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Last week’s post on iron levels got a big response and garnered a ton of questions from you guys. Today, I’m going to clarify a few things and answer as many questions as I can. First, do iron and ferritin levels mean different things for men and women? If so, how do those differences manifest? What about premenopausal women vs postmenopausal women? Second, what do we make of the fact that ferritin is also increased in times of inflammation? Is there a way to distinguish between elevated ferritin caused by inflammation and elevated ferritin caused by high iron? Third, is desiccated liver a good option for liver haters? And finally, I share some exciting plague news.
I’d love to see more info on iron levels as they relate to men and women differently. I recently had an iron infusion for low ferretin, not thinking much would change I actually experienced so many positive effects I didn’t even know were coming my way. I’m less cold, no more afternoon fatigue, less hair falling out, no more random palpitations, improved restless leg syndrome and the number one big change is it improved anxiety levels – in fact my anxiety is now gone. The last two are due to a connection between iron and dopamine. I learnt that children with mental health issues are often treated for low ferretin where possible, elevating levels to around 100 showing positive results (would love to see literature on this), for me my ferretin went from 20 to 130 and its changed my life, at 31 I haven’t felt this good in years. Yay iron!
That’s awesome to hear. Yes, it’s important to stress the very basic essentiality of iron. Without it, we truly cannot produce energy. And since energy is the currency for everything that happens in the body, an iron deficiency makes everything start to fall apart.
As for gender and iron, there’s a lot to discuss.
A good portion of women with hemochromatosis never actually express it phenotypically, meaning their lab tests don’t show evidence of dysregulated iron metabolism or storage. According to one study of hemochromatosis homozygotes (people who inherited the mutation from both of their parents), being a woman makes it 16x more likely that your hereditary hemochromatosis won’t actually present as iron overload.
Another study found that among mostly-age-matched men (42 years) and women (39 years) with hemochromatosis, 78% of the men had iron overload while just 36% of the women had it. Iron overload was defined as transferrin saturation over 52% combined with ferritin levels of 300 ng/mL for men and 200 ng/mL for women.
High iron levels are more of an issue for postmenopausal women than premenopausal women. The latter group regularly sheds blood through menstruation, and if anything, they’re at a higher risk of low iron. Plus, estrogen is a key regulator of iron metabolism. As menopause sets in and estrogen diminishes, that regulation suffers.
In postmenopausal Korean women, high ferritin levels predict metabolic syndrome and subclinical atherosclerosis.
High ferritin predicts metabolic syndrome in postmenopausal but not premenopausal women.
In premenopausal Korean women, higher ferritin levels predict better bone mineral density; menopause nullifies this relationship.
Remember that ferritin is actually a measurable protein bound to iron, so testing a ferritin level is technically an indirect way to measure iron. Why is this important? Another characteristic of ferritin (the protein) is that it is an ACUTE PHASE REACTANT. This means that ferritin levels can fluctuate with illnesses and other inflammatory states in the body that drive up a ferritin value that is not related to an actual iron level fluctuation. Don’t get ferritin checked when you are sick with a cold or other illness.
This is a great point.
Ferritin is marker of long term iron storage, but it’s also an acute phase reactant that up regulates in response to inflammation or oxidative stress.
If you want to be really careful, you should get a HS-CRP test—that measures your overall inflammatory status. If CRP is elevated, ferritin can be elevated without saying anything about your iron status.
Come to think of it, if elevated ferritin can be a marker of inflammation and oxidative stress, the inflammation could be responsible for some of the negative health effects linked to high ferritin. Or, if having too much iron in the body can increase oxidative damage, it may be that high iron levels are increasing inflammation which in turn increases ferritin even further. Biology gets messy. Lots of feedback loops. However, the fact that many studies cited in the previous iron post that use blood donation to treat high ferritin have positive results indicates that for most people, ferritin can be, in most situations, an accurate estimation of your iron status.
To make sure it’s an iron problem, get a transferrin saturation test as well. That indicates the amount of iron you’re absorbing, with below 20% being low and over 45% being high. People with high ferritin and high transferrin saturation do have high iron levels. People whose ferritin is artificially enhanced by inflammation will have normal transferrin saturation levels.
I have one last question on this. You say “Don’t stop eating liver every week.” If you can’t stand the taste of liver, what do you think about taking liver capsules made from grass-fed New Zealand beef every day instead?
That’s a great option. Go for it.
People should generally aim for 4-8 ounces of fresh liver a week. Note the amount of desiccated liver in your capsules and multiply by 3 to get the fresh liver equivalent, then take enough each day (or all at once) to hit 4-8 ounces over the week. I hear good things about this one.
Thank you for your article on HH. I carry the gene but have been managing my iron levels through phlebotomies. I am full Keto, meat and all and have found my iron levels have not been effected by going Keto. Early detection is the key and ongoing monitoring. Bring on the plague!!!
You joke about that now, but there’s a startup that’s breeding heritage rat fleas that produce a mild strain of the plague that evades the attention of the immune system and proliferates throughout the body to keep iron levels in check without killing you. I’m an early investor, have a couple swarms installed in my condo, and (knock on wood) so far have avoided anything worse than a sore throat and maybe a mild open sore or two. There’s actually a big rift forming between the techs who want to keep the fleas heritage and those who want to go ahead with CRISPR and engineer them. One variant has had a deer tick gene inserted that adds an anesthetic compound to the flea’s saliva. That way you can have a personal swarm on you and never feel any bites or itches.
I’m not sure about CRISPR just yet, but I gotta say it’s pretty nice to be covered in fleas and not feel the bites. Time will tell.
Ok, I’m joking.
That’s it for today, folks. I hope I’ve answered some of your concerns, and if not, let me know down below. Thanks for reading!
Lainé F, Jouannolle AM, Morcet J, et al. Phenotypic expression in detected C282Y homozygous women depends on body mass index. J Hepatol. 2005;43(6):1055-9.
Qian Y, Yin C, Chen Y, et al. Estrogen contributes to regulating iron metabolism through governing ferroportin signaling via an estrogen response element. Cell Signal. 2015;27(5):934-42.
Seo SK, Yun BH, Chon SJ, et al. Association of serum ferritin levels with metabolic syndrome and subclinical coronary atherosclerosis in postmenopausal Korean women. Clin Chim Acta. 2015;438:62-6.
Cho GJ, Shin JH, Yi KW, et al. Serum ferritin levels are associated with metabolic syndrome in postmenopausal women but not in premenopausal women. Menopause. 2011;18(10):1120-4.
Chon SJ, Choi YR, Roh YH, et al. Association between levels of serum ferritin and bone mineral density in Korean premenopausal and postmenopausal women: KNHANES 2008-2010. PLoS ONE. 2014;9(12):e114972.
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So you start your keto diet, and things are going well. You’re dropping excess fat, your carb cravings are noticeably reduced, your energy is steady throughout the day… and then one day you start to have the sneaking suspicion that you’re shedding more hair than usual. After a few days, it’s unmistakable: your hair is definitely falling out at an alarming rate.
Take a deep breath. Nobody wants to lose their hair, obviously, but it’s probably a harmless and temporary condition called telogen effluvium (TE). Hair growth is cyclical. Each hair follicle goes through a growth phase (anagen) and a rest phase (telogen). Usually the cycles are staggered from follicle to follicle, so some are growing while others are resting and shedding. With TE, more follicles than normal go into resting at the same time, leading to noticeable hair loss.
The good news is that TE usually resolves itself within a few months. For many people the answer is simply to wait it out. However, hair loss can be caused or exacerbated by issues that you can address on your own or with the help of a medical practitioner. Let’s dig into it.
What Causes Telogen Effluvium?
TE is one of those diagnoses that describes what is happening but not why. It’s kind of a catch-all label to describe diffuse but likely temporary hair loss that could be caused by a number of factors, and it’s not terribly well understood. The general consensus is that TE can occur whenever the body experiences stress. Unfortunately, the body can interpret any big changes, even ones that feel positive like the birth of a child, as stressors. Dramatic dietary changes and/or sudden or rapid weight loss, as often occurs when starting a keto diet, are two such potential stressors. (This isn’t unique to the keto diet, by the way!)
If you think back three or so months from the time you started to notice your hair thinning, can you identify a major change or stressful life event that happened around that time? If so, it’s likely that you’re experiencing TE.
Eating in a big caloric deficit and eating too little protein might also trigger TE, and both are potential (and easily remedied) issues for keto dieters. When the body has limited resources to devote to building, repair, and maintenance, hair growth will go on the back burner, since it’s a non-vital process. Specific nutrient deficiencies have also been implicated in TE, particularly iron and zinc. The link between iron deficiencies and TE is stronger for women, while zinc deficiencies might affect men more, but the evidence for both is mixed. In part, it is hard to pin down dietary causes because the same foods that are the best sources of iron are also rich in zinc and amino acids.
Why Doesn’t Everyone Lose Their Hair When They Go Keto Then?
Great question. Whether or not your body interprets any given situation as too stressful is complicated. It’s a factor of your chronic stress levels, other acute stressors that happen to co-occur, your physical health and hormone status, and probably tons of other things. Your mindset undoubtedly has a lot to do with it, too. You can inject stress into a situation with how you think about it, whether you worry or try to micromanage, whether you feel optimistic or pessimistic. It’s also possible that some people who experience TE don’t really notice it because their hair loss is fairly minor.
Is There Anything I Can Do?
First, prevention is the best medicine. There is no way to guarantee that you won’t experience TE when starting keto, but The Keto Reset Diet approach is specifically designed to mitigate stress. Whereas other methods of keto induction involve severe carb restriction and sometimes multi-day fasting to body slam you into ketosis, the Keto Reset is a kinder, gentler process (not to mention a more nutrient-dense approach). First, you get fat-adapted, then gradually lower carb to ketogenic levels to avoid an acute shock to the system. This is also why we ask people to take the midterm exam in the book before even starting keto. The midterm exam looks for signs that you are already stressed (poor quality sleep, for example) in an attempt to prevent your “stress bucket” from overflowing (and the hair from shedding!).
If you’re already thinning, and it’s pretty clear what probably initiated it two to four months prior, then chances are you can just wait it out. Within a few months you should be seeing regrowth, and in six months to a year you’ll be past it. Yes, I know it’s easier said than done to just wait six months to see if your hair is growing back, so if you want to be more proactive, here are a few ideas.
- Manage stress. While TE usually follows more acute stressors, chronic stress can also contribute. Whatever you can do to reduce your day-to-day stress might help your hair loss and if nothing else will improve your overall quality of life.
- Look at your diet. If you are eating in a caloric deficit, especially if it’s greater than 20% of your baseline calorie needs, perhaps try adding back some calories. You’ll know if you overshoot it if you stop hitting your weight loss goals or if you start gaining if you were at maintenance already.
- How’s your protein intake? Too many keto dieters have been scared away from protein by the gluconeogenesis boogeyman. The Keto Reset Diet recommends starting with 0.6 to 0.8 grams of protein per pound of lean body mass. You can increase to 1.0 gram/lb/LMB if it seems appropriate for your situation.
- Make sure you’re incorporating plenty of iron- and zinc-rich foods. Even though the evidence is not conclusive as to whether iron and zinc are linked to TE, they are still vital for health. The best sources are red meat, seafood (especially oysters), and poultry. You’ll notice these are all animal products, which means if you’re vegetarian or vegan, you have to work extra hard to get these nutrients. Leafy greens, nuts and seeds, and legumes (if you choose to incorporate them) can provide some of what you need, but they are not the best options.
A well-formulated multivitamin/mineral is worth considering if you don’t already take one, but get your iron and zinc levels tested before supplementing either of those on its own. With both, there are concerns about over-supplementing and developing toxicity. Iron overload such as that caused by the genetic condition hemochromatosis can also cause hair loss, so consult a doctor before taking iron supplements. Lastly, some people also swear by adding biotin, a member of the B vitamin family. While biotin is associated with nail and hair health, there is not empirical evidence to support biotin supplementation for TE.
When to See Your Doctor
Now that I’ve spent all this time telling you it’s probably TE and nothing to worry about it, I must add the caveat that TE is only one of many potential causes of hair loss. Be sure to enlist the help of a medical professional if you are experiencing any other unexplained or disruptive symptoms, or if there isn’t an obvious reason why you might be experiencing TE. Do not ignore symptoms such as unexplained weight gain or weight loss, fatigue, sleep disturbances, feeling cold all the time, menstrual irregularities, or digestive issues, especially in combination with significant hair loss. Depending on your symptoms, your doctor may want to test you for nutrient deficiencies, sex hormone imbalances, or thyroid issues.
Have any follow-up questions? Join the Keto Reset Facebook community for answers to all your keto queries! Thanks for stopping by today, everybody.
Abdel Aziz AM, Sh Hamed S, Gaballah MA. Possible Relationship between Chronic Telogen Effluvium and Changes in Lead, Cadmium, Zinc, and Iron Total Blood Levels in Females: A Case-Control Study. Int J Trichology. 2015; 7(3):100-106.
Harrison S, Bergfeld W. Diffuse hair loss: its triggers and management. Cleve Clin J Med. 2009; 76(6):361- 367.
Malkud, D. Telogen Effluvium: A Review. J Clin Diagn Res. 2015; 9(9): WE01–WE03.
Moeinvaziri M, Mansoori P, Holakooee K, et al. Iron status in diffuse telogen hair loss among women. Acta Dermatovenerol Croat. 2009; 17(4):279-284.
Rushton DH. Nutritional factors and hair loss. Clin Exp Dermatol. 2002; 27(5):396-404.
The post Explaining Keto and Hair Loss (and Why Any Dietary Change Might Cause It) appeared first on Mark’s Daily Apple.
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Men occupy an interesting place in the health sphere. While there’s a disparity—albeit one that’s approaching parity—between men and women in the conventional medical literature, in the alternative health world, it’s flipped. Women are a “special interest” group, and their specific health issues and special considerations related to diet and exercise receive a lot of attention, often as a way to counteract the conventional imbalance—and because women tend to be higher consumers of health information. I have far more posts (including a post on Keto For Women) explicitly directed toward women and women’s issues (and the same can be said across many ancestral health sites).
Men are assumed to be “the default,” requiring no special consideration, but is that actually true?
Today, I’ll be talking about any special considerations men should make when following a Keto Reset plan.
Play At the Margins
Historically, anthropologically, and biologically speaking, men can tolerate great variations in environmental intensity. They’re usually (not always of course) the ones going to war, performing great feats of physical endurance and strength, willingly subjecting themselves to misery and pain, as well as being more violent and getting into the most trouble. (On the whole) carrying more muscle mass, secreting more testosterone, and being physically larger than the opposite sex will tend to make all that possible. We see this kind of sexual dimorphism play out across most mammals, and there’s no reason to think humans are any different.
Most of us don’t have these extreme situations foisted on us any more, but we still thrive doing them. Try a 2-day fast. Do one meal a day. Eat a 3-pound steak, then no meat at all the next day. Eat a dozen eggs for breakfast (whenever that happens). Try lots of seemingly extreme experiments to see what works. It may be that you thrive doing the occasional intense bout of keto bravado. Only one way to find out.
Whereas women tend to have a lower tolerance for perturbations in caloric intake for their potential impact on fertility status, men have far more leeway. Take advantage of that.
Be As Strict As Possible Early On
I’m not going to mince words. Get strict. Most of the men I encounter who are having problems with keto do better the stricter they are. For women, it’s often the opposite—they need to relax their keto adherence and just eat.
Don’t mess around with carb refeeds, pre-workout carbs, or “just one donut hole” until you have a good thing going. Get those fat-burning mitochondria built. Stay strong and stay strict.
Manage Your Stress Levels
This is good general advice for everyone on any diet, but it’s especially so for men eating keto.
A big part of traditional masculinity (for better and worse) is stoicism—the ability to soldier on through a difficult situation. This is, on balance, often a good yet misunderstood trait that gets a bad rap that it doesn’t always deserve. Stoicism isn’t unfeeling. At its healthiest, it’s the ability to address the feelings without being ruled by them. It’s feeling grief without letting your life fall to pieces. These are positive ways to respond to life’s slings and arrows. But this can lead to a denial of the physiological ramifications of stress and a failure to manage them with anti-stress behaviors.
Keto does not make you impervious to stress. Being a man does not make you impervious to stress. There are still limits to the amount of stress we can tolerate, physiological ones that no one should try to transcend. At those levels, “mind over matter” stops working. Stress will spike cortisol, blunt testosterone, and make all that decidedly non-keto junk food all the more attractive and alluring.
Monitor Your Testosterone Levels
For the most part, going keto tends to improve testosterone levels:
It reduces body fat. Researchers have known for decades that carrying extra body fat depresses testosterone levels, and that losing the extra fat restores them. In fact, a recent study found that a man’s body weight is such a fantastic predictor of low testosterone and poor sexual function that the authors recommend it should be used as a standard biomarker for evaluating testosterone levels. If keto is helping you lose body fat, it’s probably improving your T levels.
It increases saturated fat and cholesterol intake. Both nutrients (yes, nutrients) are important building blocks for the production of testosterone. Studies show that low-fat, high-fiber diets lower testosterone in men, while diets higher in saturated fat increase it.
Once the initial exodus of body fat is over, though, you have to be more vigilant. Calories can dip too low. Deficiencies of micronutrients you haven’t been thinking about may start to surface. And this can all impact your testosterone levels.
Make sure you’re not starving yourself. Men are built to handle and even prosper from acute boluses of extreme caloric restriction or expenditure (fasts, heavy training), but extended bouts can destroy our hormonal profile. Just look at what happens to a seasoned bodybuilder preparing for competition with caloric restriction and intense training—their testosterone tanks and their cortisol shoots up.
Make sure you’re getting adequate amounts of the pro-testosterone micronutrients. Zinc, vitamin D (either through sun exposure, vitamin D-rich foods like wild salmon, eggs, cod liver oil, or supplementation), saturated fat, cholesterol, magnesium. Using a tool like Cronometer can help you track them and get your diet in order.
Don’t Let Keto Take Over
Men tend to obsess over things that interest them. We scour the literature, try to optimize everything, spend every waking moment thinking about how to do something—in this case, keto—better. We can get a little iron-willed and myopic if we don’t watch ourselves.
Focus is all well and good, but not if it starts impeding your ability to handle other aspects of health that are no less important.
Don’t stay up ’til 2 A.M. arguing on keto forums and reading PubMed abstracts. Get your sleep.
Don’t become a recluse because none of your friends understand your “weird keto thing.” Maintain your social relationships, your community.
Don’t stop sprinting because you measured your blood glucose once after a hill session and it spiked. Exercise is equally important.
Make Sure You’re Lifting
Keto does not replace strength training.
I’m a firm proponent of weight lifting for everyone—man, woman, elderly, and sometimes child (depending on the child). The benefits are unassailable and vast. Carrying lean muscle mass is a wholly beneficial trait for everyone.
But you have to admit, it’s especially crucial for a man. There’s nothing more indicative of poor metabolic health than the male skinny fat look. I see far too many men on keto diets who carry around the skinny fat look, and it’s usually because they aren’t lifting anything heavy. Yeah, you’re burning a lot of fat. Yeah, you’ve got some nice-looking mitochondria. Yeah, keto is protein-sparing. But are you using those mitochondria? Are you taking advantage of that lost dead weight to do some extra pull-ups? Are you content with merely limiting the number of amino acids your ketogenic metabolic state extracts from your muscle tissue, or are you going to build brand new muscle tissue?
Get to it.
That’s what I’ve got. What about you? Can you folks recommend any special tips, tricks, or tactics for men doing a keto diet?
Thanks for reading, everyone. Take care.
Masterson JM, Soodana-prakash N, Patel AS, Kargi AY, Ramasamy R. Elevated Body Mass Index Is Associated with Secondary Hypogonadism Among Men Presenting to a Tertiary Academic Medical Center. World J Mens Health. 2019;37(1):93-98.
Wang C, Catlin DH, Starcevic B, et al. Low-fat high-fiber diet decreased serum and urine androgens in men. J Clin Endocrinol Metab. 2005;90(6):3550-9.
Pardue A, Trexler ET, Sprod LK. Case Study: Unfavorable But Transient Physiological Changes During Contest Preparation in a Drug-Free Male Bodybuilder. Int J Sport Nutr Exerc Metab. 2017;27(6):550-559.
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