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February 11 2020

PCOS

Jtnazz Women's Health

Polycystic ovarian syndrome (PCOS) is another condition where our health industry finds itself without any good medications that can be sold to effectively manage the condition. Except for birth control, sure, why not take birth control instead of actually figuring out WTF is going wrong??? (watch Samantha Bee to maybe laugh at our sad sad system – https://www.youtube.com/watch?v=X2FS0s95o_Q )

image from – https://guardian.ng/features/health/knowing-polystic-ovarian-syndrome-pcos/

While clearly the struggle to conceive or infertility troubles may take center stage in one’s life, the impacts of PCOS go way, way beyond just that.  This is one of the diseases that cluster together all being caused by metabolic syndrome (early T2 diabetes or hyperinsulinemia), which is becoming exceedingly common, but quite serious.  The high insulin causing the androgen production in your ovaries will also cause damage to your arteries, increase liver fat and potential cirrhosis, gut dysbiosis and low grade inflammation, increased risk of heart attack, stroke, Alzheimers/dementia, loss of glycemic control a.k.a. T2 diabetes (leading to many potential organ and tissue damage, blindness, amputations), and even many types of cancer. 

Oh right, lets not forget that if you do manage to get pregnant, but have not resolved the high insulin, then you will be at much greater risk for many potential complications, such as miscarriage, preeclampsia, premature birth, and other fun stuff.  See here for more: https://www.nichd.nih.gov/health/topics/pcos/more_information/FAQs/pregnancy

If we stop to better understand why and how this condition progresses, then we actually learn some techniques that may help to better manage it. Similar to type 2 diabetes, PCOS is also a disease of metabolic derangement.
For the general understanding of PCOS, I am going to refer mostly to IDM program’s blog (Dr. Jason Fung and his team – in this case Dr. Nadia). They are the primary ones that I have seen address the underlying causes of this condition (although I haven’t yet looked all that hard elsewhere, maybe someone else has good info too?), so they are a good place to start.
To the best of my understanding, two of the biggest contributors to this problem are high insulin (insulin resistance) and too much growth signaling (mTOR). You can find plenty of info on mTOR and mTORC1 modulation/dampening in some scholarly articles and some good nerdy videos, but you got to be ready for that crap or it will put you to sleep. The basics principal is that to control insulin, we need to greatly reduce processed carbohydrates, starches, and especially sugars – fructose being one of the worst offenders to the liver; and to control mTOR, lowering insulin is huge, but reducing amino acid availability is also required, so basically water-only fasting becomes an ideal tool (provided you are not pregnant).

Now if you are a big fan of pharmaceuticals, than metformin may be a good place to start, but fortunately these two birds are killed with the same stone naturally. The best tools being low carb higher fat diets (such as ketogenic), periodic fasting, and time-restricted eating. Now, you could pick one and go with it, and maybe get sufficient results, but if you combine all three, now you are cooking with fire, and will get where you want to be much quicker and stay there much more easily. A strict therapeutic ketogenic diet can be difficult to maintain, but if you restrict your eating window to 6-8 hours a day (with last food at least 3-4 hours before bedtime), then you will likely be able to eat a bit more protein and some healthy carbs (i.e. unprocessed) and still maintain a high enough state of ketosis. Myself, I just skip breakfast, eat a large lunch at about 1pm, and a small dinner (usually by 7 or 8 pm).
First and foremost, sugar and processed carbs must be greatly reduced from daily consumption. Start off by counting how many grams of sugar a day you are eating. Then cut it in half. This could mean eating half portions of your treats or eating them half as often. After a few weeks, cut it in half again, and again, until you get down near 10 grams a day most days. If you go too fast it will be harder, but don’t drag it out too long either, because you got somewhere you want to be. This gives your body time to adjust and ween yourself off of this need for constant sweetness. My brain gave me a very hard time, especially after lunch. I wasn’t hungry, but I wanted my sugar fix. I was addicted since a young child, but now I get very little pleasure out of sweets, and can’t even eat much if I wanted to.
Fake sweeteners? Just don’t! Some will still spike insulin if eaten with food, some have been shown to negatively impact gut bacteria, so they certainly are going to do something in your body. My personal thought is this – it’s your brain asking for this glucose bump, and if you eat fake sugar, well, you taste sweetness, but your brain is still at the door waiting for the package to be delivered. It knows it didn’t get it, and will ask again. Slowly take that away, and it will quit asking for so much. If you order an item online, and it never comes, eventually you are going to wonder where the hell it is, and maybe order it again from somewhere else. Don’t think that your brain is that stupid that you can fool it with fake sugar. My hypothesis is that cravings are mostly driven by a reduction in available brain energy, and my quick fix is to eat butter (in the context of low insulin) and MCT oil (processed coconut) in order to compensate. So far it has worked quite well for me.
Throw in a 24hr fast once every week or two, and you may find that it’s really not that hard to do. Now it’s nothing that I really look forward to, so I find it helpful to designate a day (say Monday or whatever) because otherwise it’s just too easy to not do it. A 24 hour fast is really pretty easy as long as you don’t mind-block yourself before trying it. Many people just think “I could never do that”, but in reality, it isn’t all that difficult. Wake up, don’t eat breakfast, don’t eat lunch, enjoy your well-deserved dinner. Congratulations, you made it! In my experience, the feeling of hunger only lasts 10 minutes or so at a time, so if you can ignore it for a bit, it will go away for a while. A cup of black coffee or plain tea can do wonders to kill hunger. If you are really motivated, then push the fast duration up to 36 or 48 hours, and eventually 3-5 days if you can. Personally, I aim to do a 3-7 day fast at least a couple times a year for the multiple benefits, especially in relation to cancer prevention, but so far the only longer fasts that I’ve managed are one 3-day and one 4-day fast. It’s much harder to pull off with family life if you are the only one doing it. If you are really metabolically deranged and want to hurry things along, then you may want to do more frequent 2-7 day fasts from the start. I’ve heard its not much fun if you are not fat/ketone adapted, but its certainly an effective way to speed things along in the recovery. And fasting is a powerful tool in recovering insulin sensitivity, autophagy, and mitochondrial rejuvenation. All good things.

Obviously exercise is another great tool for improving insulin sensitivity. While HIIT or high-intensity interval training is getting pretty popular, in reality, low-intensity long-duration exercise is said to be great for improving mitochondrial health and reducing the amount of insulin required to maintain glucose levels, a.k.a. improving insulin sensitivity. This should be a brisk walk for most people, something that lets them maintain conversation without getting short of breath. For a deep discussion of this exercise and mitochondria topic see Peter Attia’s podcase episode #85 –https://peterattiamd.com/inigosanmillan/

IDM Program – Looks like they have quite a few parts now:
intro – https://idmprogram.com/fasting-polycystic-diseases/
1) https://idmprogram.com/the-faces-of-polycystic-ovary-syndrome-pcos/
2) https://idmprogram.com/diabetes-of-bearded-women-pcos-2/
3) https://idmprogram.com/hyperandrogenism-pcos-3/
4) https://idmprogram.com/differential-diagnosis-pcos-4/
5) https://idmprogram.com/pcos-and-obesity-pcos-5/
6) https://idmprogram.com/pcos-and-associated-condition-pcos-6/
7) https://idmprogram.com/pcos-and-hyperandrogenism-pcos-7/
8) https://idmprogram.com/pcos-and-hyperinsulinemia-pcos-8/
9) https://idmprogram.com/pcos-anovulatory-cycles-and-hyperinsulinemia-pcos-9/

Looks like Nadia and Fung have a new book coming out in May https://www.amazon.com/PCOS-Plan-Prevent-Polycystic-Syndrome/dp/1771644605/

See her short interview with Ivor Cummins for a brief background:  https://www.youtube.com/watch?v=ijn6ICTIJVM

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Discussion from 2009 – Diana McNeill, MD and Ann J. Brown MD MHS

https://www.youtube.com/watch?v=ABGVgpbW9Iw&t=357s

Very good overview – knowledgeable understanding of the disease, and much more detail on other aspects and issues.

IR at the center of treatability – lifestyle most effective approach.

Discussion of testosterone testing and limitations.

Apparently unaware of the potential effectiveness of fasting.  I guess in 2011 it was not all that embraced as a medical tool.  Fasting has many mechanisms of action, probably many still unknown, but definitely minimizes insulin and greatly dampens mTOR activity.

I recall Dr Peter Attia had noticed his testosterone nosedived during a 1 week fast.  Not sure if this would occur in women as well, and if it did, could shorter more frequent fasts be an effective means to maintain lower T?

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Understanding a little bit about mTOR can help to tie all of this together a bit.
Michael Hall (University of Basel): The Story of TOR (Target of Rapamycin) https://www.youtube.com/watch?v=VYVjE6HEgy0
David Sabatini (Whitehead, MIT, HHMI) 1: Introduction to mTOR and the Regulation of Growth https://www.youtube.com/watch?v=EnIerDljc7g

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Links for ketogenic diet help:

Check out my page on ketogenic diets for an overview and good keto links – https://revhealthhub.com/ketogenic-diets/

Dominic D’Agostino’s site – many resources for keto diet, and also many great video interviews exploring other aspects of ketone physiology.
https://www.ketonutrition.org/practical-guides-to-the-ketogenic-diet

And in terms of better understanding metabolism, I would always recommend Dr. Jason Fung’s books The Obesity Code, and the Diabetes Code.

October 7 2019

Gallbladder concerns?

Jtnazz Uncategorized

  When I first started getting into the whole high fat diet, this thought popped into my head “What about gallstones?”  I’ve never had issues myself, but I know people who have, and the typical advice they were given was to avoid a fatty diet to avoid problems.  If people are so well adapted to eating fats for energy, then surely there must be some kind of big misunderstanding here as well.  Absolutely!  A terrible misunderstanding of the nature of the problem.  So as brief and simple as I can put this:  the gall bladder stores bile acids (made by the liver) that assist in digestion and absorption of dietary fats.  The purpose of bile is to help digest fat, so how can anyone explain how using bile for what it was intended could cause stone formation?  It just sounds stupid because it is!  However, when we eat a low-fat diet, we don’t need as much, so by decreased use, the pool of bile acids sit around stagnant and concentrates in the gallbladder.  Crystallizations begin to occur, which eventually result in the formation of sludge and/or gallstones.  (Clinical study – https://www.nature.com/articles/0800634)  So now that you have managed to form these stones by eating too little fat, and have them already present, sitting in your gallbladder, NOW if you do suddenly eat a very fatty meal, your gallbladder activates with a strong response, pushing these crystallizations/stones into the narrow passageways in route to your GI, causing obstruction and sometimes complete blockage.  Here are a couple sites that explain it fairly well, but there are numerous others out there as well if you need more convincing: https://www.dietdoctor.com/gallstones-and-low-carb, https://www.atkins.com/how-it-works/library/articles/dealing-with-gallbladder-disorders. 

Full stop! – That was the overly-simplified explanation that already seemed more plausible than the traditional view, but it still didn’t complete the puzzle. It also didn’t provide too much for ways to make a meaningful impact on risk aside from liver health.  Realistically it has to be something more than simply stagnation and lack of use, but rather some biochemical event must be changing the tendency of the bile to produce or not produce stones.

While a very low-fat diet seems to promote gallstone formation, not eating anything at all (a.k.a. fasting) does not cause any substantial risk of gallstone formation in most people, so clearly some biochemical change must occur that lowers the solubility of the bile salts and cholesterol.  Additionally, some people manage to get gallstones despite eating plenty of fats, and stone formation tends to correlate with metabolic syndrome (hyperinsulinemia), and is also higher with celiac damage, so clearly there are multiple pathways and contributing factors.  Stones can also form in the common bile duct, gallbladder or not, so nothing to do with stagnation there. This sent me out in search of some sort of explanation to make sense of these inconsistencies. I eventually found a brief mention in a decades old abstract – that phosphatidylcholine (PC) and oxysterols in combination help stabilize bile and prevent crystallization, which seemed pretty important to me.  I am assuming that oxysterols are less likely to be in short supply, and that PC is more deserving of our attention. A number of other papers seem to confirm that increased PC correlates with lower stone incidence as well.

https://www.ncbi.nlm.nih.gov/pubmed/

So let’s see, choline deficiency will cause fatty liver (obstructs bile production/flow), and not enough choline may result in the body stressed to produce enough phosphatidylcholine, which could then decrease the solubility of the bile within the gallbladder, resulting in stone formation.  Maybe we want to avoid choline/betaine deficiency!!!  (Side note – its going to be much more difficult to get sufficient choline/betaine on a low-fat diet).

The pathways of choline and folate are intertwined, both help power methylation, which is needed to maintain SAM (s-adenyl-methionine), and proper SAM supply is needed for PC synthesis, creatine synthesis, regulation of anti-oxidant glutathione production, etc. Folate deficiency or MTHFR mutations can cause a much greater need of choline/betaine, so both are capable of causing imbalance.

I personally go out of my way to get more choline in my diet and add plenty through supplementation as well, although I do have SNPs downregulating both MTHFR and choline pathways, so that may not be all that necessary for everyone.  Oh, and seriously doubling up the egg yolks in some scrambled eggs is super tasty! (Secret to good eggs – just add lots of butter and don’t overcook them or burn the butter.)

Interesting note – “phosphatidylcholine led to an improved clinical activity index” for ulcerative colitis, meaning it decreased the severity of disease symptoms. https://doi.org/10.1080%2F00365521.2017.1326163  I’m guessing that an increase in bile flow had something to do with the improvement in disease status, as well as PC playing an important role in the intestinal glycocalyx/mucosa (gut barrier layer) antibacterial protection (https://www.sciencedirect.com/science/article/pii/S0005273617300627).  Sufficient bile helps promote overall GIT health, as well as improved absorption of fat-soluble vitamins such as A, D, E, and K.  And yes, fat-soluble means eat your veggies with some sort of fat to maximize absorption of these nutrients.

People who develop gallstones despite eating plenty of fat may have choline deficiency issues and/or liver dysfunction, or might be celiac (diagnosed or not), or possibly some other mechanism is at play.  Whatever it may be, eating too much fat is almost certainly not the cause.

As briefly mentioned above, in celiac afflicted individuals consuming gluten, gastro-intestinal tract (GIT) damage in the duodenum can cause sensory cells that normally should trigger contraction of the gallbladder in the presence of fats to become damaged, resulting in a muted, sluggish, or dysfunctional contraction response, and thereby decreased bile ejection.  Bile serves many functions in maintaining proper absorption, as well as GIT lubrication and microbiome moderator, so decreased bile surge is likely to exacerbate an already damaged GIT that is a hallmark of celiac disease.

Liver health is another big factor in the formation of gall stones.  Your liver is the organ that produces bile, which is then concentrated and stored in the gall bladder.  If someone develops liver disfunction (which could be caused by fatty liver due to excess fructose, hyperinsulinemia, 1-carbon metabolism imbalance, alcohol, etc.), then it may not be able to make sufficient bile, or thyroid hormone, both of which can affect stone formation and also leads to a number of different problems.  Amino acids taurine and glycine are precursors to bile salt formation, so supplementation may be helpful to ensure deficiency isn’t impeding production.  The slide below is from a powerpoint I found on the web, most of which was a little too specialized to be helpful for me, but slide 7 struck note – notice the risk of stone formation is huge for those with three abnormal liver function values.  I was going to say 10 times higher, but that doesn’t really capture the magnitude of the increased risk, which afflicted HALF of the group with 3 abnormal values.  It went from 4/100 to 50/100, so yeah, the liver is a big player here.

https://www.slideshare.net/drferzli/common-bile-duct-stones-leave-them-get-them-or-refer-them

Systems in our body are not independent, but rather they are intertwined.  The liver, thyroid, gall bladder and GI all affect each other, and they do so in both directions, so problems in one system will lead to other systems dysfunction as well.  Liver problems may not be as noticeable, but might still be impacting the health of other systems in ways that we do notice.  The liver is responsible for creating/converting a large percentage of thyroid hormone, so liver disfunction will impair this task, and people with hypothyroid issues have an increased risk for bile problems and common bile duct stone formation.  So yes, it’s complicated, but if you can avoid giving yourself a fatty liver by fixing insulin resistance issues, minimizing fructose consumption, and avoiding choline deficiency, then there is less chance of things getting pushed out of balance, and recovering liver function may even help bring thyroid and other systems back into balance.

If you do get your gallbladder removed, it isn’t any more dangerous to continue eating fats, but you will be less able to metabolize fats and will be less efficient in absorbing fat-soluble nutrients.  Doctors and hospitals may want to remove your gallbladder due to their failure to understand its importance, and because they get to charge you a lot of money to do so.  I’ll let you decide which of those two factors weighs in heavier on their decision, but if it were me, I would tell them that we need to focus on increasing bile production and dissolving the stones, and to leave the organ where it belongs (provided that it is otherwise healthy) since it is far from a useless organ.  Also, getting your gallbladder removed doesn’t eliminate the possibility of stone formation within the biliary tree and common bile duct.  To do that, it would take actual lifestyle changes to reduce that risk.

September 19 2019

Fasting and Time Restricted Eating – Two Great IR Tools

Jtnazz Uncategorized

Intermittent or Periodic fasting: a powerful tool for addressing insulin resistance – Quite a few of these specialists make reference to the benefits of both intermittent and periodic fasting, which I tried really hard to ignore at first.  The idea of intentionally not eating sounded painful and stupid, and I really had no interest in it. 

My basic thought – “I love food.  Are you are suggesting that I intentionally not eat for how long?  No way, you’re nuts!”

I previously hated the idea of even missing a snack, never mind missing a whole meal.  However, since quite a few knowledgeable specialists/researchers go out of their way to incorporate this into their lifestyle, I figured that there must be something real going on there.  I finally decided to educate myself a little on the topic and was amazed by how much sense it made in regards to metabolism and insulin sensitivity (with what is known to date).  There is a lot of new research around fasting, with many studies just beginning, and surely a whole lot more discover.  While a few pathways and mechanisms have been elucidated, many more are likely involved.  Some important known effects of longer-term fasting (approx. > 3days):  greatly reduced insulin levels, gastrointestinal healing, gut microbiota alterations/balancing, dampened mTOR activity (reducing excess growth signaling), increased sirtuin activity (improving gene expression and silencing – some slowing aging benefits).  You may not know what these last two are, but be assured that this is desirable (periodically) for adults.  Plus, you get the added benefit of losing weight.

Anyways, I eventually tried it out a few times and found it really wasn’t all that torturous.  Initially just skipping breakfast seemed like a long fast, but it was manageable, and I slowly worked my way up to longer multi-day fasts.   I’ve since worked a 24hr fast into my routine every week or two (which now days barely phases me), and a few occasional longer fasts.  The freedom to not have to drop everything and eat just because its lunch or dinner time is so liberating.  And to make it through, however long I need to, calm and content, not shaky, weak, edgy, or enraged; that is a gift that was unforeseen to me.  The term generally used to describe this state would be metabolically flexible – meaning someone who can quickly and easily use alternate sources of stored energy such as fatty acids and ketones in addition to glucose.

The more I learn about the biological mechanisms currently known to be involved, the more I find myself a big supporter of fasting.  Who would have thought?  However, the real surprise is how many different pathways it affects.  The human body is an extremely complex universe of intertwined systems, and somehow fasting is able to help bring things back towards balance in multiple systems all at once.  Almost as if it were a natural state of being that we should be experiencing somewhat frequently.  What a crazy thought.  Right?

Even though fasting has been known to have health benefits for thousands of years, this is a new field when it comes to research in studying the mechanisms and pathways/targets of fasting, and so far looks very promising as a treatment for auto-immune diseases, cancer, and many other conditions.  While time-restricted feeding may be an effective strategy for weight loss and correcting metabolic issues such as T2 diabetes, longer fasting periods, like somewhere in the range of 3-7 days or more will likely be required for targeting other pathways involved in treating cancer and auto-immune issues.  I recall fasting being mentioned as a first-line treatment for epilepsy (followed by a strict classical ketogenic diet) back before the modern medication era, so apparent neurological protective pathways are invoked as well.

To clear up the terminology as I understand it:  definitions are a little murky (and everything is relative), generally anything less than 24 hours is considered time-restricted eating (TRE), though some people who only eat once a day most days may still consider 24hrs as a form of TRE.  Intermittent fasting is typically a specific regimen such as fasting every other day for a couple weeks.  Periodic fasting is generally longer 2-7 days or more, and sometimes may be done for several weeks (under medical supervision), but done at less frequent intervals, say once every 1-6 months.  Longer fasting periods will produce greater results, but at greater risk of adverse effects, and require greater care in exactly how to break the fast.  Starting with a longer fast is not wise.  Like anything, if you don’t know what you are doing, start small and work your way up.  No one takes up running by doing a marathon, well at least if they plan on not dying in the process.

Some fasting plans allow some caloric intake on fasting days, say 25%, which sounds like trouble to me, as this opens up room for error and cheating.  Did you eat 500 calories of sugar, or was it almost pure fat (like butter)?  Was it really just 500 calories? Was it all at once, or was it little bits throughout the day?  By eating at all, you are changing your body’s metabolic response to lack of food energy, and likely not in a good way if you are going to continue restricting food access.  If you are not eating, then just don’t eat.  Is eating just a few bites of food actually satisfying when you are hungry?  Not to me.  When I’m breaking a fast, I’m eating till I’m full.  If hunger pains are killing you, then take a spoonful of coconut oil or a tablespoon of butter; not a true fast, but at least it will have minimal effects on insulin.  If that still seems intolerable, then consider going low carb first.  Getting insulin under control with a low carb diet can make fasting much easier and less painful by allowing you quicker access to your fat stores.

Dr. Jason Fung has a lot more information and explanations for the therapeutic use of fasting for targeting T2D on his blog (see links further below), and I highly suggest watching a few of his videos. He also has a few books that present the information in a more organized format.  His clinical work has repeatedly demonstrated that fasting can be a very effective tool in reversing the condition of insulin resistance (hyperinsulinemia)/type 2 diabetes.

I found that to be very true for me being on a very low carb diet:  a couple years ago for our health screening at work, after fasting for the 12 hours, I decided to try it out and skip breakfast completely.  It was already 9 am, but could I make it till noon without eating anything?  I was very surprised at how I didn’t really feel hungry at all.  I had been dialing down the sugar and processed carbs for a couple of years, and what a difference from the experience of going hungry previously.  I wasn’t tempted to snack, and I wasn’t cranky, in a bad mood, or tired; and it didn’t even trigger a migraine or anything.  In the following months, I skipped quite a few more morning meals and felt just fine. (I now understand that this is really just time-restricted eating, but at the time it felt monumental).  A few little moments of hunger, here and there, but nothing difficult or torturous.  After a while, I was skipping breakfast more often than not, and I eventually noticed that I felt considerably more tired on the days that I did eat breakfast, so my new breakfast time became noon-1 pm most days.  Once in awhile I will still eat early or 3 meals in a day, but not too often.

Currently, since I only eat twice a day most of the time, a 24hr fast just means skipping lunch, so pretty darn easy to me.  Sometimes I do it intentionally for metabolic health, while other times I’m just too busy and don’t want to lose all that time from eating and digesting, especially when working on big house projects.  It’s nice to have the flexibility of not eating and remaining productive, all without biting anyone’s head off. 

While I typically do at least one 24hr fast every week or two, I haven’t been as disciplined in working in longer fasts – a few 48hrs, and one 52hr, 3-day, and 4-day fast.  My goal is to do a 5-7 day fast a couple of times a year, but that’s pretty tough when you have a wife who cooks delicious food, and kids to cook for.  The smell while cooking, or licking peanut butter or whatever off your fingers when making breakfast or packing lunches… and suddenly I remember I’m fasting for the next X-many days.  Fun is the one thing that fasting is not, but neither is work, yet I see the necessity in continuing that pursuit as well.

Over time I’ve skipped a lot more meals because I’m just not always that hungry anymore.  There are some benefits to exercising in the fasted state too, so just because you’re active doesn’t mean you have to eat, but it does take some time for your body to adjust.  Again, start off slow/easy and work your way up to more intense activity.  From my own personal experience, a few ultimate Frisbee games were probably not the best type of exercise opportunity to start with (in one game my heart was pounding so hard that I was getting a bit concerned, but we were shorthanded, so I had to keep running).  One great thing about exercising in the fasted state – you know exactly where your energy is coming from – primarily stored body fat.

Dr. Fung has been utilizing fasting for quite a while, and he discusses the many benefits of fasting on his blog.  Dr. Attia and many others have also eventually delved into this potent therapy as well.  One rather notable benefit is to increase the rate of autophagy (recycling old degenerative cellular components and other dysfunctional proteins), and the role this can play in regenerating our mitochondria and other cellular structures, which is thought to play a critical role in preventing cancer and many other degenerative diseases.  Longer fasting periods are known to affect many hormones and nutrient levels that are beneficial in fighting already established cancers.  https://idmprogram.com/fasting-and-autophagy-mtor-autophagy-1/

Although it could be the increase in sirtuin activity helping to better regulate epigenetic expression that could be a big player in fighting cancer too.

If you have any interest in fasting, read this first!!!  https://idmprogram.com/1-rule-fasting/

Fasting should not cause muscle wasting.  Dr. Fung thinks this is possibly due to an increase in growth hormone that occurs during fasting, which may have the effect of preserving muscle mass.  Or perhaps sufficient circulating fatty acids and certain amino acids provide your muscle with what it needs to survive, and then your liver kicks out the glucose required for any exercise you pursue.  (It’s always kinda cool to see my glucose go from about 70 to 110 before and after exercise during a multiple-day fast).  Your body is fine-tuning to be more efficient, not to self-destruct.  Once you have burned through your glycogen reserves, it will take most energy requirements from fat stores, and target unnecessary protein for any protein needs.  Why burn muscle, when there is loose skin, cellulitis, dysfunctional cells, organelles, and accumulated junk protein that is readily available. 

(Neat random info – while the maternal and paternal contributions towards nuclear DNA may be relatively evenly matched, cellular components such as mitochondria and other organelles are typically maternal in origin.  There have been some reported instances of paternal mitochondria being passed on, but they are said to be rare.)

Other areas of benefit concerning fasting – https://www.the-scientist.com/features/running-on-empty-31436  a pretty good review, however, the author’s assertion that intermittent fasting (IF) “is just caloric restriction in disguise” is just plain wrong.  The biochemical patterns induced by IF and periodic fasting is completely different than traditional caloric restriction, and the responding metabolic effect is also very different.  Chronic caloric restriction tends to lower metabolic rate (at least when done with a high-carb diet), whereas period fasting does not (upon refeeding).  If you keep track of glucose and ketones during a fast, (for a healthy individual) you will see a dramatic shift occur somewhere in the 2 to 3 day mark where glucose levels drop way down and ketones levels rise significantly.  Not sure when and to what extent that will happen in someone with hyperinsulinemia/T2 diabetes.  This shift in energy substrate utilization is unique to fasting, and will never happen if you are still eating small amounts of food (even on a ketogenic diet).  Metabolic changes due to fasting are said to last multiple weeks, so clearly quite the powerful tool.

Also not quite accurate in that review, as I mentioned above, more effective IF would require no nutrient intake during fasting periods (i.e. water, black coffee, plain tea only).  Rhonda Patrick has a couple of good interviews with Valter Longo and also with Dr. Guido Kroemer discussing other benefits of fasting on autophagy and cancer.

To my limited knowledge, fasting is the only way known to rejuvenate the immune system, for which it can be effective at reducing auto-immunity issues without sacrificing overall immune function.  Some part of this impoved immunity is likely by allowing the full gastro-intestinal tract to repair and recover – improving gut barrier function.

NOTE: true fasting is referring to the absence of nutrients, so all these trendy cleanses using veggie smoothies and juice fasts are not going to work as effectively, if at all.  While there is some controversy as to whether black coffee or plain tea is acceptable in regard to inducing autophagy, certainly for weight loss and fat burning purposes there should be no concern for most people.  Although if you notice it affecting your blood sugar, then maybe you are one of the few that should avoid that as well.

There is some indication that something in coffee (caffeine, possibly the polyphenols, etc.) actually stimulates autophagy, and therefore would be expected to further enhance the process https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4111762/pdf/cc-13-1987.pdf.  While being a mouse study, the fact that increased coffee consumption has been positively correlated with many health benefits and/or reduced risk for many conditions could be seen as evidence that this may be a conserved pathway for humans through which it’s acting.  When it comes to cancer cells this becomes a little complicated, as autophagy can be a lifeline for some cancer cell lines, and a death sentence for others (in vitro), which makes it a little less clear as to if coffee increasing autophagy would be a good thing or not, or if it would even make a difference?  I don’t think we know the answer to this at this point.

Another coffee consideration – from my own personal experience – if you drink lots of coffee, then don’t just stop or slow way down during a long fast.  Caffeine withdrawal is quite unpleasant.  No reason to add adverse side effects to an already not all that pleasant experience.  Maybe taper off slowly before fasting if you really want to go all out with strict water-only fasting.

I would also throw ketone salts, MCT and partial MCT oils in here for consideration as well. They certainly make 24 hr fasts much easier for me, so if you are having trouble with sticking to it, maybe give it a try.  You won’t lose weight as quickly, but it will increase your ketone supply, as well as reduce hunger.  In general, I like to use these before exercise or after a poor night of sleep for an easier source of energy.  If you are mostly fasting for improving insulin sensitivity and liver health, then they are probably ok.  Will they affect sirtuin activation levels?  Someone out there probably knows the answer to that, but I do not.

Time-restricted eating (TRE) is another approach to improve insulin sensitivity.  Very easy to do, and quite effective.  Regardless of what you eat, this is a great tool to help improve general health and many metabolic markers for risk.  The basic idea that you eat all your food (and beverages that affect glucose/insulin) in a smaller window of the day (ideally within 6 to 8 hours), and the rest of the day you don’t eat. (NO snacking outside of window).  Some fairly well-controlled studies have been done eating the same food but restricting the eating window, and indicate some benefit in regard to biomarkers related to metabolic health, even while eating a standard American diet (i.e. lots of processed crap food).  To be more effective, this eating window should be during your active part of the day.  Eating later at night has possible mechanisms that inhibit weight loss and can negatively impact metabolic markers.  Another benefit of TRE is that if you are only eating for a short window of the day, it becomes difficult to over-consume, so no need to worry about portion sizes.  Perhaps better to emphasize that if you are doing strict TRE, you should NOT restrict quantity, but rather eat until satisfied (within reason – if you are full then quit eating). 

Personally, this just seems like the most natural way to eat less.  No one wants to quit eating if they are still hungry; better to just eat less often.  Going longer before eating isn’t actually all that hard to do, and I typically find that I get much less tired after eating if I have been fasting for longer (provided that I don’t binge on processed carbs).

While there isn’t really any data that I’m aware of that could indicate if an early eating window or middle of the day is better or worse, it does seem that eating later into the night may have some negative consequences.  This seems to go along with what some of our grandparents might have told us, with the probable mechanism being disturbed sleep quality, which can alter cortisol and insulin levels and sensitivities.  Realistically digestion is exhausting, and it requires organs like your liver, pancreas, and parts of your brain to be active regulating digestion when they may need to be doing other activities to recuperate and prepare for the next day.  The idea that missing half a night’s sleep causes a great reduction in insulin sensitivity, suggests to me that the body knows it was not fully able to prepare what it needed to, and therefore is taking corrective action to cope with the situation.  Is this to spare glucose for the brain?  What about glucose metabolism is so exhausting?  Perhaps enzyme levels or general ATP stores… I’ve lots of questions and few answers for this issue.  My personal experimentation has indicated that I do better fasting most of the day and taking MCT oil throughout on days that I get crappy sleep.  It seems to help with brain energy and reduce cravings, but not too much help with the sluggish feeling of exercising when overtired.

Some good discussion on the latest research regarding TRE:  https://www.foundmyfitness.com/episodes/satchin-panda, https://www.foundmyfitness.com/episodes/satchin-round-2

So a big take away here is that skipping meals is not only ok, but it can actually improve health.  But this would require you to fully skip the meal, and not eat any junky snacks instead.  If you do have to snack, make sure it is low in sugar and refined carbs, meaning higher in fat and protein.  It may not quench that thirst for sugar, but that’s when you realize it’s not really hunger that you are fighting, but rather sugar addition, which will get easier in time.

Snacking:  Our current culture is really pushing this idea of snacking as being something good or necessary.  For some reason we have developed such an aversion to hunger nowadays, as if that feeling is somehow going to digest our own stomach.  In the period of my lifetime, I have seen snacks go from something that will ruin your appetite or just not considered necessary, to something schools are requiring – a “healthy” snack for the morning and afternoon.  WTF?  What’s next, a continuous I.V. drip of dextrose?  Hmm, wonder why we keep getting fatter?  There really is no other logical explanation than that we have been brainwashed by the food industry so that they can sell more product.  When I was in grade school we didn’t have snack time at school.  Nobody needed them.  We were fine all the way till lunchtime.  Now we are growing nice little piggybanks for big pharma.  Did someone order some T2 diabetes?  Coming right up!  However, I will concede that when you are insulin resistant, hunger is much more intense and unpleasant, which is another very good reason to avoid this death spiral.

Historically snacking had never before been viewed as healthy (go ask the elderly if you are doubtful), and from an insulin response point of view, it can be very harmful, cranking up insulin exposure, and thereby increasing the degree of insulin resistance.  While ideally we would like to get to a point where we rarely snack, it’s not so easy if we are starving by 10 am.  Until you have improved your insulin sensitivity and can readily access your fat stores for energy, you probably are going to keep getting hungry between meals, so try to get snacks that have the least effect on insulin (no/low sugar and carbs, and higher in fats).  They may not always satisfy that craving that you have for something sweet, but at least you won’t be hungry.  Plan ahead and bring something with you, because there is probably nothing in the vending machine that meets that criteria, and gas station convenience stores are pretty lacking as well.  Eventually, once you are more insulin sensitive, if you eat a breakfast that is more truly healthy, you probably won’t even feel hungry until close to lunchtime or later.

A truly healthy snack – a healthy (low processed carb) snack might be a quick and easy substitute for a meal if you are not very hungry.  Sometimes after a long day at work, the idea of cooking anything just seems very unattractive when hunger is relatively low. Something little is usually all I need to make it through the evening provided I ate a big lunch.

July 20 2019

Ketogenic Diets

Jtnazz Nutrition

In many videos and articles to which I have linked, you will often hear discussion of ketone bodies and/or ketogenic diets (very low carb, high fat, moderate protein).  What is this “keto” diet, and is it safe, natural, or healthy?

It isn’t a specific diet, but a pattern of eating that could partially mimic fasting when in the high state of ketosis, basically lowering insulin enough to allow your body to break down dietary and/or stored fat to produce ketone bodies.  While it won’t deliver the full benefits of a complete fast (water only), if applied correctly it can be quite effective and beneficial for addressing a number of metabolic and neurological issues.  NOTE: a ketogenic diet is not necessarily a weight loss diet.  Babies consuming only breastmilk are often on a type of ketogenic diet due to the high fat consumption, and they are neither losing fat nor muscle, but rather growing intensely and storing away necessary fat for future rapid growth spurts (nay-sayers see links below).  The body is not stupid – during development, it will save up fat stores until it has enough energy for the next growth phase, then boom… the growth spurt occurs.  Are babies in a high state of ketosis, probably not, but they are able to make use of multiple fuel sources rather than being restricted to just glucose.  After all, what it the point of storing fat, if you are unable to use it effectively?  Additionally, how in the hell do you think you are going to lose fat if you never get into at least low-level ketosis through diet or fasting?  Whether or not you lose fat or not will depend on a number of factors such as total food consumption, eating window, reducing hyperinsulinemia and resulting changes to body set point (ref Dr. Fung), etc.  If you stuff your face full of keto friendly foods throughout the entire day, then you are probably not going to lose any stored fat, but at least your insulin should come down some, so it’s still better than doing nothing.

Abstract – Neonatal ketosis is not rare https://www.ncbi.nlm.nih.gov/pubmed/11482735

Patterns of metabolic adaptation for preterm and term infants in the first neonatal week https://adc.bmj.com/content/archdischild/67/4_Spec_No/357.full.pdf

I could find more evidence, but this proves the point already.

If your goal is fat loss, then you will ultimately need to avoid over-eating so that you can begin to utilize your stored fat more than dietary fat.  Fortunately, this type of diet can help diminish hunger by a number of pathways, so eating less on a ketogenic diet is often much more tolerated than on a high carb type diet.  There are a variety of approaches from more meat/fat and dairy-based, a healthy mix, or even could be done vegetarian or dairy-free if necessary.  For most people, this type of diet will improve metabolic markers of cardiovascular disease, but for a small percentage of people there is the possibility of increasing risk on some variations of the diet, so if you find yourself enjoying this lifestyle and sticking to this type of eating for multiple years, then it’s important to monitor important biomarkers such as LDL-p and CRP (really these biomarkers should be tested occasionally regardless of what particular diet you prescribe to, well homocysteine too, but that’s less related, and one single day’s values are not always going to represent your average, so don’t freak out for one single test. Repeat a few times, and if still bad, then start to take action).  While many people respond well to this type of diet, due to genetic diversity and epigenetic expression, there are always going to be a few that struggle to switch over, and even a few that just don’t do well on this type of diet.  A 3 to 7 day fast might be helpful to jumpstart the process if you are having trouble switching your body over to ketones and fatty acids.  Myself, I switched over slowly for minimal side effects and had no issues, but some people have more trouble physiologically using ketones, or some just less patience.

As a spectrum, the diet could cause anywhere from intermittent and/or light ketosis, to moderate or more intense nutritional ketosis, but will never reach the dangerous condition of ketoacidosis provided that you are not a type 1 diabetic.  By lowering carbohydrate consumption enough, while avoiding excessive protein, the body begins releasing fats for energy, some of which your liver processes into ketone bodies.  While most people know that cells use glucose for energy production, they can also use fatty acids and ketone bodies as primary fuels to produce energy, and there are many benefits of doing so.  Ketones must be metabolized aerobically in the mitochondria, and most anything that promotes cellular respiration is typically good for improving/sustaining mitochondrial health.  While there are a lot of benefits to this, and it can be an effective treatment for certain conditions, it is not a requirement to always be in a state of ketosis to be on the road to a healthier you, and perhaps cycling in and out of ketosis might be a more natural and healthy pattern for many people. 

Ketosis is not a cure-all, but there are a surprising number of conditions that can be improved with a higher state of ketosis. To me, this seems to suggest that rather than being some sort of magic diet, its more likely that it just resembles our natural state of being. Biochemical patterns that we were evolved/programmed to experience; bringing balance back a number of intertwined and interconnected systems.

For more info:  Diet doctor has a lot of info in both English and Spanish

https://www.dietdoctor.com/low-carb – see this for who should NOT be doing keto without medical supervision.

https://www.dietdoctor.com/low-carb/ketosis

https://www.dietdoctor.com/es/keto

Peter Attia has a lot of info on his blog about ketosis (https://peterattiamd.com/), as well does Ben Bikman in his videos, Dominic D’Agostino is good for more advanced ketone topics and many interviews with discussion on the use of ketone supplements https://www.ketonutrition.org/

and Attia mentions Stephen Phinney as being other very good sources of info on this, but I haven’t followed up on that yet myself.

Also see https://www.ketogenic-diet-resource.com/ (as referenced by Dominic).

It’s pretty hard to avoid carbohydrates completely, so the level of ketosis will vary by how much you are able to avoid or lower your processed carbohydrate and starches, as well as limit protein intake on a daily basis.  The amount of time spent in the fasted state will also play a big role as well.  If your goal is to stay in a constant state of ketosis, then you will want to be very careful about your protein intake, and you might need to even limit some types of vegetables.  Eating fat and fiber together with protein can help reduce the insulin spike that would otherwise occur due to the protein.  Depending on how sensitive your body is or how severe your resistance, you may need to avoid fruits for a while until your resistance has improved.  And when you do eat them, eat them whole (i.e. not blended or liquefied).

I personally think it unwise to take protein powders.  Why?  Because you need a lot more than just protein/amino acids – like minerals and micronutrients, fat, and fat-soluble vitamins, choline, essential fatty acids, etc.  Maybe eat some real food if you need more protein?  Lean protein is flavorless and awful for a reason, listen to your body, it wants all the fat and connective tissue also.  Bones have a lot of nutrients that can leach out into the surrounding tissue or broth when cooking, so keep some of those in there as well.  Organ meats are very nutritious as well if you are open to it. I personally haven’t been very adventurous on that front, but chicken wings have taken a spot on my favorites list with their high skin, fat, and connective tissue to meat ratio.

A low carbohydrate high fat (LCHF) diet is not necessarily a (constant) ketogenic diet, the level of ketosis will depend on a number of factors such as fat, protein, and carb ratios, as well as frequency of meals, total amount consumed, and daily fasting period.  When you eat, insulin will rise up, and ketone production will decrease, spike insulin too high and it will drop ketone levels below the measurable range.  The more that you condense your daily eating window and produce a long daily fasting period, the longer/higher you may be able to sustain significant ketone levels.

One thing I found interesting is it takes time for your body to be able to fully take advantage of ketones and fatty acids for energy usage – http://www.insuliniq.com/what-does-it-mean-to-be-fat-adapted/.  So if you try to jump into a ketogenic diet quickly, you will probably feel a little drained in the beginning, mostly if you try to exercise, but after a few weeks energy levels should be getting back to normal or even better.  If you are jumping into this very quickly, you may get a week or so of “keto flu”.  Full ketone/fat adaptation is not a quick process.  Many things are changing such as the ability to produce ketones, cellular ability to take in and utilize both ketones and fatty acids, as well as gut microbiome changes to adapt to HFLC type diet.  While significant recovery and benefit can be noticed after a few weeks, Dominic mentions that different physiological and epigenetic changes continue for many months.  Dom also mentions that in addition to being an energy source, ketones are signaling molecules affecting different systems in the body, and even have epigenetic effects.

A newer product on the market is ketone supplements (exogenous ketones like BOHB esters or salts).  These are pretty expensive, especially the esters.  They have shown some potential therapeutic value in the treatment of cancer, Alzheimer’s, and some other neurodegenerative diseases, but further research is needed to better understand pathways and effectiveness.  Cost is another hurdle for most people, so making your own (internally) is probably the best route when possible.  Medium-chain triglyceride (MCT) oil, virgin coconut oil, and MCT powders can also be taken to help give a bump in your ketone levels (a more modest bump, but for a much more affordable price).  Although some GI issues may arise with the MTC oil, in which case the MTC powders may be preferred for some.  However, the greater range of MCT types found in virgin coconut oil may provide other benefits that the MCT oils or powders do not (I will let you search for C8, C10, and C12 properties on your own).  MCT vs VCO – a MCT oil will have a quicker and higher peak, whereas virgin coconut oil will see a lower elevation in ketones, but for a longer time period.  Fasting is obviously a very effective way to boost ketone levels also.  Taking exogenous ketones will reduce the amount that your body needs to create, meaning that you will burn LESS fat for a similar performance.  This is fine in the treatment of Alzheimer’s or cancer, where your intent is not to lose weight.  Just don’t think you will burn fat by taking ketone supplements (which is exactly what some ketone salts advertise).  Taking ketone supplements might help jumpstart the adaptation phase, so in that sense could make it less painful to go hungry, but if your goal is to lose weight, then generally you want to utilize your fat stores to make your own.  I also wonder if this shortcut would dampen the AMPK signaling response, and if so what consequences that would have?  Meaning your body senses an energetic crisis, and in response upregulates a number of pathways to remedy the situation, including mitochondrial remodeling and biogenesis.  Will ketones dampen this response, or will this adaption have to occur before the ketones can be fully utilized to improve the ATP ratios?

After experimenting with a few ketone salts, esters, and virgin coconut oils (VCO), I have taken a liking to a partially concentrated coconut oil made by Carrington Farms.  I’m sure some other companies make some good ones, but this is just one I found at a local store and liked (however much cheaper online).  Not a pure C8 MCT oil, but it’s much easier to swallow than the VCO, and has a good balance of C8, C10, and C12 (all of which have some beneficial properties).  I notice a decent increase of mental energy, but at the fraction of the cost of a ketone salt.  Note:  if you are going to experiment with this, take one big spoonful at a time, maybe two.  Taking more can result in a stomach ache for 20-30 minutes.  I’ve taken up to 4 tablespoons at a time, sometimes getting away with it, and sometimes almost throwing up.  And I didn’t really notice any extra benefit from taking more at once, so not worth the risk to me.  Start off small, and increase over time as you get used to it.  I also try to take it at least 45-60 minutes before exercise – again, minor stomach discomfort being the concern.  I tend to get migraines when I fly or drive up into the mountains, but on the last few events I have had none while taking this the morning of.  Maybe this is a key tool to avoid migraines when certain triggers are unavoidable, or maybe I just got lucky.  I will keep trying it out to see if the pattern holds.  (I’ve also recently been trying to address high homocysteine with a combination of supplements, so clearly I’m tweaking more than one factor at a time, making it harder to draw any conclusions.  Not sure if the homocysteine has improved yet, I need to get it re-checked soon.)

https://www.amazon.com/Carrington-Farms-hydrogenated-unflavored-Packaging/dp/B072JNXCH6/  (actually is organic now – maybe they will update their site eventually).  Note: I have no affiliation with this company and get no reimbursement, so click the link, search it out for yourself, or buy a different brand; it doesn’t affect me.

Testing for ketones – There are test strips that you can get for certain glucose monitors that can measure ketone levels in the blood.  I prefer to keep track of both glucose and ketones (probably because I’m a little anal, but certainly there are some good reasons to do so).  Nowadays I only test occasionally, except for when I am doing a longer fast, then I will check a few times per day.

https://www.dietdoctor.com/low-carb/keto/best-ketone-meter

https://www.myketokitchen.com/keto-resources/best-ketone-meters-monitor-ketosis/

The test strips are not cheap, so I went a long time before I finally got curious enough to buy one.  They will most certainly be required if you are doing this for therapeutic reasons and need to confirm your ketone to glucose ratios.  They may also be a worthwhile purchase if you are not sure if what you are doing is working or not, and just want to confirm if you are getting into nutritional ketosis.  You may also notice more of a fruity smell to your sweat, so that could also be an indicator of some level of ketosis.  Urine test strips are cheaper. Although they are not an accurate indicator of ketone levels in the blood, but could still be useful to know your approximate level of ketosis.  There are some breath ketone meters now as well – said to be useful for indicating the general range, but not able to give accurate values at this point; hopefully they will get there soon.

Ketone meters may be able to tell you if you are in a state of ketosis, but knowing to what extent is quite a bit more complicated and not very clear.  First off, early morning is not a good time to measure either ketone or glucose levels.  This is due to the dawn phenomenon causing higher glucose and lower ketone levels than the rest of the day, even when fasting https://www.dietdoctor.com/the-dawn-phenomenon  https://www.dietdoctor.com/low-carb/fasting-blood-glucose-higher. 

Also, if you are already fat/ketone adapted, then your body is more efficient at using ketones and fatty acids for fuel.  In this case, you may not see ketone levels get as high because you use them as quick as you are making them, so they do not continue accumulating in the blood.  This is a good thing, but if you are not aware of this, it could be a little discouraging by causing you to think that you are barely in ketosis, when in reality you may just be a good ketone user.  On the flip side, someone could be getting high ketone levels, but if not yet keto-adapted or they have some genetic variation resulting in the physical inability to use ketones readily, then they may not be able to make good use of them.  Probably paying attention to how you feel regarding energy levels, mental acuteness, and hunger is a better measure of how well you are producing and using ketones.

 https://www.dietdoctor.com/low-carb/fasting-blood-glucose-higher.  Also, if you are already fat/ketone adapted, then your body is more efficient at using ketones and fatty acids for fuel.  In this case, you may not see ketone levels get as high because you use them as quick as you are making them, so they do not continue accumulating in the blood.  This is a good thing, but if you are not aware of this, it could be a little discouraging by causing you to think that you are barely in ketosis, when in reality you may just be a good ketone user.  On the flip side, someone could be getting high ketone levels, but if not yet keto-adapted or they have some genetic variation resulting in the physical inability to use ketones readily, then they may not be able to make good use of them.  Probably paying attention to how you feel regarding energy levels, mental acuteness, and hunger is a better measure of how well you are producing and using ketones.

Ketogenic diets have been used for about 100 years as an effective treatment for epilepsy not responding to medications.  They have also been found to be an important component in metabolic cancer treatment, as well as useful for some migraine reduction, reducing autism symptoms, delaying Alzheimer’s or improving severity, and other neurodegenerative diseases.  The classical therapeutic diet would be very high fat (90% of calories).  This is pretty extreme, and not required for general health and fat-loss purposes, and may be more difficult to adhere to long term (this would be quite difficult to achieve dairy-free).  A modified keto diet generally allows for more protein and low-sugar/non-starchy fruits and vegetables (my favorites are sweet peppers, avocados, and broccoli).  While you may not get quite as strong of an effect with the higher protein, if you wanted to further boost ketones, you could add time-restricted eating to help ramp up ketone levels during the longer fasting period (aim for 6hr or less eating period per day for maximum effects). 

I personally don’t keep track of calories, carbs from non-starchy veggies, fats, protein, etc. (with the exception of very roughly counting grams of added sugar per day).  I’ve never really tried to track them; it just seems like too much a pain in the ass, and impossible to do accurately, so I just don’t.  So for me, time-restricted eating plus low carb works to keep me in a low state of ketosis for much of the day.  I know that if I eat my massive lunch (see photo for my typical weekday), that all the protein will probably bump me out of ketosis for a short while, but not nearly as long as if I hadn’t been fasting for the last 16-18 hours.  Plus most days I only shove my face that full once, and then it’s often a smaller dinner.  Occasionally (i.e. maybe once per week) I may have a donut to finish it off, and then I know that retaining consciousness will be near impossible.  Not advisable, but old addictions die hard.  Unfortunately, they just don’t taste anywhere near as good as I remember, so I mostly just stick to dark chocolate these days.

White stuff – Whole milk plain Greek yogurt, and sour cream for dipping broccoli

While the majority of people will see an improvement in cardiovascular disease risk, Attia and others talk of a small but significant (maybe up to 20%) of people who respond differently to an extremely high-fat diet in regards to LDL- particle numbers and inflammation.  Does elevated LDL-P with low oxidative stress, inflammation, and low insulin still contribute to cardiovascular disease?  I would think that it could still be concerning, because all of the three required factors (particle number, inflammation, ox stress) are never zero, even in an individual with the best markers, there will always be some low level of arterial damage.  Hopefully at a rate low enough that the body is able to clean and repair most of it, but nonetheless it is occurring.  Because none of these three factors could really be considered rate-limiting, it stands to reason that raising any of them will increase the rate of damage incurred.  Thereby, even with low oxidative stress and low inflammation, a high LDL-p will likely have a higher rate of damage compared to when all three are low.  Are they still lower risk than before they started the diet?  Possibly, but even if true, that doesn’t mean they couldn’t improve their risk further by trying to tweak their diet and drop down the LDL-p. 

The reason for this LDL-P spike is not well understood.  Maybe it could have something to do with gut health or poor microbiome diversity?  Or possibly if a food allergy or mild intolerance to something like wheat, dairy, etc. is causing intestinal permeability, that will lead to inflammation.  Also, if the only forms of carbs that you are eating is sugar, soda, or donuts, rather than veggies and fruits, that might not be so good for your insulin levels or your gut.  Or maybe this is due to something else entirely, like sleep, stress/cortisol, micronutrient deficiency, etc.  Dr. Attia says he has found that tweaking the fat composition (increasing monounsaturated fats and reducing saturated fats) has worked out well with many patients, with the possibility that a genetic polymorphism related to fat metabolism might be to blame for some individuals.  Whereas Dom mentions that he himself had to reduce (but not eliminate) dairy proteins and increase coconut and other oils to reduce his LDL-p, so it’s possible that this is more of a response to a specific fatty acid type/length or protein found in dairy for some individuals.  As occurs frequently in the field of medicine, there are often multiple causes/pathways/dysfunctions that yield a similar phenotype; what works well for some, may have no effect for others with the same symptoms but different root problem.

It also stands to reason that someone could follow a keto-type diet, but if they eat frequently for most of the day, they may end up missing any improvement or progress towards their goals. The lack of the fasted state is likely a major contributor towards our current health crisis.

In summary, ketogenic diets are a useful tool for lowering insulin resistance, glucose control, neurological health, and many other things, but for maximum health, some individuals may need to be a little more careful in their approach.  Effective health screening, like advanced lipid profiles(LDL-P), hrCRP, etc., should be able to signal that there may be some adverse effects, but at least from my own personal experience most physicians don’t run these tests as part of any routine screening, so those may need to be specifically requested, and may need to be paid for out of pocket.  If you do see some of these numbers go in the wrong direction, you don’t have to just quit.  Recheck in a couple of months to verify that it wasn’t just a transient effect, and if they are still off, then try tweaking the sources of fat that you are consuming.  Cardiovascular disease doesn’t develop overnight, often developing over decades of exposure, so don’t get too stressed that things are off for a few months, but don’t let it go indefinitely either.

If you are doing this for fat loss, then it’s critical to keep in mind that this is not an all you can eat keto buffet.  Keeping your insulin low will help avoid gaining weight, but if you eat more than you need to run your metabolic processes, then you won’t lose any fat either.  As you turn down insulin, your hunger should become less intense.  Don’t just eat out of habit, but rather listen to your body and eat less often (and/or smaller portions).

March 16 2019

Bam!

Jtnazz Uncategorized

Well, I was going to try to get this website at least halfway put together before I made it live, but I guess I somehow activated it already, so here we go. Rather than figure out how to throw it back under a sheet, I think I’ll let it serve as some pressure to get my ass in gear an and get to work.

So it will look a little bare, generic, and incomplete for a while. I’ve got zero experience and knowledge in setting up a website, but I’ll suffer through some video tutorials and see where that gets me. Maybe I’ll get it figured out, or maybe I’ll get some help. Either way, I’m going to focus first on content, and then eventually I’ll come back and make it look pretty.

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