Saturday, July 21, 2012

You Know You're Married to A Homeschooler When . . .

We've been homeschooling our kids for the last two years . . . well, let me clarify . . . my wife has been homeschooling our kids with the occasional help I can give her.  (She's my hero because of this, by the way).  
You know you're married to a homeschooling mom when:

  • The only time your wife looks refreshed is during the summer and at Christmas.
  • Your wife's eyes light up when you say Homeschooling Curriculum Conference
  • You give your wife a love note and . . . she grades it.
  • Your wife gets misty eyed when a school bus drives by.
  • Your wife prays nightly for the return of the Lord before school starts tomorrow.
  • Your wife scolds in her sleep.
  • You've eaten cereal for dinner at least once this week.
  • The first place you look for your wife when you come home from work is in the closet.
  • Your wife will only talk to you if you raise your hand.


Homeschooling is a tough job. . . I think it is one of the toughest jobs on the earth.
Thanks, dear.


Friday, June 29, 2012

What the ACA (Affordable Care Act) Means to Me

Yesterday morning I read the Michigan Osteopathic Association (MOA) and the American Osteopathic Association (AOA) statement's on the SCOTUS decision and got nauseated.

I was not surprised when I read that the American Medical Association is a comfortable socialist bed partner with the White House, we have had evidence of this for the last four years. But, I was notably surprised that the American Academy of Family Practioners joined them as the dirty mistress with their recent positive support.

However, I was physically nauseated when I read that the American Association of Colleges of Osteopathic Medicine "applauded the decision," that same SCOTUS decision that the AOA and the MOA took a position of quiet neutrality.  

To them all I say, "All that is necessary for the triumph of evil is that good men do nothing."  Doing nothing . . . that I what I see many of the medical society and organizations, including the AOA, doing. Doing nothing with quiet neutrality.  

They say, this is a "sticky" issue and there are strong feelings on both sides, and we have to approach this delicately. If I recall, similar words were issued when the Titanic sunk!

I cannot support the statement by the AOA that the passage of the Affordable Care Act demonstrates "significant strides have been made" to improve access and quality. 

This act has already priced at least 100 of my senior patient's out of insurance by causing an increase in their premiums by 100-500%, has made obtaining their current medications more difficult, and will likely make it impossible for me, a small business owner, to provide adequate insurance for my staff of 14 people as premiums continue to rise.  If I don't provide insurance for them, then I will be taxed out of business in 2014.

This is the largest tax increase in American history with twenty new taxes on each of us individually found within this bill.  It also brings 159 bureaucracies, 47 new governmental agencies, and adds 16,500 new IRS agents. This bill now makes the IRS the most powerful arm of the government.

I am appalled that the AOA and the MOA would release a statement that their position is one of neutrality. Do they not actively practice in the trenches and see what this bill is already doing to the good people, small or solo practice physician and seniors of these United States?

Because of this bill, I have already had a pay cut of 1.5% on Medicare reimbursement and will most likely receive another 1.5% on July 1st because the Medicare electronic prescribing submissions were "not qualified" according to Medicare and I can do nothing about it.

The decision that this bill is constitutional was NOT an overwhelming majority, it was split 50/50 and passed only because our senior Supreme Court Justice lost his spine.  This only accelerates the destruction of health care as we know it and will push our system to a single payer system within the next 3 years.

This mandate does not fix the SGR, medical liability reform, or adoption of improved clinical communications.  In fact, it appears to have made them worse by placing them further from our view and moving them off the table for the last 2 years.

A position of neutrality by the medical societies is interpreted by the lay public that we as physicians feel further socialization of health care paid for by increased governmental control and increased tax is what "every physician" wants. 

The only statement that I have read that seems to take a position other than weak political coddling is that issued by the American College of Osteopathic Family Practitioners (ACOFP).

Sincerely, mortified.

Adam Nally, D.O.

Friday, June 22, 2012

Vanilla Low Carb Ice Cream

I love ice cream. I mean I really love ice cream. This has been one of my vices for years that I thought I would have to forever give up to follow a low carbohydrate dietary lifestyle . . .but worry myself no more!  
My sweet wife did it again.  She perfected the ice cream recipe she has been working on for the last year. 

You have to try this recipe.  It's delicious.  

Thanks, sweetheart!

Vanilla Low Carb Ice Cream:
1 cup Almond or Coconut Milk
1 quart of Heavy Cream
1 tsp Vanilla
1/2 cup Erythritol
1 scoop Vanilla Protein Powder
1/2 tsp of Salt

Blend for approximately 20 minutes in a 2 Quart Cuisinart Ice Cream Maker (that's the one we use) or the ice cream maker of your choice until the desired consistency and then place what you don't finish eating in the freezer for later.

Sunday, May 20, 2012

Low Carb Chocolate Chip Cookies

I love chocolate chip cookies! However, over the last three years, as I have followed a low carbohydrate diet I have not been able to indulge my chocolate chip cookie craving -- until recently.  
My gorgeous and very ingeniousness wife has perfected her chocolate chip cookie recipe and - Oh, Wow! - are they good. 
Warm tasty chocolate chip cookies that are actually good for you served up by a beautiful blond in a very cute apron. . . I think this is what heaven is like. 

I have been promising my patients this recipe for quite a few months, but have neglected to write it down and post it. I would forget to take a picture of the cookies before my family had eaten them all.  So, this morning I took a snapshot and I had a few moments while eating the cookies on the plate above.  Here is the recipe:

Low Carbohydrate Chocolate Chip Cookies
1 tsp vanilla
2 eggs
2 sticks (1 cup) of butter, softened
1/2 cup Splenda
1/4 cup Sweet Perfection
1/4 cup erythritol 
1/4 cup Just Like Sugar (chicory root sweetener)
1 tsp salt
1 tsp baking soda
1 tsp baking powder
1 1/2 cup almond flour
1 cup coconut flour
1/2 cup Carbalose flour
2 ChocoPerfection Milk Chocolate bars chopped 

Mix the vanilla, eggs, butter and sweeteners until creamy or fluffy. Add in all dry ingredients and mix. Add chocolate and mix. Place dough on parchment paper covered cookie sheets in 2 tsp sized scoops.
Bake at 350 degrees for 8-10 minutes. 
Makes 45-50 cookies

(~ 2 net carbohydrates per cookie)

Enjoy!!

Monday, May 14, 2012

Mom's Cream Cheese Waffles

Mother's Day is a great event in our home, and traditionally it is a chance to make breakfast for Mom.
In our home, Mom loves waffles.  But changing to a low carbohydrate diet put a damper on the waffles for a while, until my sweet wife found and perfected the following recipe. (She adapted this recipe from Jennifer Eloff's Cream Cheese Bran Waffle recipe found in her book, Splendid Low Carbing for Life Vol 1.) These waffles are amazing! They are now lovingly referred to in our home as "Mom's Cream Cheese Waffles."
Breakfast for Mother's Day in our home consisted of Mom's Cream Cheese Waffles, freshly grilled thick slice bacon and strawberry flavored whipped cream to top off the waffles and was easily prepared by my 11 year old daughter.  A perfect low carb Mother's Day meal. Enjoy!
Mom's Cream Cheese Waffles

Mom's Cream Cheese Waffles:
16 oz regular cream cheese (softened)
6 eggs
1 cup wheat germ
1/4 cup heavy cream
1/4 cup water
1/3 cup Splenda Granular
1 tsp baking soda
1 tsp baking  powder
1/4 tsp salt

In a food processor or electric mixer, blend the cream cheese until smooth.  Add the eggs and continue to blend.  Add the Carbalose flour, wheat germ, cream, water , Splenda, baking soda, baking power and salt.  Continue to blend. 

Pour 1/4-1/2 cup onto hot greased waffle iron. Close and cook for approximately 3 minutes.  

Yeild: 12-16 "plate sized" waffles
1 Waffle: approx. 7g protein, 9g fat, 3g carbs


Saturday, May 5, 2012

Mid-Meal Protein Shake. . .

A number of my patients have asked what I use personally as a protein supplement and whether I use protein shakes.  I've struggled to find a great tasting protein shake that does not contain any artificial sweeteners (see my article The Skinny On Sweeteners) that raise the insulin levels.  Most of the pre-prepared shakes (including the Adkins, EAS, Muscle Milk, and many others) will significantly slow weight loss and knock you out of ketosis due to an insulin response stimulated by drinking them.

My sweet wife just perfected our family's favorite high fat, low carbohydrate protein shake.  Oh, it's good and  it's filling.  You'll love it and you won't be hungry for at least 3-4 hours after savoring this sweet taste-bud sensation. 

This is a great shake for a mid-meal snack or a quick meal on the go.

Tiffini's Low Carb High Fat Protein Shake:
[One serving (~ 2 cups) is 4.5 grams of carbohydrate]

Blend to preferred texture. . . (may add more heavy whipping cream if it is still too thick). 
Enjoy!!


Friday, April 20, 2012

The Power of Positive Thinking


One who is very comfortable in his diabetes and heart disease risk . . . 

Wednesday, March 21, 2012

Medicine and Fast Food

No, the practice of medicine is not like fast food.

We live in a society of fast cars, fast food, instant messages, and instant pictures.  We want it our way and we want it now.  This is evident by the fact that the average American household has $16,000.00 in credit card debt (2011 Household Statistics).  We want it now and well worry about payment or consequence later. This is also evident by the successes of instant messaging services, cell phones and fast food restaurants.

As a family practitioner, I feel pressured by both patients and insurance companies to serve up a diagnosis and a low cost generic pill with the same speed.  No, the practice of medicine is not like fast food. If it were, then I would install a drive up window next to my office desk, and place a large marquee with a clown wearing a stethoscope at my front door.

Medicine is an art.  A picture is painted of the patient by what is seen, heard, felt and understood through the eyes of the practitioner.  This can't be done over the phone or through a drive-through window. It requires a patient who is willing to place his or her history, symptoms, feelings, private concerns and trust upon the examination table It requires the astute observer to see all the reflections of light and shadows and all the highlights.  It requires the observer, the doctor, to recognized that many times this is difficult for the patient.  That trust is built through a relationship that occurs over a period of minutes and a period of years.  The beauty of the art occurs when the practitioner and the patient understand one another and application of healing can begin.

The art of medicine paints a different picture every time. That's why art isn't sold under the golden arches, or at the corner pharmacy.  No, the practice of medicine is not like fast food.

Friday, March 16, 2012

Vitamin D Effect on Weight

Vitamin D plays an interesting role in may aspects of human health. It plays a role in disease prevention including osteoporosis, some cancers, autoimmune disorders, hypertension, diabetes and has recently been found to effect weight loss.
What is Vitamin D?  It is an oil-soluble (fat-soluble) vitamin that helps in the absorption of calcium and phosphorus in the intestine and suppresses parathyroid hormone (PTH), the hormone that stimulates bone resorption (breakdown). Vitamin D also plays a role in muscle function and in the immune system, but our understanding in these roles are still limited. (1)
Vitamin D can be found in fatty fish, cod-liver oil and eggs. In the United States, cow's milk is supplemented with Vitamin D and this is often the source from which most people obtain it. Deficiency in Vitamin D often occurs from lack of sun exposure, inadequate intake, surgery to or damage of the intestines ability to absorb, or from kidney or liver damage resulting in problems processing Vitamin D. Recent studies reveal that obesity is a major factor in altering the way the body uses Vitamin D and stimulates PTH.
I find that about 30-40% of my patients are Vitamin D deficient.  Many researches claim this is due to poor sun exposure or the use of sun screens, however, I live in Arizona.  Sun over exposure is usually the problem here, yet I still find that 30-40% of my patients are deficient.  My patients should be able to get enough sunlight walking from their cars to the grocery store entrance.  I disagree that "lack of sun exposure is the cause."  Although our current labs claim vitamin D levels should be above 20 ng/dl, I find people do not get the needed effect until 25 Hydroxy-Vitamin D levels should are greater than 32 ng/dl.
Poor Vitamin D intake is usually the problem.  Our bodies convert 25 Hydroxy-Vitamin D into the active molecule 1,25 Dihydroxy-Vitamin D.  Recent studies reveal that higher Body Mass Index (BMI) leads to lower conversion of 25 Hydroxy-Vitamin D to 1,25 Dihydroxy-Vitamin D. (2,3)  Simply adding 25 Hydroxy-Vitamin D as a supplament frequently helps with weight management in many of my patients. Supplementation with 1000-2000 IU is often adequate.  Higher doses should be discussed with your doctor.

References:

1C P Earthman, L M Beckman, K Masodkar and S D Sibley. The link between obesity and low circulating 25-hydroxyvitamin D concentrations: considerations and implications.International Journal of Obesity (2012) 36, 387–396; doi:10.1038/ijo.2011.119; published online 21 June 2011.


2. Frost M, Abrahamsen B, Nielsen TL, Hagen C, Andersen M, Brixen K. Vitamin D status and PTH in young men: a cross-sectional study on associations with bone mineral density, body composition and glucose metabolism. Clin Endocrinol (Oxf) 2010; 73: 573–580.

3. Konradsen S, Ag H, Lindberg F, Hexeberg S, Jorde R. Serum 1,25-dihydroxy vitamin D is inversely associated with body mass index. Eur J Nutr 2008;47: 87–91.

Saturday, February 11, 2012

Cholesterol Drugs Increase Risk for Diabetes?

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

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

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.

Thursday, July 7, 2011

Is Your Diet Soda Making You Fat?

Is your diet pop causing you to gain weight?  It is very possible. There have been a number of small studies linking some of the artificial sweeteners to weight gain. The most recent of these studies was completed by Ganesh Halade, Ph.D., Gabriel Fernandes, Ph.D., the senior author and professor of rheumatology and clinical immunology, and Sharon P. Fowler, M.P.H., in the Division of Clinical Epidemiology. They studied the relationship between oral exposure to aspartame (NutraSweet) and fasting glucose and insulin levels in 40 diabetes-prone mice. Aspartame is an artificial sweetener widely used in diet sodas and other products. 
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.