liver healthThe liver is incredible. Most people think of it as a filter, but filters are physical barriers that accumulate junk and have to be cleaned. The liver isn’t a filter. It’s a chemical processing plant. Rather than sit there, passively receiving, filtering out, and storing undesirable compounds, the liver encounters toxic chemicals and attempts to metabolize them into less-toxic metabolites that we can handle.

  • It oxidizes the toxins, preparing them for further modification
  • It converts the toxins to a less-toxic, water-soluble version that’s easier to excrete
  • It excretes the toxins through feces or urine

Bam. It’s an elegant process, provided everything is working well back there. And it’s not the only process it controls.

The liver is the primary site of cholesterol synthesis and disposal. It creates cholesterol as needed and converts excess into bile salts for removal via the bile duct. The liver also plays a huge role in the burning of fat for energy, the storage of vitamin A, the metabolism of hormones, and the regulation of blood sugar. If you enjoy burning ketones, you can thank the liver because that’s where they’re produced.

The liver supports full-body health, in other words. If it isn’t working correctly, nothing is. Everything starts to fall apart.

How do we support the liver?

It’s not one thing we do. It’s many things. It’s nutrition, supplementation, lifestyle, sleep — everything. It’s also the things we don’t do. The stakes are high, you see. Whenever there’s a grand overarching orchestrator regulating dozens of different processes in the body, you must protect it from multiple angles. A lot can go wrong. Or right, depending on how you look at it.

Since the liver is “hidden away” and you can’t really “feel” it, you may not give it too much thought. When you’re overweight, you know it. When your fitness is suffering, you consciously experience it. When your liver is overburdened or suffering, you don’t necessarily know it. That’s where doing the right things for the sake of doing them comes in handy.

So, what should you do to maintain pristine liver health?

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11 Ways to Maintain a Healthy Liver

Liver health depends on steps you take toward a healthy lifestyle, and equally as important, the things you refrain from doing. Here are some things you can to to contribute to lifelong liver health:

  • Reduce linoleic acid intake
  • Reduce refined carb intake
  • Reduce alcohol intake
  • Stop overeating, and lose weight
  • Practice time-restricted eating
  • Eat fatty fish and get omega-3s
  • Eat egg yolks and other choline sources
  • Take NAC
  • Take whey protein
  • Regularly deplete your liver glycogen
  • Get good, regular sleep

Reduce Linoleic Acid Intake

When a patient can’t eat, they get something called parenteral nutrition — a direct infusion of nutrients into the gut. The classic parenteral nutrition consists of an emulsion of olive oil and soybean oil. It’s very rich in linoleic acid and typically leads to elevated liver enzymes and fatty liver. That’s right: the medical establishment for whatever reason just accepts that people receiving parenteral nutrition have a high chance of developing fatty liver disease.

Okay, but what’s happening here? Is it really causal? Yes. The more linoleic acid you eat, the more oxidized metabolites of linoleic acid show up in your body. The more oxidized metabolites of linoleic acid you have, the higher your risk of fatty liver. These toxic metabolites of LA are actually full-fledged biomarkers of liver injury.,patients%20with%20obesity%20(48).‘>2 which affects how efficiently your liver works.

Of course, the combo of high linoleic acid and high refined carbohydrate is just about the worst thing possible.

Reduce Alcohol Intake

To detox alcohol, the liver converts it into the metabolite acetaldehyde. Acetaldehyde is far more toxic than ethanol itself, so the body then releases acetaldehyde dehydrogenase and glutathione to break down the acetaldehyde. If you stick to just a few drinks and space them out accordingly, your body’s natural antioxidant enzyme production can keep up. If you start binging, though, glutathione stores become overwhelmed and the liver must produce more. Meanwhile, acetaldehyde, which is between 10-30 times more toxic than ethanol, accrues in your body.‘>4

Eat Fatty Fish and Get Omega-3s

If you offset some of that olive oil and soybean oil with a blend of medium triglycerides and fish oil, liver enzymes may drop and overall integrity of the liver may improve.‘>6 Taking it with vitamin C may be even more effective.

NAC is well-known for boosting levels of glutathione, the primary antioxidant used by the liver to metabolize toxins and protect itself.

Take Whey Protein

Obese women with fatty liver who took 60 grams of whey protein per day reduced their liver fat by almost 21%.‘>8 When liver glycogen is full, it becomes far more likely that your liver will turn any subsequent carbohydrate it encounters into fat for storage. If you keep liver glycogen low, or regularly deplete it, you can avoid de novo lipogenesis because there’s usually a place to store the glucose.

Furthermore, keeping liver glycogen low increases fat utilization from all over the body, including the liver.‘>10 If you don’t get to sleep at a normal, consistent time, your rhythm is disrupted and the molecules can’t do their jobs.

If you hadn’t already noticed, these are good health practices in general. We keep running into this phenomenon, don’t we?

What’s good for the liver is good for the brain is good for the cardiovascular system is good for your performance in the gym is good for the mirror.

It makes things easier and harder.

You know what to do.

Thanks for reading, everyone. Do you have any other recommendations for liver health? Which of these do you follow?


The post All About the Liver, and How to Support Your Favorite Detoxification Organ appeared first on Mark’s Daily Apple.

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collagen benefits bones heart sleepGreat news: If you’re already using collagen peptides for your hair, skin, and nails, you’re likely getting a bunch of other whole-body benefits.

Clearly we humans are meant to consume a good amount of collagen. Our ancestors ate nose-to-tail, consuming skin and connective tissue, and boiling down bones to make broth. Gelatin and collagen would have been abundant in the human diet. They provide amino acids needed for a dizzying array of metabolic functions. The amino acids also serve as blocks for collagen in the body.

Collagen is the most abundant protein in the human body, providing structure and support for the musculoskeletal and cardiovascular systems. Crucially, we need glycine from collagen to balance the lifespan-shortening effects of methionine in meat.‘>2

Human studies show that just 3 grams of glycine taken before bed improves sleep quality and daytime alertness for individuals with chronic sleep issues,‘>4 and sleep restriction.‘>6 Glycine also facilitates the drop in core body temperature that promotes a healthy sleep cycle.‘>8

Sleep experts generally recommend taking 3 to 5 grams of glycine before bedtime. You can buy glycine supplements, but collagen is about one-third glycine. A heaping scoop of collagen peptides will net you those 3 grams of glycine, plus other important amino acids.

Collagen Benefits Your Muscles, Tendons, and Bones

When talking about body composition, we usually mean the amount of body fat and muscle mass an individual carries. What about the other stuff—the bones and connective tissue that give our body structure and allow us to move around? In fact, the entire musculoskeletal system benefits from the amino acids in collagen.

Collagen to Build Strength

Lots of people use whey or soy protein supplements to enhance the effects of resistance training and build muscle. Collagen, on the other hand, has been largely overlooked because it’s not a complete protein. In particular, it doesn’t contain the levels of BCAAs found in whey protein.

I think collagen deserves a second look, though. For one thing, the high amount of glycine plus alanine in collagen provide building blocks for creatine. Creatine boosts energy production in muscle cells, and it’s probably the most widely used supplement for increasing muscle mass.

Also, in a series of studies, elderly men with sarcopenia,‘>10 and premenopausal women‘>12

What does this mean? Collagen ups the effectiveness of resistance training. More research is needed to understand precisely how—whether it increases muscle synthesis, tendon integrity, both, and/or other. In any case, though, adding a couple scoops of collagen to your post-workout routine seems a worthy experiment.

Collagen for Your Connective Tissues and Joints

Speaking of tendons, there’s evidence that collagen supplementation helps strengthen and maintain connective tissue. Connective tissue is made up of collagen, so it’s not really a big surprise. I first become enamored with collagen after rehabbing a serious Achilles tendon injury. I’m convinced that my recovery was accelerated thanks to loading up on collagen peptides.

Studies back up my experience:

  • Animal studies using rats‘>14 show that feeding the animals glycine and collagen peptides, respectively, strengthens their Achilles tendons.
  • In humans, taking 15 grams of gelatin plus 50 mg of vitamin C before working out improves tendons’ performance by increasing collagen deposition and remodeling.‘>16
  • Male and female college athletes who supplemented with 10 grams of collagen hydrolysate for 24 weeks reported significantly less joint pain across various activities. The effects were particularly strong among participants with pre-existing knee arthralgia (pain).‘>18
  • In another study, adults over 50 with joint pain took a modest dose—1.2 g/day—of collagen for 6 months and reported less pain in the shoulder, arm, hand, and lumbar spine. There were no differences for knee or hip pain, though.‘>20

Collagen Builds Strong Bones

More than 90 percent of the organic matrix of bone is collagen, mostly type I.‘>22

It should come as no surprise, then, that collagen supplementation seems to improve bone health. This has been demonstrated repeatedly with rats.‘>24 In humans, adding 5 grams of collagen peptides per day for 12 months increased bone mineral density in postmenopausal women at risk of osteoporosis.‘>26

Collagen for Heart Health

Many animal studies suggest that supplementing with collagen can improve cardiovascular health. Glycine, specifically, may be cardioprotective thanks to its known anti-inflammatory and anti-oxidative properties.

Collagen for Diabetes?

It might sound like a stretch at first, but individuals with low glycine are at greater risk for developing diabetes,‘>38 while high glycine is associated with normal blood sugar control.‘>40 A handful of studies further show that glycine can reduce certain diabetic complications in rats and humans.‘>42

I’m interested in your experience. Did you start incorporating bone broth or collagen peptides in your routine and notice any unexpected benefits? What’s your favorite way to get collagen in your diet?


The post Collagen Benefits for Your Bones, Heart, Sleep and More, Backed by Science appeared first on Mark’s Daily Apple.

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risk factors severe covid-19The way it’s reported, you’d think that susceptibility to COVID-19 severity is equally distributed across the world’s population. But when you compare case and mortality rates between countries, differences emerge. There are even differences within countries and states and cities. It’s clear that other variables besides simple exposure to the virus and infection are at play. Research continues to emerge regarding risk factors for severe COVID-19.

What are they?

And, more importantly, can you modify any of the variables?

Does Blood Type Predict COVID-19 Severity?

Early on, researchers noticed an apparent association between blood type and coronavirus infection. Those with A or B-type blood were more likely to be positive; those with type O were less likely to carry the virus.‘>2 All 12 studies analyzed had similar results; there was very little heterogeneity.

Is this caused by sex, though? After all, from what I could tell, the meta-analysis failed to control for other variables that might have differed between the groups, like metabolic syndrome or obesity. And yet sex does play a role, even when a risk factor like obesity is accounted for. Other research confirms that overweight men are at greater risk for coronavirus severity than overweight women, for example, and we know from previous research that men and women have different types of immune responses to viruses and vaccines.‘>4

Verdict: Sex matters. Men are at greater risk.

Selenium Status and COVID-19

Early on, I noticed that selenium status plays a big role in susceptibility to a number of different viruses, including the flu, the original SARS, and many others. The viruses sequester selenium and utilize it to replicate and to weaken the host. Many of the original places where COVID-19 took hold had abysmal levels of soil selenium; this translates to lower levels of selenium in the food grown in the soil and a higher risk of population-wide selenium deficiency.‘>6

Verdict: Likely. This hasn’t been proven to be causal, but it’s certainly trending in that direction. It can’t hurt to eat a couple Brazil nuts every day.

Can Adequate Vitamin D Improve Coronavirus Outcomes?

The earliest coronavirus hot spots were actually colder, cloudier spots with low UV-indexes. Wuhan, China, had a ton of cloud cover in January and always has a lot of air pollution which further blocks the UV light. Lombardy, Italy, also had pollution problems and UV index too low to produce much vitamin D. And now, studies are finally coming out lending credence to the idea that vitamin D protects against severe infection.

In Iran, COVID-19 patients with vitamin D levels above 30 ng/ml had a lower risk of severe infection and death.‘>8

It’s not just vitamin D, of course. Vitamin D is more likely a marker of sun exposure, which confers a multitude of other immune and health benefits. One such benefit with known links to COVID-19 is nitric oxide. Another is normalization of the circadian rhythm. So don’t assume mega-dosing vitamin D supplements will protect you from COVID-19 as much as getting natural sunlight will. Most of these people probably weren’t supplementing (or even thinking about) vitamin D at all. They went into the infection with the levels they had.

Verdict: Aim for 30 ng/mL and above. Get plenty of sunlight.

Does Obesity Make You More Susceptible?

Obesity is an enormous complicating variable. It’s not just because obese people are more likely to be unhealthy in other ways, although that’s probably part of it. It’s because obesity itself is unhealthy. Body fat secretes more inflammatory compounds and promotes an elevated baseline of inflammation. The coronavirus damages your body in part by up-regulating those inflammatory compounds. If you’re starting with elevated inflammation, you’re making the virus’ job that much easier.

Sure enough, obesity is linked to COVID-19 severity.‘>10 Extreme obesity (BMI of 45+) is even worse, with some research suggesting it quadruples the risk of severe COVID-19.‘>12 Among Chinese patients in another study, the mortality risk was 7.8% in those with diabetes and 2.7% in those without diabetes.‘>14

However, those hypertension patients taking ACE inhibitors had a lower risk of severity or death than those hypertension patients who were not being treated.‘>16 In another study, between 20-50% of unexposed people showed t-cell activity against COVID-19.‘>18

Both dietary omega-3s and omega-6s have been shown to strongly influence tissue levels of omega-3 and omega-6 and thus inflammatory/anti-inflammatory eicosanoid balance. My guess is that seed oil-eating people with elevated tissue omega-6s are at a greater risk for severe COVID-19 than people with more balanced omega-6:omega-3 tissue levels.

Verdict: We’ll see.

Primal Blueprint Primal Omegas: a high-quality source of the two key omega-3 fatty acids, EPA and DHA

Fermented Cabbage Intake

Most of the countries with low COVID-19 mortality rates have a long tradition of eating fermented cabbage. There’s South Korea with kimchi and the Balkans and Central Europe with sauerkraut. And in a recent study, researchers found that fermented cabbage intake predicted low COVID-19 mortality.‘>1

Although the above statement is true, call this less science more anecdotal but it’s my observation that men need to lift heavy objects every now and then. Lean muscle mass is healthy, fat mass is not. Obesity is a leading cause of low testosterone while pumping iron raises it. You don’t have to be a bodybuilder or gym junkie but you do need to lift some weights, carry some heavy objects, climb a rope, do some body weight push-ups, pull ups, sit ups or simply join a CrossFit class for two times per week. The reason, blood flow.

Promising Approaches to Erectile Dysfunction

Ok, now that we know some of the leading causes of ED let’s dive into fixing it, the natural way without having to reach for the little blue pill.

Step 1: Improve your sleep.

Tips to improve your sleep:

  • Keep you bedroom between 65-68 degrees Fahrenheit
  • Eye mask to sleep
  • Room darkening shades
  • Cover all lights in room with electrical tape (you know those little red and green lights that your laptop or LED TV have)
  • Phone face down or on airplane mode or off
  • CBD with Melatonin
  • Ear plugs to block noise
  • Blue light blocking glasses if looking at a device before bed

Step 2: Lower Stress

Tips to to Lower Stress:

Meditation, prayer, breathing exercises, stillness or yoga are all wonderful ways to relieve stress. The best part is you don’t have to take up large amounts of more time with traveling to a yoga class for an hour and a half class and then drive back to the office home thus taking up a total of two hours of your precious time. I recommend this site and thus you can do yoga right from home or even the office. The best part, you get to choose how much time you have. Often, i will select the 10 minute session, that’s all you need to lower that blood pressure and get blood circulating again.

One other tip, I highly recommend the book “Stillness is the Key” by Ryan Holiday.

Step 3: Eat more grass fed beef, wild caught fish, organic vegetables

It’s not as hard as you think. You are already here at Mark’s Daily Apple so you have already taken the first step!! Next, if you haven’t already is to dive into the Primal Blueprint Laws. Eating primally provides your body with the building blocks it needs to create and balance hormones.

Step 4: Eliminate Inflammatory foods

Eating in a way that minimizes inflammation will help get roadblocks out of the way. Take massive action and throw out any and all inflammatory foods from your cupboard. Going Primal and eliminating industrial seed oils (like corn, soy and sunflower) will help a lot! Replace them with avocado and olive oil.

Guard your health because well, your bedroom time and your life may depend on it. Eat more whole foods, and learn, study and live Primal. Have a sweet tooth? No problem, you can still have dessert! Just choose healthy ingredients. For example, here is my go-to almost daily after dinner dessert:

  • One cup organic berries
  • One Primal Dark Chocolate Almond Collagen Fuel Bar cut up
  • Organic Cinnamon, ginger, or whatever spices you like to sprinkle on
  • Organic vanilla unsweetened almond milk
  • An occasional teaspoon of organic honey

Step 5: Lower Inflammation

How to support a healthy inflammation response

  • Cold shower of ice plunge. Doesn’t sound like fun? Well, start out with just 10 seconds at the end of your shower and work your way up from there.
  • Infrared sauna
  • Daily moderate exercise
  • Research supplements such as Curcumin and CBD

Step 6: Get Moving!

Although I advocate for pumping iron, at the end of the day just move! Take up whatever form of exercise you like whether it be swimming, biking, hiking or tennis but get moving, get that blood circulation in high gear and oh, get out in the sun a little! That Vitamin D is also good for raising your testosterone.

Lastly, as a bonus here are a few herbs and other “hacks” as they say in the biohacking community that may help with libido issues:

  • Maca Root
  • Ashwaganda (included in the Adaptogenic Calm formula)
  • Tong Kat Ali
  • Horny Goat Weed
  • Foods high in nitric oxide, arginine and citrulline such as arugula, beets pistachios and watermelon
  • Peptides, particularly PT-141. or if you want an erection while also getting a tan, Melanotan 2.

Always work with a qualified medical professional when choosing supplements and health regimens. 

Tthanks for reading everyone. I hope this helps and at a minimum opens your eyes to addressing bedroom woes through healthy lifestyle choices and perhaps reducing your reliance on pharmaceuticals while still remaining in poor habits. You can do it! You are a Champ!

peter montpelierAbout Peter Montpelier, Health Coach/Longevity Expert at Team Appollon LLC

I am the co-founder and lead health coach of Team Appollon ( a peak performance and health company. I help people lose weight, build strength and create energy in their life to do the things that they love. Sign up for my free weekly health newsletter here.


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what do antioxidants doAntioxidants serve as a powerful first line of defense against damage to your cells from aging, stress, and inflammation. Moreover, antioxidants appear to contain cancer-fighting properties and to support the immune system (among many other benefits).

Many, many foods, especially colorful vegetables, contain a range of valuable antioxidants. We’ve listed a few of the most potent and popular choices for each class of antioxidants. Here, we’ll go through the most important ones.

What Do Antioxidants Do?

Antioxidants are molecules that capture free radicals, or harmful oxygen atoms, that occur in response to normal body processes and environmental conditions. Even the simple act of digesting your food produces free radicals.

Over time, an overabundance of free radicals can slowly damage healthy cells, and then healthy tissues and eventually organs. You want to minimize the damage as much as possible, and antioxidants can help protect you.

Your body can make some antioxidants, and you get others from food.

Antioxidants can be broken into two general categories: antioxidant enzymes, and antioxidant nutrients, which include vitamins, minerals and the various -noids detailed below.

Antioxidant Vitamins

Antioxidant vitamins can be broken down into flavonoids and carotenoids.


Flavonoids (also called bioflavonoids) are polyphenol pigment compounds that are present in most flowering plants. They are commonly grouped under anthocyanidins, proanthocyanins, and phenolics. The coolest fact about flavonoid antioxidants: they offer a double-punch because they improve vitamin C’s antioxidant capabilities.

Foods that contain flavonoids include tea, citrus fruit, citrus fruit juices, berries, red wine, apples, and others.‘>2

Antioxidant Enzymes

The antioxidant enzymes are superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx).

SOD: Cruciferous vegetables are a must!

CAT: Get enough iron from beef, mushrooms and sturdy greens to ensure proper catalase production.

GPx: Selenium activates this enzyme, so get plenty of eggs, chicken, and fresh garlic in your diet. If you’d like to supplement glutathione, you can take n-acetylcysteine, or NAC, a building block of glutathione that gives your body what it needs to make more.

Super Food List: The Best Antioxidant Foods by ORAC Value

Foods’ antioxidant quality is measured as an ORAC value, which stands for Oxygen Radical Absobance Capacity. Here is a list of some of the best antioxidant foods with the the highest ORAC values according to the USDA:

  • Prunes: 5770
  • Raisins: 2830
  • Blueberries: 2400
  • Blackberries: 2036
  • Kale: 1770
  • Strawberries: 1540
  • Spinach: 1260
  • Raspberries: 1220
  • Brussels sprouts: 980
  • Plums: 949
  • Alfalfa sprouts: 930
  • Broccoli flowers: 890
  • Beets: 840
  • Oranges: 750
  • Red grapes: 739
  • Red bell pepper: 710
  • Cherries: 670
  • Kiwi fruit: 602
  • Grapefruit, pink: 483
  • Onion: 450
  • Corn: 400*
  • Eggplant: 390

*Corn is a grain, which may not work for people following a Primal lifestyle.

These lists of antioxidants and antioxidant foods are certainly not comprehensive, as there are thousands of phytonutrients currently being studied and more are discovered every year. Bottom line: the more you get, the better. A combination of prudent supplementation and plentiful, colorful vegetables is your smartest bet.


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age related muscle lossWhen most people worry about getting old, they focus on the obvious degenerative diseases like diabetes and cancer and Alzheimer’s or the catastrophic health emergencies that can occur, like strokes or heart attacks. They think about the melange of medicines they might have to take, the panicked rush to the ER in the dead of night, the slow but unmistakable descent into painful oblivion. But one of the deadliest health conditions afflicting older adults is also one of the most silent and unknown: sarcopenia, or the degeneration and loss of muscle mass and strength.

People just don’t think about losing muscle mass and strength as they get older. If they do, they assume it’s just part of the aging process. They figure it’s unavoidable, because, after all, everyone around them just gets weaker and more decrepit as they age. It’s one of those “inevitabilities” that you “just have to accept.”

Screw that.

Muscle loss is not your destiny. You don’t have to sit there and take it. In fact, sitting there and taking it is the single best way to get sarcopenia; standing up and fighting is the single best way to avoid it. Plus, taking the necessary steps to mitigate or even prevent sarcopenia will help prevent all those other age-related maladies I mentioned in the opening paragraph.

Health Problems Related to Muscle Atrophy, or Muscle Loss

Sarcopenia the specific condition is linked to a number of poor health outcomes:‘>2:

  • It’s degradation of the muscle tissue.
  • It’s conversion from fast-twitch Type 2 muscle fibers that can handle heavy loads and high intensity to slow-twitch Type 1 muscle fibers that can only handle lighter loads and lower intensities.
  • It’s the loss of motor units at the muscle itself, forcing the few remaining motor units to pick up the slack and extending recovery times.
  • It’s the loss of cardiac strength, which impairs cardiovascular function and lowers VO2max.
  • It’s the impairment of tendon function, reducing strength and mobility and increasing the risk of injury.

Sarcopenia Definition

The European Working Group diagnoses sarcopenia if you have two of three conditions:‘>4

  • In elderly women, resistance training induces hypertrophy and lowers inflammation.‘>6
  • Even in subjects older than 80, strength training seems to counter the effects of sarcopenia.‘>8 Even more may be needed, since attaining nitrogen balance isn’t necessarily optimal. 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.‘>10‘>12

    Normally I’d favor just sunlight, but the potential for impaired vitamin D production in older adults makes supplementation plus sun a wise choice.

    Check Your Hormone Levels

    For older men, low testosterone is a huge risk factor for sarcopenia. Inadequate testosterone makes building and retaining lean muscle mass harder than it should be, so even if you strength train and eat extra protein to fight sarcopenia, you get subpar results. Optimize your T levels, whether through natural means or, if required, supplemental.://‘>14

    Get a Handle on Inflammation

    Patients with sarcopenia tend to have higher baseline levels of inflammation.‘>16

    Eat plenty of seafood and fish oil while avoiding seed oils to balance out your inflammatory precursors.

    Recover from your workouts with adequate protein and calories and fat.

    Don’t overeat too much. Not only is overeating on a regular basis inflammatory, it can increase intramuscular levels of fat in the muscles which degrade their function and exacerbate the sarcopenia.

    Lose Body Fat

    For years, researchers assumed the causality went sarcopenia—->obesity. Makes sense on some level. The weaker and more frail you are, the less you’re able to get enough physical activity to stay fit and trim. But the latest research suggests the causality runs the other way: excess adipose tissue secretes inflammatory adipokines which impair muscle function and structure.‘>1 It also activates reward centers in your brain so that food is more appealing, and your motivation to eat is stronger.‘>3 and more strongly in response to eating carbs and protein, compared to fat.‘>5 On the flip side, individuals with anorexia or cachexia due to chronic illness, who are in a severe state of negative energy balance, have high circulating ghrelin levels.‘>7‘>9