions on just one observational study.
More to come on this subject I'm sure . . .
Reference:
1. Culver AL, Ockene IS, Balasubramanian R, et al. Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative. Arch Intern Med. Published online 2012 Jan 9. doi:10.1001/archinternmed.2011.625
Musings of a family practitioner & medical bariatrician deep in the trenches of today's medicine.
Saturday, February 11, 2012
Monday, October 31, 2011
Meal Journal - Sunday
For breakfast, my favorite, sausage and eggs . . . over easy.
For lunch, a nice lettuce wedge salad with blue cheese dressing left over from yesterday's dinner. . .
A handful of roasted almonds was all I had time for at dinner.
Saturday, October 29, 2011
What's For Breakfast?
Many of my patient's ask me what I eat regularly. I thought that I would document my meals for a few weeks to give you ideas and include recipes when pertinent. Here was this mornings breakfast . . . and, Oh, was it tasty!
Friday, October 28, 2011
Wednesday, October 19, 2011
Wednesday, August 24, 2011
Saturday, July 30, 2011
The Skinny About Sweeteners
I am often asked about which sweeteners are safe and which ones can be effectively used to assist with weight loss and maintenance. It has been long in coming, but I finally put it all together in my article "The Skinny About Sweeteners". You can find it at The Arizona Bariatric Institute website under Recommended Links.
Wednesday, July 27, 2011
Integrated Blog with Website!
After struggling for a few weeks, I figured out how to integrate my blog into my bariatric website. Just a little reading about "iframes" solved the question and there it is.
The website is a work in progress. My hope is to help people successfully lose weight and give people an edge up on the dietary treatment of obesity.
Let me know what you think. I would love to make it a user friendly place for answers.
The website is a work in progress. My hope is to help people successfully lose weight and give people an edge up on the dietary treatment of obesity.
Let me know what you think. I would love to make it a user friendly place for answers.
Thursday, July 21, 2011
Thursday, July 7, 2011
Is Your Diet Soda Making You Fat?

After three months, the mice that were fed aspartame with a high fat diet had a notable increase in glucose levels but a decrease in insulin levels compared to those mice fed only a diet high in fat. These results imply that the aspartame stimulates a decline in pancreatic beta-cell function, the cells responsible for production of insulin. This may explain the sudden rise in diabetes we have seen over the last 40 years. Heavy intake of aspartame in humans potentially leads to diabetes. Increased glucose levels leads to increased need fro insulin and if the aspartame is suppressing the beta-cell function, this will cause overload of the pancreas, increased obesity, and eventually progression to diabetes.
Other studies commented on in the recent conference of the American Diabetes Association have shown that the use of diet soda in general increases thirst and sensation of hunger that stimulates overeating.
So, what can you and I do about it? Well, for starters. Don't order that diet pop with your meal. Second, increase your water intake. Most of us don't drink enough water anyway. You should be drinking at least eight 8oz glasses of water per day. Third, be careful with other low carbohydrate foods that are sweetened with aspartame (NutraSweet). Stay tuned for more information on sweeteners. Upcoming blog posts will contain the good, bad and ugly on specific sweeteners.
Until then, stay healthy!
Click here to register for Dr. Nally's free online weight loss mini-course.
Thursday, June 23, 2011
Age & Weight Gain
I was recently asked why it gets harder to lose weight as you get older. There are a number of reasons.
Why the Slowing of the Metabolism ?
First, it is commonly known in the medical community that your metabolism slows by about 5% every ten years after age 30. This occurs due to intracellular slowing of the mitochondria, the little powerhouses in each cell within your body. This leads to a significant decrease in the overall fuel you burn on a daily basis and leads to a decreased need for fuel intake over time. Interestingly, we frequently seem to increase our food intake over time and the sizes of our meals has become larger and larger over the past century.
With Aging We Burn Fewer Calories Each Day -
Second, the average person burns approximately 100 calories less per day for every ten years of age past thirty. That’s 36,500 calories less each year than in previous years when you and I were younger. The average American gains 1-3% of his or her body weight each year.
Shifting of Hormones -
Third, there is a hormone shift that occurs with aging as well. In men, and in some degree in women, testosterone commonly decreases. This lowering of testosterone leads to decreased stimulus for muscle mass and muscle gain. We see some natural wasting of muscle tissue as we age. The muscles are where most of the fuel is burned in the body and it is one of the main locations fat can be metabolized and burned as fuel. The less muscle you have, the less fat you burn.
Women also experience a decline in estrogen over time and recent studies show that a decrease in estrogen leads to an increase in retention of abdominal fat.
Decreased Activity -

How Do I Avoid This?
This is the age old question asked throughout the centuries and the answer to which many have sought for the fountain of youth. However, what we do know about slowing the slowing is this.
- Exercise increases the number of mitochondria in our muscles cells. A healthy well balanced diet will provide the body with adequate protein, amino acids, omega 3 & 6 fatty acids and the essential vitamins and minerals necessary to keep the metabolism operating at its best.
- A diet low in simple sugars and carbohydrates has been show to decrease free radicals and oxidative stress at the cellular level.
- Getting adequate sleep is another key. Sleep gives the body time to repair and restore damaged tissues. Following up with your doctor to check hormone levels may be needed. These hormones can often be modified by dietary changes or can be supplemented through medications.
- Drink adequate water. Many people’s metabolisms are slowed for the simple reason that they are frequently dehydrated. Your urine should be the color of tap water. If its any darker, you’re probably not drinking enough water.
- Eat frequent smaller meals 5-6 times per day. Eating a small meal every 3-4 hours helps your body not to feel like it is starving and it will be less likely to store fat.
Age will affect us all in the end, but we can age gracefully and slow the process if we apply the simple principles listed above.
Tuesday, May 10, 2011
Diet High in Saturated Fat Improves Heart Failure
Impaired contractile function of the heart is a hallmark of heart failure. A recent study published in the American Journal of Physiology revealed that a diet high in saturated fat actually improved the contractile effect of the heart muscle. This may be related to the effect of ketone as the primary source of fuel in place of glucose. Read more about this here.
Wednesday, April 27, 2011
Ketogenic Diet Reduces Diabetic Neuropathy
Very impressive kidney results were found in both Type I and Type II diabetic mice placed on a low carbohydrate ketogenic causing diet in just 8 weeks. The nephropathy (passage of protein through the kidneys) was completely reversed in all the mice. This is the first in what I suspect will be a series of articles showing that ketogenic diets have significant effect on reversal of age related and diabetic tissue damage. See the article here.
Wednesday, April 20, 2011
Never Give Up!
Failure should not mean defeat. Remember all good things require effort and patience and time. . .
Thursday, April 14, 2011
Thursday, April 7, 2011
Look, Dad, My Thumb Turned Green!

I have been following my own very low carbohydrate diet for the last 18 months. While discussing this lifestyle with my wife one evening, she commented to me about the significant amount of leafy greens that our family eats. She noted a significant chunk of change goes to Sprouts grocery store every week because of the changes in our family's diet. After talking about it, she located a book a few family members had previously mentioned on gardening and picked it up.
The book is "Square Foot Gardening" by Mel Bartholomew. We read it together. (I recommend reading something regularly with your wife and family. We either read or listen to an audio book as often as possible. It really is refreshing.) Mel Bartholomew does a wonderful job. He makes the process of gardening simple. For someone with limited time and limited space, this is an amazing approach to gardening.
I found myself standing in my yard looking over what is beginning to look like one of my father's gardens. He passed away a few years ago, but I felt as though he was standing there with his arm around me saying, "Well done, Adam. Well done."
Thanks, Mel.
Tuesday, April 5, 2011
Senate Nixes 1099 ACA Health Requirement . . .
April 5, 2011 — Following the lead of the House, the Senate today voted 87 to 12 to eliminate an onerous tax-reporting duty in the new healthcare reform law.
The repeal measure now goes to President Barack Obama, who has signaled that he will sign it . . .
Read the full report here on Medscape.
Bill Cosby's Take On Liberty
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Monday, March 14, 2011
The Infamous Stool Sample
Toward the end of a very rough day in the office, one of my patients tells me, "Doc, I have just one more complaint. . . ." When a patient phrases it like that I have learned to brace myself, 'cause it's usually chest pain, or something major they saved for the last minute. Today, however, this patient says, "I brought you a stool sample thinking you were going to need it."
Now, when a patient brings you a stool sample and reaches into their pocket to pull it out, you really begin to worry. He tells me he has been having trouble with his stools and thought he would bring me this sample to examine. He wanted a diagnosis right there on the spot. . .
So, I ask you, what's your diagnosis?
Thursday, March 3, 2011
Medical News: Marijuana Use Precedes Psychosis - in Psychiatry, General Psychiatry from MedPage Today
A recent German study reports that users of marijuana have twice the risk of developing subsequent psychosis than those who have never used marijuana. The study was completed over an 8.5 year period with close to 2,000 participants ages 14-24. Risk for psychosis increased to 20% of those using marijuana. Read a summary of the study here.
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