For today’s edition of Dear Mark, I’m answering five questions taken from this Twitter thread. First, does collagen offer anything special above and beyond glycine? Second, what’s the relationship between keto and gallstones? Third, do I recommend eating raw liver, and why or why not? Fourth, why does one reader’s scalp itch when eating stevia? And finally, what’s the best way to lose fat and gain muscle at the same time?
If collagen is broken down into amino acids in the gut before being absorbed, is it just the amino acid profile (i.e. high glycine) that makes it so beneficial? Anything else?
Glycine is a major reason why we need collagen in our diets, but it’s not the only one.
When you feed people collagen derived from pork skin, chicken feet, and cartilage, many different collagenous peptides appear in the blood. You don’t get any of these from isolated glycine:
Proline-hydroxyproline, a peptide with protective effects on osteoarthritic cartilage degradation.
Glycine-proline-hydroxyproline, a peptide that makes it into the blood and turns into proline-hydroxyproline, which makes it into the skin.
Collagen peptides have beneficial effects above and beyond glycine alone—although glycine is great for balancing out methionine intake from muscle meat consumption. It’s also been used in several studies to improve multiple markers of sleep quality.
A family member has a complicated health history including cancer and wants to eat keto. But, now she finds she has gallstones. Any thoughts on a good way to attack this complicated issue?
Has your family member already gone keto? Did going keto come before the gallstone reveal?
If so, that’s actually normal.
The primary role of the gallbladder is to collect bile from the liver, concentrate it into potent super-bile (my term), and release the concentrated bile to break up incoming dietary fat into smaller molecules that lipase can attack and digest. Dietary fat is the biggest driver of gallbladder emptying.
If the gallbladder isn’t regularly emptied, gallstones can form. Usually made of hardened cholesterol, gallstones are quite common and often produce no symptoms. Problems arise when normal gallbladder emptying flushes out a stone small enough to make it into but too large to pass through the bile duct and a blockage occurs. Gallstones can also directly damage the walls of the gallbladder, leading to cholecystis, or gallbladder inflammation.
A high-fat diet can exacerbate or even uncover gallstone issues by increasing gallbladder emptying. Remember: the more fat you eat, the more often you empty your gallbladder—and everything in it.
But high-fat diets don’t generally cause gallstones to form. They only reveal pre-existing ones. The biggest risk factors for gallstone formation are:
- A high intake of high-glycemic carbohydrates.
- High estrogen levels, which concentrate cholesterol deposition in the gallbladder. This is why women, especially pregnant women and/or those taking hormonal birth control, are more likely to have gallstones.
- Obesity, which also increases cholesterol levels in the gallbladder.
- Weight loss, with a caveat: high-fat weight loss diets reduce and even prevent gallstone formation. In fact, when you compare people who lose weight on a low-fat diet to those who lose it on a high-fat diet, research shows that 45% of the low-fatters develop gallstones while none of the high-fatters develop them.
Once the gallstones are all clear, keep up with the keto eating, as eating more fat will keep your gallbladder regularly flushed and clear of stones.
Is Raw Liver safe to eat?
I’ve eaten raw liver before. I know people who eat raw liver. I can’t recommend it, however, because I don’t know what kind of liver you have access to. Who raised the animal? What did it eat? What were the processing conditions?
But because I know people are going to try this…
Freeze it first for several days.
Buy from a trusted source.
Buy only liver from well-raised, grass-fed, organic animals.
If it looks unhealthy, it probably is. I would never eat a pale, flaccid liver with ugly spots, cooked or raw.
Don’t eat raw (or even medium) pork liver. A huge percentage of pigs carry the Hepatitis E virus, which is transmittable to humans and concentrates in the liver.
Why does stevia make my scalp itch?
Stevia can be an allergen actually. It’s not very common, but as more and more people use stevia, more will be revealed to have an allergic reaction.
I’d just skip it.
Is it possible to gain muscle and lose weight with properly timed IF around workouts?
It is possible, although you may not actually lose weight, but rather body fat (which is better).
The best way I’ve seen people do it is the classic Leangains method.
Fast from 8 p.m. to 12-1 noon.
Fasted workout in the afternoon, perhaps with a little BCAA or whey isolate before the workout. Lift heavy, compound movements.
After the workout, walk for 20 minutes. Brisk pace to utilize all the free fatty acids swimming around.
Then eat. If you’re going to eat carbs, do it in this meal and keep the fat low-to-moderate. Load up on protein.
Eat as much as you like until 8 p.m.—the end of your eating window. Favor protein and, again, if you’re eating carbs keep fat lower than usual.
Maintain the fasting period every day. On rest days, eat low/no carb and higher fat. Protein always high. Go for walks on rest days.
That’s it. That usually works really well, but it presupposes you have a flexible schedule and can actually train in the afternoon whenever you want. Your mileage may vary—though it will work at any time.
Muscle gain won’t be as rapid as it would drinking a gallon of milk a day, eating pizza smoothies, and cramming ice cream made with whey protein at night, but it will minimize fat gain and perhaps even help you lose fat as you gain muscle. No guarantees, but it’s the best method I’ve seen.
That’s it for today, folks. Thanks for reading, take care, and be sure to leave a comment down below if you have any questions.
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For today’s edition of Dear Mark, I’m answering six questions from some of my Twitter followers. Yesterday, I asked the community for questions and got some great ones in return. For instance, how much oily fish should one eat each week? And how does diet and nutrition influence posture and coordination? Third, how should a low-carb diet affect acid reflux? Fourth, is there a good replacement for whey protein? Fifth, does milk with your coffee break a fast? And sixth, how does one stop viewing and using food as an indulgence? I’ll get to the rest next time.
I’m wondering, should the average person limit oily fish per week? Kresser says eat up to a pound. Masterjohn says fish PUFA should be no more than 4-8 ounces per week.
I’ll defer to the Chrises on matters concerning biochemistry, but here’s how I look at fish consumption:
It’s very self-regulating. I’ll go on wild salmon benders where I’m eating it every single day for a week or two, then none for awhile. Back in Malibu, I used to have my fish guy save King salmon heads for me, which I would then roast—the things were huge, fatty, and extremely filling. Between the brains, the cheeks, the collars, and all the skin, I reckon a King salmon head had about 20-30 grams of omega-3 fatty acids. Maybe more. Every time I ate one of those I didn’t feel like even looking at fish (or fish oil) for a week or so.
Ancestral background matters here. Your average Inuit is going to have a very high tolerance of (and likely requirement for) dietary long-chained omega-3 fatty acids because that’s the environment his or her ancestors inhabited. As someone of Northern European ancestry, I have a higher baseline tolerance for and requirement of long chained omega-3s; my ancestral food environment was very high in cold fatty fish. Someone with South Asian background is going to be better at converting shorter-chained omega-3s (ALA) into the long chained ones, so they don’t need to eat as much marine fat as a guy like me.
What is the influence of diet and nutrition on posture and coordination?
First and foremost, the micronutrients and macronutrients in the food we eat help program and provide substrate for the hormones, neurotransmitters, proteins, and energy used to coordinate movements and maintain posture. Every physiological process has a physical corollary; a good diet full of vital vitamins and minerals and absent toxic foods is a diet that supports good posture, energy generation, and movement.
One specific example is thiamine, a B-vitamin. Extreme thiamine deficiency is a disease called beri-beri, characterized by nerve tremors, difficulty moving, and extreme fatigue (among other serious symptoms). Almost no one in developed nations gets beri-beri anymore, but low level thiamine deficiency is common enough and can most likely result in deficient neuromuscular coordination.
I know that a diet deficient in collagenous materials (collagen powder, connective tissue, bone broth, skin) will worsen the health and resilience of your bones, tendons, ligaments, and fascia—the connective tissues that support and enable your mobility.
And finally, a diet that results in low energy levels, unwanted weight gain, and bad aesthetics will worsen your mental health and leave you down in the dumps—itself an independent predictor of poor posture.
But this is a difficult question to answer with specific references to individual nutrients or foods because no one I’m aware of is running studies on the connection between diet and posture. Just know that “it matters.”
Perhaps I’ll revisit this in greater depth.
What is a low-carbber to do if he deals with acid reflux? I’m told that a high fat diet aggravates symptoms… and it has for me. Is there any way I can stick to a healthy diet without having to resort to a “conventional wisdom” reflux plan?
That’s pretty strange. Normally, low-carb diets are great for acid reflux. There’s actually a lot of evidence showing that low-carb is the best diet for the condition, even a “cure.”
However, there’s also evidence that high caloric density within meals (in other words, huge meals) can worsen GERD severity and high fat intakes can increase the frequency of acid reflux episodes.
How do we square this evidence away?
In one study, the very low carb (under 20 grams a day) anti-GERD diet that treated obese individuals allowed unlimited meat and eggs with limited portions of hard cheeses and low-carb vegetables. That’s a standard Primal diet, but it doesn’t say anything about the fat content of the diet. If you’re eating ribeyes, that could be a pretty high-fat diet. If you’re eating sirloin, that could be a very high-protein and moderate-fat diet.
I’d stay low carb, but try eating more protein and not overeating. Avoid huge meals; don’t drink melted butter.
I’m allergic to whey protein. What can I use instead?
Does coffee with milk impact fasting effects on keto?
It depends on how much milk you’re using.
Milk itself is rather insulinogenic, owing to its lactose and protein content. That doesn’t mean it’s bad, but anything more than a few tablespoons will effectively “break the fast.” I’d opt for heavy cream over milk. It tastes better in coffee, provokes a much lower insulin response, is mostly just fat, and thus allows the fat-burning metabolism of fasting to continue relatively unabated.
Hello Mark! Thank you for everything! – Question – what can be done to change how food is viewed? As life – not as a indulgent part of our lives?
That’s a good one.
You have to LIVE. You have to stop mulling over the thoughts swirling through your head. You have to go outside and do the things you’ve been considering doing.
I know people who have all the knowledge they’d ever need to know (and some they wouldn’t) about health and human happiness and nutrition and productivity and business, yet they act on very little of it. Instead of taking the lessons to heart and living out the conclusions of the latest study, they just move on to the next bit of research.
Food, like any substance or activity that triggers the reward systems of our brains, can fill a void in a destructive way. Fill that void with meaning, with love, with purpose and direction. The food will still taste good (or even better), but it won’t become an end in itself.
That’s it for today, everyone. Take care. Be well. And write in down below with any further questions or comments!
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For today’s edition of Dear Mark, I’m answering a few questions. First came in from an email and regards a new study showing a link between chicken eating and several types of cancers (melanoma, prostate cancer, non-Hodgkin’s lymphoma) among British adults. What do I think of the study? Second, did I really tell people not to neuter or spay their dogs? Third, can dogs take collagen powder, and if not, are there any alternatives? And last, I address a comment about early time restricted feeding.
What are your thoughts on this study that showed a link between chicken consumption and cancer?
Okay, let’s do this.
First of all, the link wasn’t between chicken and cancer, it was between chicken and specific cancers. The specificity suggests that there may be something going on here.
Look, I love a good roasted chicken. There’s almost nothing quite like crispy chicken skin.
But today’s birds are exceedingly high in omega-6 fatty acids. Your standard battery-fed bird—which is what most people in these studies are eating—eats a diet of soybean oil, corn byproducts, and other junk high in omega-6 fats. Those dietary fats are incorporated into the animal’s tissues, which get incorporated into your dinner, which get incorporated into your body.
Most of the cancers in question have been previously and mechanistically linked to elevated omega-6 levels and/or reduced omega-3 levels.
Melanoma and other skin cancers?
One study out of Australia—land of skin cancer—found that adults with the highest serum concentrations of DHA and EPA had the least “cutaneous p53 expression.” When your skin is in danger of damage from the sun, p53 expression is upregulated to protect it. The fact that p53 expression was low suggests that the skin wasn’t in danger; the omega-3s were protecting the skin and reducing the “perceived” (and real) danger. Acute intakes of EPA reduce the inflammatory skin response to UV radiation.
One problem of excess omega-6 fats is that they crowd out DHA and EPA from the serum and cellular membranes. The more omega-6 in your diet, the less DHA and EPA you’ll have laying around to protect you from the sun.
Anti-inflammatory omega-3 fatty acids (found in seafood and fish oil) are generally linked to lower rates of prostatic inflammation and a less carcinogenic environment; omega-6 fatty acids can trigger disease progression. A 2001 study of over 6,000 Swedish men found that the folks eating the most fish had drastically lower rates of prostate cancer than those eating the least. Another study from New Zealand found that men with the highest DHA (an omega-3 found in fish) markers slashed their prostate cancer risk by 38% compared to the men with the lowest DHA levels.
I didn’t see any solid evidence one way or the other with non-Hodgkin’s lymphoma, but omega-3 intake is linked to a lower risk. If that’s a causative connection, and excessive omega-6 is competing with your omega-3s for physiological supremacy in the body, that could increase the risk of non-Hodgkin’s lymphoma. But again, this isn’t a sure thing.
I couldn’t find the study mentioned in the article, but according to the article the scientists focused only on “meat consumption patterns.” They weren’t looking at other foods or nutrients—just what kind of meat they ate. If that’s the case, they wouldn’t have controlled for the intakes of fries and mayo and other junk foods often consumed alongside chicken.
British are eating more chicken than ever before, and they’re moving increasingly away from big family chicken meals—roasts and such—toward individual chicken meals for one—pasta and stir fries.
The fastest growing fast food in Britain is fried chicken. That’s chicken that’s been breaded in flour and fried in reused, rancid vegetable oil, then served alongside french fries and smothered in mayonnaise.
Now, I’m not going to say you should eat chicken for every meal. Red meat, fish, and eggs offer far more nutrients than chicken, and they’re much lower in omega-6 fatty acids. But I’m not going to shy away from a good roast chicken, or even a chicken chili, especially if I’m using well-raised, preferably pasture-raised chickens.
I’m sorry, are you recommending people DON”T spay/neuter their pets?!? Am I reading an article in The Onion? Is it April 1st? What the hell is going on??? Dear Bob Barker is rolling in his grave and thousands of dogs and cats will be unnecessarily euthanized today (and tomorrow, and the next day, and the next….) because there are just too many of them.
Nope, I’m just recommending that people read the literature and understand that spaying/neutering can have unwanted health effects, especially if you do it too early.
Most experts agree that fixing the dog after they’ve stopped growing is pretty safe and reduces the risk of later health issues. That to me is a good compromise.
And I’m not speaking to the masses. I’m speaking to the people reading this who are in general a reliable, conscientious bunch.
Also, a vasectomy is a good option that few people consider but more vets are offering.
Mark, would there be any harm or benefit in throwing in a scoop of collagen on top of my dog’s raw meat&veggie patty?
You could definitely do it. Just be aware that I’ve found some dogs have bad digestive responses to protein powders of any kind. A raw chicken foot will do the trick, if you’re up to trying it. I’ve also seen freeze-dried tendons in pet stores.
After a few years of IDF that had me mostly eating between noon and 8, I recently tried early time-restricted feeding (eTRF) and man it seems to work well for me. I did it under the influence of this guy’s posts: https://www.patreon.com/CaloriesProper/posts
And I learned about him from an MDA post…
Yes, some people for whom intermittent fasting doesn’t seem to be working may want to switch to an early feeding system. The vast majority of people who skip meals every day are skipping breakfast. It’s easier that way, you can just have some coffee and keep trucking. But not everyone benefits from it. If that’s you, try eating breakfast (and lunch) and skipping dinner.
And yes, Bill Lagakos is a great resource. Always love his stuff, even or especially if it conflicts with something I held to be true.
Thanks for reading, everyone. If you have any more questions, drop them down below!
The post Dear Mark: Does Chicken Cause Cancer, Should You Neuter, Dog Collagen, and Skipping Dinner appeared first on Mark’s Daily Apple.
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Yesterday, I explained the potential benefits and drawbacks of intermittent fasting for athletes. Maybe yesterday’s post intrigued you. Maybe you’re curious about this whole intermittent fasting thing but don’t want to sacrifice your performance in the gym or on the field.
What are my specific recommendations for athletes who wish to explore intermittent fasting? I’ve got twelve…plus some details about my own fasting and workout routine.
1) Use Restricted Eating Windows Over All-day Fasts
Athletes who want to lean out or maintain strength and performance while lowering body weight might have more success with shortened eating windows than with all day fasts or “one meal a day.” Fast for 12-16 hours, train, and break the fast. Then have 8-12 hours to eat. This will give you a nice block of almost pure fat-burning with enough of an eating window to get the calories you need to grow and maintain muscle and to recover from your training.
2) Small Amount Of Protein Pre-workout May Help
Having a small bit of protein (20 grams whey or maybe 10 grams BCAAs) can help if truly fasted workouts are too hard.
3) Fasted Walks In the Mornings
Whether you skip breakfast or dinner, you’ll have a block of time in the mornings before eating anything. That’s when fat-burning will be upregulated, and brisk fasted walking is a nice way to enhance it.
4) Light Cardio After a Fasted Lifting Session
A heavy lifting session will get free fatty acids liberated from your adipose tissue, particularly if you’re fasted. Doing some very light cardio after your weights should in theory help you utilize all that mobilized adipose tissue. Go for a 20-minute walk, do ten minutes on the bike, or something similar.
5) “Train Fasted, Race Fed”
This is a more intense version of “train low-carb, race high-carb,” a popular and well-researched method of enhancing fat adaptation and increasing fuel efficiency in endurance athletes. Training in a fasted state “forces” the athlete to burn stored fat because, well, there isn’t a whole lot of carbohydrate available. Plus, fasting necessarily increases the circulation of free fatty acids, which can be burned for fuel. This applies to everyone, not just people “racing.” The trick is to train in a fasted state (if you find it helps) and compete (whether it’s CrossFit games, a basketball game, a lifting competition, etc.) in a fed state—as long as it seems to improve your performance.
6) Most Of the Time, Break the Fast Shortly After the Workout
If you’re skipping dinner and eating breakfast, try morning workouts. If you’re skipping breakfast and eating lunch, try afternoon workouts.
7) Every So Often, Continue the Fast After a Workout
This enhances secretion of growth hormone, which fasting already elevates. Don’t make this an every-workout habit, though. Diminishing returns and all.
8) Every Athlete Can Probably Benefit From the Occasional Longer Fast (24 hours+)
This will normalize inflammation, boost growth hormone, and upregulate autophagy, giving you all the necessary co-factors for rest and recovery. Tissues will heal, joints will recover. Do nothing more on these days than easy movement (walks, hikes, bike rides, swims). Time this fast away from competition because your performance may suffer. Do these once a week or every other week.
9) If You Have Joint Problems (or Want To Avoid Them), Take Collagen or Drink Bone Broth Before a Fasted Workout
Fifteen grams of pre-workout collagen or gelatin with a few hundred milligrams of vitamin C has been shown to improve collagen synthesis in connective tissue, and collagen shouldn’t disrupt the fast too much.
10) More Isn’t Better
I see this a lot, especially with endurance athletes who get into intermittent fasting. They start eating breakfast later and see their times drop and their body fat disappear. They feel lighter on their feet, faster, just better all around. So they push breakfast even later and maintain the benefits, even building on them. Pretty soon they’re skipping lunch, and their performance drops off a cliff. When trying to use fasting to improve athletic performance, less is more generally speaking.
11) Realize That Exercise and Fasting Are Additive
For the average couch potato to get the benefits of fasting, he or she might need to go 16 hours without food. The couch potato isn’t liberating body fat through training. The couch potato isn’t getting into ketosis through physical activity. The couch potato isn’t increasing mitochondrial density—the power plants of the cells which actually process fuel—with exercise. The athlete is doing all those things. For the athlete, many of the benefits of fasting will appear with smaller fasting windows.
12) Consider Sleeping Low
“Sleeping low” is an alternative to full-on fasting that actually seems to work well. This is how you do it:
- Afternoon workout. This should be something intense that depletes glycogen—sprinting, metabolic conditioning, high volume strength training, high intensity endurance workouts.
- Eat protein and fat at dinner, no carbs. You’re not refilling your glycogen. You’re reveling in your lack of glycogen.
- Wake up and do low-intensity cardio (walking, cycling, hiking, swimming) before breakfast. Eat carbs at breakfast.
When a group of triathletes followed this protocol, both their submaximal efficiency and supramaximal capacity. High submaximal efficiency means you get more power out of each stroke/pedal/step with less energy required. Your “easy pace” becomes faster and more powerful. High supramaximal capacity means you can last longer at your maximum power output.
It’s likely that full-on fasting could be integrated into this protocol. Maybe with a compressed eating window leading up to the afternoon workout.
A Few Words About My Routine:
A few people have asked, so I’ll give an overview of how I approach this topic for myself:
Every day, I do time-restricted feeding. This isn’t a formal declaration I make with myself every day. It’s not really a schedule. It just happens naturally. I wake up and most days I’m not very hungry for anything but a cup of coffee, so I “skip” breakfast and eat my first meal around one in the afternoon following a workout.
Most of my workouts are performed in a fasted state, and I usually keep fasting after the workout for a few hours. I’ll extend that fast after the workout to really take advantage of the increased secretion of growth hormone. I’m not really trying to “get big” or anything, I’m more interested in maintaining body comp and function and increasing longevity. Natural pulses in growth hormone help with that.
Before most workouts, I’ll do some Collagen Fuel. This doesn’t seem to impair my fast and it helps me keep my joints working well—an important part of aging.
Half an hour before my weekly Ultimate Frisbee game, I’ll also include a little Primal Fuel (my whey isolate powder). This just helps me perform better. I’m not going to lose. (By the way, I’ll talk more about protein types for different functions in an upcoming post.)
That’s it for today, folks. Have you tried any of these fasting workout tips? Have they worked? Do you have any more to add? Let us know down below!
Marquet LA, Brisswalter J, Louis J, et al. Enhanced Endurance Performance by Periodization of Carbohydrate Intake: “Sleep Low” Strategy. Med Sci Sports Exerc. 2016;48(4):663-72.
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To the average person, the idea of elite athletes skipping meals sounds like pure madness. Athletes are fine-tuned, well-oiled machines. Machines need fuel. You don’t see race car drivers running on empty to “promote training adaptations” in their vehicles. No, high performance requires high energy reserves.
Athletes need to eat, and eat well. Right?
But humans aren’t machines. We’re biological. The car doesn’t respond to training stress, but we do. We adapt, grow, recover, and build new capabilities in response to the stress we endure. You expose yourself to a ton of stress, recover from that stress, and end up stronger/fitter/faster on net. That’s training. And sometimes, high stress is exactly what we need to progress—a few heavy sets of squats, some rounds on the Airdyne, a killer CrossFit workout—as long as you can recover from it. A major modulator of our stress is the amount of food we have coming in. At least in theory, exercising in a fasted state could provoke a powerful adaptive response that athletes would find helpful.
So, does it stack up? What exactly can intermittent fasting offer athletes?
Benefits Of Fasting For Athletes
Increases In Growth Hormone
Growth hormone helps spur, well, growth. It improves immune function. It builds muscle, bone, and cartilage. Kids are swimming in the stuff, and they heal like Wolverine. Older adults who inject it enjoy improved wound healing and workout recovery. That’s why it’s a banned substance in professional athletics, and it’s why natural ways to augment growth hormone secretion can be very helpful to athletes of all stripes.
Fasting increases growth hormone, most likely as a way to limit harmful tissue degeneration and preserve muscle; so does exercise. Once or twice a week, I like to fast after workouts to extend and expand the GH release. That’s a slightly more extreme version of post-workout carb abstention, but it’s the same idea: withholding food and forcing your body to adapt. This increases growth hormone (important for fat burning and cellular repair) and speeds up fat adaptation.
Improvement Of Metabolic Flexibility
In experienced male lifters (5-year history of 3-5 days/week training upper and lower body, drawn from advertisements placed in bodybuilding gyms), fasting for 16 hours a day and eating for 8 increased metabolic flexibility.
Metabolic flexibility is the ease with which a person is able to switch between sources of energy—from carbs to fat and back again. For the average person interested in health and longevity, maintaining metabolic flexibility is an important way to live a healthy life. For an athlete interested in performance, health, and longevity, metabolic flexibility is absolutely essential.
If you’re metabolically flexible, you can burn fat for longer before switching over to carbs. You can burn carbs when you actually need them, right away. And afterwards, you can switch back into passive fat-burning mode to keep unnecessary carb cravings and insulin low and improve recovery.
Reduction Of Inflammation
To attain the training effect, an athlete must incur a big blast of inflammation (from the exercise) and then recover from that inflammation. Blunting the initial inflammatory response with drugs and even mega-doses of vitamins will impair the training effect. You can also reduce the training effect by training too soon after a workout, thereby stacking inflammation.
You need the inflammation, but you also need the inflammation to subside. Both sides of the coin matter. What fasting does is improve your natural ability to dampen inflammation. You get the big inflammatory response of a tough workout.
This is where a fasted workout can really shine. When you’re fasted, you’re in a state of very low inflammation. And then you introduce the workout, and inflammation spikes. It’s a big response, a heightened response—and you must adapt to it. Oscillating between fasting, training, and feeding lets you hit those extremes, those margins where peak performance occurs.
Maintenance Of Energy Expenditure
There’s something revitalizing about going without food for a decent period of time and then feasting. You could spend the week restricting calories each day or use fasting to arrive at the same weekly caloric load and the effects will be different. Chronic calorie restriction enervates. Intermittent calorie restriction peppered with intermittent feasting energizes.
For an athlete, chronic calorie restriction spells doom. They need energy. They need to be able to expend energy when they need it. Luckily, studies show that intermittent fasting is one way to “reduce calories” without reducing energy expenditure. Perhaps the main reason is that IF doesn’t necessarily lower calories; it just changes when you get them. In the bodybuilder study, the athletes in both the fasting and the control groups ate about the same number of calories. But only the fasting group lost a lot of body fat, and they did this without suffering a drop in energy expenditure. Pretty cool stuff.
That said, you can overdo it. Too much fasting for too long will depress energy expenditure, as would happen with any kind of chronic calorie reduction. It’s just that fasting seems to stave off the drop in energy longer than other forms of “dieting,” especially if you maintain your calorie intake.
Concerns About Fasting For Athletes
May Reduce Testosterone
In the bodybuilder study, the group with the 8-hour eating window experienced a drop in testosterone. As T is essential for muscle protein synthesis, performance, strength, and general vitality, this could be problematic for athletes (particularly male ones). Despite the drop in testosterone, though, they still gained lean mass, lost fat, and got stronger—so it may not be practically relevant.
May Be Hard To Get Enough Calories To Gain Muscle or Recover
Athletes do need more fuel than the average person. A big draw of fasting for weight loss is that it makes it easier to reduce calories by erecting illusionary barriers that we nonetheless adhere to. If you only have an 8-hour eating window, you can’t eat outside of it. If you’re “fasting today,” you simply can’t eat. It makes things really simple for people who otherwise have trouble limiting food intake.
The flip-side is that it can make eating enough calories difficult, especially for athletes who do need more fuel than the average person. In a recent study, lifters who ate inside a 4-hour eating window had a 650 calorie daily deficit, lost a little bit of body fat but failed to gain any lean mass, while the control group—who ate more calories and protein—did gain lean mass. The fasting group simply wasn’t able to eat enough food or protein. Despite that, the 4-hour eating window group still gained upper and lower body strength, and they didn’t lose muscle mass. I suspect they could have gotten great results with a few hundred more calories of protein.
As is the case with every study that attempts to collate the individual experiences and results of hundreds of humans into “trends” and “averages,” there’s a wide variety of personal responses to fasting among athletes. The name of the game is experimentation—you have to see what works for you. This week I’ll give some specific recommendations for specific types of athletes, as well as my own experiences utilizing fasting in the pursuit of better physical performance.
For now, though, how has fasting worked for you and your athletic pursuits? Does it seem to help or hinder?
Moro, T., Tinsley, G., Bianco, A., Marcolin, G., Pacelli, Q.F., Battaglia, G., … & Paoli, A. (2016). Effects of eight weeks of time-restricted feeding (16/8) on basal metabolism, maximal strength, body composition, inflammation, and cardiovascular risk factors in resistance-trained males.J ournal of translational medicine, 14(1), 290.
Tinsley, G.M., Forsse, J.S., Butler, N.K., Paoli, A., Bane, A.A., La Bounty, P.M., … & Grandjean, P.W. (2017). Time-restricted feeding in young men performing resistance training: A randomized controlled trial. European journal of sport science, 17(2), 200-7.
The post Intermittent Fasting For Athletes: Benefits and Concerns appeared first on Mark’s Daily Apple.
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Today’s post is about dry fasting. I’ve covered plenty of other aspects of intermittent fasting, including recommendations around longer fasts, but lately I’ve gotten enough questions about this particular angle that I thought I’d address it.
Dry fasting is going without both food and fluid. That means no coffee, no tea, no broth, and no water or liquid of any kind (except the saliva you manage to produce). It’s an extreme type of fast whose fans and practitioners are adamant that it can resolve serious health issues. But does it? Is it safe? And what kind of research is available on it?
Where Does the Idea of Therapeutic Dry Fasting Come From?
The main proponent of dry fasting is a Russian doctor named Sergei Filonov. Filonov is still practicing from what I can tell, somewhere in the Altai mountains that span Central Asia. I found a very rough English translation of his book—Dry Medical Fasting: Myths and Realities. Difficult to read in full because it’s not a professional translation, but manageable in small chunks.
His basic thesis is that dry fasting creates a competitive environment between healthy cells, unhealthy cells, and pathogens for a scarce resource: water. The dry fast acts as a powerful selective pressure, allowing the strong cells to survive and the weak and dangerous cells to die off. The end result, according to Filonov, is that the immune system burns through the weak cells for energy and to conserve water for the viable cells, leading to a stronger organism overall. He points to how animals in nature will hole up in a safe, comfortable spot and take neither food nor water when recovering from serious conditions, illness, or injuries that prevent them from moving around. But when they’re able to move while recovering from more minor issues, they’ll drink water and abstain from food. I’m partial to this naturalistic line of thought, but I don’t know if the claims about animal behavior during sickness are true.
Another claim is that dry fasting speeds up fat loss relative to fasts that include water. There may be something to this, as body fat is actually a source of “metabolic water”—internal water the body can turn to when exogenous water is limited. Burning 100 grams of fat produces 110 grams of water, whereas burning the same amount of carbohydrate produces just 50 grams of water.
Are There Any Dry Fasting Studies?
Unfortunately, we don’t have many long term dry fasting studies. In fact, we have one 5-day study in healthy adults. For five days, ten healthy adults refrained from eating food or drinking water. Multiple physiological parameters were tracked daily, including bodyweight, kidney function, heart rate, electrolyte status, and circumference of the waist, hip, neck, and chest.
Participants lost weight (over 2 pounds a day) and inches off of various circumferences, including waist, hip, neck, and chest. The drop in waist circumference was particularly large—about eight centimeters by day five. Blood pressure, heart rate, oxygen saturation, sodium and potassium levels, creatinine, and urea all remained stable throughout the study. Creatinine clearance—which can be a marker of muscle breakdown but also a normal artifact of fasting—increased by up to 167%.
The most voluminous research we have on dry fasting is the Ramadan literature. During the month of Ramadan, practicing Muslims complete a daily dry fast—from sunup to sundown—every single day. They eat no food and drink no fluids during daylight hours, which, in the countries where Islam originally arose, run about 15-16 hours. These are shorter dry fasts than the 5-day fast detailed above.
What happens to health markers during Ramadan? Mostly good things.
- Almost everyone loses body fat. Few lose muscle. There’s no sign of overt dehydration.
- In fatty liver patients, Ramadan fasting lowers blood glucose, insulin levels, inflammatory markers.
- In obese and overweight subjects, Ramadan fasting lowers inflammatory markers, body weight, and insulin resistance.
- In obese adults, Ramadan fasting improves the lipid profile.
- Athletic performance is compromised during Ramadan (like impaired maximal force production of the muscles), though not as much as you’d expect.
A 15- or 16- hour dry fast isn’t very extreme, even in the hot climates of the Near East. Two or three day-long dry fasts, particularly in hot weather, is another thing entirely. What works and is safe across 16 hours might not be safe or effective over three or four days.
I wonder if there’s a genetic component to dry fasting tolerance, too. Have populations who’ve spent thousands of years in hot, dry, desert-like climates developed greater genetic tolerance of periods without water? I find it likely, though I haven’t seen any genetic data one way or the other. It’s an interesting thing to ponder.
Is Dry Fasting Safe?
Obviously, skipping water can be dangerous. While we’ve seen people go without food for as long as a year (provided you have enough adipose tissue to burn, take vitamins and minerals, and are under medical supervision), going without water is a riskier proposal. The number I’ve always heard was three weeks without food, three days without water, though I’ve never really seen it substantiated or sourced.
One reason I’m skeptical of “three days” as a hard and fast rule is that most cases of people dying of dehydration occur in dire circumstances. People are lost out in the wilderness, hiking around in vain trying to find their way back to the trailhead. They’re thrown in jail after a night out drinking and forgotten by the guards for three days. They’re spending 24 hours dancing in a tent in the desert on multiple psychoactive drugs. These are extreme situations that really increase the need for water. Your water requirements will be much higher if you’re hiking around in hot weather bathing in stress-induced cortisol and adrenaline, or dancing hard for hours on end. Very rarely do we hear of people setting out to abstain from water on purpose for medical benefits, water on hand in case things go south, and ending up dehydrated. Part of the reason is that very few people are dry fasting, so the pool of potential evidence is miniscule. I imagine this last group will have more leeway.
Still, if you’re going to try dry fasting, you have to take some basic precautions.
6 Precautions To Take When Dry Fasting
1. Get Your Doctor’s Okay
Sure, most will be skeptical at best, but I’d still advise not skipping this step—particularly if you have a health condition or take any kind of medication. Diuretics (often used for blood pressure management), for one example, add another layer to this picture.
2. No Exercise
Avoid anything more intense than walking. For one, the hypohydration will predispose you to middling results, increasing cortisol and reducing testosterone. Two, the hypohydration may progress rapidly to dehydration. If you’re going to exercise during a dry fast, “break” the fast with water first and then train.
3. Keep It Brief
Yes, there was the 5-day study, but those people were being monitored by doctors every single day. I’d say 16-24 hours is a safe upper limit and probably provides most of the benefits (as Ramadan literature shows). Any longer, buyer beware. (And, of course, make sure you get fully hydrated in between any dry fasts you might do.)
4. Fast While You Sleep
Ramadan-style probably isn’t ideal from a pure physiological standpoint. The length (16 hours) is great, but the eating schedule is not. Those who observe Ramadan fasting ritual often wake up before sunrise to fit in food. They may stay up late to eat more. They go to sleep in a well-fed state, never quite taking advantage of the 8 hours of “free” fasting time sleep usually provides (and, of course, that’s not what their fasting practice is about). For a health-motivated dry fast, on the other hand, you should take advantage of it.
5. Take Weather Into Account
Hot, humid weather will generally cause the most water loss. Cold, dry weather will cause the least. Adjust your dry fasting duration accordingly.
6. Listen To Your Body
I’ve said this a million times, but it’s especially worth saying here. If you’re not feeling well during the dry fast, listen to your instinct rather than your agenda. (And don’t begin a dry fast when you’re ill. That should go without saying.) This is an optional tool. There are hundreds of other ways to serve your health and well-being. Don’t lose the forest through the trees because you’re drawn to a practice that feels more radical. Approach it smartly, but let your body’s intuition be the final arbiter.
That’s it for me. I haven’t done any dry fasting, not on purpose at least, and I’m not particularly interested in it for myself, but I am interested in your experiences. Do any of you do dry fasting? What have you noticed? What do you recommend?
As always, if you have any questions, direct them down below. Thanks for reading!
Mascioli SR, Bantle JP, Freier EF, Hoogwerf BJ. Artifactual elevation of serum creatinine level due to fasting. Arch Intern Med. 1984;144(8):1575-6.
Fernando HA, Zibellini J, Harris RA, Seimon RV, Sainsbury A. Effect of Ramadan Fasting on Weight and Body Composition in Healthy Non-Athlete Adults: A Systematic Review and Meta-Analysis. Nutrients. 2019;11(2)
Fahrial syam A, Suryani sobur C, Abdullah M, Makmun D. Ramadan Fasting Decreases Body Fat but Not Protein Mass. Int J Endocrinol Metab. 2016;14(1):e29687.
Aliasghari F, Izadi A, Gargari BP, Ebrahimi S. The Effects of Ramadan Fasting on Body Composition, Blood Pressure, Glucose Metabolism, and Markers of Inflammation in NAFLD Patients: An Observational Trial. J Am Coll Nutr. 2017;36(8):640-645.
Unalacak M, Kara IH, Baltaci D, Erdem O, Bucaktepe PG. Effects of Ramadan fasting on biochemical and hematological parameters and cytokines in healthy and obese individuals. Metab Syndr Relat Disord. 2011;9(2):157-61.
Saleh SA, El-kemery TA, Farrag KA, et al. Ramadan fasting: relation to atherogenic risk among obese Muslims. J Egypt Public Health Assoc. 2004;79(5-6):461-83.
Gueldich H, Zghal F, Borji R, Chtourou H, Sahli S, Rebai H. The effects of Ramadan intermittent fasting on the underlying mechanisms of force production capacity during maximal isometric voluntary contraction. Chronobiol Int. 2019;36(5):698-708.
Shephard RJ. Ramadan and sport: minimizing effects upon the observant athlete. Sports Med. 2013;43(12):1217-41.
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Folks, you know I’m a long-time believer in intermittent fasting for longevity, autophagy, mental clarity, fitness performance, metabolic health, and more. I’m excited that Dr. Jason Fung has stopped by the blog today to share a bit about common fasting mistakes. Enjoy!
So, you’ve decided to add some fasting to your lifestyle. Excellent. No matter how much you have (or haven’t) read on the topic, you’re likely to find aspects of fasting to be challenging or even frustrating. It can be hard to stay on track when you’re feeling hungry, irritable and not really noticing any changes.
It’ll become tremendously easier once you begin to experience the health benefits of fasting, but we all know it takes a little while for that to happen. Benefits like mental clarity and improved energy will show up sooner than significant weight loss. Plus, the benefits you experience will depend on what kind of fast you’re doing and how well you stick to it.
But if you’re making fasting mistakes, you might never accomplish the benefits you were hoping for. . Before you throw in the towel, I want to help you identify some possible fasting pitfalls you might not be aware of and also help you avoid them. Plus, don’t miss the Number One reason fasts fail, shared at the end of this article.
1. You’re Snacking or “Grazing”
Look, the entire purpose of a fast is to contain your eating within certain windows of time. Snacking or “grazing” all day long is basically the opposite of fasting, so stop thinking that you can get away with it. Fasting is “on” or “off”—there is no gray area. Even having “just a bite,” no matter how healthy or how little, will almost invariably kick your body out of fasting mode and will interfere with the healing process responsible for fasting’s many benefits. It also creates a situation where your body is producing insulin all day long. Bad idea.
Avoid grazing by putting snacks and food out of sight. The phrase “out of sight, out of mind” really applies here. You’ll be amazed how much easier it is to bypass snacking when the food isn’t sitting right in front of you. If you snack out of habit, get creative and find new, non-food based habits. If your snacking comes from genuine hunger, you may need to re-evaluate the meals you eat during your eating window. Make sure you’re getting enough healthy, unsaturated fats with each meal as these will keep you satiated for longer.
2. You Aren’t Drinking Enough Water
This is not only a common fasting mistake, but a mistake most people make no matter what their diet is. Drinking a minimum of eight glasses of water daily is essential to staying hydrated and healthy. Some signs that you aren’t drinking enough water include dizziness and lightheadedness, feeling tired, or constipation.
Even worse, when you don’t drink enough water, your brain may try to trick you into thinking that you’re hungry, so you get the vitamins and minerals you’re lacking. Minerals like potassium and magnesium are essential to your brain health. So don’t be surprised next time you feel hungry but find that drinking a glass of water makes the appetite disappear. Various kinds of tea are also a satisfying way to hydrate, or try some bone broth if you’re truly struggling.
3. You Aren’t Consuming Enough Salts
Speaking of vitamins and minerals, appropriate salt intake is vital to your health. Now, when I say “salt,” I’m not talking about the kind you put in a shaker. I’m talking about electrolytes, which are essential to your diet. Sodium (Na), which is also commonly known as table salt, is one of these electrolytes, along with potassium (K), magnesium (Mg), calcium (Ca), and chloride (Cl).
How can you tell if you’re low on electrolytes? Some symptoms of electrolyte deficiency are anxiety, irritability, trouble sleeping, muscle spasms, fatigue, digestive issues, and dizziness. If these are the kinds of symptoms you experience during your fast, lack of electrolytes could be the answer. Try taking some pink Himalayan rock salt and placing it under your tongue to dissolve. You can also try drinking some pickle juice — just make sure it’s from high-quality natural pickles and not the kind made with sugar.
4. You’re Eating Right Before You Go To Sleep
Your body needs time to digest all the food from your last meal before you go to sleep. If you’ve scheduled your eating window to happen right before bedtime, your body will be taking all the time you’ve allotted to rest to digest instead. That takes energy, and instead of waking up feeling restored and ready to take on the day, you’ll just feel tired.
When you’re following a fasting plan, a seven-hour window is an ideal amount of time to leave between your last meal and when you go to sleep. Even three or four hours is enough to make a difference. Unfortunately, with crazy work schedules and early mornings, a lot of people aren’t able to stick to that three- or four-hour window. It’s more like get home, eat dinner, and go straight to bed. If this is you, the next best thing is to eat a light meal, like salad, and avoid a meal filled with carbohydrates and protein.
5. You’re Eating Too Much of Some Food Groups
When we cut certain foods from our diet, especially carbs, it’s easy to rely on other food groups, like nuts and dairy. They’re readily available and a staple of most diets.
Nuts are a low-carb, healthy fat option, but only in small amounts. They’re great to add to fruit or veggie salads, and they’re easy to grab a handful of when you need a quick snack. But those quick snacks can add up, especially on top of eating full meals. Nuts are high in good fat, low in carbs, and are a good source of protein, but too much protein can be detrimental to your fast. Excess protein that your body doesn’t need is converted to glucose and stored as fat. If you’re fasting to lose weight, this is the exact opposite of what you want.
Dairy, the other easy food group that too many people defect to, can cause inflammation, upset stomach, bloating, gas, and other kinds of discomfort. If this is a pattern you’ve noticed with your own health and eating habits, try cutting out dairy for a few weeks and see if these symptoms improve. If you haven’t noticed these symptoms, be more mindful of your eating habits and track how you feel after eating dairy.
6. You Aren’t Eating Enough of Certain Food Groups
As easy as it is to eat too much of one food group, it’s equally easy to not get enough of another. Just because you can eat “whatever” you want during your eating window doesn’t mean you should. Empty calories and junk food are momentarily satisfying, but they don’t fuel your body. Eating the right foods provides your body with the nutrients it needs to thrive throughout the day; these foods will also keep you feeling fuller, longer.
Vegetables are one of the best food groups to keep you nourished and thriving. They’re low calorie and they provide different vitamins and minerals like potassium, fiber, folate, vitamin A, and vitamin C. Fruits are also healthy, but don’t overdo it, as most are high in sugar. Fruit juices typically have added sugar as well. Naturally flavored drinks and teas are the healthiest option. Nuts are high in fat and a good source of protein, as are eggs. Refined carbohydrates and sugars are highly unnecessary for your body and if you’re going to include them in your meals, there should be very little.
7. You’re Pushing Your Body Too Hard
Did you dive off the deep end and go from zero fasting to attempting 24-hr fasts every other day? Back up and take a more moderate approach first. Don’t expect fasting to be easy right away. Not only will your body need time to adjust, but your mind will, too. If you’ve been accustomed to three square meals a day, plus snacks and calorie-filled drinks, your body has gotten used to this routine.
Your body needs time to adapt. First it burns through stored sugar and then it will start burning body fat for energy. Start slow and get a feeling for this new practice. You can start with a twelve-hour fasting period and twelve-hour eating window. When eight hours of that fast are during your sleeping hours, this window is relatively easy. Once you’ve become accustomed to this schedule, you can reduce your eating window to ten hours. Continue decreasing your eating window by two hours every one to two weeks, until you’ve hit the fasting period you want.
8. You Have the Wrong Mindset
Fasting provides your body with everything it needs to thrive, but without the right mindset, you’re bound to fail. Focusing on the negative, like not being allowed to eat certain foods or at certain times, will easily spiral into other negative self-talk. The harder you are on yourself, the more difficult it is to achieve success.
Rather than thinking about how hard the fast is, focus on the positive that will come out of it. Fasting allows your body to heal. Fasting can help you lose weight. You’ll feel more energized and have a clearer mind. Whatever the reason you’ve chosen to fast, focus on that. Fasting with a friend, family member, partner, or online community is another way to hold yourself accountable and can be very helpful.
9. You’re Too Stressed
When you’re stressed, your body releases a hormone called cortisol. Cortisol is problematic when fasting because it can prompt your body to break down muscle tissue instead of fat. When fasting, your body should tap into stored body fat and preserve your healthy muscle tissue.
If you’re stressed on occasion, this shouldn’t cause much of a problem. But if you’re chronically stressed, that constant release of cortisol can lead to a breakdown of muscle tissue.
Not sure if you’re stressed? Here are some symptoms:
- Teeth grinding
- Muscle tension
- Digestive problems
- Trouble concentrating
Alleviate stress with deep breathing, positive visualization, an epsom salt bath, and stress-relieving teas. If you can, take some time off from work. If you’re an outdoorsy person, relax in nature.
10. You’re Inactive
Being inactive is one of the biggest mistakes people make during their fast. If you aren’t eating, you should rest and save your energy, right? Wrong. Exercise is a great way to improve your fasting. Activity increases fat burning and boosts circulation. Going outside and getting some sunlight and fresh air can improve your mood, making you more likely to stick to your fast. Movement generally makes people feel better than sitting on the couch inside all day; being inactive makes you cold, tired, and unfocused.
Since a lot of people work sedentary jobs that tie them to a desk all day, exercise isn’t a convenient way to stay active. But taking a short walk or stretching are two easy ways to get your blood flowing throughout the day.
Fasting shouldn’t be synonymous with suffering. If you’re feeling deprived during your fast, be sure that you aren’t making any of the above fasting mistakes. Ease yourself into your fast, stick with it, and enjoy the results when they come with time.
But there’s one more—in fact, the number one reason fasts fail….
Can you guess what it is?
***Giving Into Cravings
Which is why I want to tell you about my new favorite secret weapon for staying fasted longer and with less difficulty: Pique Fasting Teas. Why tea? The combination of catechins and caffeine gives you a higher chance of experiencing tangible benefits from fasting. It suppresses hunger cravings, boosts calorie burn and supports malabsorption of unhealthy fats and sugars.
These Fasting Teas include ingredients targeted at maximizing the fasting experience:
1) Organic highest ceremonial grade matcha, which increases levels of l-theanine to calm and tide you through your fasts with ease. 2) Organic peppermint, which is a natural appetite suppressant with calming properties. 3) Proprietary blend of high catechin green Tea Crystals, which regulate the hunger hormone ghrelin and increase thermogenesis (burning fat for fuel). This helps you to stay fasted and see quicker results. 4) Additional plant ingredients including ginger and citrus peel to support digestion and enhance autophagy.
As with all of Pique’s teas, you can rest assured these are pure and Triple Toxin Screened for pesticides, heavy metals and toxic mold. For a limited time only, if you order through the Mark’s Daily Apple link, you can get up to 8% off and free shipping (U.S. only).
Thanks again to Dr. Jason Fung for today’s post. Have questions on fasting protocols or missteps? Share them below, everybody, and have a great day.
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It seems every “keto for women” forum abounds with stories about menstrual cycles gone wild in the first few months of keto. Irregular cycles, breakthrough bleeding, and periods lasting much longer than normal are common complaints. Sometimes these stories are cited as evidence that keto isn’t good for women, at least not premenopausal women, and that we need carbs for healthy hormones. Yet, many women don’t notice any changes in their menstrual cycles at all, while others report improvement in PMS symptoms and cycle regularity from the get-go.
What gives? Why do some women’s cycles apparently become wacky when they start keto, while others feel like keto is the key to period bliss? Can keto “mess up” the menstrual cycle?
We know that diet—what and how much we eat—can profoundly affect our hormones. This is true for both women and men. One of the reasons people are so excited about ketogenic diets is specifically because keto shows promise for helping to regulate hormones and improve cellular sensitivity to hormones such as insulin and leptin.
At the same time, women’s hormones are especially sensitive not only to dietary changes but also to downstream effects such as body fat loss. Furthermore, one of the ways women’s bodies respond to stressors is by turning down the dial on our reproductive systems. It’s reasonable to hypothesize, then, that women might have a tougher time adapting to or sustaining a ketogenic diet. Keto can be stressful depending on one’s approach, and that might negatively impact women’s reproductive health. But do the data actually bear that out, or is so-called “keto period” more misplaced hype than genuine fact?
Note that throughout this post, I’m going to use the term “reproductive health” to refer to all aspects of women’s menstrual cycle, reproductive hormones, and fertility. Even if you aren’t interested in reproducing right now, your body’s willingness to reproduce is an important indicator of overall health. When your reproductive health goes awry—irregular or absent periods (amenorrhea) or hormone imbalances—that’s a big red flag. Of course, post-menopausal women can also experience hormone imbalances that affect their health and quality of life (and low-carb and keto diets can be a great option for them).
Menstrual Cycle 101
Let’s briefly review what constitutes a normal, healthy menstrual cycle, understanding that everybody’s “normal” will be a little different. A typical cycle lasts from 21 to 24 days on the short end to 31 to 35 days on the long end, with 28 days being the median. Day 1 is the first day of your period and begins the follicular phase, which lasts until ovulation. Just before ovulation, levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), and estradiol (a form of estrogen) spike. Next comes the luteal phase covering the approximately 14 days from ovulation to menses. LH, FSH, and estradiol drop, while progesterone rises. Estradiol bumps up again in the middle of the luteal phase. If a fertilized egg is not implanted, menstruation commences, and the whole cycles starts over again. All this is regulated by a complex communication network under the hypothalamic–pituitary–gonadal (HPG) axis, which is closely tied to the actions of the adrenal (the A in HPA axis) and thyroid glands.
Across the cycle, fluctuations in body weight are common as fluid is retained and then released along with shifts in estrogen and progesterone. Changes in blood glucose are also normal, and insulin-dependent diabetics often find that they need to adjust their dose at different times of their cycles to keep their blood sugar in check. The most common pattern is higher blood glucose readings in the pre-menstrual period (the second half of the luteal phase), and lower readings after starting your period and before ovulation. This is generally attributed to the fact that progesterone, which is highest during the luteal phase, is known to reduce insulin sensitivity. However, different women experience different patterns, which can also be affected by other factors such as oral contraceptive use.
Normal fluctuations in insulin resistance and blood glucose can mean that women get lower ketone readings at certain times of the month than others. When these occur premenstrually—and so they tend to coincide with a period of (transient) weight gain and food/carbohydrate cravings—women often feel as though they are doing something wrong. Rest assured that these variations reflect normal physiology.
The many factors that affect your cycle and the levels of your sex hormones include: other hormones, gut health and microbiome, metabolic health (e.g., insulin sensitivity), environmental toxins, stress, sleep, immune health, nutrient deficiencies, activity level and energy expenditure, and age. Each affects the others, and all (except age of course) can be affected by diet. It’s no surprise, then, that it can be extremely difficult to pin down a root cause of menstrual changes or reproductive issues.
What the Research Tells Us About Keto and Menstruation
As I said at the outset, there are lots of anecdotes, both positive and negative. In my experience, most women whose cycles seem to go crazy when they start keto find that things get back to normal—and often a better version of normal—after a few months.
First, it’s tricky to determine the effects of keto per se, since many people combine a ketogenic diet with calorie restriction (intentionally to lose weight or unintentionally due to the appetite suppressing effects of keto) and with fasting (intermittent and/or extended). Each of these can independently impact the factors listed above, lead to weight loss, and affect the menstrual cycle and reproductive health.
So, is there any evidence that keto itself causes changes to menstruation?
The scientific evidence is scant….
The one statistic you’ll see floating around the interwebs is “45% of (adolescent) females experience irregular menstrual cycles on keto.” This statistic comes from one small study of adolescent girls using a therapeutic ketogenic diet to treat epilepsy. Six of the twenty girls reported amenorrhea (loss of period) and three were diagnosed with delayed puberty. However, the ketogenic diet used for epilepsy is different and usually much stricter than an “everyday” keto diet needs to be, and epilepsy is frequently associated with menstrual dysfunction regardless of diet.
To extrapolate the findings of this study and argue that nearly half of teenage girls (or women generally) are likely to experience menstrual problems from going keto is a huge leap.
The fact is, I’m unable to find any studies done in healthy human females (or mice for that matter) demonstrating that otherwise normal menstrual cycles are disturbed by going keto.
5 Ways Keto-Related Factors *Might* Affect Your Menstrual Cycle
With the limited amount of research looking directly at keto and menstruation, let’s look first at whether there are direct effects of carbohydrate restriction or elevated ketone production on the menstrual cycle. Those are the defining characteristics of keto and what differentiates keto from other ways of eating. Then we can examine indirect effects that occur due to factors such as weight loss. These are not unique to keto, though they might be more likely on a ketogenic diet compared to other ways of eating.
There is no real body of evidence that looks at ketogenic levels of carb restriction and menstruation, but there are some clues. In this small study, functional hypothalamic amenorrhea (FHA) was associated with dietary fat restriction; women with FHA actually ate non-significantly more carbs than matched controls and nearly identical total calories. Likewise, in this small study, FHA was associated with lower fat intake but no significant difference in carb intake.
This meta-analysis looked at the effect of low-carb (not keto) diets on markers of reproductive health among overweight women. The researchers found four studies that examined effects on menstruation; all showed improved menstrual regularity and/or ovulation rates. Of six studies that looked at levels of reproductive hormones, five reported significant improvements.
Carb restriction also results in decreased insulin production. Hyperinsulinemia and insulin resistance are frequently associated with polycystic ovarian syndrome (PCOS), one of the leading causes of female infertility and a frequent cause of menstrual irregularity. There is currently a lot of interest in using keto to treat PCOS, but only one small study has so far directly tested the effectiveness of a ketogenic diet to treat PCOS, with positive results.
No studies have looked at the direct effects of ketones on menstruation.
Of course weight loss is not unique to keto, but keto can be very effective for weight loss. Some women experience rapid weight loss when first starting a keto diet. Weight loss in and of itself can impact menstruation through a variety of pathways. A key way is by reducing the hormone leptin. Leptin’s main job is to communicate energy availability to the hypothalamus—high levels of leptin tell the hypothalamus that we have enough energy on board, which also means we can reproduce. Low leptin can disrupt the menstrual cycle and is linked to hypothalamic amenorrhea.
Body fat loss can also affect estrogen levels since estrogen is both stored and produced in adipocytes (fat cells). While fat loss in the long term will decrease estrogen production, it is possible that rapid fat loss might temporarily raise estrogen levels and can also affect estrogen-progesterone balance. These transient changes in estrogen levels might underlie some of the menstrual irregularities women report.
Stress can impact the menstrual cycle in myriad ways. Cortisol acts on the hypothalamus and pituitary glands, affecting hormone levels, sleep, immune function, and gut health, to name a few. Diets can be a source of stress, both at the physiological and psychological levels. Keto has a reputation for being especially stressful because it is more restrictive than other low-carb diets, but this can be mitigated by following the Keto Reset tips for women.
Thyroid dysregulation is another common cause of menstrual irregularities, and there remains a pervasive belief that keto is bad for thyroid health. Indeed, the thyroid is sensitive to nutrient deficiencies and caloric restriction, and thyroid hormones, especially T3, do frequently decline on keto. However, as Mark has discussed in a previous post, changes in T3 levels might not be a problem, especially in the absence of other problematic symptoms. Moreover, many practitioners now use keto as a cornerstone in their treatment of thyroid disorders.
What Should I Take From These Findings?
The first takeaway: there just isn’t much direct evidence about how keto might affect your menstrual cycle, positively or negatively. We have some studies suggesting that low-carb diets improve some aspects of menstruation and reproductive health, but keto is more than just another low-carb diet. Ketones themselves have important physiological properties, such as being directly anti-inflammatory, which might positively impact women’s reproductive health.
Second, the ways that keto is likely to (negatively) affect menstruation aren’t unique to keto, they’re common to any diet: hormone shifts mediated by energy balance, stress, and weight loss.
Furthermore, since keto is so often combined with caloric restriction, time-restricted eating, and fasting, even the anecdotal evidence might not be able to tell us all that much. If a woman is eating ketogenically, in a big caloric deficit, and doing OMAD (one meal a day), and her leptin plummets, how are we to know what really caused it? We don’t have good evidence that otherwise healthy women start a well-executed ketogenic diet and end up messing up their menstrual cycles.
That said, women do need to be cognizant of the sum total of the signals they are sending their bodies when it comes to energy availability and stress. A lot of women come to the keto diet with a history of adrenal, thyroid, metabolic, and reproductive issues. It’s important that they’re extra careful about how they approach keto. Done correctly, it might be just what the doctor ordered. I encourage any woman who’s dealing with other hormonal issues to work with a medical practitioner to tailor a keto diet to her unique needs.
But I’m Telling You, Keto Made My Period Go Haywire!
Ok, I believe you, really! But changes do not necessarily equal dysfunction. It is normal to experience hormone fluctuations when you make a massive—or even a relatively small but important—shift in your nutrition. Sometimes those fluctuations are unpleasant or unwanted, such as a period that lasts 14 days or one that arrives a week before you planned while you’re on vacation. However, that doesn’t make them bad from a health perspective. We need to respect that our bodies are dynamic systems. Changing the input will invariably change the output, and the system might need a few months to adapt to a new normal.
If your cycle goes wonky but you’re otherwise feeling good, give it a few months to sort itself out. If after a few months it’s still all over the place (or definitely if you’re having other disruptive symptoms), enlist help. In the meantime, check to make sure you’re not short-changing yourself nutritionally or calorically. Scale back on fasting efforts, and consider shifting more toward a traditional Primal way of eating.
At the end of the day, if you go keto and experience negative effects, stop. Keto is super hyped right now, but if your body is sending you clear signals that keto is not a good approach for you at this time, don’t do it. You can always try again later. It might be that your first attempt at keto didn’t work, but with a few adjustments and some experimentation over time you can find a version of keto that works for you.
Thanks for reading, everyone. Do you have comments, questions, or feedback? Let me know below.
Comninos AN, Jayasena CN, Dhillo WS. The relationship between gut and adipose hormones, and reproduction. Human Reproduction Update 2014; 20(2): 153–174.
Fontana R, Della Torre S. The Deep Correlation between Energy Metabolism and Reproduction: A View on the Effects of Nutrition for Women Fertility. Nutrients. 2016;8(2):87.
Klok MD, Jakobsdottir S, Drent ML. The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Obesity Reviews 2007;8(1):21-34.
Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A, Maciejewska-Jeske M. Functional hypothalamic amenorrhea and its influence on women’s health. J Endocrinol Invest. 2014;37(11):1049–1056.
Tena-Sempere M. Roles of Ghrelin and Leptin in the Control of Reproductive Function. Neuroendocrinology 2007;86:229-241.
The post Keto and the Menstrual Cycle: Is There Reason To Worry? appeared first on Mark’s Daily Apple.
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Last week, I explored the impact of all the various foods, beverages, and food-like substances people consume while fasting—and hoping to maintain a functionally fasted state in the post, “The Definitive Guide To What Breaks a Fast.” Does MCT oil break the fast? What about coffee, tea, or bone broth?
There were more than a dozen, and I even did a follow-up. Today I’m going to discuss whether commonly-consumed supplements break the fast.
Fish oil is pure fat. If you’re taking the average supplemental dose of 1-2 grams of fish oil, it’s not a problem. That’s not even a teaspoon. It’s about 9-18 calories.
You may burn slightly less fat than you would otherwise, but in the grand scheme of things, a few grams of fish oil won’t break the fast.
Cod Liver Oil
Cod liver oil is fish oil with extra vitamin D and vitamin A. As long as you keep the doses low enough, cod liver oil won’t break the fast.
Multivitamins do not break a fast. They are usually non-caloric. However, not all of their components will be absorbed very well on an empty stomach, so keep that in mind.
If you’re still not on board, note that in the older studies with really overweight people who fasted for upwards of a year straight, they usually supplemented with a multivitamin.
A popular one I’ve seen around—Alive, made from kale and raspberries—has just 2 grams of carbs per dosing. It’s not ideal, but it’s not a deal breaker—or a fast-breaker.
Gummy vitamins have the potential to be about 5-6 grams of sugar, a gram of protein (from gelatin), and a gram of fat (if including omega-3s) per serving, so they’d arguably break the fast. Plus, they taste like candy and are likely to stimulate cravings and make fasting harder.
Gummy vitamins break the fast.
Potassium is non-caloric and does not break the fast. In fact, it can help you handle the fast better by replenishing electrolytes.
Potassium doesn’t break the fast.
Creatine contains no calories and has no effect on insulin secretion (or glucose in the absence of calories).
Creatine does not break the fast.
Protein powder provokes an insulin response, which opposes autophagy, which means you’re breaking your fast. Plus, protein powder contains calories.
I’m going to say “yes, protein powder breaks the fast.”
If you’re strict and technical, then yes, collagen breaks a fast. There’s evidence that glycine—the most prominent amino acid in collagen—can inhibit autophagy, but it was a convoluted animal study where inhibiting autophagy with large doses of glycine after brain injury actually improved outcomes. It probably doesn’t apply to someone adding a scoop of collagen to their coffee. Besides, even if it slightly reduces autophagy, a little collagen won’t negatively impact ketosis, fat-burning, or energy intake.
I’m going to say “technically yes,” but “realistically no, collagen doesn’t break the fast.” Avoid if your main focus is autophagy, however.
Branch Chain Amino Acids (BCAAs)
BCAAs trigger an insulin response and thus stop autophagy…and the fast. That said, many proponents of fasted training recommend using BCAAs before a workout to help preserve muscle and improve the post-workout anabolic response.
I’m going to say “yes, BCAAs break the fast.”
Vitamin D is fat soluble and thus comes packaged in an oil carrier, but the dosage is so small that it won’t affect your fast.
Unless you find that 1/8 teaspoon of olive oil ruins your fast, vitamin D won’t break a fast.
Probiotics contain no calories and will not break a fast. However, they are best absorbed in the presence of food—the food protects them as they travel through the digestive system, and most probiotics occur naturally in food—so taking them during a fast is probably, mostly useless.
Probiotics don’t break a fast, but why take them during one?
Pure prebiotics will not break a fast, as they contain no digestible carbohydrates. Prebiotic-enriched foods will break a fast, as they do contain calories.
Adaptogens are compounds, usually herbs or herb derivatives, that modulate your stress response. They improve your ability to tolerate and respond to stressful situations; they don’t blindly inhibit the stress response if the stress response is warranted. They keep you honest and counter unnecessary stress responses. They contain no calories, unless you’re chowing down on a big hunk of maca or ashwagandha root. In fact, most adaptogens have traditionally been consumed in tea form, extracting the active compounds and leaving behind any calories. Have at ’em.
Adaptogens do not break the fast.
Medicinal mushroom extracts come from mushrooms, which are technically food. But the amounts you take are so low—usually no more than a teaspoon—that they won’t impact your fast or provide any significant amount of caloric energy. Four Sigmatic has those “mushroom coffee” blends you add to hot water. They can get up to about 30 calories per serving, but even that’s going to let you maintain most of the fasting benefits.
Mushroom extracts don’t break the fast.
I used to keep the old Trader Joe’s melatonin on hand because it was half a milligram, whereas most other melatonin supplements are in the 3-5 mg range. It was also sweet, tasting like those white Valentine’s Day mint hearts you used to get back in the day. I haven’t come across any sweetened melatonin supplements since Trader Joe’s phased those out, but that’s the only thing I’d worry about on a fast.
Melatonin does not break a fast.
Final Note: Most supplements are okay to take on a fast, though the lack of food may make absorption more difficult. If you have any other questions about supplements on a fast, drop them down below. Thanks for reading, everybody.
On a related note, with supplements on my mind this week I thought it would be a good time to offer one of my favorite deals—just for the MDA community: 20% off my full supplement line, plus Primal Fuel and Collagen Fuel. It’s a great time to stock up on favorites or to try something new. Offer ends 4/24/19 midnight PDT. Use code WELLNESS20 at checkout. (Offer doesn’t apply for autoship orders.)
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For today’s edition of Dear Mark, I’m answering a round of questions drawn from the comment section of the “What Breaks a Fast” post. You folks had tons of follow-up questions about whether other types of foods or compounds break a fast. Does a teaspoon of honey? Does elevated insulin from BCAAs? Does coconut milk? Does pure prebiotic fiber? What about longer fasts—are they recommended? And how about unsweetened cocoa powder? What explains my ability to predict your questions? Do sausages break a fast? Does liquor? How should you exercise?
Let’s dig right in:
Hey, what about honey? 1 tsp in morning tea?
A teaspoon or less of honey is fine and won’t negate the benefits of fasting. I alternate between doing collagen coffee and coffee with cream and teaspoon of sugar (which was my typical morning coffee for over a decade). No reasonable person should fear a teaspoon of sugar or honey.
For what it’s worth, honey isn’t “just” sugar. It elicits a more beneficial (or less negative) metabolic response than other forms of sugar.
I’m shocked about the BCAA. I used to fast and take BCAA’s (yes, to continue dynamic exercise). I used to find it extremely difficult to fast compared to now when I fast without taking them. Does that mean that the insulin response made fastic more difficult?
It’s possible. Insulin impairs lipolysis—the release of stored body fat into circulation for energy usage—and the success of fasting depends on lipolysis. Without lipolysis, you can’t access all that stored energy.
Thank you very much for this info!! I am a butter-coffee-for-breakfast drinker, and I always worry about the ingredients breaking a fast. Could you please comment on coconut milk (in the can)? I love putting that in my coffee/breakfast.
Coconut milk is a less concentrated source of medium chain triglycerides, or MCTs (as in MCT oil). MCTs convert directly to ketones, making MCT oil and to a lesser extent coconut oil or coconut milk a potential “boost” for fasting. Still, energy is energy, and any energy you take in is energy you won’t be pulling from your body.
I find MCTs and coconut to be more useful when someone is just getting the hang of fasting or ketosis—as a nice boost to get things moving in the right direction.
Keep your coconut milk under a tablespoon and you’ll be fine.
Does prebiotic (resistant starch) fiber break a fast? Acacia senegal or potato starch? Thanks!
No. If you’re worried, test your postprandial blood sugar after eating the fiber.
Great input Mark as someone 3days into a 7day water fast with electrolytes of course what’s your view on longer fasts.
Check out the post I wrote on long fasts. Potentially beneficial but the risks accumulate the longer you go. You just have to be even more careful and methodical.
How about unsweetened cocoa?
A tablespoon runs just over 12 calories (depending on the brand; some cocoa powders contain more fat and thus more calories), with around a gram of net carbs and a gram of fat. Also a nice source of potassium and magnesium, along with a ton of polyphenols which can have fasting-mimicking effects on their own.
Eating enough unsweetened cocoa powder to knock you out of your fast would be incredibly repulsive. Probably impossible.
Cocoa is definitely a nice addition.
Okay it’s almost creepy the way Sisson answers my questions before I even ask them! I was wondering about this yesterday and then this post popped up in my inbox.
How does he do that…?
Kraft-Heinz has a strong relationship with Google and Amazon, and the Kraft acquisition gave me access to Alexa/Google Home datasets and the ability to predict what my readers are wondering about.
Just kidding, though it’s scarily not out of the realm of possibility anymore.
What about a small snack of paleo sausages, smoked or dried? So meat and fat (beef, pork or lamb), and some spices. Maybe 100g worth.
Well, that’s a legit snack bordering on a small meal. That will break the fast, but it’s not all for naught. There is the whole “fasting-mimicking diet,” where you eating very few calories for several days out of the week and retain many if not most of the benefits of full-on fasting.
Let’s just say if you ate a small snack of paleo sausages on your “fasting” days, you’d still be way ahead of 99% of people.
But do try a full-on fast at least once. You might surprise yourself.
Great post! What about alcohol? Specifically, a shot or 2 of liquor. I would assume beer and wine would break a fast, but what about whiskey or tequila?
When alcohol enters the system, utilization of all other energy sources is suspended until the alcohol is burned. Back in 1999, researchers did a study where they gave fasting adult men the equivalent of a couple shots of liquor. They stopped releasing stored body fat, stopped burning body fat, and began burning way more acetate (a product of ethanol metabolism). They didn’t exactly “break” the fast, but all the metabolic trajectories we love about fasting took a big pause.
Good morning Mark,
How does one exercise in the morning while fasting? When to eat?
You can exercise any way you like, but I change how I train based on when I’m going to break the fast with food.
If I’m going to break the fast with a meal right after, I train any way I like. I’ll do sprints, HIIT, weights, anything.
If I’m going to keep fasting after the workout, I like to stick to strength training and low-intensity movement (walking, hiking, standup paddling). The strength training is essential during a fast because it’s an anabolic signal to your muscles—move it or lose it. Simply lifting heavy things during a fast can stave off muscle loss.
That’s it for today, folks. Stay tuned later this week for “What Breaks a Fast: Supplements Edition.”
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