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Known commonly as DocMuscles on the internet, Dr. Adam Nally is a board-certified family practice physician and board-certified obesity medicine specialist with advanced curriculum obesity treatment and health policy fellowships. He provides his patients a health program that brings a heightened sense of well-being, health & vitality through a uniquely personalized approach. He treats the whole family from the cradle to the grave, and has a special focus on insulin resistance, diabetes, cholesterol, hypertension, and weight management. He is also specially trained in laser skin revitalization, fat sculpting, tattoo and hair removal. He is the
owner and chief medical officer of Nally Family Practice and the Arizona Bariatric Institute.
Dr. Nally is a nationally and internationally recognized speaker on health, ketogenic diets and exogenous ketone supplementation. He is the author of The Keto Cure (Victory Belt Publishing) to be released April 10, 2018.
He is a blogger on, and the owner of DocMuscles.com. He was the cohost podcaster on the internationally recognized KetoTalk with Jimmy and the Doc, a top 50 health podcast available on iTunes.
He served as the Past-President and member of the Executive Committee for the Arizona Osteopathic Medical Association, and is recognized as a Health Policy Fellow through the American Osteopathic Association.
He serves as an Adjunct Professor, for both A.T. Still University and Midwestern University medical schools.
Dr. Nally served for six years in Air Force Reserve as a Major in the Flight Medicine Department of the 944th Medical/Dental Fighter Squadron. He also served as the Team Physician for Willow Canyon High School from 2002-2010.
After graduating from Grand Canyon University in Phoenix, Arizona, he attended medical school at the Kirksville College of Osteopathic Medicine in Kirksville, Missouri. He completed residency in 2002 at John C. Lincoln Hospital in Phoenix, Arizona, in Family Medicine where he served his last year as the Chief Resident. He
is board certified in Obesity Medicine through the American Board of Obesity Medicine and completed a 500 hour Advanced Curriculum Fellowship through the American Society of Bariatric Physicians.
He resides in Waddell, Arizona, with his wife and two children on a small ranch where he enjoys horseback riding, archery, camping, and gardening with his koi in his aquaponics garden and pond. He is an avid reader and enjoys active participation in his church.

Transcription

Carole:                  Hey, welcome everyone to another episode of Keto Chat. I’m your host Carole Freeman, certified nutritionist. I’m here to talk to Doctor Nally about his brand new book.

Dr. Nally:              Cool!

Carole:                  Oh, my gosh! Well, we’re going to talk about the book, but just for the three people that are watching this that haven’t met you or don’t know who you are, will you please tell us who you are all the way out here in Arizona?

Dr. Nally:              Well, you came out to sunny Arizona. Right now, I think it’s about 75 degrees right now.

Carole:                  I know [crosstalk 00:00:36].

Dr. Nally:              Probably.

Anyway, I’m Doctor Adam Nally. I’m a board-certified family physician and a board-certified obesity medicine specialist. Started doing family medicine about 18 years ago and about five years in realized 85% of the people I saw had major illness associated with obesity and so went back to get trained as an obesity doc.

In the process of learning to treat obesity, found that the lifestyle or the dietary approach that seemed to be the most effective for this group that I treat on a regular basis is the ketogenic diet.

Carole:                  Okay.

Dr. Nally:              So, about 13 years ago, just dove in, headlong, realizing that if I started asking people to eat more fat and more protein, that a lot of my colleagues would ostracize me and think I was a quack.

What I wanted to do was to be literally the expert in the fat and protein and ketogenic world. So, I just began doing everything I could to learn about what’s going to be helpful for patients and what does the science actually say? What’s fact and what’s fiction?

Carole:                  Yeah.

Dr. Nally:              For the last 13, 14 years, that’s what I’ve been doing.

It led to me putting together lots of information, podcasts, blogs, and now a book that I found would be helpful.

Carole:                  Congratulations.

Dr. Nally:              Thank you very much.

Carole:                  Your first book, right?

Dr. Nally:              First book, yes. It’s the first book.

Carole:                  What was it like writing this book? How relieved are you to be done?

Dr. Nally:              Well, we planned … My phone keeps pinging, so pardon me. I meant to turn this off beforehand.

The really cool thing about the book is that … Well, I thought I was going to be done in about a year because of the life of a doctor, that didn’t really happen and it took me a lot longer. It took almost two years to really put everything together and get the pieces into place and for the publisher to do everything that publishers do with your book once you do it.

So, it took a little longer than I thought it would take, but it’s very relieving and very exciting to have it done.

Carole:                  Yeah, yeah. I didn’t say the name of it. It’s called The Keto Cure: A Low Carb, High Fat Dietary Solution to Heal Your Body and Optimize Your Health. Official release date, April 10th, 2018.

Dr. Nally:              April 10th.

Carole:                  Some of you’ve seen this. Probably by the time you’re seeing this it’s going to be out. You can get it wherever books are sold.

Dr. Nally:              Wherever books are sold, yep.

Carole:                  Yeah. Who’s the book for?

Dr. Nally:              Originally, when Jimmy Moore and I were doing Keto Talk together, I’d told Jimmy, “I have this book in my head. I have this outline in my head.” I said, “I’m interested in publishing it.” He goes, “Well, hey. Let’s do a book.” I told him about what the outline was and what I was interested in doing, knowing Jimmy had a great publisher, he said, “Well, let’s pitch it to the publisher. Let’s see what the publisher says.”

That’s what we ended up doing is presenting it. The book was really written … It’s written in a way that I sat down and said, “Well, how do you write a book like this?” I thought, “Well, what would my patients want to get?” If I walked into an exam room, and the patient said, “I have gout and I don’t understand, how is this diet work with gout?” Well, I wanted to be able to give them some information.

Actually, a lot of the information that was in there are bits and pieces of what I actually use in conversations with my patients every day. There are pieces of what come out of my chart system for them that print out when they walk out of the room. There are modules that I’ve actually written for patients to hand them and say, “Okay, this is what I want you to understand about how the diet works.”

So, I looked at this book saying, “If you were with me one-on-one in the exam room, what would help you the most in explaining how this disease works and how the diet applies to it? What else helps that disease improve?” That’s really what it is. I picked the 10 or 12 most common things that I saw and said, “This is what I do on a regular basis. How can I take it from medicalese into layman’s terms and make it easy for you or the average person to understand?”

Carole:                  Nice. Okay. If you’re a patient of any doctor, this is for you. What I also thought would be great as well is that it’s great for the patient to read and understand what’s going on and then to have a conversation with their doctor.

Dr. Nally:              Exactly.

Carole:                  Because the things that you’re explaining and the fact that you’ve got names of medications and things in here, the doctor’s going to recognize that this is written by somebody that knows what they’re talking about. It’s not just some whatever book for dummies that-

Dr. Nally:              Exactly.

Carole:                  … anybody wrote.

Dr. Nally:              Exactly. Most people come to me, they say, “Okay. Well, Dr. Nally, I’m on these medicines and I want to do this diet. What can I expect from the diet and what can I expect from the medicines? Then, are there any alternative things I can do? Are there supplements I can add? Are there herbal products I can add? Is there other pieces of activity that will be beneficial for my lifestyle if I do this with that disease process?”

What I wanted to be able to do is if someone had the book and they were with their doctor they could say, “Well, based on these articles that are here, where the citations are, I should use this medicine, but I should be cautious of this medication.” That’s a conversation that you have with your doctor. Your doctor knows you really well, so he knows the pros and cons of using a medicine or a supplement and so he can actually have a good conversation with you. That way you can actually have something that helps you understand why he wants you to use this medicine or why he would recommend not using the medicine.

Carole:                  Yeah.

Dr. Nally:              Or, she. He or she, however that works.

Carole:                  Yeah. It’s a patient empowerment book.

Dr. Nally:              Hopefully, that’s what it is. Hopefully, it’s empowering, yeah.

Carole:                  Yeah. Okay, so the other thing I want to ask about then too is this … Gosh, every day I talk to people that are deciding to embark on a keto diet or thinking about it. Their doctors told them that, “Well, they’re overweight, so that’s why they have diabetes,” or, “They’re overweight and that’s why they have hypertension.” I just need to get the weight off and then my high blood pressure’s going to go away. Can you speak to that?

People can’t hear it because they’ve been told for so long that obesity causes all these things.

Dr. Nally:              Well, it’s the chicken or egg issue. When I came out of medical school, we were told that the weight was what caused the diabetes or the weight caused the cholesterol issues. The weight caused this problem. So, people want to get the weight off.

Then, we’ve been told that you just have to exercise to get the weight off, but exercise doesn’t work and we know that. I know it. Thousands of patients have tried it, doesn’t work. You can’t outrun a bad diet.

What we’re learning and what I’ve learned in the last 13 or 14 years of doing this, is that the weight is a symptom. Although, obesity itself is a disease, and thankfully we’ve been able to identify it as a disease, it’s also a symptom of an underlying disease process called insulin resistance. That insulin resistance is what drives the weight gain. It’s an overproduction of insulin in response to starches and sugars and all of us have a variable degree of that response.

In some cases, it’s a syndrome, which doesn’t necessarily mean it’s a disease. It means that your body is responding genetically to certain food types and that genetic response either predisposes you to weight gain or not. There’s a number of reasons for that.

My personal opinion is that years ago before we had Bisquick and beer and we had refrigerators, that that insulin production actually helped people to survive harsh winters or harsh summers. So, there’s a reason for it, but when we apply the standard American diet, now that genetics is predisposing you to gaining weight. Those genetics and those hormone responses are also predisposing you to disease processes that always come along with the weight gain.

It’s like the blind man looking at the elephant. If you always see the trunk when see the elephant …

Carole:                  That’s in the book too.

Dr. Nally:              Yeah. If you always see the trunk with the elephant, you’re always going to think an elephant has a trunk. But, what if elephants don’t have trunks? That’s one of the questions is we have to ask ourselves, is the weight really the issue? None of the science says it’s the weight, although the weight’s always an associated issue with that disease process.

What we’re finding is that if we … What I’ve seen over the last 13, 14 years is that when I am able to decrease hormone response to starch, both obesity and the blood pressure or both obesity and cholesterol get better.

Carole:                  Yeah.

Dr. Nally:              If that makes sense.

Carole:                  Another piece of the puzzle is that there are people out there that have Type 2 diabetes that aren’t overweight.

Dr. Nally:              Exactly.

Carole:                  Or, that have heart attacks. I’ve talked to people that say like, “Well, my husband, he’s fine because he’s normal weight. He can eat whatever he wants.” And, I’m like, “Oh.”

Dr. Nally:              Well, yeah.

Carole:                  There are those people.

Dr. Nally:              There are those people. Their scale weight normal weight, but metabolically they’re sick. If you look at their metabolism … That’s one of the things that your doctor does is he’s not only looking at how you look on the exam table, but he’s also looking at what your triglycerides are, what’s your insulin, and what’s your hemoglobin A1C? What do these numbers metabolically mean?”

It’s amazing how many people I see who are normal weight, yet metabolically sick. That’s driven heavily by these processes, unfortunately.

Carole:                  Yeah. Yeah, yeah. Well, I want to ask about … Probably a lot of people watching are wondering Keto Talk was my favorite podcast. We miss you so much, but I understand. You’ve got a lot of stuff going on, but you have anything else planned there? Now, that you’re not writing a book, you have all this free time.

Dr. Nally:              I’m not writing a book, exactly. Well, yeah. My wife says, “Are you going to actually be home now?” Well, I was home, but are you actually going to be present?

I love doing Keto Talk and it was actually a lot of fun. The biggest challenge was for every hour we did in Keto Talk, I was putting four to six hours of prep time in and four to six hours is a whole day in the office.

Carole:                  Yeah, yeah.

Dr. Nally:              So, the challenge was I was having to reschedule office time and it was interfering with my ability to provide care for patients and it was taking away from family time and all the things that were essential for my life and my growing family.

I had to make a big decision, will Keto Talk … Although the great benefit was there, when it comes down to the nuts and bolts of doing what you’ve got to do every day, I had to say something has to give.

Carole:                  Yeah.

Dr. Nally:              I knew the book would be important. I wanted to continue with that, but Keto Talk itself, there’s a bunch of great people out there that understand a lot of things. My hope is that now, once I have the book in place, I’m in the process of revamping my website, creating some membership sites that provide access for people to get more, I guess you could say, one-on-one time with me …

Carole:                  Okay.

Dr. Nally:              … without having to actually be in my office. I’m looking to see how can we think outside the box in regards to medicine and diet because, with medicine, it’s so hard to create that doctor-patient relationship without being in my exam room. Unfortunately, with insurance and the way things are going, it gives you five minutes, which isn’t enough time to really help people.

I do a lot of live streaming, so if you check my website, you can see all the live streams that are there. I answer a lot of questions that way and I’m actually looking in the future, down the road, and I don’t know when yet, but I still have in the back of my mind maybe another podcast or even a video-type broadcast that we could do.

Carole:                  Yeah, ’cause you’re very active on … I know Facebook Lives. You’re still doing Periscopes as well?

Dr. Nally:              I actually dual-stream, so I do Facebook and Periscope at the same time. Facebook Live is what actually gets saved and what gets put in my website, but I’ve got a whole group of followers on Periscope that are those that are hanging in on Periscope, but still watch when I do live stream.

The biggest challenge with that is you have to have bandwidth to do it. So, if I’m in my office or at home, I can actually live dual-stream, but if I’m out and about it’s usually just Facebook Live.

Carole:                  Okay, okay. Yeah. One of the things that I think a … Oh, man. Was it in here? … that I was most shocked about was how ratings as a doctor are based on are you prescribing enough of these medications that are the normal ones that people get prescribed for these.

Dr. Nally:              Yep.

Carole:                  And, how you can get docked how much you pay, no pun intended, docked, docked how much you get paid for a patient if you’re not prescribing enough medications. That was so eye-opening for me to realize-

Dr. Nally:              Really?

Carole:                  Yeah, I had no idea that was going on behind the scenes. It explains a lot because I have … One of my cohorts from Bastyr that’s a practicing nutritionist in Seattle area was saying how she went into a clinic to shadow another dietician and they were seeing a Type 2 diabetic patient. My friend said, “Well, why are we not trying a low carb diet with this person? I’ve heard that it can help people get off their medications.” And, the dietician said, “Well, why would we want to get them off their medications?”

My friend was scratching her head and she didn’t really understand. Now, it’s like, “Oh, it makes sense to me now.” It’s crazy thinking.

Dr. Nally:              This era that we now live in, which is one of the struggles that most physicians deal with and you can call it Pay for Performance or whatever you want to call it. Insurance plans and the government have had to figure out ways to determine are you a good doctor? Are you practicing based on current, normal guidelines?

Carole:                  Yeah.

Dr. Nally:              The challenge is that those normal guidelines are following science that’s 15 years old.

Carole:                  Yeah.

Dr. Nally:              The guideline, even today, I got plans that actually will ding me if 70 or 80% of my patients aren’t on statin drugs. I’m financially de-incentivized if they’re not on those statins or if they’re not a beta blocker if they had heart disease.

Statistically, the data shows that people who’ve had heart disease who are on a beta blocker, have better long-term outcomes. However, that statistic is only between with the beta blocker and without a beta blocker. There’s no statistics to say, “What if they lost 70 pounds and their heart functions better?” How would that statistic be there?

The challenge is that if you’re practicing standard medicine, you’re going to be pushed into, both financially and from the science that’s there, to believing that, “Hey every patient I see … ”  Every diabetic I see, I get a report card on myself every quarter that says, “So many of your patients are on ACE inhibitors. So many of your patients are on beta blockers. So many of your patients are on statins and so many of your patients have quit smoking and so many of your patients had their mammogram.” Then, I actually get incentivized or de-incentivized based on those statistics.

Carole:                  Wow!

Dr. Nally:              Which is really hard when I’m trying to get people off of statins. I’m trying to get people off their blood pressure pills.

Carole:                  What a conflict of interest!

Dr. Nally:              It’s a difficult arena and it’s just getting harder because they’re tightening those things up even further.

One of the challenges is to make sure that those incentives are based in real science, but when there’s a 15-year lag, that’s hard to do.

Carole:                  Yeah. Well, it seems like it would make sense that the metric would be, are people getting off their medications because they’re getting well and they’re reversing these diagnoses, but most other practitioners out there aren’t seeing that. They don’t have the tools with diet to be able to help people actually reverse these things and get off of them.

Dr. Nally:              That’s one of the reasons I titled the book, The Keto Cure. We’re not necessarily curing all of these major diseases, and that’s been one of the arguments that people have said, “You should never call it that.” The whole reason the book was titled The Keto Cure was because we’re actually essentially curing once of the essential underlying hormonal factors that drives these diseases. When we improve or fix that, that hormonal drive, specifically insulin, when we fix that insulin resistance, all of a sudden, these other diseases improve.

Carole:                  Yeah.

Dr. Nally:              I was told in medical school that it was impossible to cure diabetes, yet I have multiple patients that are no longer diabetic by the standard definition. I had a patient today, she came in and she was on two blood pressure medicines and a statin drug. She came in today. She’s nine months out from starting her weight loss. She’s lost 65 pounds. She’s off of both of her blood pressure medicines and her statin drugs and her cholesterol’s pristine and her blood pressures 120/70. How can you balk at that?

Carole:                  Yeah.

Dr. Nally:              She feels great. She’s saving money. She feels better and she’s going to live probably 20 or 30 years longer, yet if her insurance company just looks at a piece of paper, I’m going to get dinged if she’s on one of those plans because I don’t have her on a statin.

That’s the hard part is helping to change medicine to understand some of these diseases are curable.

Carole:                  Yeah. Well, and they’re not looking at how much money they’re saving in not paying off those three medications for her every month.

Dr. Nally:              Exactly, exactly, exactly.

Carole:                  Yeah.

Dr. Nally:              Yeah.

Carole:                  Wow. Yeah. All right, so what else should people know about the book? What else …

Dr. Nally:              Well, number one, many people know Jimmy Moore, so I want to make sure Jimmy gets some credit where he’s got credit due there. Jimmy, having interviewed thousands and thousands of people who’ve done low-carb and ketogenic diets and fasting, all those kinds of things, actually gives commentary as we go through that and tries to help take some of what I explain and even break it down even further.

Carole:                  Let’s see if [crosstalk 00:17:13].

Dr. Nally:              You’ll see little blurbs off to the side-

Carole:                  Sneak peek off on the side of a … If we can get this screen … There we go. On the side with little Jimmy, little cartoon.

Dr. Nally:              Little cartoon Jimmy on the side. Yeah, so he jumps in there and he gives these great little blurbs of information and adds to it.

We’ve actually found that a lot of people learn really well with block-type learning. So, you read a block and then you slightly change the subject, then you go on to the next block. Your ability to retain is a whole lot better that way.

Carole:                  Okay.

Dr. Nally:              This was written in a way to hopefully be easy to read too. Both a book that you can read, but also a reference book. Then, wonderfully, Maria Emmerich sat down and she literally slaved for hours and hours and probably days and days over 60 really amazing recipes in there.

I looked around and since Maria was one of those first few people that literally provided some of the recipes for my family to make a change, I wanted to give her the option to say, “Hey, can you add to this book and give us 60 really great recipes?” And, she did. She gave us some phenomenal recipes in there.

Not only is it a book to talk about disease and how to improve that disease, but it’s also a cookbook in providing some great recipes. We just made the low-carb ice cream in there and it’s a crossover between custard and ice cream and it is yummy.

Carole:                  Oh! I bet, yeah. Every recipe I ever tried of hers has been delicious.

Dr. Nally:              They’re really good. They’re not really difficult. They’re easy enough that Doctor Nally can make them.

Carole:                  That’s great, yeah. Well, I’m super excited for your book here. Anything else that we should share about or anything else like that? You’ve got some-

Dr. Nally:              No, just grab the book. Get a copy. Read it and then let me know about it. I want to hear about it. You can find me at docmuscles.com. I’m all over the internet at docmuscles. Give me some input. Give us some feedback. I’d love to hear how you like it, what you find helpful. What you would like to see further if we were to add to it or make some changes? What would help?

Carole:                  The Keto Cure 2!

Dr. Nally:              Could there be a Keto Cure 2 or what else could we do? That’s the cool thing.

Carole:                  Excellent.

Dr. Nally:              Yeah.

Carole:                  Well, thank you so much for letting me come in in the middle of your day. I’m literally here on his lunch break to talk to him and squeezed in between all the other things you’ve got going on. So, I really appreciate you-

Dr. Nally:              No, thank you. We were looking forward to it. I got a chance to meet you … What was it? Two years ago?

Carole:                  Yeah, two years ago we did our first interview. Yeah, yeah.

Dr. Nally:              It was great and so when you called up I said, “Yeah! Come on. That’s great!”

Carole:                  Yeah, great. Well, I got to close with my normal question though of the meteor’s coming to Earth, we’re all going to get wiped out today. It’s your last day on the planet. What’s going to be your final meal?

Dr. Nally:              My final meal. I am going to smoke a really nice brisket and a …

Carole:                  We’re going to know it days in advance.

Dr. Nally:              Oh, yeah. We’ll see it coming. So, I’m going to smoke a few briskets and I’m going to have brisket every day before the meteor hits.

Carole:                  All right. [crosstalk 00:20:00]. No bacon on the side though? You’ve got to have bacon in it.

Dr. Nally:              Probably. I’ll probably put bacon on there as a … Bacon is the pixie dust of the culinary world. Yeah, a little bacon and brisket.

Carole:                  Excellent. Sounds delicious.

Hey, thank everybody … Thank everybody. Thank you, everyone. Thank you.

Dr. Nally:              No, thank you.

Carole:                  Thanks, everyone, for watching. Give us a thumbs up if you enjoy this. Subscribe if you want to see more. I’ve got all of Doc Nally’s contact info below in the show notes there, so we’ll see you again soon.