4 Steps on How to Start Keto (per Dr. Adam Nally)
4 Steps on How to Start Keto (per Dr. Adam Nally)
Did you get a chance to catch the Facebook live interview I did featuring Dr. Adam Nally this past Sunday? We talked about a weight loss stall and the 4 steps he advises on how to start keto!
You can watch the video replay here:
Here’s How to Start Keto in 4 Simple Steps
These are the 4 steps Dr. Nally does with the patients he sees in his obesity clinic:
Step 1: Your total carbohydrate intake must have to be less than 20
Step 2: You’ve got to control your hunger, and the only way to control your hunger is to ensure that you’re eating enough protein and fat. The fat and protein should be at a 1 to 1 ratio. Bacon is the perfect 1 to 1 ratio. Chicken Thighs with the skin on is a good ratio too. Fats help satiate you and ward away the hunger. Be sure to see how much protein you should consume in a day below.
Step 3: Get your Thyroid checked. (see specific tests to ask for if you are trying to lose weight on the Keto diet)
Step 4: Hormones
How to Calculate How Much Protein You Should Consume:
Ideal body weight is based on height.
Protein in grams per day of your ideal body weight if 50 grams for the first 5 feet of your height.
Then add 2.3 grams for each inch over 5 feet.
Then multiply the number by 1.2 for sedentary male.
The average male needs approximately 1.2 g of protein per kg of ideal body weight per day.
Example: 6 ft male = 50 grams for the first 5 ft in height + 27.6 grams (2.3g x 12 inches) = 77.6 grams x 1.2 = 93.2 grams of protein per day.
Note: If you are exercising more than 60 minutes 5 days per week, your values should be multiplied by 1.6 grams per kg instead of the 1.2 grams.
Protein in grams per day of your ideal body weight if 45.5 grams for the first 5 feet of your height.
Then add 2.3 grams for each inch over 5 feet.
This lets you calculate the average female needs 1.0 grams per kg of ideal body weight for a sedentary female.
Example: a 5’4 female = 45.5 grams for the first 5 ft in height + 9.2 grams (2.3g x 4 inches) = 54.7 grams of protein per day.
Note: If you are exercising more than 60 minutes 5 days per week, your values should be multiplied by 1.4 grams per kg instead of the 1.2 grams.
Check your Thyroid:
Ask your doctor for these specific tests:
Full Thyroid Panel (includes free T4, Free T3 – make sure it’s the “free” T3 and not the bound)
The reason you want to check your thyroid function is to make sure you the T4 is converting correctly to T3. If you are insulin resistant, those high levels of insulin tend to suppress the enzyme that convert T4 to T3. This can cause a problem in those who are trying to lose weight with the keto diet.
Watch this presentation Dr. Nally did on thyroid at a Low Carb Conference recently:
Read the full Dr. Nally Interview on How to Start Keto in 4 simple steps:
Jennifer Marie: Hey, friends. Happy Sunday. How’s everybody doing? We have Dr. Nally back in the house. We are so excited to invite him back on. Dr. [Boz 00:00:11] is traveling in China. She told me that China hotel rooms are between three and six dollars a night. I have a feeling she might be there for a while. She’s having a blast, and good for her. She gets some time off. If you guys didn’t follow in and catch last week’s show, Dr. Nally is a board certified family physician, and he is an obesity medicine specialist. He has a practice, an obesity clinic, where he helps people lose weight, and he’s been doing it over 20 years. So, the dude knows what he’s talking about, and I love talking to him. So, hey, Lita says the sound’s not working. Is the sound working for you guys? Can you tell me if you can hear or not? Hi, everybody. Oh, wow. We have lots of people. Hey, Kimberly, Angela, Kathy, Stacy, Heather, Tiffany. I’m so glad you guys can join us. Let’s see. Okay. Okay. They can hear. Hey, Joe. Thanks, Kathy, for letting me know that you can hear. Okay. Sounds good. Yay, we got sound.
Dr. Adam Nally: Sound is always good.
Jennifer Marie: So, guess what. We are talking about a weight loss stall, and it’s such a hot topic, but Dr. Nally, I was totally thinking that after the holiday weekend, we should’ve been talking about how to recover from a cheat.
Dr. Adam Nally: Exactly. Yeah.
Jennifer Marie: I don’t know about you. I didn’t cheat. We totally barbecued. I did not step foot in the kitchen. We’ve been spending time at the lake, and I did a Live from the lake showing how we barbecue just everything from breakfast out on the grill to steaks for dinner. So, it was good. What did you do for the 4th?
Dr. Adam Nally: It was very quiet. We actually barbecued. Excuse me, my grill’s running right now, in fact. See, my smoker’s on. We’re smoking steaks. So, I’m going to have some steaks that come off the grill. I actually smoke my steaks for about an hour. My wife’s going to put some shrimp on their in about 30 minutes, and then, so, I’m going to have steak and shrimp. We have steak in the freezer. We pull it out, thaw it out, and that’s what we do on Sundays, but we grill or barbecue every holiday that we possibly can.
Jennifer Marie: I think we do. We try and go out to the lake every weekend or every other weekend, and we have a fifth wheel RV, and I’ve never used the stove. I cook for a living. So, there’s no way I’m cooking.
Dr. Adam Nally: Really?
Jennifer Marie: Yeah. So, we always grill. Always.
Dr. Adam Nally: Wow. That’s awesome.
Jennifer Marie: Yeah. Well, Gloria starts us off. She says, “I don’t cheat, but I’m stalled again.” Boy, isn’t everybody who does keto … I’m pretty sure you’re going to hit a stall, and I’m not exactly sure why, but I think Dr. Nally can help us explain why. I think I understand why I hit a stall at certain times, but I think there’s many more reasons that I probably don’t understand for many different people. What do you say, Dr. Nally?
Dr. Adam Nally: Well, I think it’s important that everybody understands that it’s natural to stall. Stalling is actually a protective maintenance that the body has. The body does not want to change. The body likes to maintain what’s called homeostasis, meaning everyone’s happy, everyone’s smiling. All the systems are in the green, and if one of the systems is suddenly dumping out fat, or one of the systems is suddenly dumping out salt, all of a sudden, the body goes, “Whoa, hold on. This is a problem.” And it slows everything down. So, you naturally see a slowing of metabolism. You’ll see a slowing of the thyroid function. You’ll see a change in many of the hormones, and that’s actually really normal. So, it’s very normal for people to hit stalls and plateau. A lot of people are really excited by a ketogenic diet because my average patient will lose 5 to 15 pounds every month for the first three months, and it literally falls off. And all of a sudden, it slows down to two to five pounds a month, and they’ll hit periods where they plateau, and they get so mad, and they come in and just … I’ve had some people come in and throw their journals at me or swear at me and say, “I’m a … ” and just get really upset.
Dr. Adam Nally: But that’s normal. So, what I try to tell people is it’s okay to stall. Remember, if you continue to lose fat, and your body can’t remodel the connective tissue in the skin and the extra muscle, you’re going to look like the Michelin tire man with all these rolls of skin hanging off your body. Your body has its own plastic surgeon. It’s just he’s just kind of slow. So, you have to just remember it takes a little while. That’s the step number one is just understand everyone hits stalls. That’s normal, and that’s your body’s way of remodeling the skin, remodeling the connective tissue, tightening up the skin because that takes time to do, if that makes sense.
Jennifer Marie: Yeah. It does. It does. Laura says, “But how does it fall off?”
Dr. Adam Nally: How does what fall off, the skin or the weight?
Jennifer Marie: Well, keto makes the weight fall off. I’m wondering if she’s talking about the skin because I know there’s been some talk about skin hanging, and I think I’ve heard answers, everything from lift heavy weights to fasting to stimulate autophagy to help that skin. Would you agree with that?
Dr. Adam Nally: So, the autophagy word, made popular by Jason Fund in his fasting books, autophagy’s a real word. I mean, it’s a real thing, but autophagy occurs in a ketogenic state, and fasting is a ketogenic state. A ketogenic diet is supposed to be a ketogenic state unless you’re eating all the stupid keto cookies, then you’re not actually in keto. That’s one of the challenges I find with a lot of people is they’re doing way too much snacking with the keto … I call it the keto crap. And so, you want to be wary of that, but any time your body is predominantly using ketones as its primary fuel, autophagy is actually working. Now, when you actually calorie restrict, they’ve actually shown studies that autophagy does actually become a little more enhanced with calories restriction, but the challenge is that calorie restriction beyond 48 to 72 hours permanently slows the thyroid function. So, that’s one of the things that you have to kind of … There’s a fine line you’ve got to ride there. So, if I’m trying to help someone tighten up skin, and I’m trying to help them look better and improve, I’m going to put them on a ketogenic diet, and I’m going to tell them to do intermittent fasting where they’re listening to their body, and they’re eating only when they’re hungry.
Dr. Adam Nally: And that may be one meal a day. That may be two meals a day, but they’re listening to their body, and they’re not grazing, like a lot of us were taught to do or a lot of us do because we’re either bored, or we’re stressed. And so, in order for that autophagy to kick in and to stay in a ketogenic state, you have to eat two really good meals, and that means protein and fat. You’re not eating nuts and cheese because those are going to halt the process. You’re eating protein, and you’re eating fat. You’re eliminating the carbs. You’re cutting them out completely, and that’s usually where you’re going to see a lot of success in jumpstarting that.
Jennifer Marie: Yeah. I find that if I’m really, really strict and just eat protein and fat, one to one, there is no way you can overeat because keto put you in a fasting state because you literally cannot eat anymore.
Dr. Adam Nally: Yeah, and a lot of people say, “Well, how can you only eat one meal a day? Because you’re cutting calories.” And if you actually look at it, you’re not. If you look at my caloric intake, my caloric intake, although I only have one or two meals a day, is still in the 2000, 3000 calorie range because of the fat content, but we don’t want to count calories because that puts us back in this mantra of, okay, the body’s a calorimeter, and it’s not. The challenge is bomb calorimeter is where they heat up water, and when they change the temperature of water, they call it a calorie. Well, your body is not a single, closed system. Your body is thousands of closed systems that interact with hormone signals, and you never know which system’s open, which system’s not. And so, counting calories is the most worthless things you can do. Your body knows how much fuel it needs because it says I’m hungry or I’m not hungry. So, the big key is learning to listen to that hunger signal. Now, some of us who are really, really insulin resistant, learning to understand that hunger signal takes us six months.
Dr. Adam Nally: And even today, I work anywhere from 12 to 18 hours a day in my office, and the stress level’s always high, and if I let myself, I can just munch on stuff all day long because that’s what I do when I’m stressed, is I munch, but I have to realize, okay, am I actually hungry, or am I thirsty, or am I just bored, or am I truly hungry and need fuel? And so, I find that as I start listening and I ask myself that question, I realize, okay, I’m not hungry. I’m actually just bored. So, what can I do to change the boredom? Or I’m not hungry. I’m just stressed. What can I do to change the stress?
Jennifer Marie: Yeah. I usually drink water at that point, and after I drink water, it’s almost like your mouth needs something to do, and that’s where I’ll pop a rock salt, and if I don’t need anything, I felt like my mouth was bored. I know that sounds so silly, but it works. It works.
Dr. Adam Nally: It does. It works very well.
Jennifer Marie: So, Ann Pepper says, “Interesting about calories restriction after 72 hours. I didn’t lose anything in the last fast after that time. So, I stopped.”
Dr. Adam Nally: And the challenge is that you’ll lose fat, but most people who fast longer than 48 to 72 hours will regain all that weight back, and one of the things that I’m seeing, and this is a couple of the research articles that talk about fasting show that there is actually a suppression to the thyroid function beyond that period of time. So, the question is if the only way you can lose weight is fasting, you can’t do a ketogenic diet or things of that nature, I can see people using that, but we have to watch that thyroid function really, really closely. And so, I don’t mind doing fasts periodically that way, but I have patients that are coming into me telling me that they’re doing a five-day fast every two weeks, and it’s like, “Okay. Let’s hold on. Why are we doing that? What’s the goal here for that?” Because you can actually cause some permanent thyroid change, which may not be the goal, and so, that’s one of the things you’ve got to be careful with.
Jennifer Marie: Wow. So, Gloria says, “Jennifer, when you wore the continuous glucose monitor, how did you test the sweeteners to find out what each one did for you? I find that I stay away from any sweeteners because it seems to affect me. I thought I would do a little individual testing for myself to see how my body handles them.” So, what I learned from Dr. Nally last week is that some of those sweeteners, I think monk fruit is what you said, could affect you three to five hours after you consume it. I don’t think I tested my body past three hours, honestly, and all the sweeteners, like the skinny syrups and all the stuff that I … I don’t use a whole lot of sweeteners anyway, but on all the ones that consume, I did test, and I did not have an insulin spike, but it sounds like I need to do three to five hours.
Dr. Adam Nally: A longer test.
Jennifer Marie: Yeah. You need to do longer tests. So, that’s pretty interesting, but if you hit a weight loss stall, first thing I would cut out is sweetener, first thing. Yeah.
Dr. Adam Nally: Absolutely, the two things to understand, all of the sugar alcohols, except for erythritol, will not raise your blood sugar period. Blood sugar will not go up, but insulin will go up, and the only way to see that is you may see your blood sugar drop later, anywhere from two to five hours later, with those. The challenge is that if insulin’s going up and blood sugar’s not going up, it’s throwing you out of ketosis, and you’re increasing your incidence for … your risk for increased hunger or increased chances of hypoglycemia. So, that’s where the sugar alcohols are a challenge. The sweetener called acesulphame potassium, which is they sneak into a bunch of other keto stuff, that one does the same thing. It does not raise blood sugar at all, but it raises insulin. And then, monk fruit, similarly, monk fruit does that through the liver, just like fructose does three to five hours after you take it in for some people, not for everyone.
Dr. Adam Nally: Alcohol, similarly, about 50% of the people that drink alcohol, even the dry forms of alcohol that’s supposed to be no carbs, I have patients. It kicks them out of ketosis at the five hour mark, where there are a few that don’t. And that really depends on how rapidly the liver metabolizes it, but that’s one of the things you’ve got to be careful of is, so, you can watch a glucose monitor, but it may not always tell you the story. This is where you need to be watching your ketones five, six hours after you have it.
Jennifer Marie: Yeah, and I think the audience is pretty in tune that if they’re testing via blood, they do look at glucose and ketone together. So, they usually get a ratio, which we’re all used to talk about.
Dr. Adam Nally: Oh, that’s right. I should know. This is the audience that understands the ratios. That’s cool. Yes, yes.
Jennifer Marie: Yeah, yeah. Yeah. We are deep in this. We feel we know what we’re doing. So, Bunny says, “Oh, I like this guy. Glad you brought him on to interview. I watched him today. He is right on.” I know. Isn’t he? I love talking to him. Okay. Ann pepper says, “Doing the beef and butter made me force myself to eat my macros and lose more.” You know what’s nice about the beef and butter fast? Is that it’s the exact macros, but you get full because it is protein and fat, and you recognize it’s more than just beef and butter. You recognized how much you should be eating and the right foods that you should be eating and that even carbs are in seasoning. So, you will find that when you season it the way that I’ve taught you to season it, that’s five grams of carbs just in the seasoning. So, if you hit a weight loss stall, I would almost bet that you’ve got what I call carb creep, is that you don’t know the amount of carbs that you’re really consuming because it can easily go over 20 grams in a day, and seasonings prove it with just the five. So, yeah.
Dr. Adam Nally: They really do. Yeah.
Jennifer Marie: Okay. So, let’s see what we have. Dr. Nally, do you have a food list you give your patients?
Dr. Adam Nally: I actually have a six-page handout that I give my patients. It’s a diet that I give them. We were talking earlier. On the membership site that I have, if people sign up for my concierge service or my keto plan service, they actually get 12 modules that are actually PD forms that they get to read about, and the first one is actually my diet. It has a list of foods that you can use, a list of foods that you have to be very cautious with and those kind of things.
Jennifer Marie: And tell them how to sign up if they wanted to.
Dr. Adam Nally: If they’re interesting, go to DocMuscles, D-O-C-M-U-S-C-L-E-S, dot com with a forward slash, membership, and there are two membership programs that are there. They can look at those programs, and if they’re interested in that, that’s how they can sign up.
Jennifer Marie: Awesome. So, Sherry-
Tiffany: [inaudible 00:15:08]
Jennifer Marie: What was that?
Dr. Adam Nally: Oh, what’s that? Tiffany, did you say something?
Tiffany: Tell her [inaudible 00:15:16] quick start.
Dr. Adam Nally: I did.
Dr. Adam Nally: So, my wife’s hollering from the other room, “Tell them this.” It’s like, “I can’t hear you. The headphone’s in. What?” So, anyway.
Jennifer Marie: So, Sherry says, “Why do people say we still have to be caloric deficient?”
Dr. Adam Nally: Because they don’t know any better, and they’re stuck in the mantra of the old world, and the probably were trained by a trainer who, bless their … If you’re a trainer out there, I’m sorry. I’m going to offend you. They need to pull their heads out because they don’t get it. There’s two or three trainers that I love them. They’re awesome. They know how to build muscle and throw weights on the rack, but they haven’t a clue when it comes to hormones. So, calorie deficiency is a swear word in my office. We actually don’t use the word “calorie” in my office because it is … The problem is that you don’t know every day if you need 1800 calories or 2200 calories or 3000 calories. Yesterday, I lifted weights for about 45 minutes. I ran for an hour. Then, I actually did my chores and fed my horses, and then, I actually washed off my truck and my boat. Today, I went to church and sat for two hours and was much more sedentary. The concern is that, yesterday, I probably needed about 5000 calories. Today, probably only need 2000 calories, but if you’re telling me I have to hit a macro every day, and I’ve got to get a calorie level, you’re going to miss the boat, and you’re going to feel horrible after you do that for a period of time.
Dr. Adam Nally: And you’re going to be so confused because you’re not seeing success that you give up, and that’s what we’ve been doing for 50 years. I mean, that’s what all of it, Weight Watchers, Jenny Craig, these are all calorie-based diets that have been ineffective. You’ll lose 20 pounds initially, but you’re not going to see your cholesterol get better. You’re not going to see your blood pressure get better. You’re not going to see improvement in gout and kidney stones and renal function. You’re not going to see any of that because you’re restricting calories.
Jennifer Marie: Yeah. I think Wes Martin says, “Permanently slows down the thyroid, question mark,” and permanently is in all caps.
Dr. Adam Nally: Yes. Permanently in all caps, underline, circle with a red pen, and highlight it with a yellow highlighter, permanently.
Jennifer Marie: Hi, Wes. Yeah. So, one thing that I tell people because I get people that ask me all the time, “How did you do it? How do you start,” whatever, and I remember being so stressed out by the macros in the beginning that, now, I tell people all the time, just don’t do sugar, watch your carbs, do the green, leafy carbs, and if you can just watch those carbs, you will naturally fall into this pattern. And up your fats because you really can’t overeat when you’re eating the right foods, and the carbs is the most important number to watch, and I mean, I think that’s the easiest way to do it. When somebody comes to your office in the beginning, and they want to start, what do you tell them?
Dr. Adam Nally: So, I tell them … All right. So, I tell them there are four steps, and if you start not seeing success, you’re missing a step. So, step number one, carbs have to be less than 20, period, end of story, and if you’re cheating, if you’re doing a bunch of carbage, I call it, if you’re doing a bunch of the keto crap as I call it, they’re nice. They taste good. They’re easy, but the problem is that you get that carb creep that you talked about. That creeps up. So, the carbs have to be under 20 grams, no matter what, period, for step number one. Step number two, you’ve got to control your hunger, and the only way to control your hunger is to ensure that you’re eating enough protein and fat. Now, a lot of people, in fact, I heard it yesterday, and I just saw one of the sponsor’s ads on, I think it was Facebook or Instagram, somewhere, where they were talking about how horrible the ketogenic diet is and how he actually took a cube of butter and stuck it in a cup and said, “This is the ketogenic diet.” And I just wanted to roll my eyes and say, “Why are you doing this?”
Dr. Adam Nally: A ketogenic diet, a well-formulated ketogenic diet, is real food, and that’s going to be a one-to-one ratio, roughly, of protein to fat. If you’re eating real food, if you’re eating bacon, sausage, eggs, cheese, even chicken, fish, and turkey, as long as you’re not breading it, you’re getting real food, and you’re going to get ratios that are somewhere around one-to-one if it’s red meat, pork, bacon, eggs, things of that nature. If it’s chicken, fish, or turkey, to make it taste good, you’re going to cook it in butter. You’re going to cook it in something of that nature, and it’s going to taste good, like the shrimp that I’ve got on my grill. That’s only 10% fat. So, I’m going to dip it in butter, and it’s going to taste really yummy, but I’m not slathering everything with butter. I’m just dipping it in butter, and so, that’s going to come up to be a roughly one-to-one ratio. So, step number one, lower the carbs. Step number two, one-to-one ratio of protein to fat. Step number three-
Jennifer Marie: Before you-
Dr. Adam Nally: Oh, go ahead. Yeah.
Jennifer Marie: … on to the next one, I’m five-four, how much protein should I be having?
Dr. Adam Nally: Okay. So, I don’t know if you have any protein calculators that you’ve used with your patients or your audience here. If you go to my website, DocMuscles.com, click on the blog link, and I can’t remember what the title is. If you type in protein, on the right side bar, if you type in protein, there’s a blog post. This is also in the book, and there’s a picture of Arnold Schwarzenegger, and go to that blog post. It has a protein calculator there for you, and it’s based on your height. So, if you’re Jenny, and you’re five-four, we’re going to calculate this right now in real time. So, for a female, we give you 45 grams of protein just for being five feet or higher. Then, the four inches, we multiply that by 2.3, and we add the 45 to that number, which is 9.2 plus 45. So, if you did absolutely nothing, and you were sedentary, and you enjoyed watching soap operas and popping bon bons every day, then you need roughly 55 grams of protein.
Dr. Adam Nally: Now, if you exercise more than 30 minutes, three days a week, we multiply that by 1.2, and that puts you around 65 grams of protein. So, you need roughly … and now, this is just a starting point. That’s all this is. It’s a starting point. You need roughly 65 grams of protein just to keep your muscle mass, and if you’re exercising more than that, if you’re doing weights five, six days a week, you may need to go to 75, even 80 grams of protein at your height. So, we have that protein calculator there, and so, your protein and fat should be roughly one-to-one. So, if you’re having 65 grams of protein a day, you should be having roughly 65 grams of fat per day. And the nice thing is if you’re eating bacon, bacon’s one-to-one. Eggs are one-to-one. Your beef and butter fast is a one-to-one ratio, and that makes life easy.
Jennifer Marie: That makes it so much easier to understand, and it’s understandable why carnivore is becoming more popular.
Dr. Adam Nally: Well, that’s why. It’s because they’re automatically doing this. They’re eliminating all the carb crap that’s out there, and they’re actually doing a one-to-one ratio of protein to fat for the most part, and that’s why it’s catching on because people are actually doing a ketogenic diet.
Jennifer Marie: Yeah.
Dr. Adam Nally: And then, the-
Jennifer Marie: Okay. So-
Dr. Adam Nally: Go ahead.
Jennifer Marie: Oh, no, no. You go ahead. Go ahead.
Dr. Adam Nally: I was going to say, well, the other thing is that, then, they’re adding in foods that we’ve stopped eating, my grandmother used to eat. They’re eating liver and heart and the gizzards and those kind of things. They’re nose to tail type eating where you’re actually starting to get some of the minerals and some of those important trace elements that we miss in regular foods now.
Jennifer Marie: Yeah, and speaking of minerals and speaking of vitamins, I find it very interesting that you have formulated a special thing just for Keto Essentials. I think it was called Keto Essentials. He’s going to send me some because I obviously need some, but the nice thing about this is that you have it specially formatted for people doing keto but also people who have the MTHFR gene, which we have to be methylated beans because we can’t methylate them within our system, but also the folate, you said, that was super hard to find, you’ve included it in your Keto Essentials. So, yeah, tell us how we can get those, too.
Dr. Adam Nally: So, well, you can go to ketoliving.com, and that’s where the … I actually had a company actually set up a site for me, and they manufacture the vitamin, and they distribute it for me, and that’s all that … And so, I don’t want to be a vitamin salesman. I just want the vitamin that I can trust. The challenge is I could not find a vitamin I could trust for years. So, a few years ago, I went to them and said, “I want this vitamin, and I want a couple other supplements,” that we added in there. But specifically, I wanted a multivitamin that would help people lose weight, that was balanced for people who had an MTHFR deficiency because 60% of my weight loss patients have neuropathies and MTHFR issues. And then, lastly, a significant portion of those patients have mitochondrial dysfunction, meaning the mitochondria, it’s like a carburetor that’s not working, and there are five or six essential components that are necessary for mitochondrial function, and those are also in there as well, ECGC, alpha-lipoic acid, and a whole slew of them. I can go into them if you want me to, but those are … I put it all in one vitamin, and I said, “Okay.”
Dr. Adam Nally: And it’s really kind of selfish because I was tired of trying to find it all and spending $500 for a box of pills. So, I said, “Can you just give me one vitamin?” And it actually is six capsules because it’s so much there, but you can spread it out through the day, but I designed it for me and my family and said, “This is what I’m doing, and if it works for me great, I want to sell it to my patients.” So, we’ve been using it for years in my practice. We also added berberine, which is similar in effect to Metformin. Berberine is the active ingredient in turmeric or goldenseal, and it actually has an anti-glycemic, antibiotic, and an antiinflammatory effect to it. And so, that’s a whole other topic we can talk about, too, but that’s what I ended up doing because I wanted a supplement that I can trust, and I hadn’t been able to find it until then.
Jennifer Marie: So, I had to get him to talk about that because I am super excited to have a keto vitamin that I can have and I know is what I need. Hey, Christa says, “Saw you at the metabolic health summit. Finally got my testosterone checked. Now on bio-identical pellet therapy. Thank you,” she says in all caps, thank you. That’s awesome.
Dr. Adam Nally: Cool. She probably feels like a new woman.
Jennifer Marie: Yeah. I think I need that. We talked about that. I need to look into bio-identical.
Dr. Adam Nally: Yes. You need to look into bio-identical hormones. Five years ago, I changed my tune completely and realized that what we were doing with regular hormone replacement just was absolutely worthless and not … and in fact, in many cases, making people worse. And so, I am a big proponent of bio-identical hormones.
Jennifer Marie: Yeah. I may need to find a referral here in Austin because I need to make an appointment. Violeta says, “Can the fasting glucose be higher in the morning the week of the period due to estrogen and progesterone surge?” Do you know that?
Dr. Adam Nally: Actually, so, yes. The short answer’s yes. Remember, you’re bleeding, and it’s an inflammatory process, that that inflammation stimulates cortisol, and it’s not the estrogen. Well, what it is is it’s a decline in progesterone and a rise in estrogen. It allows the lining of the uterus to begin to slough. Well, as that lining sloughs, there’s an inflammatory response that occurs, and whenever the body sees inflammation, CRP goes up, and cortisol goes up. Cortisol stimulates the liver to raise the glucose. So, yes, you will see a rise in glucose. That’s normal. Don’t worry about it. It means you’re a woman. It means you’re normal. So, be happy with that.
Jennifer Marie: Doesn’t he talk really fast? I love it.
Dr. Adam Nally: Too fast for some people.
Jennifer Marie: Hey, Jilly says, “I had my yearly physical. I am on Metformin now, but my cholesterol went way up. Is it too much fat? Stay at 20 carbs.”
Dr. Adam Nally: And I don’t know if you’ve seen the video I did on cholesterol. Remember, this is one of the presentations that I give, is that it’s actually normal for your total cholesterol to go up on a ketogenic diet. Total cholesterol and LDLC, which are the two markers that for years and years, we thought were the end all, be all of our risk for heart disease. They’re actually worthless measurements. They’re absolutely worthless. When your body’s using fat as its primary fuel, you’re going to see a rise in total cholesterol and a rise in LDLC. That’s actually normal, but remember, LDLC’s made of three subtypes, and I talk about this in my video on YouTube. But it’s the small particle that’s the problem, not the medium-sized or the big, fluffy ones. And so, even if LDL goes up and even if total cholesterol goes up, that means nothing. What you need to know is your triglyceride under 100, and is your small, dense LDL particle less than 500. And ketogenic diet, if you’re doing a ketogenic diet, 99.9% of the time, those are normal, and your cholesterol is actually doing great. So, if you want to know more, I did a whole video, and I’ve got slides and everything there. So, you’ve got to watch that, if they want to see that.
Jennifer Marie: Okay. Well, we’ve got to get back to steps three and four that you tell your new patients.
Dr. Adam Nally: Oh, yes, yes.
Jennifer Marie: Yeah. So, we got totally sidetracked by protein, the protein calculations.
Dr. Adam Nally: Yeah, sidetracked by all sorts of stuff. Yeah. So, carbs under 20, protein and fat, one-to-one. So, the next step is thyroid. Check your thyroid. A lot of people tell me, “Well, doc, I think it must be my thyroid. So, I’m going to go take a cellular supplement.” I don’t recommend doing that. I recommend going to your doctor and getting your thyroid checked. Let someone actually check it.
Jennifer Marie: When you say get your thyroid checked, normally they do this simple panel. Do you have to ask for the T3 and the T4? What do you specifically ask for? Because I feel like you almost have to beg your doctor to give you the full-
Dr. Adam Nally: Yes. You might have to beg your doctor. Yes.
Jennifer Marie: Yes, yes.
Dr. Adam Nally: All right. So, I want a TSH. So, TSH is number one, and most doctors will order that. I would want a full thyroid panel. Now, that’s going to give you the free T4, free T3’s, but I also want a … Specifically, you want three T3. That’s T as in Tom with a three. You want the free one, not the bound, and then, you want a reverse T3. On my YouTube channel, I did … Actually, the thyroid talk I gave in Keto Salt Lake, it’s an hour long talk, and it’s on my YouTube channel, and it shows all those on there, and we talk about thyroid in depth there, but that’s what I want to see. And the reason I want to see it is the TSH is telling me what your pituitary gland is telling your thyroid gland. I want that signal to be balanced. Secondarily, the T4 is telling your thyroid telling your brain how well it’s responding. I want that to be balanced. Lastly, your thyroid produces T4. T4 is converted into T3. From your neck down, T3 is the gas pedal for the cells in the body. If your free T3 is low or if you’re reverse T3 is greater than 15, you’re not converting T4 to T3 correctly, and that needs to be checked.
Dr. Adam Nally: Now, most doctors have no idea how to do that. It’s starting show up in the literature, but the challenge is that very few doctors understand that conversion, and even fewer doctors understand that a high insulin level suppresses the enzyme that converts T4 into T3. So, if you’re insulin resistant, guess what. You’re probably also hypothyroid, and if you’re hypothyroid, and you’re saying, “I’m keto,” you probably aren’t. So, there’s probably something in their … There’s some carb creep that’s keeping the insulin up, not letting you convert that thyroid hormone. So, we want to balance the thyroid hormone and make sure that’s correct.
Jennifer Marie: So, if you are that, how do you fix it? Just very, very strict keto?
Dr. Adam Nally: So, strict keto, number one, and then, number two, if that doesn’t balance it within a month or two, then using either a T4 or a T3 supplement is what I do in my office. So, we can actually supplement it if we need to, but we want to watch it really closely every three months because that make fluctuate, and we want to adjust it. So, a lot of people say, “Well, I don’t want to have to check it all the time.” Well, do you check the fuel gauge in your car all the time?” Same thing. We want to make sure we’re check that because as you’re losing weight, that thyroid level’s going to flux, and it really will. It’ll be depending on if you’re eating less food. You’re going to naturally see a suppression in the T4, and you’re going to see a change in your TSH. That’s not going to be permanent, but we want to adjust to it. Basically, we want to make sure that as you’re losing weight, your engine is performing at its peak.
Jennifer Marie: Got it. So, what’s step four now?
Dr. Adam Nally: Step number four is hormones, the female hormones, the male hormones, so testosterone, progesterone, and estrogen. Now, guess what. Your progesterone, your testosterone, and all three of your estrogens are made from a really cool thing called cholesterol, and guess where you get cholesterol from? Butter and beef, which apparently, some of you are going to start the beef and butter fast or bacon. It comes from any of those things. So, if you’re eating a ketogenic diet or a carnivore diet, you have the precursor molecule to making progesterone, testosterone, and estrogens. The problem, though, is that a lot of us, well I don’t, but a lot of my patients have had hysterectomies. They’ve had their ovaries removed. A lot of men, 60% of the men who are prediabetic or diabetic have a low testosterone because the insulin suppresses the conversion of these hormones. So, checking those hormones is really important because we can modify the diet further, or we can add hormones if we need to to try to help modulate that fat burning process to move forward.
Dr. Adam Nally: Can you still lose weight if they’re off? You can, but it’s going to be very slow. You’re going to see lots of plateaus. You’re going to be … It can be depressing for some people. So, we want to modulate those. And so, number one, progesterone, free and total testosterone, and now, if you say, “I would like my estrogen checked,” and your doctor checks your total estrogen, you probably need to find a new doctor because there are actually three estrogens, and I want estradiol and estrone, two of the three which tell us. And if your doctor understands that, you probably have a doctor that understands hormones correctly. So, you want to make sure those are checked. I will also sometimes check what’s called a pregnenolone. I’ll check a DHEA. I’ll check a DHT. Those are more extensive hormones that don’t necessarily fall into this, but they help with overall energy and libido and those kind of things, but that’s actually really important to understand. So, that’s step number four, is balancing those hormones out.
Jennifer Marie: Got it. So, that’s what you tell your patients when they get started, but let’s talk more now about a stall. So, can we talk about, so let’s say, too much alcohol?
Dr. Adam Nally: Oh, yes.
Jennifer Marie: [inaudible 00:33:50] the 4th weekend.
Dr. Adam Nally: So, what happens with alcohol? Well, remember, alcohol was a starch. It was a carbohydrate, and we converted into an alcohol, and the problem is the liver sees that as a toxin. So, it has to detoxify it, and the liver detoxifies alcohol identically to the same way it detoxifies fructose. 100% of fructose, which is one half of a sugar molecule or the sugar found in fruit, is processed through the liver, and it creates an aldehyde first. And the aldehyde is really cool because it goes to the brain and stimulates the same receptor in the brain that morphine does and goes, “Ooh, that was really good. I want a donut in two hours,” and that’s what drives that process. So, fructose does it, and alcohol does it. Number two, then, as they’re both being processed, they raise uric acid, which increases your risk for kidney stones and gout. It lowers nitric oxide, which actually increases your blood pressure, and then, at the very end, five hours later, spikes your insulin.
Dr. Adam Nally: And so, the challenge is if you’re drinking a lot of alcohol, or you drink alcohol, it’s going to kick you out of ketosis for at least 24 to 48 hours. If you’re using alcohol on a regular basis, it’s going to dramatically inhibit your ability to lose weight. It’s going to raise your blood pressure and increase your risk for gout and stimulate the cravings to be heavy. So, I would say if you truly want to lose weight, lose the alcohol.
Jennifer Marie: Cut it.
Dr. Adam Nally: Cut it out. Get rid of it.
Jennifer Marie: Get serious, cut it for a while, and then, maybe when you get healthy a little bit, you can do moderation maybe.
Dr. Adam Nally: Well, I tell people, if you drink one glass of wine, now that’s actually one glass. That’s the way they actually pour the glass. That’s not the [inaudible 00:35:22] of wine. That’s one glass of wine. One glass of wine is the equivalent. It isn’t sugar. It’s an alcohol, but it is the equivalent, once the liver processes it, of 20 grams of carbohydrate. That’s just the alcohol, and that’s based on proof. The higher the proof, the higher the carb equivalency.
Jennifer Marie: We have a question here from Catherine. It says, “Dr. Nally, do you recommend the coronary artery calcium score testing for your patients? I feel that is a very important test.”
Dr. Adam Nally: If you’re independently wealthy, yes. If you have the funds to do it, great. The problem is that it misses 40% of blockages, and I realize that that’s not what everyone else is promoting out there, but that’s because they sell the test. So, what’s important to understand is the reason your insurance company won’t pay for that test is because 60% of calcium blockages have calcium … Let me rephrase that. 60% of blockages have calcium in them, and that CAT scan will pick it up. 40% of your blockages have no calcium, yet they’re still blockages, and I have had two patients that have had heart attacks with non-calcified blockage so that their coronary calcium test missed it. So, the standard of care for a heart test is a stress test of a cath, but you have to have a normal risk factor for a catheterization test. That’s the wire they stick up your groin into your heart to look at it, but a stress test will pick it up. An echocardiogram, a stress echo picks it up, and in my office every year, we do carotid ultrasounds, which is we’re looking at the carotid artery, and if I see blockage in your carotids, I can pretty much guarantee there’s blockage in your heart, too.
Dr. Adam Nally: So, we can do a combination test, which is an ultrasound of the artery in your neck, and we measure the wall thickness in your neck, and the combination of those two scores give me a good idea as to whether you’re getting better or worse. So, if you have the funds to buy a CAC, a calcium artery score or a calcium artery test, great. Do it, but most insurance won’t pay for it. No insurance in my area will pay for it. It’s not horribly expensive, but I’ve been told it runs anywhere from 150 to 450 bucks. So, if you want to test it, great, but again, it still misses 40%. So, I don’t hang my hat on that test.
Jennifer Marie: Okay. So, another question. Tracy says, “Can [Ampisol 00:37:40] increase cholesterol if having acid reflux? So, therefore, is keto good for acid reflux people?” Oh, I’ve got a story for you.
Dr. Adam Nally: Yeah, I bet you do. So, keto actually decreases reflux by 65%. Eric Westman actually did a really nice study showing that 65% of people who do a ketogenic diet will actually see reversal or reduction in their reflux and their heartburn. What about the rest of those 35% of people that still have it? There’s drugs like omeprazole and Protonix and Prilosec and all of those that are out there, and they’re great drugs. The challenge is that when you use them long-term, you can decrease absorption of some of your vitamins, like vitamin D as in dog. And so, there’s some risks. So, you have to play the risk versus the benefit of those medicines. I’ve got some patients that have what are called Barrett’s esophagitis, and that puts people at significant risk for esophageal cancer. With those patients, I want them to take their omeprazole, and we watch closely their vitamin supplementation and ensure that they’re also getting that correctly. The challenge is that those drugs were only designed to be used for two to three months at a time and then to be backed off and checked again. So, that’s something you want to work really closely with your doctor on. And if your reflux is almost completely improved, then start using apple cider vinegar, a tablespoon of apple cider vinegar and some water and drink it. It’ll act as a buffer for you, and that works for a lot of my patients that way.
Jennifer Marie: Yeah. I was diagnosed with acid reflux a long time ago, and this was way before I knew anything about eating keto. I was carb and sugar addicted, but that lining was so frail that I had an internal bleed that put me in the hospital for six days. They did uppers, lowers, and it was in between the reach of both of those where they couldn’t find.
Dr. Adam Nally: Oh, wow.
Jennifer Marie: Yes, and luckily, it stopped. Luckily, I was on this [Emprazole 00:39:39] for a long time, and then, I learned keto, and I was told that I had such thin lining that I couldn’t even take … Was it Tylenol? I think it’s Tylenol or any … No, ibuprofen because-
Dr. Adam Nally: Ibuprofen, yeah.
Jennifer Marie: … my stomach would bleed at ibuprofen, and I’ve been keto two-and-a-half years, and I had the worst headache the other day, and Dr. Boz told me, “Take an ibuprofen,” and I argued with her. I’m like, “No. I will never take an ibuprofen the rest of my life. You don’t understand. I could bleed internally.” And she’s like, “Girl, your gut has been healed. You’ve been doing this long enough,” and I put so much trust into what she says that she said, “Take your Tylenol. Take your ibuprofen,” and I mean, it was splitting headache. I took the ibuprofen. I was so scared, and I swear, my guy has to be healed because I didn’t cramp. I mean, I had no issues, and to know that I was that severe from never taking an ibuprofen before with the lining, it is just amazing that I know it has healed my gut and what carbs and sugar do to your gut in the first place. I was in a bad way. So, that’s just an amazing story that I think … Was it keto that did it? I believe it was. I don’t know that there’s studies out there that say, but I-
Dr. Adam Nally: There are.
Jennifer Marie: Yeah.
Dr. Adam Nally: There actually are. There are, and you’re a case study of … Yeah.
Jennifer Marie: Totally, totally. So, definitely keep up keto and heal those guts, seriously.
Dr. Adam Nally: Oh, absolutely. Absolutely.
Jennifer Marie: Yeah. Yeah. So, let’s see. Gloria says, “Explain how the reverse T3 affects the thyroid, so I can explain it to my doctor.” I think you explained that pretty well, didn’t you?
Dr. Adam Nally: Well, just remember that if your body can’t convert T4 to T3, then it’s going to use a different enzyme to convert to what’s called reverse T3. Reverse T3 is an inert product. It doesn’t do anything, where T3 actually stimulates the … It’s like the gas pedal for the cells from your neck down, and so, that’s really what we’re doing. So, if your reverse T3 is going up, it means your body’s converting the T4 into an inert product that’s not being effective. It’s not working, and so, that’s essentially what that means.
Jennifer Marie: Okay. Rhonda says, “How can someone go dairy free and still get fats in?” Man, my first thought is avocado.
Dr. Adam Nally: Well, the issue is if you’re doing dairy, you’re limiting all lactose. If you’re doing butter, remember butter, the lactose is gone. It’s just the butter fat that you’re using. Lactose is essentially absent. The only challenge with people who have to do dairy free is they have to do … If they’re doing creams, heavy creams, you have to find a cream that has very minimal lactose in it because some of that cream still has some lactose in it. But cheese, remember cheese, if you have a hard cheese, that cheese has been processed to where the lactose is gone. The bacterial cultures have eliminated for that, and so, you can do … And then, your fats come from … if you’re doing red meat, pork, and eggs, those are 50% fat no matter how you cook them. So, that’s where your other fat comes from.
Jennifer Marie: So, Monica has a good question. She said, “Why does one doctor say keto is not good for thyroid issues?”
Dr. Adam Nally: Because they don’t understand the thyroid, number one. So, it’s important for them … So, what happens is this. Any time you start any diet, you’re going to see a drop in your T4. That’s actually normal because what’s happening is your body’s losing weight, and that T4 level will fall suddenly because the body doesn’t need as much T4, and a lot of what’s happening is because you’re burning fat, a lot of the T4’s being converted to T3, the free form. And so, you actually see a drop in T4, but nobody’s measuring the free T3 or the reverse T3. They’re not measuring it because we were never taught to do that in school. So, all what they say is they say, “Oh, that must be a horrible diet because your T4 dropped, and it’s terrible.” Well, if you look at the studies that did that, and this is usually … There’s a paleo doc, and there’s a couple other people out there that claim keto’s so horrible for your thyroid because it has this T4 thing.
Dr. Adam Nally: If you look at the study they quote, it’s essentially a four week study. They looked at the thyroid for four weeks. Who does that? It takes the thyroid literally eight weeks to change. So, if you measure this study for four weeks, you’re only getting half the picture, and there’s another study that they quote for 12 weeks, but the challenge is at 12 weeks, suddenly, you change again, and that thyroid resets itself. So, the problem is what study are they quoting, and the two studies that they are quoting, they’re not helpful in the long run because we’re looking at 6, 12, 24 months is what we’re trying to see. And usually, that resets. It comes right back up very quickly.
Jennifer Marie: Got it. So, Ruben says, “I’ve been having headaches since I’ve been doing keto. Why? I immediately want to scream electrolytes. Sodium, potassium, calcium, and magnesium, you need … and [crosstalk 00:44:35] salt.
Dr. Adam Nally: Salt, you need salt.
Jennifer Marie: Definitely.
Dr. Adam Nally: I have salt on my table. It’s on my desk. If I start feeling bad, I do salt chasers.
Jennifer Marie: I carry it with me. I carry sale with me. I know that sounds crazy, but I carry it with me. When a headache comes on, I’ll pop a rock salt. I went to the gym this morning, and I must be very dedicated because on a Sunday, after the 4th of July weekend, there was nobody at the gym, and I had my salt with me.
Dr. Adam Nally: Yep. Yep. They’re still recovering from their hangover from the alcohol and the carbs. So, I’m sure. I’m sure.
Jennifer Marie: So, let’s just sum up. A weight loss stall is normal. Homeostasis means your body wants to stay the same. When it’s changing, there’s going to be some fluctuation. Too many carbs, you must lower your insulin in order to get that going. Sneaky carbs, let’s give a list, nuts, starchy vegetables, avocados, if they’re too much avocado, [inaudible 00:45:40] and alcohol, [inaudible 00:45:42] sauces, dressings, marinades, [inaudible 00:45:45], flavored coffee, sugars, protein, too much protein or too little protein even, too much fat. You need to make sure you have the protein, one-to-one fat ratio, too much alcohol, or for insulin resistant people, alcohol in general. The only other thing that I have written down that we didn’t talk about is [inaudible 00:46:09].
Dr. Adam Nally: Oh, yeah. Yeah. So, sleep, your body has to recover, and if you can’t recover effectively, your cortisol’s going to stay high, and cortisol’s the driver to turn the liver … turn up the glucose production of the liver. That’s essentially what … That’s what cortisol does. If you’re not getting adequate sleep, if you’re not getting recoverable or restful sleep, if you have sleep apnea, and it’s not controlled, another issue, you’ve got to treat that because you’re going to see high cortisol, and if you’re not sleeping chronically, your testosterone’s going to drop. The fat cell has essentially five back doors to let fat out. One of those is testosterone, and if your testosterone’s falling because of insulin being high or chronic high stress responses with poor sleep, your testosterone’s going to drop, and you’re not going to see a weight loss with that, too. Again, the body’s going to maintain in those, “I’m under stress. I’ve got a problem. We’re shutting all the doors.” It’s like the school on lockdown, essentially is what it is.
Jennifer Marie: Got it. So, Karen [Minson 00:47:10], oh, she’s been a long-time viewer. She says, “Will keto help Graves disease? My 16-year-old granddaughter was just diagnosed.”
Dr. Adam Nally: Will it help Graves disease? Absolutely. Yes, it does, and remember Graves disease is driven by thyroid antibodies, and those antibodies are often more predominant because of a high insulin presence. Insulin actually affects a part of the brain that products the thyroid antibodies, the thyroid peroxidase antibody, and that’s … which is a driver in Graves disease. So, keto is probably the best thing that you could do for that person.
Jennifer Marie: So, Jilly says, “If you’ve been on Synthroid medicine for a long time, can you ever get off it?”
Dr. Adam Nally: Sometimes. It really depends on your … I’ve had about 50% of my patients on keto have been able to cut their thyroid dose in half. The other 50% have been able to come off. So, it really depends on where your thyroid is in the process of function. If you have a very poorly functioning thyroid, you may not get the function back. So, you may have to use a supplement for the rest of your life, but it’s probably going to be half or a quarter of the dose that you [inaudible 00:48:20] had to use before.
Jennifer Marie: Okay. So, I just saw a question. Hold on. Monique says, “So, can keto actually help a thyroid issue?” And she wants to understand how.
Dr. Adam Nally: So, there’s a whole chapter on the how in my book. So, have her get the book and read it. I did an hour long presentation on my YouTube channel. So, look up my thyroid YouTube video at Keto Salt Lake or Low Carb Salt Lake that I did a couple months ago. They’ve got the whole presentation there. I do talk fast. So, you might want to turn it on slow so you can keep up, but yes, it helps in multiple ways. We can do a whole hour long program on it.
Jennifer Marie: Okay. Sounds good. Maybe we should have you on and talk thyroid issues next.
Dr. Adam Nally: We could do that if you want. Testosterone, thyroid, progesterone, if it’s a hormone, I love it. I love to study it and fine tune it.
Jennifer Marie: Yeah. I love to listen. If you guys found this helpful, if you could share this video out, we will definitely have Dr. Nally on again. It sounds like we need to talk deeper into thyroid issues, honestly.
Dr. Adam Nally: There’s a lot of thyroid questions. I’m seeing these thyroid questions pop up. There’s a ton of them. Yeah.
Jennifer Marie: We should. Let’s put on the calendar to have you back, so we can talk thyroid.
Dr. Adam Nally: Yeah. Let’s do thyroid. Yeah.
Jennifer Marie: Yeah, and if you haven’t gotten this book, I highly suggest you get it. It’s called The Keto Cure. It’s got really good reviews. You’re welcome, Karen. Let’s see. Yeah. Oh, they want to talk about … Christy wants you to talk about all hormones.
Dr. Adam Nally: Well, there are 38 of them that are related to weight loss. So, we could do 38 shows.
Jennifer Marie: Yeah. We could do … We might have to bump up the Live. Well, I hope you guys found this broadcast helpful. We are definitely trying to provide information and help you along your journey. You guys be sure to thank Dr. Adam Nally for joining us. Follow him on YouTube. Grab his book. Let’s show some support. Go to Keto Living. Grab his vitamins if you need them. I know I’m getting them. Thank you. So, thanks for coming on, Dr. Nally. I appreciate it. We’ll definitely have you on again to talk [crosstalk 00:50:32].
Dr. Adam Nally: Thanks for having me.
Jennifer Marie: Yeah, for sure. We’ll talk about-
Dr. Adam Nally: You have a good audience.
Jennifer Marie: Yeah, definitely. They’re very involved, and they love to learn, and I love that, also. If you haven’t gotten it, oh, I’ve got some news. My book, Easy Keto for Busy People: Keto Friendly Recipes, it’s number seven. It’s been out seven weeks, and it’s number seven, rank number seven in the whole country of cook books. So, a lot of you guys have gotten the book already. A lot of you guys have given me wonderful reviews. I thank you so much for that. I’m so glad you’re enjoying it. You guys have a great evening, and we will see you next Sunday. Bye bye.
Dr. Adam Nally: Take care.
If you enjoyed this interview, be sure to check out the interview I did with Dr. Adam Nally on Insulin Resistance here!