Moving the Blog

I have moved my blog and Arizona Bariatric Institute webpage to http://www.docmuscles.com. Wordpress gives me a little more ability to do what I need. I will be transitioning posts and information.  Please see the new blog and website here.

Hope you keep following and like the new look.

Love to hear your comments.

FDA Approves Avantame (New Artificial Sweetener)

The FDA approved an intense new artificial sweetener, Advantame. Because of its chemical similarity, Aspartame now has a super sweet cousin. This sweetener, 20,000-37,000 times more sweet than table sugar (sucrose), is found in powder form and dissolves in water. However, it does partially break down when exposed to heat or used in heated drinks, so it may not be that great for cooking.
Similar to Aspartame, one of the breakdown metabolites is phenylalanine, implying that those with sensitivity to phenylalanine or PKU may need to avoid it, however, the amount of phenylalanine produced when ingested was felt to be fairly negligible.
My interest was peaked by the fact that Advantame does not raise blood sugar or insulin levels in the multiple animal and three humans studies reviewed here and here. This implies that it probably won't cause weight gain and the studies in animals actually revealed some negligible weight loss.
The FDA claims this is a very safe artificial sweetener due to it's intense sweetness and requirement for only small quantities to be effective. In fact, Josh Bloom from the American Council on Science and Health was quoted saying that, "About the only way this stuff could harm you is if you were run over by a truck that was delivering it."

From the perspective of weight loss, this may be another sweetener that could be used effectively on a carbohydrate restricted diet. 

Keeping the Fat High on the Low-Carb Cruise

I had the wonderful opportunity to speak last week on the Low Carb Cruise sponsored by Jimmy Moore's Livin La Vida Low Carb on the Freedom of the Seas (Royal Carribean).
What an experience!  I was able to take my family with me for some long-anticipated family time as well.
I spoke with some of the most well respected physicians, authors and dietitians specializing in low-carbohydrate, Paleo, and ketogenic dieting in the world.
Among the wonderful presentations, the underlying theme seemed to be that most people are not taking in enough saturated fat. The research is pointing to the fact that increasing your total fat intake to 60-80% of your daily caloric intake seems to be most effective for weight loss and overall cardiovascular health (while limiting your carbohydrate intake - OF COURSE!)

A few of the Ketogenic Nutritional Experts:
Christine Cronau, Maria Emmerich, Franziska Spitzler

Franziska Spitzler, Dr. Eric Westman, Emily Maguire

We heard from the likes of Dr. Eric Westman, Dr. Jayson and Mira Calton, Dr. Jeffry Gerber,  Jackie Eberstein, Jimmy Moore, Christine Cronau, Wendy Myers, Dr. George Diggs/Dr. Kerry Brock, Dr. Phillip Blair, Dr. Michael Fox, Franziska Spritzler, Tommy Runesson, Maria Emmerich, Dana Carpender, Rocky Angelucci, Emily Maguire, Diane Sanfilippo, and fitness expert Fred Hahn. Overall, it was a fantastic course and a wonderful trip.

Hats off to Jimmy Moore and his very talented group of planners that put this program together. Thank you!!

An Empty Tomb?

Dear Family and Friends,

 A few, on occasion, will ask why I do what I and why I feel the way I feel. My answer is "Because of Him." What does that mean? The video below says it all. May each of your hearts be full of hope and joy because the "bands have been broken" and "death no longer has it's sting." He was the carpenter, the teacher, the outcast, the leader, but He is the Master Physician.  I hope that this week brings a special peace to your heart as you contemplate the meaning of Passover and the profound effect an empty tomb has on your life:

 Happy Easter!

Rise In Allergic Symptoms

This is a bad allergy season in Arizona.  I am seeing a huge surge in patients with significant allergy symptoms.  I found the reason . . .

Thoughts of the Moment

A man would do well to carry a pencil in his pocket, and write down the thoughts of the moment. Those that come unsought for are commonly the most valuable, and should be secured, because they seldom return. 

Insurance Rates . . .

The Media's New Role . . . Obama's Parrot

It is quite amazing and notably funny that our media has literally become a "parrot" for President Obama.  I have never seen anything like it . . .



I laughed and cried all at the same time "because, it would be funny if it wasn't so crazy."

The Gods of the Copybook Headings

One of my favorite poems by Rudyard Kipling, this poem should be read and memorized by every young American. Kipling teaches that history repeats itself in the worse possible ways, and the only way to avoid terror and slaughter is to stay bound and rooted to self-evident truths. 

A little background: A copybook was a writing exercise book used to practice handwriting. The pages were blank except for horizontal rulings and a printed specimen of perfect handwriting at the top. The young man or woman was to repetitively copy the specimen down the page. The specimens were proverbs, quotations, commonplace hortatory or admonitory sayings — the ones in the poem illustrate this kind of thing. These little thoughts and principles became known as the copybook headings.

As I pass through my incarnations in every age and race,
I make my proper prostrations to the Gods of the Market Place.
Peering through reverent fingers I watch them flourish and fall,
And the Gods of the Copybook Headings, I notice, outlast them all.
We were living in trees when they met us. They showed us each in turn
That Water would certainly wet us, as Fire would certainly burn:
But we found them lacking in Uplift, Vision and Breadth of Mind,
So we left them to teach the Gorillas while we followed the March of Mankind.
We moved as the Spirit listed. They never altered their pace,
Being neither cloud nor wind-borne like the Gods of the Market Place;
But they always caught up with our progress, and presently word would come
That a tribe had been wiped off its icefield, or the lights had gone out in Rome.
With the Hopes that our World is built on they were utterly out of touch,
They denied that the Moon was Stilton; they denied she was even Dutch;
They denied that Wishes were Horses; they denied that a Pig had Wings;
So we worshipped the Gods of the Market Who promised these beautiful things.
When the Cambrian measures were forming, They promised perpetual peace.
They swore, if we gave them our weapons, that the wars of the tribes would cease.
But when we disarmed They sold us and delivered us bound to our foe,
And the Gods of the Copybook Headings said: "Stick to the Devil you know."
On the first Feminian Sandstones we were promised the Fuller Life
(Which started by loving our neighbour and ended by loving his wife)
Till our women had no more children and the men lost reason and faith,
And the Gods of the Copybook Headings said: "The Wages of Sin is Death."
In the Carboniferous Epoch we were promised abundance for all,
By robbing selected Peter to pay for collective Paul;
But, though we had plenty of money, there was nothing our money could buy,
And the Gods of the Copybook Headings said: "If you don't work you die."
Then the Gods of the Market tumbled, and their smooth-tongued wizards withdrew
And the hearts of the meanest were humbled and began to believe it was true
That All is not Gold that Glitters, and Two and Two make Four —
And the Gods of the Copybook Headings limped up to explain it once more.
. . . . . . . . . . . . . . . . . .
As it will be in the future, it was at the birth of Man —
There are only four things certain since Social Progress began: —
That the Dog returns to his Vomit and the Sow returns to her Mire,
And the burnt Fool's bandaged finger goes wabbling back to the Fire;
And that after this is accomplished, and the brave new world begins
When all men are paid for existing and no man must pay for his sins,
As surely as Water will wet us, as surely as Fire will burn,
The Gods of the Copybook Headings with terror and slaughter return!

Stock Market Crash in April?

Tom DeMark, the founder and CEO of DeMark Analytics, discovered a very scary trend found on the graph below, He joined Glenn Beck on radio this morning to discuss what the eerie pattern could mean for the United States that you can hear here.

This means that a 1929 like stock market crash might occur around April of this year. Tom DeMark has been in the investment business over the last 45 year and he stumbled upon this pattern at the end of 2013 when comparing patterns. 

What do you think?

“Well, we could have had it last week. There was a 10% chance that could happen. It probably won’t and the market will rally and we have seen the rally now,” Tom said. “There’s two scenarios currently: If the Dow Jones Average closes above 16,000 next Monday and Tuesday, then there’s a chance yes, we could go down. And it could be something comparable to 1987. We’re shifting things a little. Our two templates, 1929, 1987 are being adjusted. It’s possible that could happen.
“We have to have a trigger. The trigger would be we’d have to decline on the S&P average below 1762,” he continued. “We have been using that for some time… It’s so widely known right now, and we are a firm believer, that markets have bottomed because the last seller, figuratively speaking, has sold. We think a lot of people have sold based upon this comparison. So it may be premature right now, but it’s going to happen.”

This looks pretty spooky. Many experts feel a big crash is going to happen in the next 18 months, and Tom DeMark states that before a sharp decline, there is always a rally like we are having this week.

What We Know . . .

As we know, 

There are known knowns.

There are things we know we know.

We also know

There are known unknowns.

That is to say

We know there are some things

We do not know.

But there are also unknown unknowns.

The ones we don't know

We don't know.

Donald Rumsfeld

Low Carb Cheese Cake

My amazing wife, among her many talents, makes a wonderful low carb cheese cake.  She has taken the recipe found in Maria Emmerich's "Secret Weight Loss Recipes" and modified it to our family's taste.  It has quickly become one of my family's favorites. 

Low Carb Cheesecake = 1 gram carb per serving
Individual spring-form serving pans

Crust:

2 cups almond flour

1/4 cup coconut flour

1/2 cup butter melted

Pinch of salt

1/2 cup erythritol

Mix and press into spring-form pan.

5 (8 oz) packages cream cheese, softened

1 cup erythritol and 1 tsp liquid Stevia

1 TBS vanilla

1/2 cup whey Protein

1 cup sour cream

3 eggs

Preheat oven to 350F. Mix cream cheese, sweetener, protein and vanilla with an electric mixer

until blended. Add eggs one at a time, mixing on low after each until blended. Blend in sour

cream and pour over crust. Place a pan of water on the lower rack place cheesecake on rack

above. Bake for approximately 45 minutes until set. Watch carefully! 

Refrigerate overnight.

Freezes well too!

My wife will often bake them in individual sized pans (as in the picture above) so that I can pull one out of the freezer, let it thaw and cover it in whip cream and a sprinkle of berries.  Tastes fantastic!

One serving is = 1 gram of carbohydrate.

How Your Beard Will Save Your Life

I'm a clean shaven guy.  I always have been.

 My wife hates a "prickly faced" man and she's made that loud and clear over the last 21 years of our marriage.  No reason to grow one has ever truly availed itself.  Even during "Movember," the month of growing mustaches raising awareness for prostate cancer, I've not been all that inclined to let the stubble arise.  It has always been one of those things passed from father-to-son that, "hey, the Nally men are clean shaven." Yes, there is a cleanness and trustworthiness that arises from a man who is clean shaven and well groomed.

Beard World Champion 2013

But once in a while I've wondered, if God made men grow hair on their faces, what use does it have? Is it to keep Norelco and Gillette in business and provide jobs for a growing population of men?  Is it because the the invention of Velcro might cause men further problems?  I've been shaving my five-o'clock shadow off for years.  I'd just like to know what purpose it has.  If I lived in Alaska, I know it'd keep me warmer, but I don't live in Alaska and I don't plan on moving there any time soon. 

After 40 years of wondering, I've finally come across the answer.  While learning to be more "manly" and studying self rescue techniques of falling through the ice I came across the following:

Good advise when crossing the frozen pond or lake, and well received.  

But, THERE IT IS...in box #5.

"Your beard can also freeze onto the ice and save you."

The big daddy reason for a beard.  Wait till I tell my wife. . .

Arizona College & Career Ready Standards ( aka Common Core)

I had the opportunity to listen to on of the valley's District Superintendents speak about the Arizona College and Career Ready Standards this evening. It was enlightening, and yet very disheartening. I attended the meeting to gain better perspective on the pro's and con's of this change in standards, and instead, I got to see a Ph.D. act as a federal cheerleader. All I heard was an endorsement for what Common Core is supposed to accomplish, a plug for "all-day" pre-K and Kindergarten, and a video of Arizona educators praising standards that have never been tested.
This is a topic fraught with political and ethical overtones and those came across loud and clear from this Superintendent. I recognize that standards are essential. I also recognize that we must come up with methods to quantifiably asses learning, however, standards based education has ruined the way we teach and learn. This has been well demonstrated over the last 10 years. Just "raising the bar" on the standard will not solve the problem. This was implemented only for bureaucratic convenience. Measurement of a mind's creativity, inspiration, and appreciation cannot be measured. We teach to free minds, to inspire and to equip. These skills are often un-measurable.

I guess I was expecting more clarification, but instead came away with none of that and was left feeling only an endorsement of the Superintendent's views.
As the adviser to young men in my church, a family physician, a health policy expert with thousands of patients affected by these standards, the President-Elect of my medical association, and more importantly, as a father who must navigate the ever darkening, murky waters of education with my children, this topic is of profound importance. I am asked about these standards regularly and must asses our youth, as their physician, and gauge their physical and mental capabilities in handling these standards when illness arises. Therefore, "I have significant skin in the game."
I have the following significant concerns about these standards and their implementation which have yet to be allayed:

1. Common Core is a big business, politically powerful advocacy collation that formed with an attempt to correct the last 10 years of failed 2002 "No Child Left Behind" legislation putting into place new federally mandated standards.
2. These standards were created in 2009 by the National Governors Association and the Council of Chief State School Officers in partnership with Achieve, Inc (who received $160 million dollars from the Bill and Melinda Gates foundation to create the standards). And, we know that when a private company funds standards with the government, that company will be involved in the monetary gain of testing of those standards. This is the epitome of "krony capitalism" at work.
3. To quote the Washington Post "Because federal law prohibits the federal government from creating national standards and tests, the Common Core project was ostensibly designed as a state effort . . ." But it was, in reality, contrived by an insular group of academic testing executives with only two qualified educational assessment experts, both of which never signed off on the program. "In all, there were 135 people on the review panels for the Common Core. Not a single one of them was a K-3 classroom teacher or early childhood professional." Parents were entirely missing. K-12 educators were mostly brought in after the fact to tweak and endorse the standards--and lend legitimacy to the results."
4. Dr. Sandra Stotsky, one of only two qualified education ESL specialists and member of the Common Core Validation Committee, recently testified against Common Core implementation before the Wisconsin Board of Education stating that it created an "empty skill set, lacking in literary knowledge"
5. Common Core was not voted upon at the federal level by Congress, the Board of Education, or by State/Local Governments, and in the state of Arizona, its implementation could only occur through the force of Gubernatorial Executive order due to its controversy in the house and senate, after its name was changed.
6. The measurement standards (PARCC Test) have not been fully implemented in Arizona and will require outside companies to formulate, read and grade our children's tests and thereby the teachers who are teaching those students. 

Upon finishing the meeting, two people also in attendance approached me as I left the building, one of which currently serves as a School Principle and another who serves as a college professor. They informed me that my concerns were "unfounded ultra-conservative delusions that have no place in the argument of school standards.

My perception of our meeting this evening is that a number of very uninformed people in our community will return home to their families with a flowery, lemming-like-acceptance of unproven, tax laden standards that, I believe, have significant potential to damage the educational and financial futures of our children.

Leadership Thoughts

A ship, to run a straight course, can have but one pilot and one steering wheel.  The same applies to the successful operation of a business.  There cannot be a steering wheel at every seat in the organization.

Carol of the Bells . . .

Amazing!! I'm now in the mood for the Holidays again. Thanks Pentatonix!

Little Drummer Boy . . . Pentatonix

One of my favorite renditions:

John Wayne on "Optimism"

Excerpts from a 1975 interview where he gives his perspective of liberal politics and political tactics sound like they could have been stated just yesterday. This is the reason John Wayne is still a true American hero. 

"The Duke's" take on liberalism is “they never listen to your point of view, and they make a decision as to what you think, and they’re articulate enough and in control of enough of the press to force that image out for the average person.”

 "Ok, Pilgrim," you just have to be a little more optimistic . . .  (I feel like I'm sitting at my grandfather's knee while listening to this bigger than life hero give a little advise.)  Thank you.
You just have to listen:

Open Letter to Legislators on Obesity

Dear Senators McCain, Senator Flake and Congressman Franks,
I am a Family Physician, Obesity Specialist and Health Policy Fellow.  I had the opportunity to meet with your staff a few months ago and would like you to consider co-sponsoring S-1184 and/or HR-2415 the "Treat and Reduce Obesity Act." Obesity affects 34% of the population and 33% of the population in the US is overweight. Obesity is affecting military readiness and our economy using 21% of all healthcare costs.
One of the challenges I find as a physician who treats obesity daily, is that medications and therapy that is effective in treatment is not covered by Medicare services.  S-1184 will allow me as a physician to use effective medications for obesity that patient's current cannot afford.
I would love to talk with you or your staff about this bill and its effect on our treatment ability.
Please consider co-sponsorship of this bill and feel free to contact me regarding this issue at any time.
Sincerely,
Adam S. Nally, D.O.
Board Certified Family Physician & Bariatrician
Health Policy Fellow

Open Letter to my Senators . . .

Dear Senators John McCain and Jeff Flake,

I am a family physician and health policy fellow, as well as a constituent in Arizona. I have a busy practice serving 5500+ patients in the Surprise, Sun City West area. I would strongly encourage you to vote to De-Fund the Affordable Care Act (Obamacare) as this bill has already increased the price of premiums 2-3 times the cost from last year and has made it nearly impossible for my Medicare patients (50%) of my practice to afford a supplemental health insurance plan. Allowing this bill to be funded will force me to lay off a minimum of 2 members of my office staff within the next year and may make it impossible to continue practicing medicine in the near future. 

I have personally heard you make the promise to stop this bill, on multiple occasions, and that reversing this bill was one of your priorities. Please keep your promise and vote to de-fund this atrocity.

Please stand with Senator Ted Cruz, Senator Mike Lee, and Senator Rand Paul in de-funding Obamacare!

Sincerely, Adam S. Nally, D.O.