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. 

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!

Said Hippocrates . . .

"Let food be your medicine, and let medicine be your food."

Melanoma

Definition: Vegetarian

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.

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.

Patient Survey on EHR Issues

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.

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 -

Fourth, as we age, we frequently become less active.  This can occur due to the decrease in muscle mass, decrease in bone density and increased fragility of the bones, increased pain due to arthritis and other medical conditions that are age related that make activity a little more difficult.  This overall decrease in activity and lead to weight gain.

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. 

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.

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.

Never Give Up!

Failure should not mean defeat.  Remember all good things require effort and patience and time. . .

Message From The Future . . .

I wish I could do this for many of my patients.  Thanks, Ryan.

Look, Dad, My Thumb Turned Green!

For many years I was under the impression that I had a black thumb.  My father was an avid gardener and never failed to have a lush beautiful garden in his back yard.  He states that he learned his gardening from his grandmother.  He often tried to pass those skills on to me in my youth, but try as I might, I had not been able to grow much in the garden other than weeds until just recently.

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.

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

Bill Cosby has a great way of"distilling" things . . .              I  HAVE DECIDED TO BECOME A WRITE-IN CANDIDATE FOR PRESIDENT IN THE YEAR 2012...   HERE IS MY PLATFORM:  (1). Any use of the phrase:'Press 1 for English'  is immediately BANNED!!!.    English  is  the official language;   speak it or wait outside of our borders until you can.  (2). We will immediately go into a two year isolationist  attitude in order to straighten out the greedy big business posture in this country. America will allow NO imports,  and we'll do no exports.     We will begin using Wal-Mart 's policy,   'If  we  ain't got it, you don't need it.' We'll make and sell it here!  (3). When imports are allowed, there will be a 100% import tax on it coming in here.  (4). All retired military personnel will be required to man one of the many observation towers located on the southern border of the United States  (six month tour).They will be under strict orders not to fire on SOUTH BOUND aliens.  (5). Social Security will immediately return to its original state.   If you didn't put nuttin in, you AIN'T getting nuttin out.  Neither the President nor any other politician will be able to touch it.  (6). Welfare. -- Checks will be handed out on Fridays, at the end of the 40 hour school week, AFTER the successful completion of a urinalysis test for drugs, and passing grades.  (7). Professional Athletes -- Steroids?  The FIRST time you check positive you're banned from sports ... for life.  (8). Crime -- We will adopt the Turkish method,  i.e.,  the first time you steal,  you lose your right hand.  There is no more 'life sentences'.  If convicted of murder, you will be put to death by the same method you chose for the victim you killed: gun, knife, strangulation,  etc.  (9). One export of ours will be allowed: wheat; because the world needs to eat.  However, a bushel of wheat will be the EXACT price of a barrel of oil.  (10).  All foreign aid, using American taxpayer money, will immediately cease and the saved money will help to pay off the national debt and, ultimately, lower taxes.  When disasters occur around the world, we'll ask The American People if they want to donate to a disaster fund, and each citizen can make the decision as to whether, or not, it's a worthy cause.  (11). The Pledge of Allegiance will  be said EVERY day at school and  every day in CONGRESS.  (12). The National Anthem  will be played at all appropriate ceremonies,  sporting events,  outings, etc.  My apology is offered if I've stepped on anyone's toes .... nevertheless......  GOD  BLESS AMERICA ! Sincerely,  Bill Cosby

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?

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.

Source reference:
Kuepper R, et al "Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10-year follow-up cohort study" BMJ 2011; DOI: 10.1136/bmj.d738.

6 Tips to Prepare Your Child For Vaccinations

See this great article about preparing your child for vaccinations at Dr. Wendy Sue Swanson's blog (Seattle Mama Doc). I agree with all of her points.