2022 Update

 I have been so busy lately with a full time Medical Directorship and Telehealth Wellness consults on the side that I have not updated this journey page in a while. Since the beginning of 2021, Jane and I have remained #NSNG. There may be 3-4 times a year with an indulgence such as a birthday, anniversary, holiday, or other special occasion. I have continued to plateau at a stable weight between 180-184 lbs. At the late year 2020-21 update, exercise was rowing or treadmill mostly at Zone 2. For the past year, Jane and I have been trained by Dr Ben Bocchicchio ,who lives nearby here in Arizona, in his SMART exercise system. What a difference this has made! For a busy professional who does not have time to spend hours in the gym, doing this two times a week with minimal equipment outlay has been true game changer. Until a little bout of COVID last month (finally!), I had not missed more than one week over the past year.

I have also become certified by both the Nutrition Network and the Society of Metabolic Health Practitioners and have stayed busy with many educational conferences, grand rounds and CME activities. AZ Low Carb is a group of likeminded practitioners including coaches, nutritionists, nurses, physicians and pharmacists dedicated to promoting low carb wellness. We support each other and are looking for community projects. Check out the AZ Low Carb Youtube Channel You might even find my Intermittent Fasting Intro Video there!

There will be many more interesting applications for low carb healthy fat nutrition beyond weight loss and diabetes care. More and more information is coming on applicability in many facets of metabolic health such as gout, GI conditions, neurologic diseases and psychiatry amongst others. We will bring all of this to you through AZ Low Carb and ourlowcarb.com. 

             2021 and beyond

The holidays came and went, and with them, 2020 is in our rearview mirror. Like many of us, we at ourlowcarb.com were looking forward to the holidays. Although somewhat tempered, given government and self-imposed hesitation on large family gatherings. Many of you have had significant stressors for most of the past year. This can lead to stress eating, poor sleep and excess cortisol, all deleterious to health. Then add holiday temptations.

Reflecting on 2020, I ended my second year of #NSNG. I had had refined sugar and flour on but two occasions during the year. The first occurred on my wife’s birthday celebration when we had a small butter cake and ice cream. The second was for Thanksgiving when I had a small piece of pumpkin pie, and a very small amount of flour in a lobster pumpkin bisque. So, we decided to end 2020 and ring in the new year by picking up takeout from PF Chang’s. Unfortunately, our new lifestyle is not compatible with regular Chinese takeout and this is something we have both missed over the past two years. I have tried to make some Asian substitute meals, and although they came out well, they were nothing like the originals. I decided that I would end the meal with their great wall of chocolate cake. As Vinnie Tortorich says, it is not what you eat between Thanksgiving and Christmas, but it is what you eat between Christmas and Thanksgiving. We planned to have a little life into living and get back on the keto bandwagon on New Year’s Day. I personally had made it through the holidays with less than a 2-pound weight gain. Since this was really the first time that I had an entire meal containing flour, sugars, and starches, after I noticed my wife’s CGM showing an immediate spike from the meal, I decided to check my blood glucose. This was a rude awakening. The initial reading was 179 and subsequently down to 140. I had only consumed about half of the chocolate cake and had placed the rest in the fridge planning to consume with my New Year’s meal. However, after seeing what that did; it went straight from the fridge to the trash. Lesson learned. Tonight, it will be pan seared scallops with fennel salad courtesy Anna Vocino’s Eat Happy Too. I will repeat the blood sugar at the same time following this #NSNG meal and report the difference.

Now, this was one meal out of 365 days. Imagine having blood glucose spikes every day of the year with every meal. Now is the time for people to take stock and plan to change behaviors for the new year. Given COVID-19, there is never been a better time to get metabolically healthy.

Update: tonight's glucose reading eating NSNG 103 mg/dL.

Transparency and Lipids

 A few months ago I outlined my own personal journey to low carb wellness. I have had smashing results with weight loss and most every other health parameter. For the first year plus, I did it without increasing exercise. I was testing whether this WOE really delivered the results promised, and it certainly did. 

Beginning this summer, I began training at zone 2 on the treadmill and we purchased a Concept 2 rowing machine. Weight and diet have remained constant. 

Just a few weeks ago I went for my annual wellness check up. Pleased to report systolic BP is down 20 points with weight down 20+ pounds from last year. It was time for annual labs. I was curious to see what changes may be in store. I had been doing my usual 16:8 intermittent fasting when I went to the visit, so it was easy to pop down to the lab afterward to get drawn. 

The labs came back and there were some changes, some better, some "worse". I put worse in quotations because that is the focus of this post. 

My labs have always been consistent over the years. Beginning in my early twenties, I had comprehensive physicals for law enforcement. Most physicians, myself included, would not screen for lipids in asymptomatic early 20's-some year old patient absent other reasons, but this was the practice and so I have that data.

So what's better? As far back as age 17, I have had mildly elevated transaminases. These are liver enzymes which can indicate ongoing liver damage/inflammation. It's always been just a couple points above normal. I have had workup over the years all negative for any serious condition. Last year after #NSNG and #LCHF was the first time in my adult life these were normal. I can now attribute this to eliminating sugar, fructose and vegetable oils. I can now report this year's labs show the same normalization.

In 2006 I had labs done for screening prior to an exercise nuclear imaging stress test. My hs-CRP was 8! I chalked this up to a recent infection for which I had been on antibiotics, but subsequent measurements have shown persistent elevation. Hs-CRP is a non-specific marker of inflammation which can suggest an increased risk of ASCVD. Last year, even on low carb, mine was still 8. Today, after another year following the tenets of #NSNG, I have seen marked improvement to 2.4, just slightly over the normal cutoff. First time!

So what is worse? Over the years, my total cholesterol has been normal, about 182. LDL-C always borderline. HDL has been high normal which is generally considered protective, but triglycerides also borderline, until last year, when they also normalized. This year, my total chol+ went up to 204 and LDL to 140. I expected, and got, the statin talk from my PCP. On the plus side, HDL is up too, and triglycerides stellar. A ratio of less than 2:1 is generally protective. and mine is 1:1.

So what does all this mean? In most cases, #LCHF does not adversely affect lipids and often improves them. It has been recognized that there is a subset of patients, perhaps up to 25-30% who will see elevations in lipids due to a low carbohydrate higher fat diet. Some will have quite dramatic elevations of LDL-C. Dr Paul Saladino, author of the Carnivore Code and host of the Fundamental Health podcast freely acknowledges his LDL-C of 533! Dave Feldman of the Cholesterol Code website terms these folks Lean Mass Hyper-responders (LMHR). These people are generally fit, athletic and his hypothesis is that the concomitant LDL elevation is to compensate for the lower carbohydrate ingestion by transporting fats to supply energy demand. 

Now, most of us in the low carb space do not believe that isolated LDL-C elevation is necessarily bad. It has been established that high LDL is associated with ASCVD. Association does not mean causation. Many people with heart attacks will have normal lipids. It is been demonstrated that some LDL is more atherogenic than others. What causes this? Factors like insulin resistance, carbohydrate intolerance, vegetable oils and chronic inflammation have been postulated as major drivers, all of which are markedly improved on low carb, healthy fat. It is the oxidized and glycated LDL which have detrimental effects. Research in this area is ongoing, but to be transparent, there are those who are still concerned about this elevation of LDL. I have contributed to the soon to be in-progress LMHR study co-authored by the afore mentioned Dave Feldman and Dr Spencer Nadolsky, a wellness and lipidology physician.

To wrap up, I must acknowledge the changes in my own labs, both good and bad. There are advanced markers such as particle size testing which can be done to help outline risk. You may find yourself in a similar situation, and this should be discussed and dissected in partnership with your own physician. Likely, the benefits well outweigh the risks, but we do not know with certainty yet. On ourlowcarb.com we have links to resources if you wish to learn more.

Following the Low-carb Way

The TLDR: On February 28, 2019 my recorded weight was 236 pounds. I started NSNG in late March 2019. Unfortunately, looking back through my fitness programs, my scale only records weight and other information back one year. One year ago at this time, my percent body fat was 32.4. Currently, I am at 22.8. I now weigh between 183 and 185 pounds. My BMI went from 32.3 to 26.

After doing my due diligence and researching the science behind low-carb and ketogenic diets, I went NSNG towards the end of March, beginning of April 2019. I did immediately notice some keto flu which passed within several days. This was mild and tolerable. I also began time restricted eating, only eating within an eight hour window daily. Later on, began incorporating some intermittent fasting of 24 to 48 hours. As an aside, fasting is an integral part of any weight loss program in my opinion, and is much easier once you are "fat adapted". By the end of the first month, I had lost approximately 11 pounds. I continued at this rate until a working vacation in mid June, which did cause a stall but no gain. Once back on track, there is a steady downward decline for the remainder of the year.

For the most part I stayed strictly NSNG. I can count on four fingers the number of desserts that I had during the past year. There was my wife's birthday, my brothers, my birthday, and our wedding anniversary. I did make a keto version of a pumpkin mousse for Thanksgiving. For the most part, my diet consisted of meats, eggs, dairy, nuts and fresh above-ground vegetables along with seltzer, black coffee, and green tea. I ate well, and hunger was never a problem.

As this was an experiment for me, I deliberately did not increase or decrease my exercise or activity level. I wanted to control just the variable of dietary intake. As you can see from the above results, the results have been amazing, down over 50 pounds. Another aside, my gastro esophageal reflux which was almost a nightly occurrence has been maybe 2 to 3 times in the last year. I no longer get shaken awake because of snoring. I have noticed an improvement in arthritis both in the large joints of the legs, but particularly in the knuckles of the hands.

I am proof that this program can work, and it can work for you too.

The Path to the Low-Carb Way

In the previous post I outlined my struggle and cycle of weight gain and loss. For the last 3 to 4 years, I maintained a fairly steady weight bordering on a 30% BMI. I was no longer able to outrun my bad diet. I thought I would go back to the teachings of my nutrition education. This is what I had been telling patients for years. Reduce caloric intake; increase exercise. This is the so-called "eat less, move more." The problem was that it hadn't worked. I thought I hadn't been active enough or diligent enough in monitoring my intake. I decided to strictly monitor calories in and calories out with tracking of fitness and exercise and daily caloric burn. I started with the MyFitnesspal application. Based on my BMI, I calculated that I could lose 1 to 2 pounds by restricting my calories to approximately 2000 kcal per day. For a few months, this worked. I actually lost 10 to 15 pounds. When I did exercise, I thought, "I burned some calories so I can eat a little bit more but I'm still under my caloric debt for the day." After a time, my weight reached a steady-state. I'd go up a pound or two here and there and for several YEARS there was no traction despite me adhering to the 1900 cal/day that was calculated based on the lower BMI. I was stubborn and based upon my prior teachings I thought that as long as I kept at it I should be losing weight. It took a couple of minor alarm bells to get me to consider other approaches.

In the beginning of last year, I went to my primary care physician for a persistent cough. At that visit and a follow-up visit, my blood pressure was borderline elevated for the first time. It had been a few years since my labs had been done and my lipids were always slightly borderline. I knew that I needed to increase my exercise, lose weight and improve diet. I wanted to postpone going on any medications for as long as possible.

My first exposure to low-carb, was courtesy of the Adam Corolla show podcast. For many years, a longtime guest is fitness expert Vinnie Tortorich , founder of NSNG (No Sugar No Grains) . My initial reaction to his low carbohydrate, high-fat approach was that this was quackery, and I was quite skeptical. After all, I had nutrition in medical school! So for years I had discounted his information.
About this time, a long time friend who would work with my wife for many years visited. She looked good and had attributed much of her success to the ketogenic diet. It was quite similar to NSNG from her description so I decided to check it out. At her suggestion, I began to read The Obesity Code written by Jason Fung, MD. The book was logical, factual, and laid out the history behind the growing obesity problem in our country. The science was sound and well referenced for those of us in the medical profession, and the examples were relatable to the lay reader. I can go into more detail in a later post, but I would strongly urge any readers who haven't read this book to check it out.

So, since what I had been doing hadn't worked, I decided to give NSNG and the low-carb approach a try. I joined the NSNG Facebook group and downloaded Vinnie Tortorich's PDF. A link to download this PDF is on his website and I have linked it on ourlowcarb.com/. In the coming post, I will let you know how this experiment fared.

A Physician's Journey to Weight Gain

As a physician now for over 25 years I have been blessed with a lifelong of learning. Part of having a base medical knowledge is to also know what you don't know. Probably most important is knowing where you can get the right answers and the knowledge that you need for the particular medical problem. I thought that I had a good base in nutrition. My medical school, the University of Nevada was a newer school and fairly progressive with a concentration in primary care. As I subsequently found out, medical school education in nutrition is scarce or lacking except in clinical rotations. We would learn about rare nutritional deficiencies in pathology which in our modern society with abundance of easily obtained food sources are fairly rare. This compared to the days when our ancestors had to deal with famine or shortages on a regular basis. At one point I thought I was fortunate because our medical school actually had 1/2 semester course in nutrition. This is more than many other medical schools. I carried this knowledge out in my practice and personal life for many years. As an Emergency physician, you deal with the acute and urgent problem. Because of the busy nature of the emergency medical field, there's not a lot of time for things such as nutritional counseling. We are dealing with the end results of many chronic conditions such as hypertension, diabetes mellitus, chronic kidney disease, and cardiovascular disease.

Because healthcare professionals make the worst patients, you tend to self treat based on your own knowledge. I have had a love-hate relationship with food and weight beginning in late adolescence. I was always physically active playing sports such as JV wrestling, cross-country, and varsity baseball. I began getting into some weight training to build lean muscle mass however my passion was running. After high school when I began working two and sometimes three part-time jobs in addition to going to college, I quickly noted weight gain. Suddenly, as I was testing for positions in law enforcement, I realized that I was overweight and out of shape. In those days, I ate as much as I wanted, whenever I wanted. It was easy to go out and start running a few miles regularly and get in better shape and cut some weight. Ultimately, I did get hired in law enforcement and continued to struggle with weight off and on for my 14 year career particularly when working night shifts. In those days, when my uniform pants and belt started to get tight it was easy to try to outrun my dietary stupidity. After 10 years in law enforcement, I decided to try to attempt a career in medicine. I was back in school full time while working full time and taking care of a family full-time. My exercising fell by the wayside and the weight jumped. During my first year of medical school I was working full-time in addition to attending classes full-time. This is when things first got really bad. By the beginning of my second year of medical school I had gained 30 pounds. I was gassed during our sophomore versus freshman class football game. During third and fourth year clinical rotations which mirrored resident schedules, sometimes doing 36 hours on call, you grab whatever junk food you can get, and deal with sleep deprivation and stress. As I have subsequently found out these are major drivers in weight gain. By the time I graduated from medical school, I was at my heaviest up 65 to 70 pounds from my weight at the Sheriff's Department.

During internship, the long hours, stress, sleep deprivation and bad eating continued. I knew it was time to get a handle on things. Despite having very little time, I joined a gym that I could bicycle to from my house; I bicycled to the hospital, and I began my running again. Within a year, I had gone from 260 pounds down to 182. Towards the end of my third year of residency, I crashed my bike and injured my heel on a curb. I could no longer run without pain. After graduation, I entered the world of private practice emergency medicine. Due to financial pressures and debts run up during medical school and residency, I began working almost the equivalent of two full-time emergency medicine jobs picking up every extra shift I could find. What fell by the wayside? Yes, exercise and back into bad diet. In addition, I was in the United States Air Force Reserve medical core and struggled to maintain weight and ultimately was passed over twice for promotion because of my excessive weight and inability to complete training. Although I did receive an honorable discharge for my three years of service, again I knew it was time to do something as I had ballooned to over 255 pounds. I would moderate my diet, and again, trying to outrun my dietary stupidity. 10 years into my emergency medicine career, I had lost 60 pounds again. I tried to maintain this despite dealing with stress, travel, shift work and poor sleep habits. I always thought that if I could moderate my calories I could eat whatever I wanted. I was a carbohydrate addict. I loved pasta, pizza, Mexican and Chinese food. I would grab fast food while I was traveling. I was frequently overtired after a long overnight shift and facing a long drive I would caffeinate and stop several times on my drive for food. I did try to maintain my gym routine and actually worked with a personal trainer. I became frustrated because despite all of this, I was still gaining weight all over again. At this point, I gave up in frustration and very quickly was back up close to 260 pounds again. This was much like the treadmill that I frequently ran on, a vicious cycle that got me nowhere.

So this was just nine years ago. Where does the story go from here? I will continue the journey in the next post.

My Purpose

Welcome to this site which will be an informational resource regarding the low-carb lifestyle and wellness. We'll address things like risk assessment and prevention of common health conditions like metabolic syndrome and cardiovascular disease. While I am a physician, I am also an individual who has struggled with weight gain and loss most of my adult life. I'm going to use these personal stories to give insights into why this works.