For today’s edition of Dear Mark, I’m responding to four reader comments. First up, if a person can’t eat eggs, doesn’t like liver, but really wants choline, can they just supplement? Second, are a couple handfuls of almonds too much omega-6 for the average person? What if they eat fish? Third, a new study claims to show that keto dieting tanks hepatic insulin sensitivity. What should we make of it? Are we giving ourselves type 2 diabetes by going keto? And fourth, I highlight a great approach to drinking alcohol (and living in general) from one of our readers.
If I can’t eat eggs, and don’t like liver, can I supplement with choline? What would be a good dose?
Yes, you can supplement with choline. Men need around 550 mg per day. Women, 425 mg. Those requirements go up if you’re pregnant or nursing, and they very likely go up if you’re drinking.
It’s very possible that those are good levels for the average person eating a low-moderate fat diet. If you’re eating a high-fat diet or engaging in cognitively-demanding work, you may benefit from higher doses.
What jumped out at me was high O6 from snacking on almonds…this was in the fish oil post too, and it’s got me looking twice at how much is too much. I have a handful or two almost every day, and not supplementing with O3 ( although just started an experiment with daily supplements or fish). Too much?
Thanks as always for the excellent post—I’ve been wondering about alcohol too!
Don’t get me wrong. Almonds are a nutrient-dense whole food. They’ve got tons of magnesium, prebiotic fiber, polyphenols. Their health effect profile is impressive:
- Almond consumption improves fatty acid profile of serum lipids.
- Almonds reduce lipid oxidation biomarkers in older adults.
- Almonds reduce 24-hour insulin secretion in non-diabetics.
- Almonds improve glycemic control in type 2 diabetics.
- Almonds improve satiety and postprandial glucose when consumed as snacks and do not increase overall energy intake.
- Almonds possess potent prebiotic fibers, particularly in the skins.
- Almond consumption improves the endocrine profile of women with PCOS.
But they are high in linoleic acid. Absent fish, two handfuls a day is probably excessive. Having some fish fat will balance it nicely.
Try this: Replace one of your handfuls of almonds with a can of sardines or smoked oysters.
Does keto cause liver insulin resistance? Just saw this study and don’t want type 2 diabetes…
First of all, it’s a mouse study.
Second of all, it was a three-day study designed to look at the short-term transitory effects of going keto. Anyone who’s gone keto knows that the early days are a bit rough. Your mitochondria aren’t good at burning fat or ketones yet. You haven’t built the metabolic machinery required to extract the energy you need from the new balance of macronutrients. This period of transition coincides with the “keto flu”—that period of fatigue, listlessness, and headaches.
If you stick with the diet and make it through to the point where you can crank out and utilize ketones, everything changes. You can suddenly start making ATP from all that body fat you’re burning off, giving you a virtually limitless supply of energy at all times. It’s great.
But in the meantime, for that early period it’s rough. You’re insulin resistant, yet unable to burn much fat. Your liver is perpetually overloaded with energy, making insulin resistance almost unavoidable (if transitory).
Third, the composition of this study’s “keto” diet was about as bad as you could get (PDF). The fat came from Crisco—the classic trans-fat laden version—rounded out with a bit of corn oil. Trans-fats and omega-6 linoleic acid. Does this look like the diet you’re eating? Does this look like the keto diet anyone is eating? If the researchers set out to get the worst possible results for the keto group, it wouldn’t have looked any different. almost looks like they were trying to get the worst possible results.
Alcohol in ketosis is just one aspect of alcohol use in a healthy lifestyle. For me personally I perceive alcohol to play not a vital but an extremely useful role.
I drink about 40 gm of ethanol just about every day in the form of a classic gin martini made with 3.5 oz of premium gin (healthy fats in that olive, brother). I consider gin to be a very special spirit because it is comprised of water, ethanol, and botanical substances like the l-terpenes from juniper berries which are known to have a tonic effect on the human organism – and none of the hundreds of dubious organic chemicals (referred to as “cogeners”) contained in whisky or tequila. I always consume this martini between 5:00 and 7:00pm, and I very rarely drink anything else at any time of day or night. I have this drink immediately before and with the evening meal which I personally prepare from scratch with fresh ingredients and consume with my wife of 51 years.
The martini seems to me to punctuate and enhance the transition from “doing” – being responsible, making things happen, solving problems, exerting myself – to “not doing” – resting, refreshing, nourishing, regenerating. Subjectively, I feel like this one drink, consumed with food, stimulates the parasympathetic nervous system. The alcohol research, so-called, tends to produce the opposite result, but in my opinion, virtually all of the alcohol effects research is dreadful – just about the junkiest junk science you can find anywhere.
I will be 80 on my next birthday, my resting heart rate, measured with a Polar FT7 heart rate monitor as an average over 3-5 minutes is 51-52. I ride a mountain bike on intermediate level trails – often in a fasted state – and recently recorded a maximum heart rate of 167. This is considerably higher than the HRmax predicted by any of the recently validated formulas. My GGT level is 16, so I have to conclude that my liver thrives on classic gin martinis. I take no prescription medications and no over-the-counter medications. I am not trying to brag here, I am just trying to document that by just about any measure my health and physical condition is exceptional for a person my age.
My personal belief is that alcohol in the right form and used properly is a health food. This conclusion is based on my personal experience, but I dearly wish that some enterprising biochemists, neurologists, and social psychologists would get together and design a quality research program to examine alcohol’s health effects under various real-world conditions. People like to drink, but a lot of what they drink is full of cogeners and sugar and genuinely toxic crap. Almost nobody has a clue what is in what they are drinking and what its health effects – positive or negative – might be. Millennials are currently destroying their livers in droves and even killing themselves with booze at distressingly early ages. Beliefs about alcohol and drinking in our culture are pathetically primitive.
I think I’ve got it figured out for me, but I think it would wonderful for the rest of the world to know the score.
I’m highlighting Daniel’s words even though he wasn’t asking a question. This man gets it. This is how to approach, appreciate, and consume alcohol. He’s drinking with complete lucidity, total awareness, and mindfulness. Alcohol isn’t “just” something you use to get loaded. It’s a sacred chemical that marks the transition from “doing” to “being.”
Many people blur the lines, drinking for the hell of it. Make it more of a special occasion, consume it mindfully and purposefully. Having a couple glasses of wine at night because I’m bored will ruin my sleep and throw off my tomorrow. Having those same two glasses of wine and some conversation with my wife or dear friends over cheese and olives has an entirely different physiological—not just psychological—effect. My liver actually processes the wine consumed with mindfulness differently.
That’s it for this week, everyone. Thanks for reading and be sure to chime in down below with your own comments, answers, or concerns.
The post Dear Mark: Choline Supplementing, Too Many Almonds, Keto and Insulin Resistance, and How to Drink appeared first on Mark’s Daily Apple.
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People like to get healthy, burn body fat, increase their aerobic capacity, and improve their cognitive function. The ketogenic diet is an excellent way to obtain those outcomes, which partially explains its meteoric rise in popularity. But people also like to drink alcohol. You might say it’s a toxin—I wouldn’t disagree. You might say we’d be better off without it—perhaps. The fact remains that people have been drinking for tens of thousands of years, and they’re not going to stop anytime soon.
Can keto and alcohol coexist? Is there anything we need to take into consideration?
First things first, does alcohol inhibit ketosis?
There are very few human studies that even look at this issue. Let’s go over the best one I could find.
How Does High Intake of Alcohol Affect Ketosis?
A 2002 study out of Poland examined the bodies of 16 recently deceased people who had died from hypothermia, mostly alcohol-induced. Most were alcoholics. They found that ketone levels and blood-alcohol levels were inversely proportional. The higher the blood alcohol, the lower the ketones. The higher the ketones, the lower the blood alcohol. In the discussion section, the authors explain:
Liver cells ‘‘engaged’’ in ethanol utilization do not accumulate larger amounts of Ac-CoA (which is a substrate for ketogenesis) because an increase in the NADH/NAD ratio during ethanol oxidation inhibits b-oxidation of fatty acids, and the acetate created from ethanol is activated to AcCoA mainly in the non-liver tissues which cannot produce ketone bodies.
In other words, at a high enough intake, alcohol metabolism supersedes and inhibits ketogenesis because both processes occur in the liver along similar pathways. The Polish study is an extreme example—alcoholics, hypothermia, death—but the basic mechanism is sound.
What About Normal (Moderate) Intake?
In real world situations, however, where people are having a drink or two, low-sugar alcohol (red wine, spirits) is unlikely to derail ketosis. Sugary drinks will inhibit ketosis because of the sugar. Alcohol-induced junk food bingeing will inhibit ketosis because of the junk you’re eating. But it appears to take some serious doses of ethanol to make a noticeable dent in your ketone production. Even then, a degree or two less ketosis isn’t the end of the world (unless you have a serious health condition warranting constant ketosis, in which case are you sure you should be drinking?).
A friend of mine, Mark Moschel, is the health evangelist for Dry Farm Wines and an avid keto dieter and self-experimenter. He recently ran an interesting experiment to determine the effects of his low-sugar dry-farmed wines on ketosis. (If you’re a numbers junkie and love charts, you’ll appreciate seeing how he put it together.)
He fasted for three days to get deep into ketosis. Two days in, he opened a bottle of wine and started drinking.
After the first glass, there was no change. Ketones and blood sugar held steady.
After the second glass, ketones dropped a bit. Sugar rose a bit.
After the third, ketones dropped some more. Sugar went down this time.
Yet, at no point was he “out of ketosis.” Even after the third glass, he was still showing 1.4 mmol. And upon waking the next morning, he had bounced back to 2.3 mmol. By the afternoon, ketones were back above 4 mmol.
Something tells me the “3-day wine fast” is going to catch on in some circles….
Are There Any Negative Interactions Between Alcohol Consumption and Ketogenic Diets?
Maybe. A commonly reported side effect that hasn’t been shown in studies (because the studies haven’t been done) is reduced alcohol tolerance on keto. People report getting drunk quicker and having worse hangovers. Let’s assume for the sake of this post that it’s true, that the anecdotes are conveying something that’s actually happening to a large portion of the keto-eating world. What could be causing reduced alcohol tolerance?
Crowded CYP2E1 Pathway
Alcohol detoxification occurs along two enzymatic pathways, one of which—the CYP2E1 pathway—is also activated by ketone bodies. The CYP2E1 pathway is ultimately a detox pathway, but some of the metabolites it produces in response to the various toxins it processes, like alcohol, acetaminophen (Tylenol), and tobacco, can increase liver inflammation and peroxidative damage. If the ketones you’re making are triggering CYP2E1, drinking alcohol may put you over the top and push you toward greater oxidative stress.
This could explain part of the reason why drinking on an empty stomach (fasting, hence elevated ketones) tends to heighten the toxicity and enhance the hangover.
Excessive Omega-6 Fatty Acid Intake
A high-fat diet can very quickly become a high-omega-6 fat diet if you aren’t careful about the foods you’re eating. You’re eating out for lunch every day at Chipotle; it’s low carb, but everything is cooked in rice bran oil. You’re snacking on almonds and sunflower seeds. Your favorite meat is whole chicken with the skin on, and you use the chicken drippings to cook up a bunch of greens. The more fat, the better, right?
All those foods are moderately-to-very high in omega-6. If that’s a daily diet, you’re getting upwards of 30+ grams of omega-6 fats, mostly linoleic acid. Why is this a problem specifically in the context of alcohol?
Omega-6 fatty acids, especially linoleic acid, are particularly harmful when you drink alcohol:
- Increased intestinal inflammation and leaky gut.
- Increased chance of liver cirrhosis.
- Induces fatty liver.
Polyunsaturated fats combined with alcohol also raise CYp2E1 more than alcohol alone, an indication of the combination’s toxicity.
Inadequate Choline Intake
High-fat diets are liver-intensive. The more fat you eat, the more choline you need to help metabolize it. High-fat diets with inadequate choline can lead to fatty liver, even if you’re eating the most Primal-friendly balanced source of fats.
Alcohol is also liver-intensive. The more alcohol you drink, the more choline you need to help metabolize it. High-alcohol diets with inadequate choline almost always lead to fatty liver, even if you’re drinking the healthiest, purest sources of ethanol.
Combining alcohol and a high-fat ketogenic diet requires even more choline than either alone. The best sources of choline are egg yolks and liver. Make sure you’re eating enough of one or the other to support your liver.
Inadequate Intake Of Phytonutrient-Rich Plants
Whether it’s coffee, chocolate, ginger, turmeric, green tea, the phytonutrients within the wine itself, or even non-psychoactive cannabidiol in cannabis, most plants make alcohol less toxic. Keto dieters who drink should definitely eat some or all of these foods.
Alcohol consumption presents a few notable challenges to people following a ketogenic diet, but they aren’t by any means insurmountable. Provided you eat a good ketogenic diet—not too much omega-6, adequate choline, plenty of phytonutrients— and make good beverage choices, moderate amounts of alcohol shouldn’t throw you out of ketosis or pose any special threat to your health.
I know we have a lot of readers with considerable experience following a ketogenic diet. Have you noticed anything different about the effects of alcohol? Has drinking hit your harder? Has it inhibited ketosis for you? I’d love to hear your experiences.
For those who are interested in a keto-friendly option, Dry Farm Wines is what I drink (and have for the last two+ years). (For those of you who stopped by our keto cocktail hour at Paleo f(x), we were serving up Dry Farms Wines there.) Mark M. and his team are good people in my book, and they get what the Primal message (and keto living) is all about. In my estimation, they’re the perfect choice for keto dieters who want to drink good wine and limit the negative health ramifications of alcohol consumption.
All their wines are also low in sugar, with a maximum of 1 gram per liter. A fourth of a gram of sugar per glass doesn’t make a difference.
All the wines are dry-farmed, meaning they’re less “washed out” from excessive watering, more complex, and more of the “grapeness” comes through in the finished product. That usually means a higher percentage of polyphenols as well, many of which mitigate the deleterious effects of consuming ethanol as mentioned above. If you’re interested, check ’em out.
In the interest of full disclosure, I’m a proud affiliate of theirs as well as a big fan. I only support and advertise a few companies on Mark’s Daily Apple that I thoroughly believe support healthy Primal living in the modern world. If it’s not in my kitchen, it’s not on my blog.
Have a great day, everybody. Take care and Grok on.
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Welcome to Friday’s For The Love of Food, Summer Tomato’s weekly link roundup.
This week industry gets busted influencing scientists, Salmonella hits the cereal aisle, and how exercise reduces inflammation.
Next week’s Mindful Meal Challenge will start again on Monday. Sign up now to join us!
Too busy to read them all? Try this awesome free speed reading app to read at 300+ wpm. So neat!
Links of the week
- It Was Supposed to Be an Unbiased Study of Drinking. They Wanted to Call It ‘Cheers.’ – Ugh, it is so frustrating to see behavior like this from scientists. Do better. (NY Times)
- This Mediterranean diet study was hugely impactful. The science just fell apart. – Although this involves a retracted paper, to me it is a less frustrating example of the scientific community policing itself (as it should). The article is also a pretty great explanation of how big nutrition studies are designed if you’d like to learn more about how we know what we know. (Vox)
- What if physicians stopped weighing heavier patients? Health care might improve. – So happy to see people finally considering the role of psychology in managing body weight. (Washington Post)
- Question for the day: Is Tofu processed? – FYI. Personally my biggest issue with tofu (which I love) is how difficult it is to find organic soy beans that aren’t imported from China. (Food Politics)
- When can ads intensify unhealthy cravings? – I’m definitely an “analytical thinker” in this context, how about you? I think understanding yourself like this is important because it helps you identify your triggers, and therefore gives you an opportunity to do something about them. Check out the most recent podcast with Paul to hear why this is important. (ScienceDaily)
- Salmonella Outbreaks Affect Kellogg’s Honey Smacks Cereal and Cut Fruit – You guys don’t eat this stuff though, right? Good. (NY Times)
- Leading Roll: Why American Cooks Can’t Quit the Paper Towel – Who knew paper towels could be so interesting? (Taste)
- To Rinse Or Not To Rinse: How Washing Some Foods Can Help You Avoid Illness – Important safety tip, thanks NPR.
- Exercise makes the blood of obese people healthier – This is kind of a horrible write up (why don’t they mention the results of the lean people?), but it’s an interesting finding about how exercise reduces inflammation via stem cell production. Being active is essential for health, whether it helps you lose weight or not. (ScienceDaily)
- How to Turn a Fridge Full of Sad Produce Into Dinner – Such a great idea! (Lifehacker)
What inspired you this week?
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Welcome to Friday’s For The Love of Food, Summer Tomato’s weekly link roundup.
This week willpower is overrated, alcohol isn’t healthy, and the downside of posting calories.
Next week’s Mindful Meal Challenge will start again on Monday.Sign up now to join us!
Too busy to read them all? Try thisawesome free speed reading appto read at 300+ wpm. So neat!
Links of the week
- Why willpower is overrated – This might be the best article on willpower I’ve ever read. My favorite line —>”And structuring your life is a skill.” (Vox)
- American Nostalgia on a Bun – Interesting look at the appeal of fast foods and, inevitably, diets as a product of American culture and values. (The Atlantic)
- It’s time to rethink how much booze may be too much – I’ve been avoiding posting about this study until I found a reasonable analysis of it. Thanks Vox for finally providing one.
- Will calorie counts on menu items do more harm than good? – OMG someone is actually thinking about psychology in public health. Be still my beating heart. (Washington Post)
- When Is It Safe to Eat Salad Again? – This is so depressing. Shopping at farmers markets is a great way to get around this sort of nonsense. (NY Times)
- To Slash Your Risk of Heart Disease, Keep Moving – Unfortunately this headline doesn’t even hint at what’s new and cool about this study: that exercise can vastly improve health outcomes even when you have a genetic predisposition to heart disease. (NY Times)
- Should You Eliminate Oil from Your Diet? – In the real world it often does more harm than good. (Scientific American)
- Study highlights need for strength training in older women to ward off effects of aging – Last I checked there were at least one or two women who read this site and care about aging well. (ScienceDaily)
- Are G.M.O. Foods Safe? – This question is one of my pet peeves. Safe for human consumption is not at all my concern about GMO foods. I’m more worried about soil depletion, ecology, pesticide use, and increasing the power of Big Ag. I hope one day we can have grownup conversations about this stuff, but I’m not holding my breath. (NY Times)
- Curried lentil, tomato and coconut soup – What a simple and wonderful way to use some basic pantry items. (Arthur Street Kitchen)
What inspired you this week?
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