I’m continuing my crusade of keto mythbusting. Recently, there was keto crotch, then keto bloat, and today I’m returning to one of the O.G. myths—keto body odor. Yes, it seems detractors of the keto diet are hell-bent on making you think your body will become a stinky, bloated mess if you dare to drop your carbs below 50 grams per day…but is it true?
Here’s the spoiler: Yes, people in online keto diet forums occasionally complain about an unpleasant change in body odor when they first go keto. There is no scientific evidence that it actually happens, nor a clear, compelling explanation for why it would. Moreover, the anecdotal (and it’s all anecdotal) evidence suggests that if it does occur, it is rare and temporary. In other words, the whole idea of keto body odor seems to be exaggerated—shocking, I know.
That said, significant dietary changes can result in other physiological changes that may manifest in a variety of ways. Since nobody wants to be the stinky kid, let’s take this opportunity to look at what might be plausible about keto body odor and what to do if you think you’ve been afflicted.
What Causes Body Odor?
First, let’s clarify what’s meant by “body odor.” In the medical literature, the term is used in reference to aromas associated with breath, urine, feces, vaginal secretions, sweat (usually from the axilla, or armpits), and general bodily essence as it were. Because it’s such a broad term, the causes are also extremely varied. For the purposes of this post, I’m going to use the term “body odor” to mean aromas from sweat and general bodily funk, since that’s what’s usually meant by keto body odor.
Body odor arises when odorless compounds leave the body through glands in the skin and interact with microbes living on the skin’s surface. The microbes then release chemical compounds—what we actually detect as body odor. Typically, commercial deodorants target both pieces of the equation by using antiperspirants to minimize the excretion of the odor precursors and by creating an unfavorable environment for the microbes living on the skin. There is also a genetic component to how much individuals secrete compounds that cause body odor.
Although a huge industry is built around trying to help people mask their natural odors—and suggesting that body odor is always the result of poor hygiene—bodily scents are actually quite important. Just as other animals do, humans use olfactory cues for recognizing kin, making judgments about others’ personality traits and attractiveness, and even for detecting fertility. Although we rarely recognize it, the data suggests that smell probably factors into all our face-to-face social interactions.
Body odor can also result from illness. Before the use of sophisticated modern disease detection techniques, doctors were taught to use their sniffers as a diagnostic tool. Even today, smell can be an important clue that an individual is unwell. Often these odors emanate from the breath or urine, but certain infectious and metabolic diseases can be associated with distinctive body odors. In addition to perceptible body odor, the human olfactory system can detect infection and sense illness in others, presumably an important means of preventing the spread of communicable disease.
Diet and Body Odor
The whole notion that a keto diet can cause body odor rests on the assumption that how we smell is affected by what we eat. It turns out that there is scant evidence that that is actually the case.
When I’ve taken up the question of keto diet and body odor previously, I noted that there are really only two human studies that speak to this. One small study found that women judged men’s body odor more negatively when they ate a diet that contained red meat compared to when they abstained from red meat. However, the diets differed in other ways as well. In contrast, a different study found that women rated men’s body odor more positively when the men reported eating more fat, meat, and eggs, and more negatively when they ate more carbs. Hmm.
Nevertheless, the common belief persists that certain foods will make you stinky: garlic, onions, cruciferous vegetables, and spicy foods especially. However, there is no evidence that this is actually the case beyond the obvious bad breath and, ahem, flatus that these foods can cause. In fact, the one study I found on the subject reported that garlic counterintuitively improved body odor.
So, Can Keto Make You Stinky?
As you can see, there’s minimal evidence at best linking body odor to diet, and none of it has to do with the keto diet itself. Nevertheless, the belief that keto causes body odor persists…thanks to the few complaints from some in the keto community (and, just maybe, those who have nothing to do with keto but want to cause a stir). While I don’t want to dismiss anecdotal evidence out of hand, I have noticed that once people go keto, their diet is immediately to blame for every weird smell, twitch, or symptom. It’s remarkable really.
In the interest of fairness, let’s look at the explanations that are typically offered for why keto might cause body odor:
Is It the Protein?
The first hypothesis is that keto dieters smell funky because they’re eating a lot more meat. As I already mentioned, there are only two small studies that speak to this, and the findings conflict. The idea at work: protein metabolism yields ammonia as a byproduct (true), which builds up because of eating “too much protein,” resulting in body odor.
To which I object… First of all, it’s not necessarily true that going keto means eating more meat. My version of a keto diet certainly isn’t a steak-and-bacon fest—I still eat tons of veggies. If anything, my observation is that keto folks by and large remain fearful of eating “too much” protein lest it kick them out of ketosis. (The issue is not nearly so simple as that, as I’ve explained.) In any case, even if you’re eating a good deal of meat, a healthy liver should be able to convert the amount of ammonia generated into urea and send it off to the kidneys to be excreted as urine.
Maybe It’s the “Detoxing”?
Toxins such as environmental pollutants accumulate in adipose tissue, a.k.a. fat cells, and these toxins are then released into the bloodstream when people burn fat. Because the keto diet often results in increased burning of body fat, the theory goes that the body is “detoxing” all these pollutants, and that’s what causes body odor. Detoxing is a controversial subject, and while it is true that some of these toxins can be excreted through the skin, the actual amounts are fairly small (the majority get excreted via urine and feces). Plus, it’s not evident that the toxins that are excreted through the skin cause any particular odor. And wouldn’t any diet that actually does what it’s supposed to—i.e. burn fat—be subject to the same “stinky” detox effect? I think we can safely chuck this claim.
Are Ketones a Cause?
Maybe ketones themselves make you smelly? This one has the most potential validity, as it’s well documented that acetone—one of the three ketone bodies—gets excreted when you’re in ketosis. However, it’s the cause of the familiar keto breath, not body odor per se. I’ve seen no evidence linking acetone to actual body odor.
What To Do About It
Ok, I hear you saying, “Mark, I see that you’re skeptical, but I’m telling you… I stink!” What can you do about it?
Well, since there isn’t a clearcut cause, I can’t give a clearcut answer, but I’ll tell you what the general wisdom says:
First, you can support your body’s own detoxification pathways as I describe here. Your body should be able to do a fine job taking out the garbage—it’s designed to do so and is efficient at it—but hey, why not drink some coffee and throw some broccoli sprouts on your salad. This is a “can’t hurt, might help” situation.
Same thing goes for taking some nice epsom salt baths, another common recommendation. Whether there is any truth to their detoxifying nature, you’ll get a nice dose of transdermal magnesium with a hefty side of relaxation. Throw in some essential oils and olive oil and soak your cares away… hopefully taking some of the b.o. with it.
You can also experiment with eating less protein and more carbs, but I do see potential downsides to both. You definitely don’t want to eat too little protein, since it serves such a vital role in healthy functioning, and you don’t want to add back too many carbs if being in ketosis is your goal. That said, especially with regard to the protein you probably have room to play around, so feel free to experiment if you want. I’m not overly optimistic that this is the answer, but I’m always a fan of finding what works for you.
Or, take a wait and see approach. Most keto side effects come and go as people become keto-adapted. If your problem is keto breath, not body odor per se, you can try chewing on some fresh herbs or taking chlorophyll supplements, but these will just mask the issue.
Lastly, if it is very noticeable and very bothersome, you can—and probably should—consult your doctor. If you are excreting significant ammonia, which usually happens via the breath, this is a sign of liver or kidney problems that need to be diagnosed asap.
The Bottom Line…
Because switching to a keto diet can initiate a profound metabolic shift, some people might experience side effects. And, sure, it’s conceivable that transient changes to body odor might be one of them. The lack of evidence that body odor is strongly affected by diet (as well as my own experience interacting with the thousands of people in my community who have tried keto) leads me to believe that this is a minor problem at most—and one that most people won’t experience at all. If it’s affecting you, feel free to try to solutions I described above. They might not resolve the problem immediately, but at least they’ll likely have other positive benefits.
Ok, what say you? Are your friends giving you a wide berth now that you’re in ketosis, or are you chalking this up to yet another thing the haters are blowing out of proportion?
Groyecka A, Pisanski K, Sorokowska A, et al. Attractiveness Is Multimodal: Beauty Is Also in the Nose and Ear of the Beholder. Front Psychol. 2017;8:778.
James AG, Austin CJ, Cox DS, Taylor D, Calvert R. Microbiological and biochemical origins of human axillary odour. FEMS Microbiol Ecol. 2013 Mar;83(3):527-40.
Natsch, A. What Makes Us Smell: The Biochemistry of Body Odour and the Design of New Deodorant Ingredients. CHIMIA Intl J Chem. 2015 Aug;69(7-8):414-420.
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Have you tried hemp oil?
After almost a century of being outlawed, hemp—a form of cannabis with extremely low levels of psychoactive THC—is now legal in the United States. This is big news for people interested in the therapeutic effects of cannabidiol (or CBD) because—while hemp doesn’t contain enough THC, the compound that provides the “high” of cannabis, or any other psychoactive compounds—it does contain cannabidiol (CBD).
For years, all anyone talked about when they talked about cannabis was the THC content. Breeders focused on driving THC levels as high as possible and ignored the other compounds. Even pharmaceutical companies interested in the medical applications of cannabis focused on the THC, producing synthetic THC-only drugs that performed poorly compared to the real thing. It turns out that all the other components of cannabis matter, too, and foremost among them is CBD.
CBD doesn’t get you high, but it does have big physiological impacts. These days, researchers are exploring CBD as a treatment for epilepsy, anxiety, and insomnia. They’ve uncovered potential anti-inflammatory, anxiolytic, and immunomodulatory properties. And now that it’s quasi legal, hundreds of CBD-rich hemp oil products are appearing on the market.
What are the purported benefits of using CBD-rich hemp oil, and what does the evidence say?
Although CBD research is growing, it’s still understudied and I expect I’ll have to update this post in the near future with more information. But for now, here’s a rundown of what the research says.
The Health Benefits of CBD In Hemp Oil
CBD For Anxiety Reduction
Anxiety can be crippling. I don’t have generalized social anxiety, but I, like anyone else, know what it feels like to be anxious about something. It happens to everyone. Now imagine feeling that all the time, particularly when it matters most—around other people. The average person doesn’t consider the import and impact of anxiety on a person’s well-being. If CBD can reduce anxiety, that might just be its most important feature. Does it?
Before a simulated public speaking event, people with generalized social anxiety disorder were either given 600 mg of CBD or a placebo. Those who received CBD reported less anxiety, reduced cognitive impairment, and more comfort while giving the speech. Seeing as how people without social anxiety disorder claim public speaking as their biggest fear, that CBD helped people with social anxiety disorder give a speech is a huge effect.
This appears to be legit. A placebo-controlled trial is nothing to sniff at.
CBD For Sleep
A 2017 review provides a nice summary of the effects of CBD on sleep:
In insomnia patients, 160 mg/day of CBD increased sleep time and reduced the number of arousals (not that kind) during the night.
Lower doses are linked to increased arousals and greater wakefulness.
High dose CBD improved sleep; adding THC reduced slow wave sleep.
In preliminary research with Parkinson’s patients, CBD reduced REM-related behavioral disorder—which is when you basically act out your dreams as they’re happening.
More recently, a large case series (big bunch of case studies done at once) was performed giving CBD to anxiety patients who had trouble sleeping. Almost 80% had improvements in anxiety and 66% had improvements in sleep (although the sleep improvements fluctuated over time).
While its psychoactive counterpart THC has been embroiled in controversial links with psychosis and schizophrenia for decades, CBD may be an effective counterbalancing force for mental health.
In patients with schizophrenia, six weeks of adjunct treatment with cannabidiol resulted in lower rates of psychotic symptoms and made clinicians more likely to rate them as “improved” and made researchers more likely to rate them as “improved” and not “severely unwell.” There were also improvements in cognitive performance and overall function. It seems the “adjunct” part of this study was key, as other studies using cannabidiol as the only treatment mostly failed to note improvements.
This was placebo controlled, so it makes a good case for CBD hemp oil as adjunct treatment (in addition to regular therapy) in people with schizophrenia.
Among 11 PTSD patients who took an average of 50 mg of CBD per day for 8 weeks, 10 (90%) experienced a 28% improvement in symptoms. No one dropped out or complained about side effects. CBD seemed to particularly benefit those patients who had issues with nightmares.
This is promising but preliminary. This was an 11-person case study, not a placebo-controlled trial.
A recent review of four human trials lays out the evidence: More than a third of all epilepsy patients experienced 50% or greater seizure reductions with just 20 mg of CBD. The effect of CBD on seizure activity is so widely acknowledged and understood that the only FDA-approved CBD-based product is Epidiolex, a plant-based CBD extract used to treat seizures in patients with Dravet syndrome and Lennox-Gastaut syndrome.
CBD for epilepsy is legit. Side note: I wonder how CBD would combine with ketogenic dieting for epilepsy control.
By far the biggest draw for medical consumers of CBD is its supposed ability to nullify pain.
In one study, researchers induced arthritis in rats with intra-articular injections, then gave them CBD. Rats given CBD were able to put more weight on their joints and handle a heavier load before withdrawing. Local CBD reduced nerve damage.
That’s great for pet rats. What about people?
There actually isn’t a lot of strong data on pain management using CBD by itself. Far more robust is the evidence for using CBD with THC for pain. According to this group of researchers, the two compounds exert “constituent synergy” against neuropathic pain. One study found that low doses of each were more effective combined than high doses of either alone in neuropathic cancer-related pain. Another gave a THC/CBD oromucosal spray to otherwise treatment-resistant neuropathy patients, finding that the spray reduced pain, improved sleep, and lessened the severity of symptoms.
Anecdotal evidence for pain relief and other benefits with CBD is vast. Chris Kresser, a practitioner and researcher I trust, swears by it. I have employees who use it quite frequently, reporting that it improves their sleep, hones their focus, reduces pain, speeds recovery, and reduces anxiety. These things are always hard to evaluate, but I can say that my people do great work, and I have zero reason to distrust them.
In later posts, I’ll probably revisit some of these other, more theoretical or anecdotal potential benefits to see if there’s any evidence in support.
Is It Safe?
A recent study gave up to 6000 mg of CBD to healthy subjects, finding it well tolerated and the side effects mild and limited to gastrointestinal distress, nausea, somnolence, headaches, and diarrhea. For comparison’s sake, keep in mind that a typical dose of CBD is 20 mg.
Mouse research indicate that extended high-dose CBD (15-30 mg/kg of bodyweight, or 1200-2400 mg per day for an 80 kg man) might impair fertility. Male mice who took high-dose CBD for 34 days straight experienced a 76% reduction in testosterone, reduced sperm production, and had dysfunctional weird-looking sperm. In the 30 mg/kg group, the number of Sertoli cells—testicular cells where sperm production takes place and sperm is incubated—actually dropped. Male mice taking CBD also were worse at mounting females and had fewer litters.
Those are really high doses. For epilepsy, a common dose is 600 mg/day, and that’s for a severe condition. Most other CBD therapies use much smaller doses in the range of 20-50 mg/day. Long term safety may still be an issue at these lower doses, but we don’t have any good evidence that this is the case.
There’s some evidence that the dosages of CBD required to achieve anti-inflammatory effects are also high enough to induce cytotoxicity in healthy cells, though that’s preliminary in vitro (petri dish) research and as of yet not applicable to real world applications. Time will tell, though, as the legal environment opens up and we accumulate more research.
Is Isolated CBD the Same As Whole Plant Extracts?
As we’ve learned over the past dozen years of reading about nutrition and human health, whole foods tend to be more effective than isolated components. Whole foods have several advantages:
- They contain all the components related to the compound, especially the ones we haven’t discovered and isolated. Supplements only contain the isolated compounds we’ve been able to quantify.
- They capture all the synergistic effects of the multiple components working together. Isolated supplements miss that synergy unless they specifically add it back in, and even then they’ll probably miss something.
It’s likely that whole plant hemp extracts high in CBD are superior to isolated synthetic CBD for the same reason. Is there any evidence of that?
A high-CBD cannabis whole plant extract reduces gut inflammation and damage in a mouse model of inflammatory bowel disease. Purified CBD does not.
Even at a 2:1 CBD:THC ratio, co-ingesting isolated CBD with isolated THC using a vaporizer fails to reduce the psychotic and memory-impairing effects of THC. In another study, however, smoking cannabis naturally rich in both CBD and THC completely prevented the memory impairment.
And as we saw in the pain section above, THC combined with CBD seems more effective against pain than either alone.
That’s not to say isolated (even synthetic in some cases—see note below) CBD isn’t helpful. We saw it improve joint pain and reduce nerve damage in arthritic rats. It’s just that full-spectrum hemp oil containing multiple naturally-occurring compounds is probably ideal for general health applications. Specific conditions requiring high doses may be another question entirely. Again, we’ll find out as more research comes out.
A word about synthetics: this is fodder for a follow-up, but it appears there may be additional concerns with synthetic CBD, and even supposedly “natural” CBD companies have in some cases allegedly added ingredients to their formulas without letting consumers know.
Is It Legal?
CBD-rich hemp oil lies in a legal grey area. The recently passed Farm Bill allows people to grow and make products from industrial hemp, as long as it contains less than 0.3% THC. That means CBD derived from industrial hemp is legal at a federal level. But because the Farm Bill has provisions that allow states to set their own rules, legality at a state level is more complicated.
States where hemp is still illegal—South Dakota, Idaho, and Nebraska—do not permit the sale or use of hemp-derived CBD oil.
In states that permit recreational cannabis—California, Vermont, Massachusetts, Maine, Oregon, Colorado, Washington, Nevada, Michigan, and Alaska—CBD derived from both hemp and psychoactive cannabis is legal.
In all other states, hemp-derived CBD is legal.
The FDA has yet to approve of CBD, so most of the big online retailers like Amazon and Walmart don’t allow CBD products to be advertised. However, Amazon sells a ton of “hemp extract” tinctures and oils with “hemp extract content” listed in milligram dosages—a workaround for listing the CBD content.
If you’re looking for CBD-rich hemp oil, watch out for culinary hemp oil, which comes in larger quantities and has no discernible CBD content. CBD-rich hemp oil will come in dropper bottles, not liters.
Many health food stores sell it. Surprisingly, I’ve seen it in every pet store I’ve entered in the last half year.
Word of Caution: Because it isn’t regulated by the FDA yet, there’s no telling exactly what you’re getting. Choose a product with verifiable lab tests. Many CBD hemp oil products have far less CBD than advertised. In addition to CBD content, the most reputable manufacturers also test for pesticides, heavy metals, mycotoxins, and bacteria and advertise their results.
CBD-rich hemp oil is a hot topic these days, and it’s only going to get hotter. I think the compound shows great promise in promoting health and wellness, and I’ll look forward to doing more research as it unfolds.
For now, what about you? Do you use CBD? Have you noticed any benefits? Any downsides? Share your questions and feedback down below.
Thanks for reading, everyone. Take care.
Bergamaschi MM, Queiroz RH, Chagas MH, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology. 2011;36(6):1219-26.
Lattanzi S, Brigo F, Trinka E, et al. Efficacy and Safety of Cannabidiol in Epilepsy: A Systematic Review and Meta-Analysis. Drugs. 2018;78(17):1791-1804.
Elms L, Shannon S, Hughes S, Lewis N. Cannabidiol in the Treatment of Post-Traumatic Stress Disorder: A Case Series. J Altern Complement Med. 2018;
Serpell M, Ratcliffe S, Hovorka J, et al. A double-blind, randomized, placebo-controlled, parallel group study of THC/CBD spray in peripheral neuropathic pain treatment. Eur J Pain. 2014;18(7):999-1012.
Silva RL, Silveira GT, Wanderlei CW, et al. DMH-CBD, a cannabidiol analog with reduced cytotoxicity, inhibits TNF production by targeting NF-kB activity dependent on A receptor. Toxicol Appl Pharmacol. 2019;368:63-71.
Carvalho RK, Souza MR, Santos ML, et al. Chronic cannabidiol exposure promotes functional impairment in sexual behavior and fertility of male mice. Reprod Toxicol. 2018;81:34-40.
Morgan CJA, Freeman TP, Hindocha C, Schafer G, Gardner C, Curran HV. Individual and combined effects of acute delta-9-tetrahydrocannabinol and cannabidiol on psychotomimetic symptoms and memory function. Transl Psychiatry. 2018;8(1):181.
Morgan CJ, Schafer G, Freeman TP, Curran HV. Impact of cannabidiol on the acute memory and psychotomimetic effects of smoked cannabis: naturalistic study: naturalistic study [corrected]. Br J Psychiatry. 2010;197(4):285-90.
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According to the “good scientists” of the Kellogg company food lab, an unprecedented number of young people are walking around with bloated guts and colons packed to the brim with impacted fecal matter, and it’s all because they’ve embraced ketogenic diets and “forsaken” fiber.
If this sounds like nonsense, that’s because it is.
Are millions of keto dieters suffering from bloating and constipation? I can find no evidence of this.
Is fiber necessary to prevent bloating and constipation? It’s complicated. I’ll explain later. But probably not.
Does the ketogenic diet necessarily exclude fiber? Not at all.
Are ketogenic diets as commonly practiced low in fiber? No.
What Is “Bloat” Anyway?
There are two things that people refer to as bloat: constipation and abdominal distension.
Constipation has different components. It’s being unable to make a satisfying bowel movement. It’s also feeling like you have to poop but are unable to. It’s being able to poop only a little bit. It’s struggling on the toilet bowl. Mostly, it’s being unhappy with your performance on the toilet.
Abdominal distension also can be different things. It might be trapped gas. It might be feeling “heavy” or “full.” It might mean your pants don’t fit after eating.
So, “bloating” can be any or all of these. You can pass hard small stools and feel like you’re bloated. You can poop just fine but have a lot of gas and feel like you’re bloated. You can spend hours on the toilet with not much to show for your effort and be bloated. So “Keto bloat” is difficult to pin down. That makes it easy to make claims and hard to disprove.
Let’s see how frequent bloating and constipation occurs in the ketogenic diet literature.
What Does Research Say About Constipation?
In a study of children with epilepsy placed on an olive oil-based ketogenic diet, about 25% of the subjects experienced constipation. So, was ketosis slowing them down? Not exactly. Those who experienced constipation were actually less likely to be in ketosis. Constipation went up as ketone readings went down, and epilepsy symptoms returned. Constipation improved as ketone readings went up and epilepsy symptoms subsided.
In adults with epilepsy on a ketogenic diet, constipation occurred in just 9% of patients. The authors note that this rate is lower than some other ketogenic studies and attribute the difference to “the heavy focus on importance of fiber from nutrient dense (fiber rich) vegetables, nuts, and seeds.” Note that they weren’t getting fiber from pills and powders. They were eating nutrient-dense foods that just so happened to contain fiber.
Another ten-year study compared the classical ketogenic diet, MCT oil-based ketogenic diet, and modified Atkins keto diet. They were all equally effective at reducing epilepsy symptoms in children, but the occurrence of constipation varied greatly. It was most common in the classic keto diet and medium chain triglyceride-based diet, both of which restrict protein. In the modified Atkins diet, which does not restrict protein, constipation was much rarer. Another study on the modified Atkins diet had similar results, with just 2 of 26 subjects reporting constipation.
Constipation does seem to be a common occurrence. However, the majority of keto diet studies are in epileptic populations following very strict clinical Keto diets. The extreme nature of these therapeutic ketogenic diets—extreme protein (7% of calories) and carbohydrate restriction—makes them an imperfect representation of how most people are eating Keto. And in studies of less-extreme, more realistic versions of the diet, such as modified Atkins (which allows more protein) or the version with “heavy focus” on vegetables, nuts, and seeds, constipation occurs at a much lower rate.
What Does Research Say About Bloating?
The only instance of something approximating bloating in the ketogenic diet literature occurred in studies using medium chain triglyceride-based diets. These are ones that use huge amounts of MCT oil to increase production of ketone bodies. It works great for curbing epilepsy symptoms, but it can also cause cramping, diarrhea, and abdominal pain. That’s not bloating per se. It’s literally the closest I could find.
Causes Of Bloating While Keto?
Okay, say you are dealing with constipation or bloating on a keto diet. What could be going on?
Not Enough Food
Constipation is often a consequence of low energy status. Everything that happens in the body requires energy, and if energy levels are low or energy availability is poor, basic functions will suffer. Bowel movements are no exception. The muscles and other tissues responsible for moving things along your digestive tract use energy. If you aren’t providing adequate amounts of energy, you’re depriving your tissues of the ATP they need to work best and sending your body a signal of scarcity which will only depress energy expenditure even more.
Low carb diets in general and keto diets in particular are very good at causing inadvertent calorie reduction. Great for fat loss, but some people take it overboard and go too far. I’m talking 800-1000 calories a day on top of CrossFit. That’s a recipe for disaster.
Water and Mineral Loss
When you go Keto for the first time, you shed tons of water. For every gram of glycogen you lose, you drop 3-4 grams of water. You also lose sodium and potassium with the water, and you need extra magnesium to regulate your sodium and potassium levels.
The water content of stool is what gives it that smooth texture we all desire. If you’re dehydrated, even mildly, you’ll have less water available for your bowel movements and be more likely to suffer from constipation.
Drink a big glass of salty water with lemon juice in the morning and sip on salty broth throughout the day. Zucchini is a great source of potassium, as is avocado.
Also, if you’re going to eat more fiber, you need to increase water intake for it to work.
Too Much or Too Little Fiber
The relationship between fiber and constipation is mixed. Some interventions do seem to help. Psyllium husk and flaxseed have both been shown to improve constipation. Galactooligosaccharides, a class of prebiotic fiber, improve idiopathic constipation. And inulin, another prebiotic fiber, improves bowel function and stool consistency in patients with constipation.
But there’s also evidence that more fiber can make the problem worse. In one 2012 study, patients with idiopathic constipation—constipation without apparent physiological or physical causes—had to remove fiber entirely to get pooping again. Those who kept eating a bit or a lot of it continued to have trouble evacuating. The more fiber they ate, the worse their constipation (and bloating) remained. Another review found mixed evidence; some people get less bloating and constipation with more fiber, others get less bloating and constipation with less fiber.
Personally, my toilet performance is stellar with or without a constant intake of voluminous levels of plant matter. Most days I eat a good amount—Big Ass Salads, broccoli, sautéed greens, berries—but on the days I don’t, I don’t notice any difference. I’m suspicious of the widespread calls for bowel-rending levels of fiber as the universal panacea for all things toilet, and I’m also suspicious of the people who claim fiber is unnecessary or even harmful.
Fiber helps some people and hampers others. There’s no one-size-fits-all with fiber, especially since there are many different types of fiber.
Too Many Sugar Substitutes
I get it. There are some interesting candies out there that cater to the Keto set and use various sugar alcohols—non-alcoholic, low-or-no calorie versions of sugar—artificial sweeteners, and fibers to recreate popular treats. It’s fun to eat an entire chocolate bar that tastes pretty close to the real thing and get just a few net carbs. But that’s a lot of fermentable substrate your gut bugs are more than happy to turn to gas.
If you want the opposite problem, you can always turn to Haribo sugar-free gummy bears.
FODMAPs stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols—the carbohydrates in plants that our gut bacteria usually mop up. Most people have gut biomes that can handle FODMAPs; indeed, most people derive beneficial short chain fatty acids from their fermentation. But some people’s gut biomes produce too much fermentation when they encounter FODMAPs. Fermentation begets hydrogen gas, which gathers in the gut and causes great distress. Common complaints of the FODMAP intolerant are bloating, stomach pain, and visits to the toilet that are either unproductive or way too productive—all of which fall into the bloating category.
The myth is that Keto people are eating salami and cream cheese for every meal. The reality is that many people go Primal or Keto and find they’re eating way more vegetables than they ever have before. These are great developments, usually, but if you’re intolerant of FODMAP fibers, you may worsen the bloating.
What Can You Do?
Eat enough protein. Most people can get away with eating 15-25% of their calories from protein and still stay in ketosis. Most people can eat even more protein and still get most of the benefits of fat-adaptation. The keto studies which had the lowest rates of constipation were far more tolerant of higher protein intakes.
Eat FODMAPs unless you’re intolerant. Most people can eat FODMAPs. In most people, FODMAPs improve gut health and reduce constipation and bloating. But if your gut blows up after a few bites of broccoli or asparagus, consult the FODMAPs list and try a quick FODMAP elimination diet.
Make sure you’re truly constipated. Your stool volume and frequency of toilet visits will decline on a normal ketogenic diet because there’s less “waste.” Make sure you’re not misinterpreting that as constipation or bloating. If there’s less poop, there’s less poop. If there’s more poop but it’s just not coming, and you have to go but can’t, that’s when you have an issue.
Experiment with fiber. Fiber clearly has a relationship to bloating and constipation. You just have to figure out what that looks like in your diet.
- If you’re bloated and constipated on a high-plant Keto Diet, eat fewer plants.
- If you’re bloated and constipated on a low-plant Keto Diet, try eating more plants. If that doesn’t help, go zero-plant.
- If you’re bloated and constipated on a zero-plant Keto Diet, try eating more plants. .
We all have to find our sweet spot.
So, to sum up, “keto bloat” is mostly a myth. There’s a glimmer of truth there, but it’s highly exaggerated. Constipation is common on the most restrictive clinical keto diets, while eating fiber from whole plant foods, being less restrictive with protein, and making sure you’re drinking enough water and eating enough calories and electrolytes seems to avoid the worst of it.
What’s been your experience with bloating and constipation? How have you handled it?
Ho KS, Tan CY, Mohd daud MA, Seow-choen F. Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms. World J Gastroenterol. 2012;18(33):4593-6.
Müller-lissner SA, Kamm MA, Scarpignato C, Wald A. Myths and misconceptions about chronic constipation. Am J Gastroenterol. 2005;100(1):232-42.
Guzel O, Uysal U, Arslan N. Efficacy and tolerability of olive oil-based ketogenic diet in children with drug-resistant epilepsy: A single center experience from Turkey. Eur J Paediatr Neurol. 2019;23(1):143-151.
Roehl K, Falco-walter J, Ouyang B, Balabanov A. Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life. Epilepsy Behav. 2019;
Liu YM. Medium-chain triglyceride (MCT) ketogenic therapy. Epilepsia. 2008;49 Suppl 8:33-6.
Arnaud MJ. Mild dehydration: a risk factor of constipation?. Eur J Clin Nutr. 2003;57 Suppl 2:S88-95.
Noureddin S, Mohsen J, Payman A. Effects of psyllium vs. placebo on constipation, weight, glycemia, and lipids: A randomized trial in patients with type 2 diabetes and chronic constipation. Complement Ther Med. 2018;40:1-7.
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For this week’s edition of Dear Mark, I’m answering three questions from readers. First, is the reduced protein efficiency in older adults due to inactivity, or is it something inherent to the aging process, or both? Second, how does a person know if they’ve actually “earned” any carbs? Does everyone on a keto diet earn carbs by virtue of exercising, or is there more to it? And finally, how can a hardgainer with a packed schedule all week long and limited gym time maintain what little muscle mass he’s managed to gain?
Let’s find out:
Interesting observation on protein needs and training in Sunday with Sisson – general consensus is that older folks need more protein as they age but maybe that’s because they are less active and not simply a result of aging.
That’s probably part of it, but it’s not all of it.
In studies where they compare resistance training seniors who eat extra protein with resistance training seniors who don’t, only the seniors eating extra protein gain muscle mass.
Now, it may be that a lifetime of inactivity degrades your ability to utilize protein, and if these older adults had always lifted weights they would have retained their protein efficiency. But maybe not. As it stands, all else being equal, an older adult needs more protein to get the same effect, even if he or she is lifting weights.
Enjoyable read. As someone who lives a ketogenic lifestyle, and who is athletically active, I am not sure exactly how to go about consuming the carbs I’ve “earned.” I rarely run into problems with athletic energy, at least not below anaerobic threshold. Not sure that eating more carbs will improve my performance. And, if they would improve my performance, how does one go about calculating earned carb replacement without losing the fat burning benefits of ketosis?
It sounds like you’re in a good place.
When I say “eat the carbs you earn,” I’m talking to the people who do run into problems with athletic energy, poor performance, insomnia, and other symptoms of exercise-induced stress. Typically, the people who “earn their carbs” are doing stuff like CrossFit, high volume moderate-to-high intensity endurance work, martial arts training, and team sports.
I doubt extra carbs will improve your performance if most of your training takes place in the aerobic zone. But if you wanted to experiment, you could try a small sweet potato immediately after a workout where you passed the anaerobic threshold.
That’s the best way to determine if you’ve earned carbs. Eat 20-30 grams after a workout and see if you enjoy performance gains without gaining body fat. There’s no consumer-friendly way to directly calculate carb debt; self-experimentation is it.
I recently took a job that has me out of bed at 4am and not home until 6pm Monday Through Friday. Is there an efficient way I can maintain muscle mass only lifting weights Saturday and Sunday? I’m a hardgainer at 5’10” and only 140lbs. I’m afraid giving up my 5 day split will ruin what muscle I’ve been able to gain.
Any hardgainer has to eat, and eat, and eat. Increase your food intake. Just eat. Stick to healthy Primal fare, but pack in the food. Meat, milk, veggies, potatoes, rice, eggs, avocados, fruit. Throw some liver in, too (old bodybuilder staple). It doesn’t sound like fat gain is an issue for you, so I’d take advantage of that and just consume calories.
As for training, get some exercise snacks in during the week.
As soon as you wake up, do a quick superset of pushups. Do as many pushups as you can. Wait 30 seconds. Do as many pushups as you can. Wait 30 seconds. Do as many pushups as you can. There you go. That shouldn’t take more than 5 minutes in the morning. Can you squeeze that in?
Repeat this every morning with a different exercise. Pullups, bodyweight rows, kettlebell swings, handstand pushups, dips, bodyweight squats, goblet squats, reverse lunges, reverse weighted lunges. Just choose one thing to do every morning, cram as many reps as you can using the same format (max reps, 30 s rest, max reps, 30 s rest, max reps). Buy any equipment you can if you choose to use weights.
When you get home at night, do the same thing with a different exercise. Morning pushups, evening KB swings, etc. That way, you get about 10 minutes per weekday of intense strength training without impacting your sleep or schedule in any real meaningful way.
Make sure your sleep hygiene is rock solid. Dim those lights at night, turn on f.lux or night mode, wear the blue blocking goggles, get to bed (ideally) by 8:30, 9 to give you 7 to 7.5 hours of sleep. Sleep is essential for gaining lean mass (and staying healthy in general).
On the weekend, hit the weights hard on both days, hitting the entire body. Go high volume/reps. If size is your goal, dropping the weight a bit and focusing on range of motion and a high rep count (10-15 per set) is very effective.
Food, sleep, reps. Good luck!
Thanks for stopping in today, everybody. Additional thoughts for these folks—or questions of your own? Share them below.
Tieland M, Dirks ML, Van der zwaluw N, et al. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2012;13(8):713-9.
The post Dear Mark: Protein Efficiency in Seniors, Earned Carbs, Hardgainer with Limited Time appeared first on Mark’s Daily Apple.
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Because people don’t have enough diets to choose from already, there’s a new one on the scene: the Pegan diet. Actually it’s not that new—Dr. Mark Hyman started writing about it back in 2014, but it’s gained traction since he published his latest book last year, Food: What the Heck Should I Eat?
According to Hyman, Pegan is a somewhat tongue-in-cheek play on the fact that it’s not quite Paleo and it’s not really vegan, hence Pegan. It claims to combine the best of both diets, namely a focus on eating lots of vegetables, as well as an emphasis on sustainable agriculture and ethical and ecologically sound animal farming.
Setting aside the obvious issue that it’s 100% possible to be a vegan who eats few to no vegetables, or to be a paleo dieter who cares naught about the environment, Pegan is touted as being easier to stick to than either vegan or paleo (presumably because Pegan allows for consumption of foods not allowed on either). Frankly, trying to frame it as a bridge between the two hasn’t proved to be a seamless, happy compromise based on social media conversation, but that’s probably of little surprise to anyone here.
I’ve had some readers ask me about the merits of Pegan and whether it offers any particular advantages over paleo/Primal, and I’m taking up that question today. (Note that I’m only focusing on the Pegan diet proposed by Dr. Hyman, not the “Pegan 365” diet offered by Dr. Oz. The latter isn’t paleo at all, allowing whole grain bread and pasta, corn, tofu, and a weekly “cheat day.” You can imagine my response to this version.)
Defining the Pegan Diet
These are the basic tenets of the Pegan diet in a nutshell:
Focus on sourcing high-quality food – Prioritize organically grown and pesticide-free produce as well as meat, eggs, and fats from pasture-raised and grass-fed animals and finally sustainably harvested seafood. Choose seafood with the lowest possible mercury content. Buy local when you can. Avoid CAFO meats and foods containing chemical additives.
Eliminate processed modern food-like substances and franken-fats – Processed carbohydrates have a high glycemic load and lead to excessive insulin production. Refined vegetable and seed oils such as canola and sunflower are pro-inflammatory. Avoid all such products.
Go gluten-free – Even if you don’t have celiac disease or an obvious gluten sensitivity, modern wheat is still a frankenfood, and gluten can damage the gut. Occasional consumption of heirloom wheat (e.g., einkorn) is ok if you tolerate it.
Go dairy-free – Dairy is problematic for most people and is best avoided. If you do decide to include some dairy, consider choosing goat and sheep milk products instead of cow. Grass-fed butter and ghee are acceptable.
Make vegetables the centerpiece of your diet – Vegetables (mostly non-starchy) should comprise 75% of your diet.
Enjoy healthy fats – Focus on omega-3s, as from small, oily fish. Eat plenty of healthy fats from grass-fed and pastured meats and whole eggs, nuts and seeds, avocados, and coconut products. Use olive oil, avocado oil, and coconut oil for cooking.
Eat meat sparingly – Dr. Hyman uses the term “condi-meat” to emphasize that meat should be a side dish, not the focus of the meal. He recommends no more than 4 – 6 ounces of meat per meal.
Include gluten-free grains and legumes in small quantities – You may eat ½ cup of gluten-free grains like amaranth or quinoa, plus ½ – 1 cup of legumes (preferably lentils) per day. If you are insulin resistant, you should limit these or refrain altogether.
Limit sugar – Avoid refined sugar and conventional “treats.” The bulk of your vegetable intake should be from non-starchy varieties, and opt for low-glycemic fruit. Natural sweeteners like honey should be used only sparingly for the occasional treat.
How Does Pegan Compare to Primal?
If you’re reading this and thinking, “Gee, Mark, this sounds an awful lot like the Primal diet,” I agree. While there are some differences between Pegan and Primal, they aren’t particularly dramatic:
Primal allows full-fat dairy consumption. Pegan discourages but doesn’t outright ban dairy.
I don’t actively encourage people to consume gluten-free grains and legumes, but I’m not as strongly opposed to them as others are in the ancestral community. I’ve said before that I consider quinoa, amaranth, wild rice, and legumes to be moderation foods (when well-tolerated, which is more an individual thing). They deliver pretty substantial carb hits relative to their nutritional value, but they certainly aren’t the worst options out there. I don’t think they should be dietary staples by any stretch—and daily consumption is too much in my opinion—but if Primal folks want to eat them occasionally, I’ve seen it work for people.
The biggest difference is in regard to protein. The Pegan diet explicitly limits protein consumption, while the Primal Blueprint recommends moderate protein consumption tailored to your activity levels, goals, age, and medical needs. On the surface, this might seem like a substantial difference, it’s probably not very disparate in practice. If a Pegan eats 3 eggs for breakfast, a large salad with 4 ounces of sardines at lunch, and 4 ounces of skin-on chicken thigh at dinner, that gets him or her to about 70 grams of protein, not counting the (admittedly incomplete) plant protein from the salad and any additional veggies included with breakfast and dinner, plus nuts and seeds. That’s within the realm of Primal guidelines, albeit less than I’d recommend for some populations.
That said, if Pegans are taking the whole “treat meat as a condiment” mantra to heart, they are probably at greater risk of underconsuming protein compared to the average Primal eater. This could present a problem for athletes and older folks looking to preserve lean mass. Likewise it is surely harder to get enough protein while also practicing time-restricted eating—and perhaps only eat one or two meals per day—and trying to follow Pegan guidelines. That isn’t a knock against Pegan per se, just a cautionary note.
Finally, while we’re on the subject of protein, I must object to Dr. Hyman’s appeal to environmentalism as a reason to limit meat consumption. I’m not at all convinced that raising livestock taxes the environment more than monocropping acres and acres of corn and soybeans.
In my opinion, Pegan could simply be called “vegetable-centric Paleo with permission to eat small amounts of quinoa and lentils if it suits you.” That isn’t catchy, though, so Pegan it is.
That said, I appreciate how Dr. Hyman for his version of the Pegan Diet emphasizes that there is no single diet that is exactly right for each individual and, like me, he advocates for self-experimentation. Dr. Hyman also speaks out against diet dogmatism and encourages his followers to focus on big-picture health. These are obviously messages I can get behind.
The Bottom Line
I’m a fan of anything that gets people thinking about food quality instead of just robotically tracking macronutrient intake and/or plugging calories into a magic weight-loss formula. Supporting sustainable agricultural practices, eating locally and seasonally, and avoiding environmental pollutants have always been part of the Primal Blueprint recommendations. In short, there is a lot I like about the Pegan diet.
However, I don’t agree that the Pegan diet is necessarily easier to implement than vegan or Paleo, which is supposed to be one of its big draws. If you’re a vegan who gets by on bagels, pasta, and Oreos, or a Paleo person who dutifully eschew grains but relies on the myriad processed, packaged Paleo food options, Pegan is not going to be easier. Changing your diet to focus on carefully sourced “real food” is still going to be a massive shift. It’s going to be much more expensive and time consuming to prepare your meals, and it will probably be incredibly burdensome at the beginning.
Sure, being able to include a small serving of gluten-free grains and legumes might make life a little easier for Paleo folks… but how much really? (For this reason I’d be skeptical if you’re considering using the Pegan diet to lose weight.) Are a lot of Paleo folks really falling off the wagon because they are feeling deprived of ½ cup of lentils? Dr. Hyman has said that his issue with Paleo is “some use the paleo philosophy as an excuse to eat too much meat and too few plant-based foods.” I’m not really seeing this pervasively in the Paleo/ancestral community, to be honest (intentional carnivore dieters notwithstanding). This strikes me as an attempt to solve a problem that didn’t need solving.
Truthfully, the things I like about Pegan are all the ways in which it is similar to Primal, which are many. Both Primal and Pegan have vegetables as the base of their food pyramids. They similarly emphasize the importance of choosing healthy fats and oils, avoiding grains and processed modern junk foods, and moderating carbohydrate intake (which Dr. Hyman frames as maintaining low glycemic load, but the effect is the same). Still, for many people the tighter Primal guidelines around carbs are probably better suited for weight loss and even weight maintenance.
Most days, if you were a fly on the wall in my kitchen, you’d see me eat a big-ass salad for lunch and a piece of meat with several types of vegetables on the side for dinner, and you wouldn’t be able to discern if I was Primal or Pegan. Then again, those nights when I tear into a giant steak would you most certainly be able to tell… and, trust me, I’m not giving those up any time soon.
The post What’s the Pegan Diet? (And How Does It Compare To Primal?) appeared first on Mark’s Daily Apple.
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I have a confession to make: I, Mark Sisson, suffer from keto crotch.
It’s embarrassing, really. I thought maybe it was just the change in climate moving from Malibu to Miami—the humidity, the heat, the fact that I’m paddling and swimming more often now. There’s a whole lot of moisture down there. Perpetual steaminess.
But then I met up with my writing partner and good pal Brad Kearns, who’s been working with me on my upcoming book. Brad lives in Northern California, which is far from hot or humid right now. He’s also a staunch keto guy most of the time, and, well, let’s just say I could smell him before I could see him. We met up at a coffee shop and cleared out everyone in a fifteen foot radius. We sampled a new exogenous ketone product he’s been trying and not one, not two, but three separate individuals approached to inquire if we were salmon fishermen.
Okay, let’s get serious. Does “keto crotch” really exist? And, if it does, what can you do to prevent it?
I’m writing this not because of overwhelming demand from loyal followers of the Keto Reset plan. In fact, I hadn’t ever heard of “keto crotch” before last week. There’s a good chance almost no one heard of it before March 2019, if Google Trend data for “keto crotch” searches is any indication. I’m writing this post because the barrage of news articles, Twitter hashtag campaigns, and extremely serious warnings from people with lots of acronyms after their name has led people to ask me if it’s a legitimate phenomenon. A few acquaintances have brought it up in social situations. Our marketing director found herself fielding keto crotch questions at a dinner for Expo West last week.
So, are women following a ketogenic diet experiencing an epidemic of stinky vaginas?
Is Keto Crotch Even Physiologically Plausible?
Vaginal odor does change. It fluctuates naturally, and sometimes it can get worse. The most common cause of unpleasant changes to vaginal odor is bacterial vaginosis, which occurs when something upsets the balance between the beneficial lactobacilli bacteria that normally live in the vagina and pathogenic bacteria. What can upset the balance?
The vagina is supposed to be an acidic environment; that’s how the healthy lactobacilli thrive. If something upsets that pH balance, tilting it toward alkalinity, unhealthy bacteria gain a foothold and become predominant, and begin producing unpleasant-smelling amines like putrescine, tyramine, and cadaverine. This is bacterial vaginosis. As it turns out, the lactobacilli bacteria normally present in the vagina are instrumental in maintaining an acidic pH. They consume glycogen, spit out lactic acid, and exert antimicrobial and antifungal effects that block common vaginal pathogens like candida, e. coli, and gardnerella from taking hold and causing trouble.
The interaction between diet and vaginal biome is understudied. To my knowledge, there exist no direct controlled trials that address the issue. It’d be great to have a study take a cohort of women, split them up into different dietary groups, and follow them for a year, tracking their vaginal pH and bacterial levels. Alas, we do not.
We do have a study that provides a hint. In 2011, researchers looked for correlations between dietary patterns and bacterial vaginosis in a cohort of nearly 2000 non-pregnant mostly African-American women aged 15-44. While there probably weren’t many keto dieters, and the diets as a whole were of the standard American variety, glycemic load—which basically boils down to carb load—was the strongest predictor of bacterial vaginosis. Other markers of food quality, like a person’s adherence to “healthy eating guidelines,” initially seemed to reduce the chance of bacterial vaginosis, but those relationships were almost abolished after controlling for other factors. Only glycemic load remained highly significant.
This connection between dietary glycemic load and bacterial vaginosis starts looking more causal when you realize that diabetes—a disease where one’s “glycemic load” is perpetually elevated and exaggerated—is another risk factor for bacterial vaginosis.
There’s also a 2007 study that found “high” intakes of dietary fat, particularly saturated and monounsaturated fat, were a significant predictor of bacterial vaginosis. In this study, “high fat” meant around 39% of energy from fat. That leaves 61% of energy from carbohydrate and protein, the kind of “high-fat, high-carb” Standard American No-Man’s-Land that’s landed the country in the current metabolic predicament. High-fat intakes in the presence of high-carb intakes may very well be bad for your vagina, but it says nothing about the likelihood of keto crotch.
At any rate, neither study was a controlled trial, so we can’t say anything about causality.
What about a yeast infection? The most common offender is candida, which usually favors sugar for fuel, but there’s also evidence that it can metabolize ketones. Could keto make a latent yeast infection worse and lead to smelly “keto crotch”?
Perhaps keto can make candida worse (that’s for another day), but that’s not the cause of “keto crotch.” Candida vagina infections don’t smell very much, if at all, and they certainly don’t smell “fishy.” That’s only caused by bacteria and the aforementioned amines they can produce.
Free glycogen levels in vaginal fluid are a strong predictor of bacterial vaginosis. If ample glycogen is available, the good lactic acid bacteria have plenty of food and produce plenty of lactic acid to maintain the acidic pH conducive to vaginal health. If inadequate glycogen is present, the lactic acid bacteria have less food and produce less lactic acid, increasing the chances of the pH tilting toward alkalinity. An alkaline vagina is a vagina where pathogenic bacteria—the ones that produce stinky amines—can establish themselves.
The question then is if ketogenic diets lower free glycogen in the vaginal fluid. That’s a fair question. I wasn’t able to find any solid answers. I guess “ketosis effect on vaginal glycogen” isn’t the most lucrative avenue of scientific inquiry.
Should I Worry?
Even assuming this is a real phenomenon, it’s a rare one. The vast, vast majority of people following a ketogenic diet aren’t coming down with keto crotch. Other than a few Reddit posts from the past 5 years, I haven’t seen anyone at all in our neck of the woods complain.
Maybe people doing Primal keto are eating more nutrient-dense ketogenic diets than people doing conventional (or caricature) keto. Salads, steaks, eggs, and lots of non-starchy veggies are a great way to stay keto and obtain micronutrients. And there are links between micronutrient status and bacterial vaginosis. The most common relevant deficiencies include vitamin D (correcting the deficiency can cure the vaginosis) and folate. Hard to get adequate folate if your diet is based on salami and cream cheese.
We also know that the health of your skin biome tracks closely with that of your gut, and that eating plenty of non-starchy veggies, fermented foods (yogurt, kefir, sauerkraut, kimchi, etc), and colorful produce can provide prebiotic fiber, prebiotic polyphenols, and probiotic bacteria that nourish your gut biome. If the vaginal biome is also connected to the gut biome (and it is), tending to the latter should also have positive effects on the former.
The Primal brand of keto tends to emphasize micronutrients and gut health a bit more than some other types of keto I see floating around. If—and it’s a very big “if”—keto crotch is legit, that may explain some of the discrepancy.
Finally, be sure to check out this very interesting Twitter thread where the author lays out his suspicions that the whole “keto crotch” phenomenon might be a manufactured stunt designed to vilify the ascendant ketogenic diet. Nothing definitive, but it’s certainly food for thought.
If You’re Concerned…
Okay. Say you’ve recently gone keto and your vagina is smellier than usual. (And you’ve ruled out other, more obvious potential causes like changes in soaps, etc.) It’s hard to ignore, and I wouldn’t want you to. What can you do?
- Confirm that you have bacterial vaginosis. Seriously, get it checked out.
- Make sure you’re getting enough folate and vitamin D. Supplement if need be.
- Eat prebiotics and probiotics. Fermented food and/or a good probiotic supplement.
- Try a carb refeed. If ketosis depletes vaginal glycogen and increases pH, the occasional carb refeed could restore glycogen by 30-50 grams and should do the trick. Note that this is entirely theoretical; I’m not saying it’s a “problem” on keto.
- Hang out in the keto zone. I’ve written about the keto zone—that metabolic state where you’ve reached full keto and fat-adaptation and find yourself shifting in and out of ketosis as you please due to increased metabolic flexibility. A few carbs here, a fasting day there, a few more days of keto. Again, if full keto is theoretically depleting vaginal glycogen, maybe relaxing your restrictions will solve the issue while maintaining your fat adaptation. This is actually where I hang out most of the time.
That’s it for today, folks. Do you have “keto crotch”? Do you know anyone who does? Or did your vaginal health improve on keto? I’m curious to hear what everyone’s experiences have been, so don’t be shy.
Take care and be well.
Thoma ME, Klebanoff MA, Rovner AJ, et al. Bacterial vaginosis is associated with variation in dietary indices. J Nutr. 2011;141(9):1698-704.
Kalra B, Kalra S. Vulvovaginitis and diabetes. J Pak Med Assoc. 2017;67(1):143-145.
Taheri M, Baheiraei A, Foroushani AR, Nikmanesh B, Modarres M. Treatment of vitamin D deficiency is an effective method in the elimination of asymptomatic bacterial vaginosis: A placebo-controlled randomized clinical trial. Indian J Med Res. 2015;141(6):799-806.
Dunlop AL, Taylor RN, Tangpricha V, Fortunato S, Menon R. Maternal vitamin D, folate, and polyunsaturated fatty acid status and bacterial vaginosis during pregnancy. Infect Dis Obstet Gynecol. 2011;2011:216217.
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The relationship between stress and carbohydrates is confusing, with seemingly contradictory arguments bouncing around the online health sphere.
There are those who say high-carb diets cause stress, and that eating more fat and fewer carbs is the solution.
There are those who say high-fat diets increase stress and eating carbs ameliorates it.
Who’s right? They can’t both be right, can they?
You’d be surprised.
Let’s dig into four common carb questions and assertions.
“Stress Increases Carb Cravings.”
This is well-established. You have a terrible day at the office, your kids have appointments twenty miles apart within fifteen minutes of each other, the traffic is backed up to your driveway, you’re late for work, the dog needs a walk, you haven’t even thought about what to make for dinner, you slept four hours last night—it adds up. People deal with a lot. And in that moment, a carbohydrate-based snack really does seem to take the edge off.
Across millions of years of hominid evolution, the human stress response developed in the context of real-world, short-term, and infrequent but intense stressors: battles, hunts, freak injuries, dangerous animal encounters, interpersonal conflicts. These were situations that demanded heightened senses, available fuel, and a rapid heart rate to deliver everything to the tissues that needed to move and act. It makes perfect sense for your body to pump out adrenaline to increase fat burning and glucose in the blood—you need that fuel to deal with the situation. It also makes sense for your body to follow that up with a blast of cortisol, which makes you crave high-carb junk food to replace the fuel you utilized. The problem is that our modern stressors are too frequent, they aren’t physically demanding, we aren’t utilizing the fuel we mobilize, and we have no real need for the carb cravings that come after.
What happens when we eat too many carbs that we never actually needed?
We get fat. Cellular energy supply becomes overloaded, impairing our mitochondria’s ability to process energy efficiently. This degrades metabolic flexibility—the ability to switch between different fuel sources—preventing us from burning the fat on our bodies in between meals. We become reliant on those carbs, and when we don’t get them fast enough, our bodies perceive that as a major stressor.
So while giving in to carb cravings can reduce stress in the short-term, it sets us up for longer-term, more chronic stress.
“What About Gluconeogenesis? Isn’t That a Stress Response?”
It can be.
A primary goal of cortisol is to increase glucose availability. It does this through multiple avenues. One I just mentioned is to increase carb cravings. Another is to make you insulin resistant, thereby preventing insulin from sucking up blood glucose. Gluconeogenesis—the creation of glucose from amino acids and other substrates—is another.
If you’re a sugar-burner, stressful situations will increase carb cravings, induce gluconeogenesis, and may even make you insulin resistant. If you’re fat-adapted, the story shifts.
A fat-adapted person will have ketones and fatty acids available to provide energy in between meals. A fat-adapted person will have ketones and fatty acids available to provide energy in stressful situations. A fat-adapted person will be able to utilize those ketones and fatty acids during stressful situations—their mitochondria will literally be primed to utilize those fuels, not just glucose. A fat-adapted person is less likely to perceive carbohydrate shortages as stress shortages because they’ve got all this other fuel available to burn.
This adaptation doesn’t happen overnight. If your diet is low-carb or keto, but your body is still reliant on sugar, you will perceive reduced carb availability as a stressor. That’s one of the hallmarks of the keto flu, and it’s one reason why some people have extended keto flu—their bodies are still expecting and demanding glucose.
Some people never get over the carb cravings; they never fully adapt. This is the subset of the population that doesn’t function or perform well on a long-term ketogenic diet. The cause is unknown, at least for now (I suspect it has to do with recent ancestry and genetic proclivities), but what matters is that these people exist. For them, a long-term keto or very low carb diet approach will probably always be stressful. But even in these folks, spending some time in ketosis—through short term low-carb eating, intermittent fasting, or even extended low-level endurance activity that primarily burns fat—is a good idea that will reduce stress and improve overall resilience.
“But Carbs Make Exercise Less Stressful!”
Exercise is stressful to begin with. But then you adapt to the stress and overcome it—and end up stronger, fitter, and faster than before. Without the stress, working out doesn’t work. A legitimate method for increasing your work capacity is to train-low (carb), race-high (carb). Athletes have been doing this for decades—training in a low-carb state to get better at performing without ample muscle glycogen, then going into a race with full glycogen reserves and the ability to perform without glycogen. Exercising in that low-glycogen state is stressful, but that’s the whole point. It makes them better, stronger, faster, and it conserves glycogen for when they really need it.
If you consistently perform glucose-intensive high-intensity anaerobic activity for extended periods of time—CrossFit style WODs done 3-5 times per week, for example—you will run up a glucose debt and should replenish some of the carbohydrates you expend or risk cortisol spikes. Fat-adaptation can improve your tolerance of anaerobic activity in a low-glucose state, but there’s a breaking point, a physiological limit.
Eat the carbs you earn. This is a subtle point I don’t often see made. The reverse is widely understood—don’t eat the carbs you don’t earn—because millions of obese and overweight people do that every day. It’s a big reason why we’re so overweight. But if you fail to eat the carbs you earn through intense, protracted physical activity, you’re creating an undeniable glycogen deficiency that your body may perceive as a stressor. It may turn out that fully fat- and keto-adapted athletes can perform intense medium-to-long-term activities at high levels, and there’s some indication that this is the case, but for the time being it appears that eating the carbs you earn can stave off the stress.
“Low-Carb Diets Are Stressful For Women.”
There’s a glimmer of truth here. Allow me to explain.
Women are inherently more sensitive to caloric fluctuations than men…on average. The reason is sheer biology. Human evolution is concerned with fertility and reproduction. Can you produce, foster, and support viable offspring? Awesome. Natural selection deems you fit.
To fulfill their biological role, men have to produce sperm. They can do so almost indefinitely. They don’t run out; they just make more. If a batch is damaged due to poor lifestyle or dietary choices, there’s more on the way. After a man gets someone pregnant, his biological involvement with the growing baby is done. What or when he eats has no impact on the survival of the growing baby.
To fulfill theirs, women have a finite number of eggs, or “chances.” Once an egg is gone, there’s no replacing it.
And so the body seeks to inculcate the egg from environmental insults.
When you are preparing to get pregnant, your body needs extra nutrients to build up a reserve and “prime the pump.”
When you are pregnant, the growing baby needs a reliable and constant stream of nutrients for almost a year.
After you’ve given birth, the growing newborn needs breastmilk. To make that milk requires additional calories and extra doses of specific nutrients. Modern technology allows us to skip nursing and go straight to the bottle, but your body doesn’t “know” that.
It all points to women being more finely attuned to caloric deficits. For example, women’s levels of ghrelin, the hunger hormone, are quicker to rise after meals. Even if you’re never going to have kids, your body is still wired to protect against these caloric fluctuations.
Where do carbs come in?
One’s carbohydrate consumption is uniquely hewed to our sense of caloric sufficiency. If carbs are plentiful, your body perceives that as a signal of environmental plenty: the weather is good, the plants are producing, the trees are bearing fruit, the men are bringing back lots of honey. Life is good. It’s the perfect time to get pregnant. Above all other macronutrients, carbohydrate consumption increases the short-term expression of leptin, a satiety hormone that signals the presence of incoming calories, caloric sufficiency, and environmental plenty.
There’s also the issue of extreme satiety. Low-carb diets often become low-calorie diets without you even trying. That’s why they work so well for fat loss, by inadvertently reducing the amount of food you eat and increasing satiety. But for some women, especially those at or approaching their ideal weight, going too low in calories can increase stress.
Are you unable to access your own body fat in between meals for energy? Then you’ll be a ball of stress unless you can get those Jolly Ranchers unwrapped quickly enough. It’ll be a constant battle. And yeah, if you keep pumping yourself full of carbs to keep your blood glucose topped off, you’ll keep stress at bay—but you’ll always be teetering on that precipice.
Are you exercising? Then you should strike a balance between gaining the adaptive benefits of training in a low-carbohydrate state and eating the carbs you earn.
Are you a woman? Then you’re probably more sensitive to diet-induced stress and may benefit from occasional carbohydrate refeeds. You should watch out for excessive satiety on ketogenic diets, which is great for fat loss but can lead to stress issues down the line if calories get too low.
The relationship between carbohydrates and stress isn’t exactly straightforward, but it is navigable. Hopefully after today you have a better idea of where you stand in the relationship.
What’s been your experience with stress and carbohydrates? Has your tolerance for stress gone up or down since going low-carb or keto? Thanks for stopping in today.
Mcallister MJ, Webb HE, Tidwell DK, et al. Exogenous Carbohydrate Reduces Cortisol Response from Combined Mental and Physical Stress. Int J Sports Med. 2016;37(14):1159-1165.
Dirlewanger M, Di vetta V, Guenat E, et al. Effects of short-term carbohydrate or fat overfeeding on energy expenditure and plasma leptin concentrations in healthy female subjects. Int J Obes Relat Metab Disord. 2000;24(11):1413-8.
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Some people just don’t do milk.
There are many reasons why. Maybe you have a dairy intolerance. Maybe you don’t like the way cow’s milk tastes. Or maybe you think cow milk is unhealthy.
I won’t contest the reasons why. That’s another topic for another post, and I’ve already covered the most common anti-dairy arguments. If you want to read about my stance on the healthfulness (or lack thereof) of dairy, read what I’ve written about raw milk, cheese, yogurt, and dairy in general. If you want to learn how to identify dairy intolerance, read this.
But the fact is, lots of people either need or want a milk alternative. Water is great to drink, but it’s not the right smoothie substrate, and it can’t replace milk in recipes or coffee drinks. You need something vaguely white and thick enough to pass as milk.
Normally in a post like this, I’d cover all the different varieties and what sets each apart—their strengths and weaknesses, their nutrient profiles, their unhealthy ingredients. And I’ll certainly do that today, but first there’s good news and bad news.
The good news is that there are plenty of good choices available. If you want something to drink, use in smoothies, or add to coffee, there are many different plant-based milk that avoid overly offensive ingredients.
The bad news is that most non-dairy milks are usually very low in nutrients. The parent food to these plant-based milks—the almonds, the cashews, the hemp seeds, and so on—are extremely nutrient-dense in and of themselves. Just check out my posts on nuts and seeds to get the nutritional lay of the land. But almond milk isn’t almonds, cashew milk isn’t cashews, and hemp seed milk isn’t hemp seeds.
This isn’t surprising when you think about how nut milks are made: by blending the nuts with a bunch of water and straining out the solids to try to extract some of the nut-ness. It’s pretty inefficient. If you could press an almond to wring out the almond milk, then you’d have something interesting. But that’s not how it works. Most non-dairy milks are superficial mirages of the real thing.
To illustrate this, let’s look at the most popular non-dairy milks and compare the nutrients in the parent nut/seed/plant to the nutrients in the nut/seed/plant-milk (when applicable).
Nutrient Profiles Of Popular Non-Dairy Milks
This is the go-to option for most strict paleo eaters starting out. It sounds like a great idea. Almonds are a nutritious nut, high in magnesium, copper, vitamin E, and manganese. They have a decent amount of protein, some nice prebiotic fiber. In your head, almond milk is fantastic. Unfortunately—and this goes for most of the other nut milks out there—the average jug of store-bought almond milk contains no more than a handful of almonds.
In an ounce of almonds:
- 163 calories
- 6 g carbs: 3.5 g fiber
- 14 g fat: 8.8 g MUFA, 3.4 g linoleic acid (LA), 1.1 g SFA
- 6 g protein
- 50% vitamin E
- 22% vitamin B2
- 31% copper
- 18% magnesium
- 28% manganese
In a cup of almond milk:
- 36 calories
- 1.4 g carbs
- 2.6 g fat: 1.7 g MUFA, 0.6 g linoleic acid
- 1.4 g protein
- 45% vitamin E (added)
- 17% vitamin A (added)
- 25% vitamin D2 (added)
- 4% magnesium
- 4% manganese
- 39% calcium (added)
- 8% copper
Not great carry over. No prebiotic almond fiber. Almost no protein, magnesium, manganese, or copper. The richest nutrients are all the ones they added after the fact.
Cashew milk is in the same boat: mostly water, not too much cashew.
In an ounce of cashews:
- 156.8 calories
- 8.6 g carbs: 0.9 g fiber
- 12.4 g fat: 6.7 g MUFA, 2.2 g LA, 2.2 g SFA
- 5.2 g protein
- 10% vitamin B1 (thiamine)
- 69% copper
- 24% iron
- 20% magnesium
- 20% manganese
- 15% zinc
In a cup of cashew milk:
- 25 calories
- 1.4 g carbs: 0.2 g fiber
- 2 g fat: 1.1 g MUFA, 0.4 g linoleic acid
- 0.8 g protein
- 2% vitamin B1
- 11% copper
- 4% iron
- 3% magnesium
- 3% manganese
- 2% zinc
- 17% vitamin A (added)
- 25% vitamin D2 (added)
- 18% vitamin E (added)
- 37% calcium (added)
Traditionally, you make coconut milk by pulverizing fresh coconut flesh, blending it with a little water, and passing it through a cheesecloth or fine strainer. This produces a very rich, very high-fat milk that runs about 550 calories per cup. This is the coconut milk used in cooking that comes in cans and cartons. A second pass with the coconut solids produces a thinner, less-rich coconut milk that runs about 150 calories per cup. This is often called “Lite Coconut Milk” and can be used to cook or to drink.
Besides the abundance of medium chain triglycerides and a lot of manganese, neither thick or thin coconut milk are nutrient-dense. A cup of rich, full-fat coconut milk gives decent amounts of magnesium, copper, zinc, selenium, and iron, but you have to realize that it takes 600 calories to get those nutrients. That’s not exactly nutrient-dense; the micronutrient-to-calorie ratio is skewed.
They do sell jugs of thin coconut milk as a milk replacement. Except for the fortifications they add (vitamin D, calcium, riboflavin, and the other usual suspects), these aren’t going to supply much in the way of nutrition.
In an ounce of flaxseed:
- 151.4 calories
- 8.2 g carbs: 7.7 g fiber
- 12 g fat: 2.1 g MUFA, 6.5 g ALA (omega-3), 1.7 g LA, 1 g SFA
- 5.2 g protein
- 39% vitamin B1 (thiamine)
- 38% copper
- 20% iron
- 26% magnesium
- 31% manganese
- 13% selenium
- 11% zinc
In a cup of flax milk:
- 25 calories
- 1 g carbs
- 2.5 g fat: 1.2 g ALA (omega-3)
- 5% iron
- 63% B12 (added)
- 25% vitamin D2 (added)
- 17% vitamin A (added)
- 25% calcium (added)
The main standout is the omega-3 content. Flax milk has a little over a gram of alpha-linolenic acid (the plant form of omega-3) per cup.
I’m not talking about the oncoming wave of high-THC cannabis milks. This is hemp milk, produced by blending non-psychoactive hemp seeds with water and straining the solids out.
In an ounce:
- 149.1 calories
- 7.8 carbs: 7.8 g fiber (all fiber)
- 10.1 g fat: 1.1 g MUFA, 2.2 g ALA, 4.8 g LA, 0.8 g SFA
- 7 g protein
- 24% vitamin A
- 63% copper
- 50% iron
- 33% magnesium
- 86% manganese
- 13% selenium
- 18% zinc
In a cup of hemp milk:
- 70 calories
- 2.2 g carbs, all fiber
- 6 g fat, 1 g ALA (omega-3), 3 g omega-6
- 2 g protein
- 18% copper
- 13% iron
- 10% magnesium
- 24% manganese
- Plus all the usual fortifications (calcium, vitamin D, vitamin A, riboflavin, vitamin B12
That’s not too bad, actually. It picks up some decent mineral levels, and hemp fat is one of the only fats to contain stearidonic acid, an intermediate omega-3 fat in the conversion pathway from ALA to EPA that increases the EPA content of red blood cells in humans (a very good thing).
There’s a product called Milkadamia. Great name, disappointing result.
In an ounce:
- 203.5 calories
- 3.9 g carbs: 2.4 g fiber
- 21.5 g fat: 16.7 g MUFA, 0.4 g LA, 0.1 g alpha linolenic acid (ALA), 3.4 g SFA
- 2.2 g protein
- 28% vitamin B1 (thiamine)
- 24% copper
- 13% iron
- 51% manganese
In a cup of mac nut milk:
- 50 calories
- 1 g carbs
- 5 g fat
- 1 g protein
- 125% vitamin B12
- 17% vitamin D
- 25% vitamin A
- 38% calcium
Despite having the best product name and the most potential for being a creamy milk substitute (has anyone tried adding mac nuts to a smoothie?—incredible!), the nutrient profile is low, and there’s not much going on.
I’ve written about oats before. They have some interesting properties, some beneficial fiber, and a decent mineral profile. Adding oat beta-glucan fibers to fiber-free instant oatmeal reduces the postprandial glucose response, so at least in the context of refined starch, oat fiber can be helpful.
The most popular and widely-available oat milk is called Oatly. The website explains the process: mill raw oats with water, add enzymes to extract the starch, separate the beta-glucan from the bran, discard the bran, pasteurize it, bottle it. This retains the beta-glucans (2 grams of fiber per cup) and starch (16 grams carbs per cup). The only micronutrients they advertise are the ones they add, including calcium, potassium, vitamin A, riboflavin, vitamin D, and vitamin B12; there’s no indication that the normal oat-bound minerals like magnesium, manganese, and zinc make it into Oatly in significant amounts. To top things off, they add canola oil for texture and mouthfeel.
Rice milk is made by blending water with cooked rice, brown rice syrup, and brown rice starch.
Like the others, its only real micronutrients comes from the ones they add to it. It’s higher in carbohydrates than any of the other milks I found.
Believe it or not, of all the popular non-dairy milks out there, soy milk contains the most nutrients and is probably the closest to cow milk. It’s high in protein. It contains a nice balanced selection of minerals. A review comparing soy milk, coconut milk, almond milk, and rice milk to cow milk found that soy milk was the closest—mostly because it actually featured measurable nutrients.
In a cup of soy milk:
- 74 calories
- 3.6 g carbs; 2 g fiber
- 4 g fat
- 8 g protein
- All the usual additions, like calcium, vitamin B12, vitamin D, riboflavin, and vitamin A
- 10% magnesium
- 15% manganese
- 6% folate
- 6% potassium
- 19% copper
- 10% selenium
It’s not ideal though. People who regularly drink soy milk tend to end up with micronutrient deficiencies. Kids who drink cow milk are less likely to have atopic eczema, while soy milk drinkers have no such protection (and may even have increased risk). The protein in soy milk can help people build muscle, but milk proteins work better and also provide other benefits to the immune system.
I’m not saying you shouldn’t use non-dairy milks. They are inoffensive and helpful for recipes. Just don’t expect any incredible health benefits from them.
3 Notable Brands With Extra Benefits
But there are a few specific non-dairy milk products that deserve a closer look, especially if you’re going to go this route.
Vita Coco Coconut Milk
Instead of blending coconut meat with water and filtering out the solids, Vita Coco mixes coconut cream into coconut water to produce a milk-like product. I haven’t tasted it myself, but the nutrient profile is pretty compelling.
- Moderate levels of fat (5 grams per cup), primarily from saturated medium chain triglycerides.
- Low carb (5 grams per cup). Naturally sweet from the coconut.
- Decent mineral levels (RDIs: 45% calcium, 15% magnesium, 10% potassium, 10% zinc).
Some of the calcium, magnesium, and zinc is added, some is natural (coconut water can be a good source of all three). Still, it’s cool to see magnesium added because so many are deficient and supplementary magnesium is well-tolerated and effective.
Back when I was toying with the idea of getting a significant amount of my protein from plant sources for a quick experiment (long story short: I didn’t do it, I like animals too much, and I found myself relying too heavily on processed powders), I got a bottle of something called Ripple. Ripple is pea-based milk, fortified with extra pea protein, algae-based DHA, calcium, iron, and vitamin D. It has as much protein per serving as milk (8 grams), using a type of protein that can promote muscle gain, and it tastes quite good. It uses high-oleic sunflower oil for fat, which is low in polyunsaturated fat. If I truly couldn’t have dairy and desperately wanted something to drink or make smoothies with, I’d probably do Ripple.
Tempt Hemp Milk
I’ve never tried this brand, or hemp milk in general. But just like the generic hemp milk analyzed above, Tempt Hemp Milk has a far better nutrient profile than most of the other nut or other non-dairy milks I ran across. If it tastes anything like hemp seed, which has a nutty, subtle flavor, I can imagine hemp milk having a pleasant taste.
Tips For Making Your Own
You’re all an enterprising bunch. Why not make your own non-dairy milk?
- You can make your own nut milk. There are thousands of recipes out there, but they generally seem to involve soaking nuts in water and a pinch of salt overnight, draining them, and blending the nuts with fresh water, straining out the solids, and sometimes adding a date or a dab of maple syrup for sweetening. The higher the nut:water ratio, the richer, more nutritious the milk.
- You can also make thicker, more nutrient-dense nut milk by blending nut butter and water until you reach the desired consistency. You aren’t discarding anything with this method.
- You can avoid nuts altogether. One scoop of MCT powder, one scoop of collagen peptides, whisked into water makes a decent approximation of milk. Use 3 tablespoons of water to make creamer for coffee. This isn’t a nutrient-powerhouse, but it provides medium chain triglycerides (which boost ketone production) and collagen.
- Or how about making a kind of nut broth? The usual audience for non-dairy milks is obsessed with consuming raw foods. They make a point to prevent their food from ever getting warmer than the hemp-clad crotch of a Trustafarian hitchhiking through Joshua Tree in the middle of summer. But consider that applying heated water to pulverized nuts will extract even more nutrients from the nut and deliver them into the water. Then you strain the solids and refrigerate the broth, producing “milk.” I bet that’d be quite tasty and more nutritious than a cold water nut wash.
The Bottom Line on Nut Milks…
Nothing on the market or that you cook up in your kitchen is going to rival the nutrient density of cow’s milk. From the protein to the healthy dairy fats to the dozens of micronutrients we know about and the dozens we have yet to catalogue, actual milk packs a real wallop that your basic almond, cashew, pecan, or flax milk simply can’t defeat. So, you’ll have to shift your view of “milk” as a whole food. Don’t give your kid four glasses of hemp milk and think you’re replacing cow dairy. Don’t wean your infant off the breast and fill a bottle with hazelnut milk instead; it’s not the same. Don’t eat a dog bowl-sized serving of cereal with some rice milk. The only nutritious part of cereal is the milk, and non-dairy milks do not qualify. Don’t rely on non-dairy milks for your nutrient intakes. Those are shoes they’ll never fill.
Instead, use non-dairy milks to make nutrient-dense smoothies. Use them in your coffee. Make protein shakes with them. In short, use these non-dairy plant-based milks to make it easier to eat more nutrient-dense foods.
Before you run out to buy cashew milk or pea milk or something similar, I will say this: I’m a fan of dairy. It’s a nutrient-dense source of bioavailable protein, healthy fat, calcium, vitamin K2, and other important and helpful compounds. If you can eat it without tolerance issues, you probably should. And if you can’t, you may be able to tolerate other animal milks, like goat’s milk. Many people who can’t do cow dairy can handle goat. It’s worth a try.
What about you? What’s your favorite non-dairy milk? Do you have any plant-based milks that you swear by?
Onuegbu AJ, Olisekodiaka JM, Irogue SE, et al. Consumption of Soymilk Reduces Lipid Peroxidation But May Lower Micronutrient Status in Apparently Healthy Individuals. J Med Food. 2018;21(5):506-510.
Hon KL, Tsang YC, Poon TC, et al. Dairy and nondairy beverage consumption for childhood atopic eczema: what health advice to give?. Clin Exp Dermatol. 2016;41(2):129-37.
Babault N, Païzis C, Deley G, et al. Pea proteins oral supplementation promotes muscle thickness gains during resistance training: a double-blind, randomized, Placebo-controlled clinical trial vs. Whey protein. J Int Soc Sports Nutr. 2015;12(1):3.
Wolever TMS, Jenkins AL, Prudence K, et al. Effect of adding oat bran to instant oatmeal on glycaemic response in humans – a study to establish the minimum effective dose of oat ?-glucan. Food Funct. 2018;9(3):1692-1700.
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For today’s edition of Dear Mark, I’m answering a couple of questions from the comment sections of the last couple weeks. First, it’s been established that fasting and exercise both raise growth hormone. What about fasted exercise—does that have an even stronger effect? And what about continuing to fast after your fasted workout? Then, I discuss the inevitability (or not) of wear and tear on the arteries from blood flow-induced shear stress. Is shear stress “bad,” or do certain factors make it worse?
Let’s dig in.
So fasting raises growth hormone levels? Interesting. So does weight lifting. I’ll bet fasted weight workouts would be pretty powerful.
They do, and they are.
What’s even better is to work out in a fasted state and keep fasting after the workout. This keeps the GH spike going even longer. And in my “just so story” imagination—which is actually quite accurate, judging from real world hunter-gatherers—it mirrors the circumstances of our Paleolithic ancestors. You’d get up early to go hunting without having eaten. You’d expend a lot of energy on the hunt. You’d make the kill, procure the food. And then you’d bring it back to camp to finally eat. Maybe you’d pass the heart and liver around the circle before heading back. And sometimes, you just didn’t make the kill. You didn’t eat at all.
Makes sense, right? Fasting, doing something physical, and continuing to fast shouldn’t be a monumental undertaking. It should be well within the realm of possibility for the average person.
Now, I wouldn’t do this all the time. There is such a thing as too much of a good thing. A hormetic stressor can become a plain old stressor if it’s prolonged for too long. Instead, I would throw post-fasted-workout fasting in on an occasional basis.
Nor would I expect huge “gains” from this. Physiological growth hormone production won’t make you huge or shredded. In fact, workout-related increases in testosterone and growth hormone don’t actually correlate with gains in hypertrophy. Instead, I’d expect more intangible benefits, things you won’t notice right away. It’s important in cognition. It helps maintain bone health, organ reserve, and general cellular regeneration. It’s great for burning fat.
Growth hormone does way more than promote overt muscular growth.
In the linked article it says:
“Endothelial cell dysfunction is an initial step in atherosclerotic lesion formation and is more likely to occur at arterial curves and branches that are subjected to low shear stress and disturbed blood flow (atherosclerosis prone areas) (7,8). These mechanical stimuli activate signaling pathways leading to a dysfunctional endothelium lining that is barrier compromised, prothrombotic, and proinflammatory.
So it seems that endothelial disfunction comes first, triggered by blood flow stresses. It’s common wear and tear in exposed areas. The patched knees on jeans. Managing endothelial health and healing may slow or diminish rate of progression or is it mostly too late for that?
I’m not a doctor. This isn’t medical advice. This is just speculation.
I find it rather hard to believe that healthy arteries are inherently fragile and prone to damage and incapable of weathering the “stress” of blood flowing through them, even at the “susceptible” curves. I find it more likely that poor health, poor diets, and poor lifestyles make us more susceptible to otherwise normal stresses.
Do the mechanical stimuli weaken the endothelium in people with healthy levels of nitric oxide production? Or are we talking about people whose poor nitric oxide status is exacerbating the damaging blood flow patterns, leaving their endothelium vulnerable to atherosclerosis?
Think about how much context matters in our response to stimuli. If you’re shy around girls, a school dance will be a traumatic experience. If you’re comfortable around girls, a school dance will be a great experience. If you’re weak, lifting a barbell will be scary, and you may injure yourself. If you’re strong, lifting a barbell will be second nature, and you may get stronger. The baseline context determines the quality of the response.
I’d argue that blood flowing through your arteries should be a commonplace occurrence. It shouldn’t be a traumatic experience. Now, maybe I’m wrong. Maybe it is stressful regardless of the baseline endothelial health and the amount of nitric oxide you produce. Maybe it’s just a matter of time. But:
- We know that, as you quote, atherosclerosis tends to occur at bends and curves of the arteries—the places most likely to be subject to “disturbed flow” patterns.
- We know that “laminar flow”—blood flowing smoothly through the artery—is protective of the endothelial wall, promoting anti-inflammatory effects and making the endothelium more resistant to damage.
- We know that “disturbed flow” has an opposing effect on endothelial health, promoting inflammatory effects and rendering the endothelium more susceptible to damage. This increases atherosclerosis.
- The question I’m wondering is if “disturbed flow” at the curves and bends of the arteries is inevitable or not. And if disturbed flow is always “bad.”
- We know that hyperglycemia—high blood sugar—makes disturbed blood flow more damaging to arterial walls. Diabetics have higher rates of atherosclerosis because their elevated blood sugar interacts with disturbed blood flow patterns.
- We know that nitric oxide increases vasodilation in response to shear stress—widening the arteries to accommodate the increased stress and mitigate the damage done. We know that people with hypertension don’t get the same vasodilatory benefits from nitric oxide.
- We know that “functional increases” of shear stress attained via exercise increase nitric oxide and oxygen production and induce autophagy (cellular cleanup) in the endothelial walls.
That sounds like there are a lot of factors that increases and mitigate the effects of shear stress on the endothelial wall. It sounds like some factors make shear stress more damaging, and some factors make it less. There may even be factors, like exercise, that make shear stress healthy.
This topic is really pretty interesting to me. It deserves a deeper dive, don’t you think?
What about you, folks? What’s your take on fasted workouts and GH secretion? Ever try one?
And do you think your arteries are doomed to fall apart at the seams?
Nyberg F, Hallberg M. Growth hormone and cognitive function. Nat Rev Endocrinol. 2013;9(6):357-65.
Park SK, La salle DT, Cerbie J, et al. Elevated arterial shear rate increases indexes of endothelial cell autophagy and nitric oxide synthase activation in humans. Am J Physiol Heart Circ Physiol. 2019;316(1):H106-H112.
The post Dear Mark: Fasting, Training, and Growth Hormone; Wear and Tear on the Arteries appeared first on Mark’s Daily Apple.
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For today’s edition of Dear Mark, I’m answering three questions. First, can LDL actually infiltrate the arteries, or is there more to the story? Malcolm Kendrick says there’s more to the story, so I dig into some literature to see if they corroborate his position. Second, is New Zealand farmed salmon good to eat? And finally, what should you do about elevated ferritin levels—and why else might they be elevated if not because of your iron?
My reading of this post by Malcolm Kendrick MD is that LDL particles cannot infiltrate the endothelial lining of our arteries:
Great read. Malcolm Kendrick is consistently fascinating, insightful, and enlightening.
He’s basically suggesting that LDL particles can’t manhandle their way into the artery wall, which are equipped with tight junctions—the same kind that regulate passage through our gut lining. Something has to “allow” them in. The something he finds most plausible is injury, trauma, or insult to the endothelial lining (artery wall, for lack of a better phrase).
A free public textbook available on PubMed since last month called The Role of Lipids and Lipoproteins in Atherosclerosis tackles the topic head on. In the abstract, they say:
Population studies have demonstrated that elevated levels of LDL cholesterol and apolipoprotein B (apoB) 100 [note: ApoB is a stand-in for LDL particle number, as each LDL-P has an ApoB attached to it], the main structural protein of LDL, are directly associated with risk for atherosclerotic cardiovascular events (ASCVE). Indeed, infiltration and retention of apoB containing lipoproteins in the artery wall is a critical initiating event that sparks an inflammatory response and promotes the development of atherosclerosis.
This seems to posit that infiltration of the LDL particle into the artery wall is a critical initiating event. But is it the critical initiating event? Does something come before it? How does the infiltration happen, exactly? Moving on:
Arterial injury causes endothelial dysfunction promoting modification of apoB containing lipoproteins and infiltration of monocytes into the subendothelial space. Internalization of the apoB containing lipoproteins by macrophages promotes foam cell formation, which is the hallmark of the fatty streak phase of atherosclerosis. Macrophage inflammation results in enhanced oxidative stress and cytokine/chemokine secretion, causing more LDL/remnant oxidation, endothelial cell activation, monocyte recruitment, and foam cell formation.
If I’m reading this correctly, they’re saying that “arterial injury” is another critical initiating event—perhaps the critical initiating event, since the injury causes “endothelial dysfunction,” which in turn modifies (or oxidizes) the LDL particles. But wait: so they’re saying the LDL particles are already there when the arterial injury occurs. They’ve already made it into the endothelial walls, and they’re just…waiting around until the arteries get injured. Okay, okay, but, just like Malcolm Kendrick points out, nowhere in the abstract have the authors actually identified how the LDL particles enter the endothelial lining. Maybe it’s “common knowledge,” but I’d like to see it explained in full.
In atherosclerosis susceptible regions, reduced expression of eNOS and SOD leads to compromised endothelial barrier integrity (Figure 1), leading to increased accumulation and retention of subendothelial atherogenic apolipoprotein B (apoB)-containing lipoproteins (low-density lipoproteins (LDL)) and remnants of very low-density lipoproteins (VLDL) and chylomicrons)
Ah ha! So, in regions of the arteries that are prone to atherosclerosis, low levels of nitric oxide synthase (eNOS)—the method our bodies use to make nitric oxide, a compound that improves endothelial function and makes our blood flow better—and superoxide dismutase—an important antioxidant our bodies make—compromise the integrity of the arterial lining. The compromised arterial lining allows more LDL particles to gain entry and stick around. So, are low levels of nitric oxide and impaired antioxidant activity the critical initiators? That’s pretty much what Malcolm Kendrick said in his blog post.
Still—high LDL particle numbers are a strong predictor of heart disease risk, at least in the studies we have. They clearly have something to do with the whole process. They’re necessary, but are they sufficient? And how necessary are they? And how might that necessariness (yes, a word) be modified by diet?
I’ll explore this more in the future.
In regards to the oily fish article (and more indirectly given the omega 6 concern- the Israeli Paradox) What do you think of NZ farmed salmon? I’m in Australia, & occasionally like a fresh piece of salmon- there are no wild caught available here sadly, but I am wondering how it measures up as an alternative?
Last year, I explored the health effects of eating farmed salmon and found that it’s actually a pretty decent alternative to wild-caught salmon, at least from a personal health standpoint—the environmental impact may be a different story.
I wasn’t able to pull up any nutrition data for New Zealand farmed salmon, called King or Chinook salmon. Next time you’re at the store, check out the nutritional facts on a NZ farmed salmon product, like smoked salmon. The producer will have actually had to run tests on their products to determine the omega-3 content, so it should be pretty accurate. Fresh is great but won’t have the nutritional facts available. I don’t see why NZ salmon would be any worse than the farmed salmon I discussed last year.
According to the NZ salmon folks, they don’t use any pesticides or antibiotics. That’s fantastic if true.
I used to eat a lot of King salmon over in California, and it’s fantastic stuff. Very fatty, full of omega-3s. If your farmed King salmon comes from similar stock, go for it.
ok can someone tell me how to reduce ferritin? Is is just by giving blood?
Giving blood is a reliable method for reducing ferritin. It’s quick, effective, simple, and you’re helping out another person in need. Multiple wins.
Someone in the comment board recommended avoiding cast iron pans in addition to giving blood. While using cast iron pans can increase iron intake and even change iron status in severe deficiency, most don’t have to go that far. Giving blood will cover you.
Ferritin is also an acute phase reactant, a marker of inflammation—it goes up in response to infections (bacterial or viral) and intense exercise (an Ironman will increase ferritin). In fact, in obese and overweight Pakistani adults, elevated ferritin seems to be a reliable indicator of inflammatory status rather than iron status.
Thanks for reading, everyone. Take care and be well!
Birgegård G, Hällgren R, Killander A, Strömberg A, Venge P, Wide L. Serum ferritin during infection. A longitudinal study. Scand J Haematol. 1978;21(4):333-40.
Comassi M, Vitolo E, Pratali L, et al. Acute effects of different degrees of ultra-endurance exercise on systemic inflammatory responses. Intern Med J. 2015;45(1):74-9.
The post Dear Mark: How Does LDL Even Penetrate the Arteries, New Zealand Farmed Salmon, Elevated Ferritin appeared first on Mark’s Daily Apple.
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