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Summary
On episode 317 of 40+ Fitness, Coach Allan sits down with Dr. Adam Nally, a family practitioner and obesity medicine specialist known online as Doc Muscles, and co-author of The Keto Cure: A Low-Carb, High-Fat Dietary Solution to Heal Your Body and Optimize Your Health.
Dr. Nally has lived a ketogenic lifestyle for nearly 14 years and has used it clinically with patients for most of his 18-year career. He explains how he started noticing the same patterns over and over in his practice, weight gain, rising blood pressure, high cholesterol, gout, infertility, all tracing back to high insulin levels showing up 10 to 15 years before a formal diabetes diagnosis.
The conversation covers what keto adaptation and “keto flu” actually are, why ketosis can drop blood pressure and restore testosterone faster than expected, and which low-carb sweeteners actually avoid spiking insulin.
Links
- https://docmuscles.com
Key Takeaways
- High insulin shows up years before a diabetes diagnosis. Dr. Nally says roughly 85 percent of the patients walking through his door had elevated insulin 10 to 15 years before ever being diagnosed as diabetic, driving weight gain, high blood pressure, high cholesterol, gout, kidney stones, and infertility along the way.
- Excess insulin acts like a worn key. A healthy amount of insulin should unlock a cell efficiently, but insulin resistance means the body has to produce far more of it to do the same job, and that excess insulin stimulates processes in the body it never should have touched.
- Ketosis can drop blood pressure before meaningful weight loss. High insulin causes the kidneys to retain sodium and water, so cutting carbs can normalize blood pressure within about two weeks, often faster than medication doses can be adjusted, which is why he insists patients coordinate with their doctor before starting.
- Low testosterone in insulin-resistant men can rebound on keto. About a third of his insulin-resistant male patients see falling testosterone and related symptoms; lowering insulin and restoring adequate dietary fat (testosterone is a derivative of cholesterol) has produced jumps of up to 150 points in a couple of months.
- Keto flu is mostly dehydration and low electrolytes, not the diet itself. Many patients cut carbs but stay afraid of fat, leaving them underfed; adding back adequate sodium, potassium, magnesium, and zinc resolves most of the fatigue and grogginess people blame on keto.
- True keto adaptation takes weeks to months. The body has to upregulate fat-absorbing receptors in the gut and cells and build up the liver’s capacity to convert fat into ketones, so reduced energy and performance in the first weeks is a real, temporary physiological transition.
- Carb withdrawal can be genuinely physical. Fructose converts in the liver into a compound that acts on similar brain receptors to morphine, which is why some patients get real withdrawal symptoms, including migraines, in their first week off carbs.
- Only a few sweeteners avoid spiking insulin. Not raising blood sugar isn’t the same as not raising insulin; Dr. Nally says erythritol, liquid stevia, and chicory root are the main options that do neither, and blends like Swerve combine them.
- Keto has to stay a lifestyle you can live with, not a rigid rulebook. He tells patients the shift from standard eating to full ketogenic living takes years for most people, and using sweeteners or adapted versions of family recipes to bridge that gap is a legitimate part of making it sustainable.
“We know that from the perspective of weight gain, there are over 32 hormones that drive weight gain itself, but insulin seems to be the master hormone.”
Dr. Adam Nally
