Keto Chat Episode 7: Dr. Adam Nally

Transcription

Carole Freeman: Well hello there, I’m Carole Freeman of Hypnotic Nutrition, the creator of the 90 Day Keto Diet Challenge. I am so excited to be here to today with Dr. Adam Nally of Doc Muscles fame.

Dr. Adam Nally: Doc Muscles yes.

Carole Freeman: Yeah.

Dr. Adam Nally: Welcome Carole.

Carole Freeman: Yeah, I’m out here. It’s Saint Patrick’s Day and surprise …

Dr. Adam Nally: It is Saint Patrick’s Day, yes.

Carole Freeman: So I’ve been binge listening to you and Jimmy on your new Keto Talk podcast and I love it.

Dr. Adam Nally: Oh no doubt.

Carole Freeman: You guys are really … It’s really entertaining, really educational as well and what I’m most hoping that I get out today is your little like Kermit/Yoda voice that you’ve been using.

Dr. Adam Nally: Oh no. You have been binge listening haven’t you?

Carole Freeman: It was only in the beginning, but we missed … In the end it’s missing, so I think you got to bring back the characters, right?

Dr. Adam Nally: Jim doesn’t like the Yoda character very much, but I’ll sneak in once in a while, he sneaks in there.

Carole Freeman: Well it’s like the voice of your patients is what it sounds like you [inaudible 00:01:04].

Dr. Adam Nally: Yes, there’s a few little voices that pop out once in a while.

Carole Freeman: Okay. Well maybe we’ll all get lucky and we’ll get to hear it today. So, well I’m just really curious about, how did you end up being a doctor anyways?

Dr. Adam Nally: Well, you know I always loved science and I always loved computers. I thought originally that I wanted to be a computer programmer, but then realized I liked the human body, I liked biology, I liked all those things. It really brought a lot of fascination to me, and they actually kind of came easily.

Carole Freeman: Okay.

Dr. Adam Nally: And my family had a number of health issues over time and so often times you find yourself searching for answers, and that really became one of the issues for me. And when I was younger in high school, I remember talking to my father about, “What should I do when I grow up dad?” And he made a comment to me one day, he turned to me one day and said, “Adam, you can always set a bone for a chicken.” So I thought, “You know, whatever ends up happening, as a doctor you always have work.”

Carole Freeman: “Set a bone for a chicken,” I’ve never heard of that.

Dr. Adam Nally: So, you there’s always a need for a doctor, so I thought, “Oh, I’ll do that.” So I started pursuing medical school. I worked for a group of sports medicine orthopedic doctors, initially before I got into medical school, and found that I really like that, and thought I wanted to be an orthopedic surgeon until I got into medical school and sort of training.

And then realized how much I enjoyed treating diabetes and blood pressure and listening to heart sounds. Toward the end of my training in medical school, I was at the orthopedic surgeon’s office and I walked in one day, he saw my stethoscope around my neck and said, “What’s that?” Because orthopedic surgeons rarely listen to hearts. And I realized in that moment that I really wanted to … To me a doctor was someone that could take care of the whole body.

Carole Freeman: Okay.

Dr. Adam Nally: And in medicine today, we’re so hyper focused on what we do and so subspecialize that I realized that family medicine, you need a broad spectrum to really cover cradle to the grave, and really feel like a doctor, one of those old treatment doctors. And so that’s why I pursued family medicine. To go further, after practicing medicine for about five years, I ended up realizing that what we were prescribing for patients with diabetes, pre-diabetes and obesity wasn’t working.

I had the same problem. My father weighed almost 400 pounds when he died at 58 of … He ended up having multiple heart attacks, he had a quintuple bypass, and three of those were stinted and ended up having all the complications of diabetes including renal failure and all the problems that go along with that.

Carole Freeman: Wow.

Dr. Adam Nally: So, I kind of watched him go down this process, this path, and realized my labs and my genetics were identical to his and everything we were doing wasn’t working to solve the problem. And I had patients that would come into me in tears saying, Dr. Nally I cut my calories down to 1,000 and I’m excising every day for an hour, hour and a half and I’m still gaining weight. And they would literally bring in food journals, [inaudible 00:04:04] journals, and I was doing the same thing. I was in the military at the time excising like crazy, cutting my calories down to 1,200 per day and just having no success whatsoever. I was 60 pounds heavier than I am today and just going, “We’re doing something wrong.”

So I went looking for some way to learn how to treat this pattern of pre-diabetes and obesity that I saw really coming together as one piece. And started seeing patterns in blood sugar, triglyceride and the way people would change over a period of time and progress to diabetes in my practice in the first five years, and started looking for answers and came across a couple training programs that gave me those tools to go forward and that’s where I … So I went on to do a fellowship in obesity medicine, got board certified in obesity medicine on top of family practice.

Carole Freeman: Okay.

Dr. Adam Nally: And for a period of time, thought I wanted to treat obesity alone, but realized obesity, in my perspective, although it is a disease, it is also a symptom of a broader spectrum underlying disease that also causes the hypertension, and the cholesterol, and the gout, and the polycystic ovarian disease and all these other symptoms that come with it. And felt like, if I don’t treat all that, I’m not really treating the whole person again.

Carole Freeman: Okay.

Dr. Adam Nally: So what I’ve done over the last 10 years is encompass or incorporated the treatment of weight and diet real heavily to the diseases of civilization essentially.

Carole Freeman: Okay, so how long ago was it that you kind of got that specialty that you were getting your board certification for?

Dr. Adam Nally: About 10 years ago, about nine, 10 years ago.

Carole Freeman: Okay.

Dr. Adam Nally: So I started that process and I got board certified about eight years ago, but I started the process about 10. So I’ve been in practice for about 15 years in total, and it was at about that 10 year mark that I realized, “Okay, we got to do something different. We’re missing it.”

Carole Freeman: So even then, carb restriction 10 years ago, was probably really cutting edge or frowned upon or …

Dr. Adam Nally: That was quackery back then.

Carole Freeman: Okay, right.

Dr. Adam Nally: Which is one of the challenges in learning about carbohydrate restriction and Ketogenic Diets. And back then, we didn’t know the word Ketogenic, it was low-carb is what it was.

Carole Freeman: Right.

Dr. Adam Nally: And at that point in time, high protein, because that’s how the Atkin’s Diet was interpreted, was a high protein diet. So, looking at that perspective … And one of the things that helped me with my training was, I realized if I’m going to ask people to make these changes, I have to be an expert in this science. Because if I’m going to be telling a patient something opposite of what their cardiologist is telling them to do, I need to know exactly why I’m doing it and I need to explain how it’s going to work, otherwise I’ll be seen as a quack across the world. So, that was one of the things I did was looked for the science, and realized that we knew the science in this regard in the early ’40’s and ’50’s.

Carole Freeman: Right.

Dr. Adam Nally: Yet, we’re just getting rolling. And so that was the whole point there was for someone to say that.

Carole Freeman: Yeah, because we back up against that [inaudible 00:06:58] fat, the fat and saturated fat causes heart disease, so we just have to ignore the other science that we know …

Dr. Adam Nally: Exactly. And the challenge is a lot of the science regarding saturated fat came from cholesterol studies by drug companies and things of that nature, so our saturated fat approaches have been meated on a false premise that fat is bad. And we took this giant leap from 1960 to 1980 and assumed, off of really bad science, that yes, saturated fat causes heart disease where there was this corelation, but here was no causation.

Carole Freeman: Right.

Dr. Adam Nally: That’s the bad science that we did in the ’70’s and the ’60’s.

Carole Freeman: We’re starting to get on the other side of that where we’ve got a lot of mud wading to get through before everybody’s going to be on the same page.

Dr. Adam Nally: I look at it like a battle ship. If you’ve every been in the military, you turn a battleship. Battleships don’t turn quickly or aircraft carriers, it takes a while to turn them. So, we’re just starting to turn the rutter and starting to see the ship begin to turn. It’s going to take a while until that ship turns around.

Carole Freeman: That’s an analogy that I use with my clients a lot was how small changes make really big results over time, right?

Dr. Adam Nally: Yeah, exactly.

Carole Freeman: It feels like a little thing now, but if you look over a year, that battleship’s going to be in a totally different place than had you kept going on that same course.

Dr. Adam Nally: Yup, you just have to turn the ship, exactly right.

Carole Freeman: Yeah. All right. Well so, you are known on social media, pretty much every avenue, as Doc Muscles, right? That’s so cool. So where does that come from?

Dr. Adam Nally: Where does that come from?

Carole Freeman: Yeah.

Dr. Adam Nally: That comes from medical school and how I got that … It’s kind of an interesting name. When I was in medical school … In our medical school in Missouri, where I was at in Kirksville, Missouri, they had a really strong program of mind, body, spirit type of approach. And so we were actually given credit and encouraged to make exercise part of our lifestyle, which is actually really cool. I like that.

So in the process of making exercise part of my lifestyle, I would be at the gym at least two to three times a week and I enjoyed weight lifting a lot, a lot more than the cardiovascular stuff just because it was something I found relaxing. And so, some of my buddies just would tease me, “Hey, you’re Doc Muscles.” One of the trainers that was there, because I was one of the student doctors, would say, “Hey, Doc Muscles.” It just kind of stuck. I didn’t really pick that name, it was just one of those things that I was called by a couple friends, and it just kind of stuck.

So when I was … I think I was trying to pick a … About 10 or 15, 10, 11 years ago when I first discovered Twitter, somebody said, “Well you have to have a handle.” And I thought, “Well, what am I going to put for that?” And the first thing that came to mind was, well the only nickname I’d ever been given by anybody was Doc Muscles. So I used it on Twitter. Well, it was on Twitter, I took it and then I added it to Facebook and I added it to Instagram and then to all the others. It just kind of naturally stuck and so I left it. It’s been a fun handle.

Carole Freeman: Well it’s easier to remember really.

Dr. Adam Nally: It’s easier to remember, yeah.

Carole Freeman: People know Doc Muscles more than Dr. Nally.

Dr. Adam Nally: In fact, Jimmy, if he comes back … When I first met Jimmy Moore, probably 10 years ago, he was sitting behind me in a conference and another doctor was sitting next to him, and this other doctor was learning about social media. And I overheard him, because I knew who Jimmy was because he was already fairly popular on social media and this person was trying to pick a handle. And Jimmy says, “It has to be something catchy, it has to be something you remember.” And I’m comparing myself, “Well is mine catchy?” So, that’s one of those things. “It works, so I’m going to stick with that. Needless to know, 10 years later would I be a co-host with Jimmy on a podcast, so it’s real fun.

Carole Freeman: You got the stamp of approval from him under catchy-

Dr. Adam Nally: At least the catchy name. Yes, he approved of that. It was good.

Carole Freeman: That’s cool. Oh and I actually want to go back and talk about, you’re an osteopathic doctor, which a lot of people don’t really know what that is. I have experience with that. So, I have a 20 year old son, but back when he was about three years old, he was having chronic ear infections and I also had chronic ear infections. And so, we just thought it was like a genetic deformity or whatever, a unique variation of our ear canals that we were just prone to that and I …

At that time, even now, I’m still into alternative and whole body medicine. And I was really looking for another solution besides putting tubes in his ears, which is what they wanted to do. And I don’t even know … Probably at that time, it had to be some random forum that I found that suggested an osteopathic doctor being able to do some kind of skull manipulation or something. I didn’t know anything about it, but I’m like, “I’ll try it if it will keep my son from being able to have tubes in his ears.”

And I went for one session, and again, I had no idea what the guy was doing. I assumed he was going to like force his head in all kinds of positions, but it was just like this gentle little … You know, touched his head and he’s never had an ear infection since with one treatment. And I was like, “I don’t know what it was, it was amazing.” Do you do ear adjustments?

Dr. Adam Nally: I actually do. The interesting thing about being an osteopath … And let me back up a little bit to prior to going to medical school. I originally wanted to go … I’m from Arizona so the medical school in Arizona is the University of Arizona, and it’s close by and you know, the in-state tuition and all the cool things, it would have been nice that way. So as I was working with one of the doctors I worked with while I was in college prior to medical school. A couple of them were MD’s and a couple of them were DO’s and I didn’t know the difference between the two.

And I remember, I had been in a car accident and was rear ended and was actually at a stop sign looking over my shoulder, and when I got hit, the car hit me. And so for about two weeks, I felt like there was this spot in my back that I couldn’t take a full breath. Every time I tried to take a full breath, it would pinch and it was killing me. So, I’m standing at the coffee machine in front of one of the doctors that I worked for copying off stuff. And he had a medical student with him walking by and he said, “Adam, how are you doing?” I said, “Well, I’m okay, but can I ask you a question?” And he goes, “Yeah.” I said, “I was in this car accident and I can’t take a full breath. I feel fine otherwise, but every time I take a breath it hurts.”

And so he kind of ran his thumb down my back and he goes, “Right there,” and he pushed on it. Yeah. He says, “Well come here.” So he takes me around the corner and goes in one of the exam rooms and he twists me up like a pretzel and the medical student’s watching him and he does this … He puts me in this one position and just a little subtle maneuver and there’s this pop and I went, “Ha, I can take a breath.” And to me it was magic. It was just this magic. At that moment, I realized, I want to learn how to do that. That’s really cool. You can, immediate relief from … And I said, “Well what was wrong?” And he said, “Well your rib was out of place.” And I went, “Rib out of place?” So, that was what spurred me into wanting to understand [inaudible 00:13:56].

Carole Freeman: Okay.

Dr. Adam Nally: He had this technique and this ability to manipulate. I went to Kirksville which is the original osteopathic school. And the difference is, essentially I tell people, the chiropractor’s learn … The first chiropractor and the first osteopath were actually at Kirksville together and the first osteopath who was an MD developed a pattern. He was a surgeon in the Civil War, but was very, very good at studying bones.

Carole Freeman: Chicken bones too?

Dr. Adam Nally: Chicken bones too. In fact, he would carry around bones with them and play with the motion of these bones.

Carole Freeman: Okay.

Dr. Adam Nally: His name was Dr. AT Still. Anyway, to make a long story short, developed a number of patterns. And this was prior to the invention of penicillin and antibiotics. Was so effective at manipulating bones that people would come to him and he would do these manipulative techniques and actually improve their outcomes from flu and things of that nature.

Carole Freeman: Oh, wow.

Dr. Adam Nally: So he became quite famous in that area. Well, the original … Another physician came to him and trained with him and they studied this pattern together. And about six months into the process, the one disagreed and went north and opened the first school of chiropractic medicine. And the disagreement was, the chiropractor, Doctor … He was … Palmer, Dr. Palmer felt that 95% of disease could be cured with manipulation and AT Still said, “No it’s just a tool.”

Carole Freeman: Okay.

Dr. Adam Nally: And so they parted ways with those different philosophies.

Carole Freeman: Oh, okay.

Dr. Adam Nally: So the first school of chiropractic medicine started with manipulation as a sole treatment and the osteopathic schools went forward with manipulation as a component of treatment.

Carole Freeman: Oh, okay.

Dr. Adam Nally: And then about two years later, penicillin was invented. And then we took off using medication as a medicinal approach. The osteopaths though, were told in order to get funding from the federal government, they had to drop the osteopathic component and just follow the Hopkins model, which was more medicinal, and that way we don’t go all osteopathic. So, but the osteopaths said, “No this works so well, we need to keep it.” So, all the osteopathic schools across the country are privately funded and have not government funding.

Carole Freeman: Oh okay.

Dr. Adam Nally: And in doing so, they maintained their osteopathic philosophy and that hands-on manipulative training. So it’s just another tool in the belt. Basically, we look at the body as a summation of wholes, each part contributing to the whole. And if one of those parts is not working correctly functionally, it can affect everybody else. And so, that’s the basic premise of the philosophy. It’s a long-winded answer.

Carole Freeman: Well that’s great because I was going to ask how it related to chiropractic, but you just led right into that.

Dr. Adam Nally: Yeah, that’s the natural … So basically, what people ask, “Well what did you do?” I said, “Well I went to … My medical school had summer school and we learned to do manipulation at summer school, so I’m basically …” Most people understand chiropractic more than they do osteopathic medicine. I’m an MD with the training to do the same thing as a chiropractor, that’s all.

Carole Freeman: Okay. Sounds like you’re better than both then.

Dr. Adam Nally: It’s kind of like a meshing of both worlds. It’s actually fun and it’s one of those things again, where somebody walks out of your office and already feels good because we’ve treated them.

Carole Freeman: Yeah.

Dr. Adam Nally: So they walk out and go, “Oh, I feel better than when I walked in.”

Carole Freeman: That feels really good. Yeah, well I have some controversial topics.

Dr. Adam Nally: Oh fun.

Carole Freeman: It wouldn’t be a Keto chat if we didn’t have controversial topics.

Dr. Adam Nally: Exactly.

Carole Freeman: I want to ask you about your take on it, or your opinion on calories. Do calories matter when you’re following a Ketogenic diet? Because we’ve got two ends of the spectrum. You’ll find people that say that calories absolutely matter, that the only reason that Keto helps with weight loss is the fact that it just reduces your appetite and you eat last, so it’s a calorie restriction in a comfortable way. And then I see the other end of the spectrum is that, “No, as long as you’re Ketosis, there’s no way for your body to store any fat at all, whatsoever, and so therefore, calories don’t matter at all.” And I literally have seen both of those arguments on the internet.

Dr. Adam Nally: And they’ve probably been existing there for years because it’s just how the internet works. I initially wondered the same thing. And when I first doing a low carbohydrate diets, I did it on myself first. Like I said, I struggled restricting calories and had no effect whatsoever in restricting calories. So I dropped my calories to 1,000 a day and was exercising an hour a day and two hours on the weekends, running triathlons and not losing weight. Actually gaining fat. My middle was getting bigger and so from that perspective, I recognized that the calorie was not the issue.

So when I learned about low carbohydrate diets and started studying how to apply them. And I went through Dr. Atkins’ information and got trained by Eric [inaudible 00:18:37] and a number of the other low carb gurus in the world. And then picked their brains and went through what they do. I realized that as you read the science, you recognize that the human body is not a bomb calorimeter. In medical school, you study how many calories it takes to burn a glass of water or a piece of bread. And they put that piece of bread into what’s called a bomb calorimeter, and they’d heat it up to a certain temperature to destroy. Well, the amount of heat that you put in there to destroy is what a calorie is.

Well the human body is different because if I eat a piece of bread and you eat a piece of bread, we’re going to process those totally differently depending on our hormones. And so, I came to realize that our calories that we retain … Let me put that. The weight that we either lose or gain is driven by a hormone, not by a calorie. I test that on myself because I heard the same thing, “If you’re just eating low carb, you’re just eating less calories.” Well, I told you I was eating 1,000 calories a day, well my dietary change shifted to eating a pound of sausage and three eggs cooked in butter every morning. And I lost 55/60 pounds.

Carole Freeman: So you probably tripled or quadrupled your calories.

Dr. Adam Nally: I added up my calories, and I was eat 5 to 6,000 calories a day, where before I was only eating 1,000 and I actually lost weight. And I stopped exercising. I stopped exercising and increased my calories to somewhere between 3 and 6,000 a day and lost weight. And so, the argument that, “Oh, it’s all calories,” is actually false. It’s absolutely false.

Now, does the calorie play a role? There’s still some argument. When people are beginning to plateau, there’s a calorie issue there. And when I help people calculate their protein contents, we use calories as a marker, but to be honest, today in my practice and in the 10 years I’ve been doing Ketogenic diets, the calories play no role.

Carole Freeman: Okay.

Dr. Adam Nally: It is all hormonal.

Carole Freeman: Okay.

Dr. Adam Nally: Now, is the debate, “I can eat my works later,” but to be honest with you, in 10 years of my practice and what I’ve doing in my office, it’s not calories, it’s hormones.

Carole Freeman: So do you ever run into the people then that maybe, on the addiction spectrum, that have maybe a food addiction where they just, even on a low carb diet, that they’re still eating such volumes that, that prevents them from losing weight, or is always an underlying hormonal issue that you’ve found?

Dr. Adam Nally: In the 10 years that I’ve been doing it, it’s always an underlying hormonal issue. It really is. And I tell patients this. I say … I would tell them this, “If I turned to my wife one month and said ‘Honey, just concentrate really hard and don’t have your period.'” That ain’t happening.

Carole Freeman: Right.

Dr. Adam Nally: And no matter how hard she concentrates, that’s not going to happen.

Carole Freeman: Willpower, just use your willpower.

Dr. Adam Nally: Use your willpower, yeah. I had an [inaudible 00:21:17] tell me, “Just push away from the table and you’ll lose weight.” That’s what I tell my wife, “Honey, just concentrate really hard and don’t get your period.” Periods are hormonal, weight gain is hormonal.

Carole Freeman: Okay.

Dr. Adam Nally: And it’s that powerful. So for someone to take … For someone to tell me that just changing my calories is going to change a hormone function is absolutely false. Your body and my body respond so powerfully to the hormones … I should say, so powerfully hormonally to certain food types, that’s what drives that process. Now those people that have food addictions, there’s often other underlying hormone or psychological issues that they are receiving some form of metabolic or psychologic reward for what they do.

Everything we do has a reason. We do it for a reason, whether it’s a negative reward or positive reward, we do it from the addiction side. There’s either a hormonal reward or psychological reward for what we do. And when you finally tease it out … I mean, in the 10 years that I’ve been doing low carb Ketogenic diets, I have never seen a calorie issue.

Carole Freeman: Oh, okay.

Dr. Adam Nally: It’s always a hormone issue.

Carole Freeman: It probably makes people really excited to think that … I mean, that’s what my clients share with me. The best thing for them about Keto compared to every other diet, because they’ve all tried every diet out there, is they’re like, “You told me I wasn’t going to be hungry, I didn’t believe you, but I have a meal and I can’t even eat half of it because I’m so satisfied and full.”

Dr. Adam Nally: You’re full, yeah. Now, there was a period of time where we just cut out carbs and we thought that protein and fat were fine, and we ate all protein and fat, we did. And initially, like I said, I was eating a pound of sausage and three eggs. And so my protein content was actually quite heavy, but in comparison to the hormone stimulus to store fat, the switch turned that off, and so I lost weight.

And so then about 30 pounds or so, my weight started to plateau out, and go, “What’s the deal here?” And then in talking with and I’m doing something, maybe it is the calories. Well for a while I thought, “Well maybe 3,000 calories is too much.” But when you really realize it’s not the calories, that protein itself plays a hormonal role also and when you start to modulate the protein and understand its hormone response and modulate it, that’s where we start to realize it’s Ketogenic and it’s high fat, moderate protein, low carb.

Carole Freeman: Right.

Dr. Adam Nally: Because that moderation of protein also plays a role in hormone response. And there are people that don’t understand that protein. They’re the ones that are always saying, “Well it is the calories.” There’s the voice.

Carole Freeman: There’s the voice. Yay!

Dr. Adam Nally: So, yeah, it’s … They’re the ones that are usually saying, “Oh yeah, it’s the calories.” And I go, “No, it’s just the protein.” When you fix the protein and you understand that protein is just as powerful as carbohydrate, then you all of a sudden switch the hormone component and the weight starts to fall off.

Carole Freeman: Yeah and I find that’s the biggest myth or misunderstanding about Keto is that people think it’s a high protein diet, or they think it’s just like Atkins. “Well I do Atkins, so I’m doing Keto diet.” It’s like, “Well, that’s the biggest difference is that protein is not moderated on. Atkins is kind of like a free food, have as much as you like. How about a 20 ounce quarter steak if you want. Whereas on Keto, we actually have a moderate protein.” And I would say compared to most people in the United States, we probably eat less protein than what the average person eats.

Dr. Adam Nally: Possibly yeah. And if you actually look at Atkins, Dr. Atkins actually limited cheese. The cheese has protein in it and so a lot of what I find when I’m eating this, is I’ll use cheese as my fat component adding fat, but I’m also adding protein when I eat cheese too. So, with Dr. Atkins, he would limit cheese and that was somewhat of a moderating of protein there. A lot of people when they’re eating red meat or pork, that fat is so filling, they will overdo the protein amounts when they eat pork or red meat, but they will when they eat cheese.

And I think … If Dr. Atkins was alive, that would my first question I’d ask him is, “Why did you have them moderate cheese?” And I think his answer would be, “Because there’s protein in that cheese and that’s what they were moderating.” Now, whether he understood that then as protein or understood that one as a calorie, I don’t know the answer to that, but that’s what I’ve found is that it’s really protein as the next step. And I have many patients that to get … And I’ve found that for people, this is a lifestyle change and it takes two or three months to understand, “How do I cut out carbs and eat more fat?” And then they get to a point where they’ve figured out how to do that. Then they’ve got to figure out, “How I monitor protein.”

Now I just take them in step each process. We start with carbs first, then we go to protein and then we look at the timing of other foods and things like that as necessary, but that’s really how I do it. That seems to be the most effective method because people well when they take one step at a time. If you give it all to them at once, they get so confused because half the people we talk to don’t even know what a carb is.

Carole Freeman: Right, right. Well you get the protein box at Starbucks, which has the bagel and the apple and the grapes in it.

Dr. Adam Nally: That’s not protein.

Carole Freeman: Yeah. Well, so you talk about the step wise approach that you take with walking people through and it does take time to adapt. That kind of leads me into the physiological adaptation that we go through as far as our digestion. So, one part of that is your body adjusting to digesting fat, but I wanted to talk to you on your take on the probiotics that our whole gut biome adjusts through this process because I was somebody that experienced … Talking to a doctor here, I can share … I had pretty sever diarrhea for quite a while.

And my own research online lead me to believe that was probably a lot of bacterial die off from … I had carb overload bacteria in me. And so, I just went with it. I’m like, “This is good, I need to get rid of this stuff, right? But, I understand it’s kind of a not very well studied area and it’s controversial. Should we add probiotics if we’re on a Ketogenic diet? Should we … What strain should we have? Do we need to worry about supplementing with the forms like the acidophilus that … The carb dependent. Do we need those? So what … That was a very rambling question, but what’s your take on probiotics? Do you recommend those for your clients/patients?

Dr. Adam Nally: Well, I think it’s important to back up first and understand that the human genome and the gut bio, the housing of where our gut bacteria live is a new field. It’s a field that’s not really well understood. We understand a very little bit about something that’s very, very expansive and may be very difficult to grasp even in the next few years, but we have enough data to recognize that it plays a significant role. And if you don’t address it in some patients, you won’t see solutions to their weight and to some of their unresolved issues because that does play a very large role.

With that being said, recognizing that … The first thing that’s important to recognize is that when you eat the S.A.D. diet, or the Standard American Diet, it does change, and the data shows this, that the gut biome changes. The bacteria in the gut shift and they shift from three or four strains to a second three or four strains. Where if you take … A number of studies have shown that when you take twins that are identical, and you put one on the American Diet and you put one on another diet, over a period of years, you will see dramatic changes in their gut. And then when you switch it, that bacteria will actually change to the opposite. It will flip back.

So, what that tells us, is that what we eat, the environment that we’re in, does play a role in our bacteria. Knowing that our gut bacteria plays a role in hormones, plays a big role in our ability to gain or lose weight. Now, from the perspective of a low fat world, when you take fat out of the diet, you remove a whole bunch of important nutrients. And the only way to find those nutrients is to either get them in the form of vegetables and fruits or supplement them in our carbage that we eat. Or take a probiotic. And the challenge with a low fat, high carb diet is it’s extremely constipating. So, you have to add a ton of fiber. Well that excess fiber and the lack of those bacteria, can and will often, shift that bacterial change.

The challenge is, we don’t really know what the perfect balance for the gut is because since we’ve been studying this, we’ve only see Standard American Diets. And there’s no perfect … We’re not able to go back to the cave men and biopsy his belly and then know what was his gut biome makeup. It’d be nice, but we don’t have that. So, the challenge is, “Well what is the correct?” Well, what’s interesting to find out is that people that feel the healthiest, have a certain balance anywhere between 17 and 23, as far as I’ve read, different bacteria, gut bacteria. And there’s argument still, and that’s still very cutting edge and we don’t know all the answers there.

But what’s really fascinating to find out is that in order to balance the small intestine, the upper gut, you need saturated fat. And a low carbohydrate diet provides that. In order to balance the bottom of the gut, the colon, you need leafy green vegetables.

Carole Freeman: Okay.

Dr. Adam Nally: You don’t need potatoes, you don’t need carrots. You only need leafy greens. Well, what does the low carb, ketogenic diet provide? Saturated fat and leafy green vegetables. Now the leafy greens are not so much there for fiber as they are for the fitonutrients. And the ability for the bacteria to create fermentation process in the gut. So adding in … You’ll hear a lot of people talk about low carb people and fermented foods, things of that nature. Well, cabbage is a leafing green and you ferment it, it turns to sauerkraut. Well, you eat your hot dog and sauerkraut, and you’ve essentially got a perfect meal for a low carb diet.

Carole Freeman: Yeah.

Dr. Adam Nally: Which provides for the nutrients necessary for a lot of those bacteria to grow. Now, for some patients, they’ve wiped out their bacteria because of antibiotics or illness or things of that nature. We will add on some probiotics as kind of a kickstart.

Carole Freeman: Okay.

Dr. Adam Nally: But we’ll also encourage them to do certain types of foods that may provide the … For bacteria to grow, if you ever took your biology class, in order for bacteria to grow, you have to provide a substance for it to grow on. Well, certain bacteria needs certain substances. One of those are certain fermenting components and the leafy greens provide that for the lower gut and saturated fat. In fact, some of the studies that have recently come out are what are needed for the upper part of the gut.

And so, what we’re finding is that’s what we’re in need of. So do I offer probiotics for patients? I do at times, yes. And I carry probiotics. And there are different types. The kind you can buy over the counter, which is the acidophilus, that’s the bacteria that’s going to help you convert lactose. If you’ve already taken the lactose out, acidophilus isn’t horribly important, but there are eight strains that are important, but those strains have to come from certain cultures and they have to be refrigerated. So, those are a little more expensive probiotics and those are types of things you probably want to talk to your doctor about to get them that way.

So do you need to start with a probiotic or are they bad? No, they’re not bad. Is it going to help you to use them? Probably, but you don’t have to. So, we’ve been learning for thousands of years about probiotics and they’re find.

Carole Freeman: Before we had all the antibacterial hand soap.

Dr. Adam Nally: Exactly right. So, if you’re one that’s gone through a process and you’ve and you’ve had your gut bacteria wiped out because of multiple rounds of antibiotics and various things like that, then you might benefit very much from one. And we’re learning more about, which ones do you need? And sometimes just taking cultures and doing some stool studies, help us a great deal in understanding which cultures may be shifting that way. So there are some stool tests and blood tests that can be done for that, but those are things you work with your doctor.

Carole Freeman: Yeah.

Dr. Adam Nally: That’s kind of a roundabout answer.

Carole Freeman: Well and I come from [inaudible 00:33:10] University, Seattle area whereas students, we shared [inaudible 00:33:14], we made sauerkraut, we took classes on all of that, so we know a lot about …

Dr. Adam Nally: You know a lot about that. And to be honest, there are other people that know a lot more about that aspect than I do, but the interesting thing I found is that using a Ketogenic diet, I really don’t have to do a lot of it. It’s not really a huge factor for a lot of patients. Because when they change their diet, the amazing thing about this body that we have, is it’s self healing. It heals itself. And so, if you provide the nutrients that it needs, it will do everything in it’s power to shift that back. Now, we can give it a push here and a push there. And in my mind, that’s what prebiotics and probiotics are, they’re kind of giving your body a push. Osteopathic medicine, manipulation is giving the body a little push right here.

Carole Freeman: Giving my son a little push on his ear.

Dr. Adam Nally: And it really is. It’s a little push in a certain area to shift some of that functionality a little faster down the road.

Carole Freeman: Yeah. So along those lines, you mentioned different people having different gut biome. One of the things I loved in listening to all your podcasts as, your theme of bio individuality in that the Keto diet can be beneficial to pretty much everybody, however, not everybody necessarily needs that. We all have a different carb tolerance level and … What’s a question about that, that I’ve got that I need to ask you a question about that don’t I?

Well, so what are … You probably see people that are all ends of the spectrum that they’re very carb sensitive.

Dr. Adam Nally: I see both actually. I have athletes that come into the office, I have weight lifters, I have a couple body builders, I’ve got some athletes that come into the office. Then I got patients that are really, really sick and on the opposite of the spectrum. And so that was a question that I had for a while is, “If I start doing this low carb thing, should everybody do this low carb thing? Do they really need it?”

I saw about a fourth or a third of the population actually did pretty well with low calorie, they actually did okay.

Carole Freeman: Low fat you mean?

Dr. Adam Nally: Low fat.

Carole Freeman: You said low calorie.

Dr. Adam Nally: Well, and they would actually cut their calories down to about 120, and they would lower the fat in that process, low calorie, low fat is what they were doing. They were lowering the fat and lowering the calories. But what often they were doing, was they were also cutting out simple sugars in the process. Now, we didn’t say that, but that’s what they were doing.

And I saw some of those patients actually did okay, but their cholesterol never improved and their gout never went away, in fact it often got worse. Or I saw their polycystic ovarian disease never improve. They lost a little weight, they felt kind of better, but these other diseases of civilization, their blood pressure went up. So that actually never improved. What I ended up finding, is that when I started doing degrees of carb restriction, patient’s cholesterol got better, their blood pressure got better, their gout got better, their testosterone and their polycystic ovarian issues got better. I started seeing this happen. And it correlated, fairly closely, with their degree of insulin resistance.

Now I started doing something 10 years ago, because I saw it as a pattern, that really didn’t get identified until five or four years ago in literature. And that was the term we call “insulin resistance.” And what that basically means is that if you give me a piece of bread, I’m going to produce a certain amount of insulin response that piece of bread. It should be slice worth, but for me because I’m so insulin resistant, I’ll produce 10 times the insulin response to that bread. It’s as if I ate the whole loaf. Now if I give you a piece of brad or my wife a piece bread, you may only produce only twice the amount of insulin, or the normal amount of insulin.

And so people that come into my office have varying degrees of insulin resistance and that’s genetic. Now, I don’t think it’s a disease. We call it a syndrome because a syndrome is a conglomeration of different symptoms, but it’s not always a problem. And I see it as a means where that person genetically could survive a famine. If … We used to not have refrigerators, so during the summertime, we’d eat our carbs. In the winter time, we’d eat more proteins and fats with a little bit of stored carbs that we had.

Carole Freeman: Mm-hmm (affirmative).

Dr. Adam Nally: But that insulin resistance and that response of insulin and fat storage is what a lot of people survive a bad winter or a bad famine.

Carole Freeman: Yeah.

Dr. Adam Nally: And so, our degree …

Carole Freeman: We’re survivors.

Dr. Adam Nally: Yes we are. I tell people, “I have a perfect U-Haul center for fats.” So, genetically I’m great, it’s fantastic. And some of my patients are too. And so when these patients come in, in tears, “Dr. Nally …” I just tell them, “Hey, when the famine comes, you and I are going to be alive. We’re going to be okay.” It’s the low fat people that are going to have a problem, I’m worried about them.

So that’s one of the challenges that I find. And what I realized, and again this is the world according to Adam based on what I see clinically, is that genetically we all respond slightly differently to that insulin. And depending on how we respond, we can increase or decrease the carb restriction and actually see improvement in those diseases of civilization. So, a lot of patients that come to me don’t need to lose weight, but they do need to improve their blood pressure; they do need to improve their cholesterol; they need to improve their gout; they have other endocrinologic diseases that are related or interrelated to that insulin component.

And when we modulate that insulin down and we help that, those get better. Most of them improve dramatically. So can everybody benefit? Yes. Does everybody need it? Probably not, but what I see is that we’re all individuals. That sounds like a movie or something, but our individuality allows us to tailor our diet to have an outcome. So when someone comes to see me, I’m trying to treat their blood pressure issue, or cholesterol issue or all of the above. And so we’re going to modulate their carb restriction based on that. So, will everybody be Ketogenic like I am? No, they won’t, but will they have some kind of carb restriction? I’m probably going to recommend it based on what I see clinically in their other disease problems that arise. These are long-winded answers.

Carole Freeman: Yeah. Well it’s a great topic of discussion. So, oh gosh I was so listening to what you said, I lost that question that I had. Oh, okay. So, one of the things that even people that I went to school with when they heard I was doing Ketogenic diet, they warned me that like, “You’re going to ruin your metabolism. You’ll never be able to eat normal again,” which they don’t even understand what … Of course, you can’t go back to eating the crap that you were eating before. This doesn’t inoculate you from all that.

So, do you find though that after people have been carb restricting for a while, that they gain a little bit of insulin sensitivity back that they might be able to tolerate a slightly higher carbohydrate intake? Or once they find that perfect level for them, is that going to be something they probably have to maintain for the rest of their life?

Dr. Adam Nally: Yes and yes.

Carole Freeman: Okay.

Dr. Adam Nally: Let me explain. I see on average, and again this is what I see clinically and there’s no data on this. It’s me watching patterns in my office. The pattern I see is that it takes about 18 to 24 months for someone to see improvement in their insulin resistance.

Carole Freeman: Okay.

Dr. Adam Nally: I’ve got actually about five patients in my practice that I know off hand, that used to be diabetic and no longer are.

Carole Freeman: Okay.

Dr. Adam Nally: And they’re no longer diabetic based on the definition of diabetes. Meaning, if I check their blood sugar when they’re fasting, they’re under 100. If I do a two hour glucose test on them, their blood sugars are non-normal. Their A1-C is now within the normal range of five point six percent less. They no longer have the signs and symptoms of diabetes. Now, genetically, they’re always going to be insulin resistant. That will never go away, but that sensitivity got better. It actually got dramatically better in these five or six people in that regard, but it takes up to two years to see that change.

Now I’m one of those. I’ve been doing low carb and Ketogenic diets for 10 years. I’m slightly less insulin sensitive, but if I do more than 20 or 30 grams, I feel it, I know it, I can tell. And so I’ve just resulted in the fact that this is the lifestyle that I have to live, but I like this, it doesn’t bother me. And I enjoy it, but it’s something that I have to do for the rest of my life and I’m comfortable doing it the rest of my life.

Now, there are a few patients, and my wife is one of them. If you took away bread, she would probably die. And she loves bread.

Carole Freeman: Oh my gosh, you just did a commercial right.

Dr. Adam Nally: I just did yeah, exactly.

Carole Freeman: I love bread.

Dr. Adam Nally: So, if she … So the bread challenge is one for her, but she’s found since she’s been doing low carb diets, she’s been able to tolerate bread without symptoms she used to get when she had bread before.

Carole Freeman: Like sourdough for example?

Dr. Adam Nally: Well she makes a homemade wheat bread that’s actually fantastic, but I can’t eat it or very often.

Carole Freeman: You’ve heard it’s fantastic.

Dr. Adam Nally: No, I know it’s fantastic.

Carole Freeman: Oh okay.

Dr. Adam Nally: It’s why I was 60 pounds heavier [inaudible 00:42:05]. But what I find, in general, is people’s insulin sensitivity does get better.

Carole Freeman: Okay.

Dr. Adam Nally: But it takes 18 to 24 months.

Carole Freeman: And for some people, it’s a small amount.

Dr. Adam Nally: Yeah, for some it’s small and for others, it’s pretty dramatic to where it literally changes their diabetes or reverse it.

Carole Freeman: So they probably can’t ever go back to the really high carb diet that they were on before?

Dr. Adam Nally: The Standard American Diet, no they’ll … And that’s one of the things I’ve seen is I’ve had patients that come in, they’ve done great, they’ve lost … One guy lost 80 pounds, did fantastic. It dramatically improved his blood pressure. Then he went out of the country for two years and was doing some mission service and then came back and fell off the wagon and gained his 80 pounds back and was right to where he was before. So if you let the diet change back and you follow that high carb, high fat approach, you’ll actually see the [inaudible 00:42:58] return.

Carole Freeman: Yeah.

Dr. Adam Nally: Unfortunately.

Carole Freeman: Yeah, so it’s true, you’re stuck with it forever.

Dr. Adam Nally: It’s genetic. It’s a genetic issue.

Carole Freeman: Yeah. So, the last thing I want to ask you about is so, I have a couple of clients that when I asked them, “What questions do you have for Doc Muscles, Dr. Nally?” Really the issue is lecithin for them. So I know you have a great blog post about that. It’s pretty technical though maybe for some-

Dr. Adam Nally: It’s textbook.

Carole Freeman: The average person that maybe doesn’t understand biochemistry and all that, so I have a couple of my patient/clients that have been tested, high lecithin, lecithin resistance. The whole … The biochemistry, it fascinates me, but it also kind of puzzles me because it seems like there’s kind of some holes in the theory a little bit as far as, if you lose weight, wouldn’t it seem like … Shouldn’t I be starving all the time because I lost weight quickly, my lecithin would be low. It would be low and so then the signal … My brain’s not getting the lecithin signal anymore, so I should just be ravenous. Right? So there’s more to that.

Dr. Adam Nally: Theoretically. If you look at lecithin from the model of a calorie issue, yes.

Carole Freeman: Okay.

Dr. Adam Nally: And that’s where a lot of people miss the boat I think.

Carole Freeman: So maybe I should reset though for the people that don’t know what lecithin is. It’s a hormone that plays a role in …

Dr. Adam Nally: It’s a hormone. If you ask me, the most powerful hormone in controlling weight gain is insulin.

Carole Freeman: Okay.

Dr. Adam Nally: Insulin drives your weight gain. The more insulin you have, the more weight you gain, period. And insulin lasts for about 12 hours, so if you give me that piece of bread and I produce enough insulin as if I ate an entire loaf, I’m going to store fat as if I ate a loaf for 12 hours.

Carole Freeman: Okay.

Dr. Adam Nally: That’s what happens to me. Lecithin is kind of the counter hormone. And lecithin is not produced by the pancreas like insulin is, lecithin is produced by the fat cells. So the fat cells, among the 177 or 176 hormones that the fats will actually make, fat cells being the largest endocrine gland in the body. The most powerful hormone in regards to satiety or hunger is lecithin. So lecithin is the driving hormone that tells you, “Hey I’m full.” It’s the one that really does help that satiation signal and it’s produced by the fat cells.

So, if you eat a big meal and your body starts putting fat in fat cells, after a period of time the fat cells go, “Okay, we’re done.” And it send a signal of lecithin to the brain to say, “Okay, stop eating.” Theoretically, if you stop sending fat to the fat cells, the lecithin’s going to lower and your lecithin is going to go up. And that’s where a lot of people say, “Well you should be hungry.” And that’s where a lot of people, right now even today, think that the set point of weight … When you lose a certain amount of weight and you plateau out and the hunger comes back is that of lecithin.

Carole Freeman: Okay.

Dr. Adam Nally: Well we fully don’t understand lecithin yet. We don’t totally know what stimulates lecithin. We know what it does in a number of areas, but we also lecithin’s actually got at least 15 or 20 different receptor sites throughout the body, a lot of them in the brain. And it actually regulates a lot of other things, other than just satiety.

Carole Freeman: Okay.

Dr. Adam Nally: So lecithin has some other stuff that we still don’t understand, or it does some things that we still don’t understand. The cool thing about lecithin though, is that that lecithin is a signal on whether the fat cell is healthy or sick.

Carole Freeman: Okay.

Dr. Adam Nally: So I look at lecithin in two ways. Number one, if you produce excess lecithin. If your lecithin level’s high, you have sick fat cells.

Carole Freeman: Okay.

Dr. Adam Nally: You’re fat cells aren’t giving the right signals. And what I amazingly find, is that over that 18 to 24 month period, that lecithin gets better too. I actually see that improve when we use a Ketogenic diet. So the body’s ability to heal, the fat cells actually gets better. And [Dr. Bray 00:46:40] actually coined the term [inaudible 00:46:42] which is sick fat cells. So that’s a term that’s out there in textbooks now. And I agree with that. I actually see that clinically.

Carole Freeman: I’m going to look that up now.

Dr. Adam Nally: It’s kind of cool. The fascinating part about lecithin though is that you would theoretically think, “Okay, if I stop putting fat in cells and losing weight, I’m going to be hungry all the time.” And you’re no.

Carole Freeman: Okay, yeah.

Dr. Adam Nally: Well fat in an of itself simulates fullness. So the fat, the triglyceride and the ketones stimulate part of your brain to stop eating. And lecithin signals part of your brain to stop eating, but what you have to understand with the fat cell, and this is the part where the calorie theory misses, is that fat just doesn’t go and sit in the fat cell. Our fat cells are kind of like change purses. So, if I eat fat, fats going in and coming out continuously, it’s cycling. And my personal opinion, although there’s no science to prove this, is that, that cycle keeps lecithin at a normal level.

Carole Freeman: Okay.

Dr. Adam Nally: And if it goes up too fast, lecithin increases. If it goes down too fast, lecithin increases, but if you have fat cycling through the system that lecithin regulates and the ability of the fat cell to improve regulates. That’s the theory from Dr. Nally.

Carole Freeman: I like that.

Dr. Adam Nally: That’s my theory. Now, nobody’s proved that, but that’s kind of what I see clinically.

Carole Freeman: Okay.

Dr. Adam Nally: And somehow this body regulation set point is affected by that. We don’t totally know how yet and that’s being researched, but that’s kind of the lecithin component, but I use lecithin … I have a lot patients that will go on a low carb diet go, “Doctor, I’m still ravenous hungry.” Well, I check their lecithin, lecithin’s way high.

Carole Freeman: Okay.

Dr. Adam Nally: Lecithin is also inhibited by telling the brain you’re full when you have the presence of high triglycerides and you have the presence of fructose.

Carole Freeman: And this was in your blog as part of it.

Dr. Adam Nally: In the blog, yeah, so this part is what I often see. So the first time, when somebody comes back to me and says, “Hey doc, I’ve been doing a Ketogenic diet, but I’m still starving and not losing weight.”

Carole Freeman: Yeah.

Dr. Adam Nally: Well, the first thing I check is their lecithin. If their lecithin’s high I ask two questions. Are you eating fruit? And they go, “Yeah. I got to cut that out too?” So that’s often the culprit.

Carole Freeman: Okay.

Dr. Adam Nally: And then I watch their triglycerides really closely. If their triglycerides are over 100, that higher triglyceride also inhibits the lecithin crossing the barrier, so you won’t get the signal correctly. And a number of things other than insulin, well actually the insulin drives triglyceride, but a number of things other than sugar alone will stimulate that insulin to make a triglyceride. Certain sweeteners do.

Carole Freeman: Yeah.

Dr. Adam Nally: Creamers in coffee do it.

Carole Freeman: Stress.

Dr. Adam Nally: Stress does it. So a number of things can drive that process and keep that lecithin from signaling the brain that you’re full even though you’re doing a Ketogenic diet. And so that’s the other component that you need to be watching, or should be watched in my perspective that helps with lecithin. It’s another one of those hormones you got to watch. It’s all hormonal. That’s where, “Is it all caloric? No, it’s hormonal.” And so come back to that question.

Carole Freeman: So I’m guessing then that more fat for those people, at least until they can get things … Like more fat to help signal, help their lecithin signals. Help with the fat signaling theory.

Dr. Adam Nally: Exactly, so in those patients we increase the fat number one. And then number two, we look at the environmental factors that may be raising their triglycerides, that may be … What may be driving your insulin up other than sugar? And are there other things, sleep and stress, and a whole slew of other environmental factors that may be playing a role in causing that sick fat cell not to send the signals or be receiving signals correctly if that makes sense.

Carole Freeman: It just reminds me of a funny discussion I had with some friends who are Ketogenic and we had this discussion of …Have you ever had any training of like sales or marketing where there’s these terms of FIFO and LIFO? It’s first in, first out, last in, last out.

Dr. Adam Nally: Uh-huh.

Carole Freeman: Like at a grocery store, you want to sell the old stuff first right?

Dr. Adam Nally: Yeah.

Carole Freeman: So we were talking about, “Well are fat cells LIFO or FIFO? Is the fat that I’m getting to now, is that 10 year old fat or is that … Is it fresh?” Because maybe you’ve had people experience this as well whereas, every once in a while, they might have a detox symptom of toxins being stored in their fats that’s being flushed out.

Dr. Adam Nally: Well they actually radiolabeled fat.

Carole Freeman: Okay.

Dr. Adam Nally: And there’s a couple studies, and I don’t remember them right off hand, but they radiolabeled fat. And that’s where the coin purse theory comes into play is because we watched fat move in and out of these fat cells all over the entire body and they radiolabeled fat. So just because you ate it here, doesn’t mean it’s not going to burned off, it’s going to go to your toe and the back of your … So it actually moves.

That triglyceride is moving, and so the only time I really see people detox and see a release of that toxin, is in the initial Ketogenic diet approach. When they first begin, use that as their fuel and mobilizing a lot more fat than lecithin, that’s when I see this happen. Once they start to fat adapt, and they start cycling that fat through the system as their main fuel source, I don’t see that happen anymore.

Carole Freeman: Then they get the skin glow right?

Dr. Adam Nally: Yeah, the wonderful glow of skin and all that good Ketosis stuff.

Carole Freeman: That is really cool. I learned a lot from you and I so appreciate you sitting with me and answering my questions and taking the time out of your schedule to meet with me. So my clients were also asking about how does this “tell a patient, tell a clinic” stuff that you do work? So for example, I’ve had some people in Seattle that want to … They’ve got these lecithin issues or something else that’s not quite working. They’ve been following Keto and it’s not quite working. How can they work with you remotely?

Dr. Adam Nally: Well and that’s one of the things I’ve been trying to pilot. Insurance doesn’t really want to cover telemedicine in a lot of cases. So right now, it’s a cash based process, but basically what they do is they log into my website, sign up. They’re going to get two emails, one from me directly on some basics of how to log in, and then they’ll actually get linked to the software, kind of how to use the software.

The software runs off of a program that is HIPPA compliant and secure. And it’s basically two pieces of software that we combined into one. And it allows you to use your iPhone or your iPad. And so it’s a video conferencing through some software that allows me to be either in the office or at home, or off of my iPhone and they can be the same place and we can video conference that way. So basically it’s a cash based approach to allow patients who don’t have access to a Ketogenic specialist somewhere nearby. They can get access to me and talk about their diet and nutrition, things like that.

Carole Freeman: Do you have a long waiting list for that?

Dr. Adam Nally: You know, I’ve got patients that log in and I think the challenge is that most people want their insurance to cover it and it doesn’t. So that’s been the biggest challenge, but I’ve got patients that will log in and we do it and it’s kind of a FIFO service. So, they pay a fee for each time that they log in with me and things like that.

Carole Freeman: Okay.

Dr. Adam Nally: And that seems to work really well. There’s no long waiting list there. I’ve got patients that can log in and want to log in. The biggest challenge is that I have to do that outside of the other normal time that I see patients in clinic, so it’s usually when I’m free to do a session, is either going to be at my lunch time or later in the evening. And then it just has to coordinate with their schedules so that’s, so that’s when [inaudible 00:53:52]

Carole Freeman: And you can order labs then?

Dr. Adam Nally: So I can actually write a lab order for them and then we can send that to anywhere they need to have. And they actually lab. Now, the challenge is whether their insurance will cover me or these labs, and that’s one of the challenges that often arises. Because if I’m licensed in Arizona, but I’m not licensed in other states. So, whether your insurance will pay for my order in that state is probably unlikely. So they may end up paying cash for that, and that’s often a factor for a lot of people is they go, “Well.” But if they’ve had the labs ordered, and they want to remote with me and they want to consult on those labs and give them some direction, then I’ll [inaudible 00:54:28] too.

Carole Freeman: Well yeah, and especially a lot of my clients I’m working with, they’re already working with a naturopath and he doesn’t have any experience, and if you tell him, “Hey, try these labs, they probably would coordinate with that and then their insurance might actually cover that.”

Dr. Adam Nally: That may cover some of that, yeah. I’m happy to consult and give direction, “Hey, try this, try this and switch this and see how that works.” And that often helps, so.

Carole Freeman: Well that’s exciting.

Dr. Adam Nally: Fun. It’s kind of the cutting edge stuff that’s … I like the cutting edge technology and this is one of those ways to … And not a lot of people are offering it, but I see this as one of the futures of how medicines working. Pretty soon we’ll have that Star Trek thing where we just wave it over and it says, “Hey, you’re lecithin’s off.” We’re not quite there yet.

Carole Freeman: That and your genes, right?

Dr. Adam Nally: Exactly right, very true.

Carole Freeman: Well, I just want to thank you again. I really appreciate meeting you and getting to talk with you and I don’t have a good closing or anything, but I’m glad I got the voice.

Dr. Adam Nally: You got to hear the voice and this has been great to meet with you.

Carole Freeman: Yeah, well thank you.

Dr. Adam Nally: Thank you.

Carole Freeman: Well thanks everyone for watching and we’ll see you later, bye.

Dr. Adam Nally: Thank you much.