Monday, December 3, 2012

Dangerous! UN Convention on Rights of Persons with Disabilities

The Senate will be voting on ratification of the "UN Convention on Rights of Persons with Disabilities."  This is a very dangerous ratification because it drastically changes the rights of the family.  Michael Farris, an attorney well versed in Federal and State law relating to the family, states it best below.  Please read his article and call your Senator today.  If you're in Arizona, please call Senator McCain's office in Washington, D.C., as he has recently vocalized that he sees no problem with this convention treaty.
"HSLDA has written about the threats posed to homeschool freedom by the UN Convention on the Rights of the Child (CRC) and the UN Convention on the Elimination of All Forms of Discrimination against Women (CEDAW).
"However, there is a third dangerous United Nations convention. This is the UN Convention on the Rights of Persons with Disabilities (CRPD).1 President Obama sent it to the U.S. Senate for ratification on May 18, 2012.
"CRPD was adopted by the UN General Assembly on December 13, 2006, and entered into force on May 3, 2008, after it received its 20th ratification. The Optional Protocol to the Convention went into force on the same day after it received its 10th ratification. The CRPD was signed by President Obama on July 30, 2009. Since it has been sent to the U.S. Senate for ratification by President Obama, the U.S. Senate could vote to ratify this treaty at any time.
"CRPD calls for numerous protections for people with disabilities. Many of these protections are included in U.S. law as part of the Americans with Disabilities Act (ADA). However, CRPD also includes numerous provisions drafted by the United Nations which would concern many U.S. citizens. Like the CRC and CEDAW, if ratified, the Convention on the Rights of Persons with Disabilities would become the supreme law of the land under the U.S. Constitution’s Supremacy Clause in Article VI, would trump state laws, and would be used as binding precedent by state and federal judges. Since it is a treaty, the U.S. Constitution requires that it must be ratified by two-thirds of the U.S. senators present at the time of the vote, or 67 senators if all 100 U.S. senators were present.

"Ten Specific Problems with the Convention on the Rights of Persons with Disabilities

"1. Any remaining state sovereignty on the issue of disability law will be entirely eliminated by the ratification of this treaty. The rule of international law is that the nation-state that ratifies the treaty has the obligation to ensure compliance. This gives Congress total authority to legislate on all matters regarding disability law—a power that is substantially limited today. Article 4(5) makes this explicit.
"2. Article 4(1)(a) demands that all American law on this subject be conformed to the standards of the UN.
"3. Article 4(1)(e) remands that “every person, organization, or private enterprise” must eliminate discrimination on the basis of disability. On its face, this means that every home owner would have to make their own home fully accessible to those with disabilities. If the UN wants to make exceptions, perhaps they could. But, on its face this is the meaning of the treaty.
"4. Article 4(1)(e) also means that the legal standard for the number of handicapped spaces required for parking at your church will be established by the UN—not your local government or your church.
"5. Article 4(2) requires the United States to use its maximum resources for compliance with these standards. The UN has interpreted similar provisions in the UN Convention on the Rights of the Child to criticize nations who spend too much on military issues and not enough on social programs. There is every reason to believe that the UN would interpret these provisions in a similar fashion. The UN believes that it has the power to determine the legitimacy and lawfulness of the budget of the United States to assess compliance with such treaties.
"6. Article 6(2) is a backdoor method of requiring the United States to comply with the general provisions of the UN Convention on the Elimination of All Forms of Discrimination against Women. This treaty enshrines abortion rights, homosexual rights, and demands the complete disarmament of all people.
"7. Article 7(2) advances the identical standard for the control of children with disabilities as is contained in the UN Convention on the Rights of the Child. This means that the government—acting under UN directives—gets to determine for all children with disabilities what the government thinks is best.
"Additionally, under current American law, federal law requires public schools to offer special assistance to children with disabilities. However, no parent is required to accept such assistance. Under this section the government—and not the parent—would have the ultimate authority to determine if a child with special needs will be homeschooled, attend a private school, or be required to accept the program offered by the public school.
"8. The United States, as a wealthy nation, would be obligated to fund disability programs in nations that could not afford their own programs under the dictates of Article 4(2). This is what “the framework of international cooperation” means.
"9. Article 15’s call for a ban on “inhuman or degrading treatment or punishment” is the exact same language used in the UN CRC which has been authoritatively interpreted to ban any spanking by parents. It should be noted that Article 15 is not limited to persons with disabilities. It says “no one shall be subjected to … inhuman or degrading treatment.” This means that spanking will be banned entirely in the United States.
"10. Article 25 on Education does not repeat the parental rights rules of earlier human rights treaties such as the International Covenant on Civil and Political Rights or the International Covenant on Economic, Social, and Cultural Rights. This is an important omission. Coupling this omission with the direct declaration of “the best interest of the child” standard in Article 7(2), this convention is nothing less than the complete eradication of parental rights for the education of children with disabilities.
"HSLDA urges . . . all freedom-loving Americans to contact their U.S. senators and urge them to oppose this dangerous UN treaty. (by Michael P. Farris, Esq., LL.M.; Taken from"

To speak with your Senator, call Washington, D.C., at (202) 224-3121 and ask for your State's Senator office.  Ask to speak with your Senator's staff and let them know you oppose the CRPD.

Saturday, November 3, 2012

The Skinny On Artificial Sweeteners

I am frequently asked about the sweeteners that can be used along with a low carbohydrate diet.  I am a strong proponent of a high fat, moderate protein, very low carbohydrate diet, and I use this dietary approach in my medical practice daily.  What follows is a reprint of my article about sweeteners that can be found on my low carb website.  

So what is the "Skinny on Sweeteners?" There are a number of sweeteners available that can be used with cooking; however, many of them are not appropriate for use with a low carbohydrate diet.
SweetenerWith an understanding that weight gain or weight loss is controlled by the hormone insulin, our overall goal is to lower the insulin levels in the blood stream.  Glucose (a carbohydrate in its most simple form) stimulates insulin to rise.   A Low carbohydrate diet works because insulin levels are significantly lowered throughout the day.  Elevation in cholesterol, elevation in triglycerides and stimulus for production of uric acid also occur because of surges in the hormone insulin. The most common stimulus for insulin to rise is the body’s recognition of the presence of carbohydrates or sugars.
First, and foremost, we must understand how these carbohydrates or sugars are labeled or named so that we can identify them in the food products we eat.  Most sugars are labeled with the ending “ose". 
Sucrose, fructose, glucose, dextrose, lactose, and maltose are very common sugars you’ll see in the ingredient list of many products containing carbohydrates. All of these types of sugars will stimulate a significant insulin rise and lead to weight gain, elevation in cholesterol and triglycerides. 
Other very commonly used names that you will find containing the sugars above are: white and brown sugar, succanat, corn syrup, high fructose corn syrup, honey, malt syrup, cane juice, cane syrup, rice syrup, barley syrup, maple syrup, molasses, turbinado, and fruit juice concentrate.  Beware of products that contain "no added sugar" because they will often contain sugar concentrates in the form of concentrated grape or apple juice.
Fructose is sometimes promoted as a suitable sweetener for patients with diabetes or people who are wanting to follow a low-carb diet; however even though it does not cause a significant insulin rise, it is rapidly absorbed by the liver and converted into glycerol which leads to increased triglyceride and cholesterol levels.  Even though fructose occurs naturally in regular fruits and some vegetables, it is usually only present in small amounts. The fiber in these fruits or vegetables balances out the fructose content.  Today, fructose is added commercially to many foods in a highly refined purified form as high fructose corn syrup. Be careful because this form of fructose is found in soft drinks, ice teas, fruit drinks, jams, jellies, desserts, baked goods and even in many baby foods.  This form stimulates an extremely powerful stimulus in the liver to form triglycerides and leads to fatty liver disease, a form of non-alcoholic cirrhosis (J Am Diet Assoc, Lustig RH, 2010 Sep; 110 (9):1307-21).
Artificial Sweeteners
Most artificial sweeteners fall into a class that is referred to as “non-nutritive” meaning that they have no nutrient value to the human body. They provide a sweet taste to the senses without raising the blood sugar. These sweeteners can be useful in cooking and in maintaining blood sugars; however, it is important to realize that many of them still stimulate an insulin response.
The most popular artificial sweetener in use today is aspartame (NutraSweet™, Equal™).  Aspartame is calorie and carbohydrate free; however, it is not the ideal sweetener. Because of its chemical instability, it breaks down under heat into its chemical constituents - namely phenylalanine and aspartic acid. This makes it notably unsuitable for cooking or for storage for more than a few days. 
Second, in light of its safety profile maintained by the manufacturer, a number of people of experience side effects including headache, stomach upset, migraine and exacerbation of depression (Neurology October 1, 1994vol. 44: 1787). Most people enjoy without problem, however.
Acesulfame Potassium
A second popular sweetener has been identified by the food and beverage companies called acesulfame potassium (Ace-K™, Sunette™). This sweetener is not fully absorbed by the gut, and yields no calories, nor does it raise blood sugar.  It also contains no carbohydrates.  To many palates, it has a slightly bitter savor, so it is often combined with aspartame to eliminate the bitter aftertaste.  The problem with acesulfame potassium is that there are a number of studies revealing it significantly increases insulin response without raising blood sugar.  Studies show that the insulin response is as remarkable as if a person ingested an equivalent amount of glucose (Horm Metab Res. 1987 Jun; 19(6):233-8.).  It appears thatacesulfame potassium works directly on the pancreas to stimulate insulin release (Horm Metab Res. 1987 Jul; 19(7):285-9).
This product appears to be one of the most popular artificial sweeteners currently used in a number of low-carb products. It can be found in many of the protein bars and protein shakes on the market.   It is also found in Coke Zero™, Pepsi One™ and a number of other diet sodas.  I have found in my private medical practice that this sweetener significantly limits weight loss.
Sucralose (Splenda™) is actually derived from regular sugar in such a way that the body doesn't recognize it, and it is not absorbed. It contributes no calories or carbohydrates to the body in its pure form. Amazingly, it remains stable in heat and has become ideal for cooking and baking.  It is available as a bulk sweetener and actually measures equivalently to table sugar.  Be aware, however, Splenda™ is not carbohydrate free. Because of the maltodextrin used to make it bulk in nature, it contains about 0.5 g of carbohydrate per teaspoon, or about 1/8 of the carbohydrate of sugar. It does cause some insulin release and may lead to weight gain or difficulty with weight loss when used in excess (J Clin Oncol [Meeting Abstracts] June 2007 vol. 25no. 18_suppl 15127).  1 cup of Splenda™ is equivalent to 2 tablespoons of sugar, or 12-15 grams of carbohydrate in 1 cup of Splenda™.
Saccharine (Sweet’N Low™, SugarTwin™) is another unstable chemical when heated, however, it does not react chemically with other food ingredients and thereby stores well. It was used for quite some time as one of the original sweeteners.  It does not increase glucose or blood sugar, but it does stimulate an insulin response and can be problematic in weight loss (Am Jour Physiol - Endo April 1980 vol. 238 no. 4 E336-E340). It is often combined with other sweeteners to preserve their shelf life.
Cyclamate (SugarTwin™, Sucaryl™) is a sweetener available in Canada that is often combined with saccharine and is similar to sucralose. However, there is some controversy over this substance as it is known to cause bladder cancer in rats. There has been no human occurrence in its 30 years of study (Ann OncolOctober 2004, 15(10): 1460-1465.doi: 10.1093/annonc/mdh256). This product is currently banned in the US because of the notable potential for cancer. Cyclamate is stable in heat and therefore is an alternative for cooking and baking.
Stevia is a non-caloric natural sweetener which contains no carbohydrate. He is to rise from a South American plant and has been widely available for use in Asia for many years. It comes from a shrub called Stevia rebaudiana that has very sweet leaves. Stevia is in extract, a white powder that is derived from these leaves.  It can be found today commercially in extract, powder, or in a powdered green herbal leaf. It has an intense sweet taste which actually does have the potential to be slightly bitter.  Stevia has two faults. First, it is so very sweet that it is hard to know just how much to use when cooking. Second, he often has a slight bitter taste as well as a sweet one. Therefore, stevia is often combined with fructooligosaccharide (FOS). FOS is a sugar, but it is such a large molecule that humans cannot absorb it. It does not raise blood sugar and it does not stimulate insulin release.  Stevia does not increase blood sugar and appears to improve insulin sensitivity in the pancreas (Metabolism, 2003 Mar;52(3):372-8.). FOS is only half as sweet in table sugar; therefore, it makes it a perfect partner for stevia.  
Sugar Alcohols
Sugar alcohols are also called polyols.  These are a class of long-chain carbohydrates that are neither sugar nor alcohol. Included in this group are maltitol, sorbitol, mannitol, xylitol, erythritol, lactitol, and hydrolyzed starch hydrolysates (HSH).  These sweeteners give the texture and sweetness of sugar to corn syrup and can be used to make crunchy toffee, chewy jelly beans, and slick hard candies, moist brownies and creamy chocolate.  However, they are incompletely absorbed by the human intestine.  This causes problems, as side-effects of these long-chain carbohydrates include gas, bloating and diarrhea for a significant portion of people. The other issue is that there seems to be notable variability in people's ability to absorb these long-chain carbohydrates.  In other words, these sweeteners affect people differently and may actually increase the blood sugar and insulin release in varying degrees among individuals. 
Maltitol, sorbitol and xylitol seemed to be worse offending culprits in this class of artificial sweeteners. They cause an insulin response of about half that of normal sugar (American Journal of Clinical Nutrition, Vol 65, 947-950).  Maltitol and sorbitolhave also been shown to increase cholesterol (International Journal for Vitamin and Nutrition Research, 1990 Vol. 60 No. 3 pp. 296-297). Erythritol is absorbed and excreted unchanged and appears to have no insulin response (Food and Chemical Toxicology Volume 36, Issue 12, December 1998, Pages 1139-1174). Erythritol also seems to inhibit fructose absorption (
So, in summary, which sweeteners will not cause weight gain or cholesterol changes?  From the research that is presently available, aspartameStevia, anderythritol have no weight gain or cholesterol changes associated with them. Splendais a great sweetener, but excessive quantities will limit your ability to loose weight. All of the other sweeteners listed above have significant insulin response when ingested and will make it more difficult to lose weight.  I have found that combinations of Stevia, Splenda and erythritol seem to provide adequate texture and remove any aftertaste that may be found when using them individually.

Sunday, September 23, 2012

Legend Has It . . . How Diabetes Was Discovered and How That Makes Me Fat

The German physiologist Oskar Minkowki was the first person to identify the role of the pancreas in diabetes.  Legend has it that on a momentous day in 1889 Oscar  noticed that urine collected from his pancreatectomized dogs (dogs that had surgical removal of their pancreas) attracted a very large number of flies.  He is said to have "tasted" the urine and to have been struck by its sweetness.  (Only in 1889 could you get away with tasting dog urine.)  He then made a very astute observation and realized that the pancreas controlled blood sugar concentration and was a key factor in diabetes mellitus.
Thirty years later, Fredrick Banting and Charles Best identified insulin as the key hormone produced by the pancreas controlling the level of blood sugar.  However, what Oscare Minkowski couldn't taste was the very high level of acetone in the urine which is produced by the liver in the conversion of fat to ketone bodies.  Had Oscar lost his sense of taste, instead of noting the sweetness to the urine he might have noted the pungent smell of acetone.  He would have then concluded that the removal of the pancreas causes fatty acid metabolism to go awry.  He then would could have extended his hypothesis and concluded that the preeminent role of insulin was not in the control of blood sugar alone, but in the control of fat metabolism.
We have become fixated upon the function of insulin and its effect upon diabetes, and in doing so, we have neglected the fact that insulin has even greater effect upon the storage and use of fat and protein in the body.
A series of discoveries from the 1920s-1960s let to a revolution in the understanding of the role of insulin in fat metabolism.  At that time, fat was assumed to be relatively inert and carbohydrates were seen at the primary fuel for muscular activity (which is still commonly believed today).  The belief was that fat is used for fuel only after being converted in the liver to suspiciously toxic ketone bodies.  Forty years of research overturned this assumption, however, it had no influence upon mainstream thinking about fat gain and obesity.  In 1973 when all the details of fat metabolism had been worked out, Hilde Bruch, the foremost authority on childhood obesity, stated "it is amazing how little of this increased awareness . . . is reflected in the clinical literature on obesity."
JAMA just released it's compendium on obesity research and the simple science of insulin's effect on fatty acid metabolism is STILL being ignored. Instead, main stream medicine is starting to push patients toward a very expensive and risky gastric bypass surgery. This scares me.
Hippocrates said, "Let food be your medicine and let medicine be your food."  The body responds with hormonal effect to what we feed it and the science explaining this has been ignored. We have been brainwashed with the dogma that the "calorie is king."
Mayor Bloomburg eating donuts
two days after trans fat ban
Based on this we are now legislating food behavior.  New York has now banned trans fats by the New York City Board of Health and has legislated all soda sizes to no larger than 12 oz. We are creating health policy on bad science.  Let's go back and look at the science before we let our legislators start cooking for us, or soon our grocery stores will look like our government run school cafeterias offering school lunches.

Friday, August 31, 2012

Policy & Politics

I read a thought provoking post from Dr. Vartabedian over at 33 Charts.  Should your doctor be involved in politics?  It is a very good question.
Stepping into the quagmire of political discourse often leaves an oratory odor.  I, too, am guilty of this.  However, in a time when transparency is important, being genuine and true to our values is essential.
Through social media and daily office interactions, I come in contact with many physician's and patent's viewpoints and compare them with my own. One thing that I find interesting is that many don't differentiate or understand the difference between policy and politics.  There is a difference.
It is very important, from the perspective of voice, to make a distinction between policy and politics when we interact.  Policy is a course of action based upon principles or values.  Politics are inter-relationships or activities that we engage into move policy in a desired direction. Don't confuse the two.
When listening to the talking heads and political pundits, it is essential that we see the difference.  Just spewing rhetoric without understanding our position on a policy seems to be what fuels the cesspool like arena of politics. It is often what turns us away from important and productive political conversation about policy.

Saturday, July 21, 2012

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

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

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

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

Friday, June 29, 2012

What the ACA (Affordable Care Act) Means to Me

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sincerely, mortified.

Adam Nally, D.O.

Friday, June 22, 2012

Vanilla Low Carb Ice Cream

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

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

Thanks, sweetheart!

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

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

Sunday, May 20, 2012

Low Carb Chocolate Chip Cookies

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

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

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

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

(~ 2 net carbohydrates per cookie)


Monday, May 14, 2012

Mom's Cream Cheese Waffles

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

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

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

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

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

Saturday, May 5, 2012

Mid-Meal Protein Shake. . .

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

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

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

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

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

Friday, April 20, 2012

Wednesday, March 21, 2012

Medicine and Fast Food

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

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

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

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

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

Friday, March 16, 2012

Vitamin D Effect on Weight

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


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

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

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

Saturday, February 11, 2012

Cholesterol Drugs Increase Risk for Diabetes?

A recent article in the January 9th edition of the Archives of Internal Medicine (1) found that post menopausal women had a 48% increased risk of getting diabetes if they used any of the STATIN type cholesterol medications. The Women's Health Initiative, an observational study of over 153,000 post menopausal women found this increased risk. This is a significant finding and a worrisome claim.
In a time when STATIN medications like Crestor, Lipitor, Zocor, and Pravachol are being used more frequently to decrease risk of coronary heart and vascular disease, this poses a significant risk and raises a number of questions.  Is the increased risk actually due to the cholesterol lowering medication, or is the progression to diabetes a component of the patient's heart disease risk due to other genetic factors?  Is the mechanism of action in these cholesterol medications contributing to diabetes risk or are these patients already in the progression to diabetes and cardiovascular changes were identified and treated prior to progression to diabetes.
What should you and I make of this data?  Well, first, don't stop your cholesterol medication. Talk to your doctor about this study and your risk of diabetes.  Second, realize that cardiovascular changes and elevation in cholesterol starts up to 20 years before diabetes is diagnosed in many patients with insulin resistance and metabolic syndrome. Third, further evaluation and research needs to be done and we shouldn't base our decisions on just one observational study.
More to come on this subject I'm sure . . .

1. Culver AL, Ockene IS, Balasubramanian R, et al. Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative. Arch Intern Med. Published online 2012 Jan 9. doi:10.1001/archinternmed.2011.625