For this week’s edition of Dear Mark, I’m answering three questions from readers. First, is the reduced protein efficiency in older adults due to inactivity, or is it something inherent to the aging process, or both? Second, how does a person know if they’ve actually “earned” any carbs? Does everyone on a keto diet earn carbs by virtue of exercising, or is there more to it? And finally, how can a hardgainer with a packed schedule all week long and limited gym time maintain what little muscle mass he’s managed to gain?

Let’s find out:

Interesting observation on protein needs and training in Sunday with Sisson – general consensus is that older folks need more protein as they age but maybe that’s because they are less active and not simply a result of aging.

That’s probably part of it, but it’s not all of it.

In studies where they compare resistance training seniors who eat extra protein with resistance training seniors who don’t, only the seniors eating extra protein gain muscle mass.

Now, it may be that a lifetime of inactivity degrades your ability to utilize protein, and if these older adults had always lifted weights they would have retained their protein efficiency. But maybe not. As it stands, all else being equal, an older adult needs more protein to get the same effect, even if he or she is lifting weights.

Enjoyable read. As someone who lives a ketogenic lifestyle, and who is athletically active, I am not sure exactly how to go about consuming the carbs I’ve “earned.” I rarely run into problems with athletic energy, at least not below anaerobic threshold. Not sure that eating more carbs will improve my performance. And, if they would improve my performance, how does one go about calculating earned carb replacement without losing the fat burning benefits of ketosis?

It sounds like you’re in a good place.

When I say “eat the carbs you earn,” I’m talking to the people who do run into problems with athletic energy, poor performance, insomnia, and other symptoms of exercise-induced stress. Typically, the people who “earn their carbs” are doing stuff like CrossFit, high volume moderate-to-high intensity endurance work, martial arts training, and team sports.

I doubt extra carbs will improve your performance if most of your training takes place in the aerobic zone. But if you wanted to experiment, you could try a small sweet potato immediately after a workout where you passed the anaerobic threshold.

That’s the best way to determine if you’ve earned carbs. Eat 20-30 grams after a workout and see if you enjoy performance gains without gaining body fat. There’s no consumer-friendly way to directly calculate carb debt; self-experimentation is it.

I recently took a job that has me out of bed at 4am and not home until 6pm Monday Through Friday. Is there an efficient way I can maintain muscle mass only lifting weights Saturday and Sunday? I’m a hardgainer at 5’10” and only 140lbs. I’m afraid giving up my 5 day split will ruin what muscle I’ve been able to gain.

Any hardgainer has to eat, and eat, and eat. Increase your food intake. Just eat. Stick to healthy Primal fare, but pack in the food. Meat, milk, veggies, potatoes, rice, eggs, avocados, fruit. Throw some liver in, too (old bodybuilder staple). It doesn’t sound like fat gain is an issue for you, so I’d take advantage of that and just consume calories.

As for training, get some exercise snacks in during the week.

As soon as you wake up, do a quick superset of pushups. Do as many pushups as you can. Wait 30 seconds. Do as many pushups as you can. Wait 30 seconds. Do as many pushups as you can. There you go. That shouldn’t take more than 5 minutes in the morning. Can you squeeze that in?

Repeat this every morning with a different exercise. Pullups, bodyweight rows, kettlebell swings, handstand pushups, dips, bodyweight squats, goblet squats, reverse lunges, reverse weighted lunges. Just choose one thing to do every morning, cram as many reps as you can using the same format (max reps, 30 s rest, max reps, 30 s rest, max reps). Buy any equipment you can if you choose to use weights.

When you get home at night, do the same thing with a different exercise. Morning pushups, evening KB swings, etc. That way, you get about 10 minutes per weekday of intense strength training without impacting your sleep or schedule in any real meaningful way.

Make sure your sleep hygiene is rock solid. Dim those lights at night, turn on f.lux or night mode, wear the blue blocking goggles, get to bed (ideally) by 8:30, 9 to give you 7 to 7.5 hours of sleep. Sleep is essential for gaining lean mass (and staying healthy in general).

On the weekend, hit the weights hard on both days, hitting the entire body. Go high volume/reps. If size is your goal, dropping the weight a bit and focusing on range of motion and a high rep count (10-15 per set) is very effective.

Food, sleep, reps. Good luck!

Thanks for stopping in today, everybody. Additional thoughts for these folks—or questions of your own? Share them below.

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References:

Tieland M, Dirks ML, Van der zwaluw N, et al. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2012;13(8):713-9.

The post Dear Mark: Protein Efficiency in Seniors, Earned Carbs, Hardgainer with Limited Time appeared first on Mark’s Daily Apple.

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As you and millions of other people embark on new dietary journeys, you’re going to hear a ton about calories.

“Calorie counting is everything.”

“If you aren’t counting calories, you won’t lose weight.”

“Just eat less calories than you expend.” For one, it’s “fewer.” Two, that’s not the whole picture.

These statements aren’t wrong exactly, but they offer an overly simplistic picture of the relationship between weight loss and calories. They ignore context. And context is everything, especially when you’re talking about calories and weight loss.

Most people (even many scientists) believe that the body composition challenge is a relatively simple equation: to lose weight you must reduce calories (either eat less or burn more), to gain weight you must add calories (eat more or burn less), and to maintain weight you keep calories constant (eat and burn identical amounts). Calories in over calories out.

Right away, it sounds preposterous. Are people really maintaining perfect caloric balance by dutifully tracking and comparing their intake to their burn? Are they walking six fewer steps lest they lose an extra ounce off their midsection?

Are All Calories the Same?

The truth is, it’s more like a complex equation where you have to factor in many other very important variables:

  • Am I getting calories from fat, protein, or carbs?
  • Am I getting my calories through whole foods or refined processed foods?
  • Are my glycogen stores full or empty?
  • When’s the last time I exercised?
  • Am I insulin-sensitive or insulin-resistant?
  • Am I trying to lose “weight” or lose fat?
  • How’s my stress level?
  • Am I sleeping enough?

The answers to all those questions (and more) affect the fate of the calories we consume. They change the context of calories.

Ideally, all that complexity is handled under the hood. That’s how it works in wild animals. They don’t calorie count. They don’t think about what to eat or how to exercise. They just eat, move, sleep, and somehow it all works. I mean, they die, often violently, but you don’t see obese, metabolically-deranged wildlife—unless the obesity and metabolic derangement is physiological, as in bears preparing to hibernate. Somehow they figure it out. They’ve delegated the complex stuff to their subconscious.

This is generally true in “wild humans,” too. Hunter-gatherer groups by and large did not and do not show any evidence of metabolic derangement, obesity, or the other degenerative trappings of modern humans living in civilization. They are fully human in terms of physiology, so it’s not that they have special genetic adaptations that resist obesity. They’re living lifestyles and eating diets more in line with our evolutionary heritage. They’re moving around all the time, not going through drive throughs. They’re eating whole unprocessed foods that they have to procure, catch or kill.

What they don’t have is the ridiculous concept of calories and macronutrients floating around in their heads, informing their dietary choices. They don’t even think about food in terms of calories, or movement in terms of calories expended. Metabolically speaking, they consume their calories in the proper context.

But you? You might have to think about context. You might have to answer those questions and create the proper context.

Most people do not think about context. They home in on the number of calories the food database claims the food they’re eating contains, plot it against the numbers of calories the exercise database claims the exercise they’re doing expends, and then wonder why nothing’s working. That’s why “dieting doesn’t work”—because, as practiced in accordance with the expert advice from up high, it doesn’t. Almost invariably, the people who see great results from strict calorie counting, weighing and balancing, those types who frequent online weight lifting forums and have the freedom to spend hours perfecting their program, have the other relevant variables under control without realizing it.

They’re younger, with fewer responsibilities—and less stress and fewer disruptions to their sleep.

They’re lifting weights and training religiously, creating huge glycogen sinks and maintaining optimal insulin sensitivity.

They’re eating a lot of protein, the macronutrient that curbs hunger and increases energy expenditure the most.

They’re eating mostly whole foods.

They’ve had less time on this earth to accumulate metabolic damage.

Not everyone is so lucky.

Fat burning, glucose burning, ketone burning, glycogen storage, fat storage, gluconeogenesis, and protein turnover—what we do with the calories we consume—do not occur at constant rates. They ebb and flow, wax and wane in response to your micronutrient intake, macronutrient intake, energy intake, exercise and activity habits, sleep schedule, stress levels, and a dozen other factors. All of these energy-related processes are going on simultaneously in each of us at all times. But the rate at which each of these processes happens is different in each of us and they can increase or decrease depending on the context of our present circumstances and our long term goals. All of these processes utilize the same gene-based principles of energy metabolism—the biochemical machinery that we all share—but because they all involve different starting points and different inputs as well as different goals or possible outcomes, they often require different action plans. We can alter the rate at which each of these metabolic processes happens simply by changing what and when we eat and addressing the non-dietary variables. We can change the context.

But don’t controlled trials demonstrate that a “calorie is a calorie”?

People hear things like “in controlled isocaloric trials, low-carb diets have never been shown to confer a metabolic advantage or result in more weight loss than low-fat diets.” While often true, they miss the point.

People aren’t living in metabolic wards with white lab coats providing and precisely measuring all their food. They’re living in the real world, fixing their own food. Free living is entirely uncontrolled with dozens of variables bleeding in from all angles. In the lab situation, you eat what they give you, and that’s that. The situations are not analogous—real world vs. controlled lab environment.

In real world situations…

Why a Calorie Isn’t Just a Calorie

The macronutrient composition of the calories we eat alters their metabolic effects.

The metabolism of protein famously increases energy expenditure over and above the metabolism of fat or carbohydrate. For a given caloric load, protein will make you burn more energy than other macronutrients.

Protein is also more satiating than other macronutrients. Eat more protein, curb hunger, inadvertently eat less without even trying (or needing a lab coat to limit your intake).

Protein and fat together (AKA “meat”) appear to be even more satiating than either alone, almost as if we’re meant to consume fat and protein in the same meal.

The isocaloric studies tend to focus on “weight loss” and discount “fat loss.” We don’t want to lose weight. We want to lose fat and gain or retain lean muscle mass. A standard low calorie diet might cause the same amount of weight loss as a low-carb, high-fat diet (if you force the subjects to maintain isocaloric parity), but the low-carb approach has been shown to increase fat loss and enhance muscle gain. Most people who lose weight with a standard approach end up losing a significant amount of muscle along with it. Most who lose weight with a low-carb, higher-protein-and-fat approach lose mostly fat and gain or retain most of their muscle.

Take the 2004 study that placed overweight men and women on one of two diets: a very low-carb ketogenic diet or a low-fat diet. The low-carb group ate more calories but lost more weight and more body fat, especially dangerous abdominal fat.

Or the study from 1989 that placed healthy adult men on high-carb or high-fat diets. Even though the high-carb group lost slightly more body weight, the high-fat group lost slightly more body fat and retained more lean mass.

Both describe “weight lost,” but which is healthier?

Whether the calories come in the form of processed or whole food determines their effect.

We even have a study that directly examines this. For two weeks, participants either supplemented their diets with isocaloric amounts of candy (mostly sugar) or roasted peanuts (mostly fat and protein). This was added to their regular diet. After two weeks, researchers found that body weight, waist circumference, LDL, and ApoB (a rough measure of LDL particle number) were highest in the candy group, indicating increased fat mass and worsening metabolic health. In the peanut group, basal metabolic rate shot up and neither body weight nor waist size saw any significant increases.

Your current metabolic state determines the effect of calories.

In one study, a person’s metabolic reaction to high-carb or low-carb diets was determined by their degree of insulin resistance. The more insulin resistant a subject, the better they did and the more weight they lost on low-carb. The more insulin sensitive a subject, the better they did and the more weight they lost on low-fat. Calories were the same across the board.

In another study, insulin-sensitive obese patients (a rarity in the general population) were able to lose weight on either low-carb or low-fat, but insulin-resistant obese patients (very common) only lost weight on low-carb.

Whether you exercise determines the effect of calories.

If you’ve just finished a heavy lifting workout followed by a sprint session, your response to a given number of calories will differ from the person who hasn’t trained in a year.

Training: Your muscle glycogen stores will be empty, so the carbs you eat will go toward glycogen storage or directly burned, rather than inhibit fat burning. Your insulin sensitivity will be elevated, so you can move protein and carbs around without spiking insulin and inhibiting fat release. You’ll be in hypertrophy mode, so some of the protein you eat will go toward building muscle, not burned for energy.

Not Training: Your muscle glycogen stores will be full, so any carbs you eat will inhibit fat burning and be more likely to promote fat storage. Your insulin sensitivity will be low, so you’ll have to release more insulin to handle the carbs, thereby inhibiting fat burning the process. You won’t have sent any hypertrophy signals to your muscles, so the protein you eat will be wasted or burned for energy.

How you slept last night determines the effects of calories.

A single night of bad sleep is enough to:

  • Give you the insulin resistance levels of a diabetic. Try eating carbs in an insulin-resistant state and tell me a “calorie is a calorie.”
  • Make the reward system of your brain light up in response to junk food and dampen in response to healthy whole food. The more rewarding you find junk food, the more your brain will compel you to eat more of it.
  • Reduce energy expenditure. Your “calories out” drops if you sleep poorly.

And those are just a few important variables that determine the context of calories. There are many more, but this post has gone on long enough…

The Take-Home Message

If calorie-counting works for you, great! You’re one of the lucky ones. Own that and keep doing what you’re doing. You’ve clearly got a good handle on the context of calories.

If calorie-counting and weighing and measuring failed you in the past, you’re not alone and there’s a way forward. Address the variables mentioned in this post that need addressing. Do you need better sleep? Do you need to manage stress better? Could you eat more protein or fat, eat more whole food and less processed food, or get more exercise, or lift more weights, or take more walks?

Handle those variables, fix those deficiencies, and I bet that your caloric context will start making more sense. The trick isn’t to increase the number of variables you plug into your calories in/calories out formula. It’s to make sure all your lifestyle and dietary ducks are in a row so that the caloric balance works itself out.

By understanding how these metabolic processes work, and knowing that we can control the rates at which each one happens through our diet (and exercise and other lifestyle factors) we needn’t agonize over the day-to-day calorie counting. As long as we are generally eating a PB-style plan and providing the right context, our bodies will ease into a healthy, fit, long-lived comfort zone rather effortlessly.

So, what’s your caloric context looking like? Thanks for reading today, everyone.

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References:

Pontzer H, Wood BM, Raichlen DA. Hunter-gatherers as models in public health. Obes Rev. 2018;19 Suppl 1:24-35.

Claesson AL, Holm G, Ernersson A, Lindström T, Nystrom FH. Two weeks of overfeeding with candy, but not peanuts, increases insulin levels and body weight. Scand J Clin Lab Invest. 2009;69(5):598-605.

Volek J, Sharman M, Gómez A, et al. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutr Metab (Lond). 2004;1(1):13.

Mccargar LJ, Clandinin MT, Belcastro AN, Walker K. Dietary carbohydrate-to-fat ratio: influence on whole-body nitrogen retention, substrate utilization, and hormone response in healthy male subjects. Am J Clin Nutr. 1989;49(6):1169-78.

Cornier MA, Donahoo WT, Pereira R, et al. Insulin sensitivity determines the effectiveness of dietary macronutrient composition on weight loss in obese women. Obes Res. 2005;13(4):703-9.

Ebbeling CB, Leidig MM, Feldman HA, Lovesky MM, Ludwig DS. Effects of a low-glycemic load vs low-fat diet in obese young adults: a randomized trial. JAMA. 2007;297(19):2092-102.

Benedict C, Hallschmid M, Lassen A, et al. Acute sleep deprivation reduces energy expenditure in healthy men. Am J Clin Nutr. 2011;93(6):1229-36.

***This article was substantially revised from the original version, which you can read here.

The post Are All Calories the Same? appeared first on Mark’s Daily Apple.

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I always feel better when I start my day with a good serving of protein. I remain satisfied for a longer period of time, my energy levels are higher … it’s just a really simple way to show myself a little love before the demands of my day take over. Except, well. It’s not like most of my typical breakfasts are exactly complicated, but even a basic smoothie requires a few ingredients, plus the cleaning of the blender, so although I can whip one up in very little time, it’s still a far cry from grab-and-go. And sometimes, I really just…

The post Plant-Based, Protein-Packed, and FAST Breakfast Ideas appeared first on Fit Bottomed Girls.

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Today’s guest post is generously offered up by Craig Emmerich, husband to—and co-author with—the queen of keto herself, Maria Emmerich. Enjoy!

When we consume macro nutrients, our bodies go through a priority for dealing with them. This priority can be very useful in understanding how our bodies work and how to leverage it for losing weight.

The body doesn’t like having an oversaturation of fuel in the blood at any time. It tightly manages the fuels to avoid dangerous situations like hyperglycemia or blood glucose that is too high. But it also manages and controls other fuels like ketones (beta hydroxybutyrate or BHB levels) and fats (free fatty acids or FFA and triglycerides) to keep them under control and not oversaturate the blood with fuel.

It is like the engine of a car. You don’t want to give the engine too much fuel and blow it up. So the body controls the amount of fuels in the blood to ensure you don’t “blow up.” To do this, the body will address the most important (or potentially most dangerous) fuels first. It does this in a very logical way—in reverse order of storage capacity.

Here is a chart showing the breakdown of oxidative priority for dietary fuels.

Modified Source: Keto. By Maria and Craig Emmerich
Original source: Oxidative Priority, Meal Frequency, and the Energy Economy of Food and Activity: Implications for Longevity, Obesity, and Cardiometabolic Disease, Sinclair, Bremer, et al, February 2017.

The #1 oxidative priority is alcohol because there is zero storage capacity for it. It makes sense that the body would address this first, since it can’t store it anywhere and too high blood alcohol means death.

The second oxidative priority is exogenous ketones. These are ketone salts that raise blood BHB levels. There isn’t a storage site for ketones either, so the body must deal with this before addressing other fuels. That is why exogenous ketones aren’t the best option when trying to lose weight. They displace fat oxidation, keeping fat stored while it uses the exogenous ketones as fuel instead.

The third oxidative priority is protein. Protein is a bit different, as there is a limited storage space for protein, but protein is not a good fuel source. It takes 5 ATP to turn protein into a fuel (glucose through gluconeogenesis) and another 2 ATP to burn in the mitochondria. Why would your body expend 7 ATP for something it can do for 2 ATP by just burning glucose or fat from your body? Protein is only really used as a fuel when other fuels (glucose and fat) are not present and it is forced to use protein. Protein gets preferentially used to stimulate muscle protein synthesis. It builds and repairs lean mass.

The next oxidative priority is carbohydrates. It has a moderate amount of storage capacity at 1,200 to 2,000 calories.

The last oxidative priority is fat. This makes sense, as there is a theoretically unlimited storage capacity for fat. There are people with upwards of 400 pounds of stored body fat, which represents 1.6 million calories.

Oxidative priority can help you understand what happens when you put certain fuels into your body. If you are drinking alcohol while eating carbs and fat, the carbs and fat will primarily go into storage while the body deals with the elevated alcohol.

To understand the power of oxidative priority take the case of an alcoholic. Alcoholics will have very low A1c levels (in the 4s) no matter what they eat! If they eat tons of carbohydrates they will still have an A1c in the 4s because the chronically elevated alcohol levels force the body to store all glucose while dealing with alcohol, creating a low A1c. I am not recommending anyone become an alcoholic to lower A1c level—but quite the opposite actually.

So, what does this mean, and how can you leverage your body’s biology to lose weight?

If you avoid alcohol and exogenous ketones, get a just enough protein to support maintenance of lean mass (about 0.8 times your lean mass in pounds for grams of protein a day), limit the carbs and then reduce dietary fat a bit to force the body to use more stored body fat for fuel you will lose body fat. When you restrict carbs for long enough (4-6 weeks for most people) the body gets used to using fat as its primary fuel (keto adapted). This means it can burn body fat or dietary fat equally well. Eliminating other fuels and keeping dietary fat moderate allows the body to focus on body fat for fuel resulting in fat loss.

That is our bodies system for processing fuels coming in through the diet. Leverage it for improved results and body recomposition.

Craig Emmerich graduated in Electrical Engineering and has always had a systems approach to his work. He followed his wife Maria into the nutrition field and has since dedicated his time researching and looking at nutrition and biology from a systems perspective. Over the last 8 years he has worked with hundreds of clients alongside Maria to help them heal their bodies and lose weight leveraging their biology to make it easy.

Thanks to Craig for today’s keto insights, and thanks to everybody here for stopping in.

You can follow Maria and Craig’s work on their website, Maria Mind Body Health, as well as their subscription site, Keto-Adapted, and their new keto courses.

Questions about dietary fuels and oxidative priority—or other points keto? Share them down below, and have a great end to the week. Take care, folks!

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Hey, folks! Today’s post is written by Dr. Lindsay Taylor. Lindsay is my co-author on The Keto Reset Instant Pot Cookbook and The Keto Reset Diet Cookbook. She also heads up our Keto Reset and Primal Endurance Facebook communities, and you might have heard her on the Primal Blueprint and Primal Endurance Podcasts. I’ve asked Lindsay if she would pop over to Mark’s Daily Apple from time to time to give us some insights from the front lines of the world of keto in addition to a few other topics. Enjoy!

Hi, everyone, thanks for having me here! Today I want to sort out one of the more common questions we get over in the Keto Reset Facebook community: “Is ____ keto?”

Fill in the blank with any type of food—beets, carrots, tomatoes, soy milk, cassava flour, you name it. It really doesn’t matter what food you insert into that blank because the answer I’m going to give is always the same:
There is no such thing as keto and non-keto food.

Now let me explain what I mean there….

Remember, ketosis is a metabolic state defined by having measurable levels of beta-hydroxybutyrate (BHB) in the blood (or acetone in the breath if that’s how you’re measuring). A ketogenic diet is any way of eating that allows you to be in ketosis. And guess what? There are no foods that automatically kick you out of ketosis—i.e., that are guaranteed to bring your level of measurable ketones to zero upon ingestion. Even pure white sugar won’t knock you out of ketosis if you eat a small enough amount, hence the saying, “Any food is keto if you slice it thinly enough.”

Of course I understand that when someone asks, “Is ____ keto?” they’re really asking, “If I eat a reasonably sized serving of this food, will I be knocked out of ketosis?” And my answer is: I don’t know.

Embracing the Keto Context

I’m not trying to be difficult here, but the answer depends entirely on the context. Among the many variables that factor in are the given individual’s carbohydrate tolerance and insulin sensitivity, how active they are and whether they have recently exercised, and how much of that particular food they intend to eat and their individual response to that food (which itself probably depends on genetics and a whole host of other variables).

In order to be able to classify foods as keto and non-keto, a given food would have to reliably affect most people the same way (i.e., no difference between individuals), and it would have to affect the same person the same way in different contexts (i.e., no difference between situations). That simply isn’t how it works.

Let me give you an example. I recently went to a birthday party at a friend’s house… a friend who just happens to make the best chocolate cake in the world. I don’t even really like cake, except hers is amazing. I reined in my desire to go face-first into the cake and ate a moderate slice. Though I patted myself on the back for my admirable self-control, I expected be out of ketosis the next morning. Guess what? At 10 a.m. the following day: 3.2 mmol/L on my blood ketone meter (anything above 0.5 mmol/L is considered “in ketosis,” and 3.2 is pretty high, especially for me).

So, does that mean that chocolate cake is a keto food? “Yes” because it didn’t knock me out of ketosis? Or still “no” because it’s chocolate cake and everyone knows chocolate cake isn’t keto no matter what my ketone meter said? But if “no,” how did I get one of the highest blood ketone readings I’ve ever registered without extended fasting? Is this the start of the new hottest diet, choco cake-o keto??

The high ketone reading was probably due to the fact that I had done a long training run the morning before and had been somewhat calorie restricted in the days prior. I would not expect the same outcome if I ate the same amount of chocolate cake on a rest day, or if I ate three times as much cake (like I wanted to) even on a heavy training day. Nor do I expect that anyone training for a marathon can eat chocolate cake after runs and remain in ketosis. I might have to do some follow-up cake testing to find out, though. Purely for science, of course….

I think that we can all agree that chocolate cake is not a food that someone should eat regularly, if at all, particularly if being in ketosis is very important to them (or likewise if they care to adhere to Primal principles). Nevertheless, this helps illustrate why “Does it kick me out of ketosis?” isn’t the right metric to use for deciding whether to include a food in your regular keto repertoire.

Ketosis can be a finnicky state. Trying to micromanage it by fretting about whether certain foods are keto seems like a waste of time, especially since most of the foods that people stress over aren’t things like chocolate cake (a “no duh” food) but are otherwise nutritious items like beets, tomatoes, carrots, leeks, and so on. And, anyway, unless you’re following a ketogenic diet to address a serious medical issue like epilepsy, staying in ketosis 100% of the time isn’t required. Mark has written before on the question of whether constant ketosis is even desirable, let alone necessary to meet our health, fitness, and longevity goals.

Fielding Expert Guidance: e.g. “But so-and-so said I’m not allowed to eat ______ because it’s not keto!”

I know if you’ve spent any time researching a ketogenic diet online, you’ve undoubtedly found list after list of “keto foods” and “non-keto foods”… and many times those lists contradict each other. What gives?

Keto being such a hot dietary strategy right now, there are approximately a bazillion keto coaches, keto Facebook groups, YouTube channels, Instagram pages, and blogs all devoted to telling you how to go keto the “correct” way. One “expert” will say absolutely that dairy is not keto, then the next Instagram model will proudly display a bowl of cream cheese with the hashtag #ketobreakfast. One Facebook group will insist that you eat nothing that grows below the ground, while the next lets you eat any vegetables except nightshades, and this one over here only allows members to eat spinach and cabbage. No wonder keto newbies get so overwhelmed!

It’s important to understand that when someone says that certain foods aren’t keto, they really mean that those foods aren’t allowed (a word I strongly dislike) on their version of a keto diet. However, as I said above, any way of eating that results in a state of ketosis—either through carbohydrate restriction, fasting, or a combination of the two—falls under the keto umbrella. There are many, many versions of the keto diet, and just because some “expert” says that certain foods aren’t keto doesn’t mean you can’t achieve your goals while eating those foods. It simply means that this person has decided that their particular version of keto is best, perhaps because it worked well for them, or perhaps because they based it on ethical beliefs or their good-faith interpretation of the available science or, frankly, sometimes because they don’t understand keto very well. And that’s fine–their audience, their rules. That doesn’t make their rules right for everyone, though.

Asking Better Questions

Lest it seem like I’m maligning anyone who sets any kind of parameters on a keto diet, let me be very clear: there are foods that we would and would not encourage members of our Keto Reset community to consume. However, we encourage our community to decide whether or not to eat something not by asking, Is it keto? but by asking, Do I believe this food is healthy?

Of course, because we are a community rooted in Primal sensibilities, we assert that some foods are more likely to promote optimal health—i.e., those in the Primal Blueprint Food Pyramid. And yes, if you decide to go keto, which restricts carbohydrate intake to less than 50 grams per day for most people, it will be harder to accommodate foods like sweet potatoes and seasonal fruit into your daily repertoire even though they fit the Primal mold. However, this is a matter of math, not an indictment of certain foods as “not keto.”

In the Primal version of keto, food quality and nutrient density reign supreme.

We also recognize that there is a lot of individual variability in terms of what constitutes an optimal diet, keto or otherwise. Whether any particular food belongs in your diet depends on how you feel and perform when you eat it, and whether it does or does not move you closer to achieving your goals. That’s highly personal.

Let’s take the example of beets, because this one comes up a lot. Beets are a highly nutritious food that are considered “approved” by Primal standards. They’re also relatively higher in carbs (8 grams per ½ cup) than other veggies, and they grow below the ground, which can feel like a no-no on a ketogenic diet.

Rather than ask:

  • Are beets keto?
  • Can I eat these beets?
  • Am I allowed to eat these beets? (Let me be clear: you are allowed to eat whatever you want, even on a ketogenic diet. Your body, your choice. That doesn’t mean you should.)

Ask this instead:

  • Do I want to eat these beets?
  • How will I feel physically and mentally if I eat these beets?
  • Do I consider these beets to be a healthy choice? (Note that this is about your values, not somebody else’s.)
  • If these beets were to knock me out of ketosis, would I be ok with that?

For example, your answer to #4 might be, “No. I have only been dedicated to the Keto Reset Diet for a few weeks, and I choose to be conservative in my carb consumption still in order to optimize the adaptation process. This serving of beets has more carbs than I want to add to this meal.” Cool, that’s totally valid—skip the beets. Or it might be, “Yes, I’ve been craving beets, beets are super healthy, and I don’t really care if I’m in ketosis later or not.” Cool, also valid—eat the beets. (For what it’s worth, I have no problem eating beets and staying in ketosis, but YMMV.)

Remember, too, If you really want to know if a certain food affects your level of ketosis, you can get a blood or breath meter and test it systematically. In my opinion, this isn’t necessary for the average ketogenic dieter, but some people prefer a data-driven approach. Robb Wolf also provides an excellent protocol for testing how certain foods affect your blood glucose response in his book Wired to Eat.

Perfection Isn’t the Goal—Health Is.

When it comes to deciding what to eat, we’ll never be able to know exactly what the perfect diet looks like—keto or not. While I certainly applaud people for thinking deeply about the quality of their diets, I also hate to see someone fret because the restaurant served shredded carrots on their salad when they heard that carrots aren’t allowed (there’s that word again) on a ketogenic diet. I have to believe that the stress of worrying about the carrot is more detrimental than the 2.6 grams of carbs in ¼ cup of shredded carrots would ever be.

If you are using the Primal Blueprint as your guiding template, it’s really hard to go wrong. Sure, you might find that your first stab at the keto diet needs tweaking to make it work for you. Maybe you feel better satiated with more fat, or maybe you need more protein. Maybe you prefer to eat breakfast instead of fasting in the morning. Maybe you do better with less saturated and more monounsaturated fat.

You can experiment and adjust these things. You don’t have to be perfect from day one. If you try something and decide you don’t like the outcome, you can move forward with new and better information. This isn’t making a mistake—it’s learning. It’s what we should all be doing to keep moving forward on our personal paths toward optimal health.

That’s it for today. Thanks for reading, everyone. Comment below, or find me in the Keto Reset Facebook group if you have any questions. And as always, #liveawesome!

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The post Why “Is It Keto?” Is the Wrong Question appeared first on Mark’s Daily Apple.

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Everyone likes dessert. via GIPHY But dessert that tastes great and has protein in it so that it helps to keep you full and doesn’t give you a big ol’ sugar crash like some sweet treats? via GIPHY Here are five types of protein-filled desserts doing that for us now. Right now. via GIPHY Protein for Dessert: Cookies Quest Protein Cookies: You know Quest Bars? Well, these are like those, but softer, more cookie-tasting and shaped like a cookie — which makes them pretty darn rad. With 15 grams of protein, no gluten-containing ingredients, only 1-3 grams of sugar (depending…

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For today’s edition of Dear Mark, I’m answering a single, significant question. It concerns the latest “anti-low-carb” study claiming that we’re all killing ourselves by not eating bread. A reader wonders if the study is legit and if we should be worried about eating fewer carbs than “normal” people.

I don’t think we should be concerned, and I’ll explain why in detail. Let’s take a look and break it down.

Hi Mark,

I’m sure you’ve seen this latest study to claim that low-carb diets will kill us all: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30135-X/fulltext

Is it legit?

Yes, I’ve seen it.

Where to start?

This study came from Walter Willet, he of the voluminous mustache and unbridled enthusiasm for seed oils.

The most glaring weakness is the way they gathered the data. Over the course of 25 years, participants were asked to accurately report their diet reaching back as far as six years. This is an inherent issue in most nutrition data gathering, so it’s not unique to this study, but come on. Can you remember what you ate 6 years ago? Did your diet change at all, or was it stable enough to encompass with a curt summary?

The characteristics of the participants differed greatly.

Low-carbers were far more likely:

  • To be men—Males have a higher risk of mortality than women.
  • To be diabetic—Diabetes lowers lifespan, especially in the 1980s (when the bulk of the data was collected).
  • To be sedentary—Failure to exercise is a major risk factor for early death, and ill health in general.
  • To smoke cigarettes—Again, this is an elementary variable. Nothing like being able to smoke indoors. Remember smoking sections on airplanes? I do.
  • To eat fewer fruits and vegetables—Carnivory is popular these days, and may work for some, but plants are still good for you and actually complement a low-carb, high-meat diet quite nicely.
  • To be overweight—All else being equal, the fatter you are, the unhealthier you are.

Even if they were able to “control for” all those variables, you can’t control for the overall health and wellness trajectory of a person hellbent on ignoring their personal health. What other unhealthy things are they doing that weren’t captured and accounted for by the researchers?

For instance, alcohol intake. They didn’t look at alcohol intake in this trial. Seriously, search for “alcohol” in the paper and you’ll come up blank. It’s very likely that the low-carbers were drinking more alcohol, as similarly-conducted epidemiological research has found that “carbohydrate intake [is] the first to decrease with increasing alcohol consumption.” (2) Alcohol can take a serious toll on health and lifespan if you aren’t careful with your intake.

Oh, and low-carbers were also more likely to be on a diet. This might be the most crucial variable of all. Who goes on a diet, typically? People who have a health or weight problem. Who doesn’t diet? People who are happy with their health and weight. There are exceptions to this, obviously, but on a population wide scale, these trends emerge. Did the low-carb diet actually reduce health and lifespan, or did the health conditions that prompted the diet in the first place reduce health and lifespan?

Ultimately, this was all based on observational studies and epidemiological data. It can’t establish cause-and-effect, it can only suggest hypotheses and avenues for future research.

Luckily, we have controlled trials that demonstrate the health benefits of low-carb dieting, all of which correspond to better longevity:

You could make the argument that the positive health effects are purely short-term and that in the long run, those benefits turn to negatives. It wouldn’t be a very good argument, though, because we don’t have any indication that it actually happens. If you go reduce carbs or go keto and you lose body fat, gain lean muscle, improve your fasting blood sugar, normalize your lipids, and reduce inflammatory markers, I see no plausible mechanism by which those improvements lead you to an early grave. Do you?

It seems the burden of proof lies in the Willet camp. If the only healthy range of carbohydrate intake is between 50-55%, he would have to show that:

  • No healthy, long-lived cultures or individuals have a carbohydrate intake that strays from the 50-55% range. Anthropological and ethnographical evidence must confirm.
  • The benefits of low-carb diets, established through randomized controlled trials, are illusory and/or transitory, eventually giving way to health decrements that lower lifespan.

That’s a tough one. Hats off if he can pull it off. I doubt he can.

Thanks for writing in. I hope I allayed any concerns you might have had.

Take care, all, and be sure to share down below with your own comments and questions.

References:

1. Seidelmann, Sarah, MD, et al. Dietary Carbohydrate Intake and Mortality. Lancet. 2018. (Online First)

2. Liangpunsakul S. Relationship between alcohol intake and dietary pattern: findings from NHANES III. World J Gastroenterol. 2010;16(32):4055-60.

3. Thorning TK, Raziani F, Bendsen NT, Astrup A, Tholstrup T, Raben A. Diets with high-fat cheese, high-fat meat, or carbohydrate on cardiovascular risk markers in overweight postmenopausal women: a randomized crossover trial. Am J Clin Nutr. 2015;102(3):573-81.

4. Ballard KD, Quann EE, Kupchak BR, et al. Dietary carbohydrate restriction improves insulin sensitivity, blood pressure, microvascular function, and cellular adhesion markers in individuals taking statins. Nutr Res. 2013;33(11):905-12.

5. Rajaie S, Azadbakht L, Saneei P, Khazaei M, Esmaillzadeh A. Comparative effects of carbohydrate versus fat restriction on serum levels of adipocytokines, markers of inflammation, and endothelial function among women with the metabolic syndrome: a randomized cross-over clinical trial. Ann Nutr Metab. 2013;63(1-2):159-67.

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The post Dear Mark: Does Low-Carb Shorten Lifespan? appeared first on Mark’s Daily Apple.

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If you ask the average person, ketosis is primarily about carb restriction and fat intake. Go on a low-carb diet, eat more fat, allow your body to burn its own reserves. Pretty straightforward. Ketones are supposed to replace glucose.

But what do we make of protein? Some keto dieters avoid it like the plague, worried anything more than a quarter pound of animal flesh will knock them back into sugar-burning purgatory. Some have even likened it to “chocolate cake.” Others eat it freely. Who’s right?

Well…

The most restrictive therapeutic ketogenic diets, the ones used to treat childhood intractable epilepsy, are very low protein—around 5-10% of calories. These diets are designed to maximize ketone production. Any more protein than that and those kids might not make enough ketones to treat their condition.

The most ketogenic state of all—fasting—is also very low in protein. Zero, to be exact.

Okay, so protein can inhibit ketosis. Why? What’s going on?

One common assumption is that too much protein converts to glucose via gluconeogenesis. This is the “steak is just chocolate cake” hypothesis. It makes sense and sounds reasonable. It’s also completely wrong.

It turns out that gluconeogenesis follows an “as needed” schedule. Our livers don’t just mindlessly produce glucose anytime protein reaches a certain threshold. Our livers convert protein into glucose when we—for whatever reason—need more glucose.  Demand-driven, not supply-driven. Keto-adapted individuals running over 70% of their brain and most of their muscle on ketones don’t demand a whole lot of glucose. Even under “optimal conditions“—giving a bunch of adults who just fasted overnight a big dose of radio-labeled protein and then tracking its fate through the body—humans convert very little dietary protein into glucose.

This isn’t a real issue.

What Causes Protein To Inhibit Ketosis?

It all starts with the Krebs cycle, that metabolic pathway that converts fatty acids into useable energy. In a “normal” cycle, fatty acids are broken down into acetyl-CoA. The liver pairs acetyl-CoA with oxaloacetate to complete the cycle and produce ATP energy. That’s basic energy generation.

Without oxaloacetate, the Krebs cycle cannot continue. Without oxaloacetate, acetyl-CoA has a different energetic fate: conversion into ketones. Where does oxaloacetate come from?

Carbs, usually. But protein can also be a source. Like carbohydrates, protein has the potential to donate oxaloacetate during the Krebs cycle. The more protein you eat, the more oxaloacetate you’ll have ready and willing to inhibit ketogenesis. This is how protein inhibits ketosis. Not by increasing gluconeogenesis. Not by spiking insulin.

By donating oxaloacetate.

How Much Protein Can You Eat and Still Remain Keto?

It depends on your goals and requirements.

If you’re dealing with serious epilepsy, creeping dementia, general inflammation, or anything else that requires or may improve with deep ketosis, aim for a lower protein content (10-15% of calories). Get those high ketone levels, see how it feels, and see if that’s the protein intake for you. Start low, really revel in those high ketone readings.

If you’re losing weight (or trying to), eat closer to 15-20%. For you, the ketone readings aren’t the biggest focus. How you look, feel, and perform are your main concern. Eating slightly more protein will increase satiety, making “eating less” a spontaneous, inadvertent thing that just happens. It will also stave off at least some portion of the lean mass accretion that occurs during weight loss; you want to lose body fat, not muscle.

If you’re trying to gain large amounts of muscle, eat closer to 20-25%.

Why You Shouldn’t Over-Restrict Protein

Just don’t go below 15% of your calories unless you absolutely need to. There’s a bottom. Protein is an incredible essential macronutrient. Fat is plentiful, even when you’re lean. Carbs we can produce from protein, if we really must, or we can just switch over to ketones and fats for the bulk of the energy that would otherwise come from carbs. Protein cannot be made. We have to eat it.

If we stop eating dietary fat, we’ll burn what we have on our bodies and—to a point—get healthier.

If we stop eating carbs, we’ll burn through our glycogen stores and then get better at burning fat. And we’ll be healthier.

If we stop eating protein, our organs, muscles, and bones will atrophy. Our health will suffer.

Another reason it’s so important (and so satiating) is that protein contains the most micronutrients. Fat-soluble vitamins are great, but the real good stuff we like—the B vitamins, the minerals—come packaged with protein.

How I’ve Changed My Approach To Protein

I think I need less than I used to think I needed. I eat maybe 80-100 grams a day max now. Some days a fair amount less, some days a fair amount more.

I also don’t think about protein meal-to-meal or even day-to-day. I tend to think of protein averages over three- or four-day chunks. If I get 200-250 grams in three days, I’m good and it doesn’t matter when or how I got it.

I know I’m in protein-sparing mode. We usually think of ketones as glucose-sparing, and they are. Generating (and being able to utilize) enough ketones to replace a large portion of the rare and flighty glucose is an invaluable asset in diseases of dysfunctional brain glucose metabolism like Alzheimer’s. Ketones are also protein-sparing. For one, if we aren’t burning through glucose, we don’t need any extra.

I make sure to eat a significant amount of collagen. Collagen reduces amino acid requirements. It’s not enough by itself to stimulate muscle protein synthesis or provide the essential amino acids. It does help balance out muscle meat intake, reduce inflammation, improve sleep, speed up joint and connective tissue healing, and reduce the amount of protein I need to reach my nutritional goals.

Important to note, though…

I’ve been doing this fat-adapted thing for a long time. My body is finely tuned to this kind of diet. It’s what it expects. People who are on week 2.5 of their keto journey might not have the same dynamic and may need more protein.

Keep in mind, too, that I’m not actively trying to gain muscle mass. The name of the game (for me) is to maintain: my body comp, my physical performance, my organ reserve, my health, my basic functionality. If I got the urge to put on lean muscle, I’d increase my protein intake.

Final Takeaways For Considering Protein Intake

  • If you crave protein, you should eat it. Cravings for a natural, relatively unadorned food can usually be trusted.
  • Know there aren’t any hard-and-fast rules about protein and ketosis. Everyone’s different. “Modified ketogenic” diets—higher in carbs and protein—are still effective against epilepsy. In one study, obese men ate an ad libitum (they ate what and how much they wanted) ketogenic diet consisting of 4% carb, 30% protein, 66% fat. They got into and remained in ketosis and ended up losing more weight with less hunger than another group on a high-carb diet with the same amount of protein.
  • If you’re going to severely restrict a vital macronutrient like protein, you’d better have a good reason. You’d better be seeing measurable, obvious benefits that disappear when you eat more protein. Don’t wed yourself to the numbers or to the idea of a thing. Always ground your dietary excursions in tangible, verifiable feedback—both subjective and objective. Do what works. Don’t do what doesn’t work, even if it’s “supposed to” be working.
  • As always (especially if you’re using keto to address a medical condition), make sure to consult your doctor.

Now I’d love to hear from you. How does protein affect your ketogenic diet? Do you even notice—or consider the question—in your process?

Take care, everyone.

References:

Mark Sisson is the New York Times bestselling author of The Keto Reset Diet and a dozen other healthy living books. He is one of the leading voices in the evolutionary health movement. 

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The post Protein Intake While Keto: Why It Matters, How Much to Eat, and What My Intake Looks Like Now appeared first on Mark’s Daily Apple.

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For today’s edition of Dear Mark, I’m responding to four reader comments. First up, if a person can’t eat eggs, doesn’t like liver, but really wants choline, can they just supplement? Second, are a couple handfuls of almonds too much omega-6 for the average person? What if they eat fish? Third, a new study claims to show that keto dieting tanks hepatic insulin sensitivity. What should we make of it? Are we giving ourselves type 2 diabetes by going keto? And fourth, I highlight a great approach to drinking alcohol (and living in general) from one of our readers.

Let’s go:

If I can’t eat eggs, and don’t like liver, can I supplement with choline? What would be a good dose?

Yes, you can supplement with choline. Men need around 550 mg per day. Women, 425 mg. Those requirements go up if you’re pregnant or nursing, and they very likely go up if you’re drinking.

It’s very possible that those are good levels for the average person eating a low-moderate fat diet. If you’re eating a high-fat diet or engaging in cognitively-demanding work, you may benefit from higher doses.

What jumped out at me was high O6 from snacking on almonds…this was in the fish oil post too, and it’s got me looking twice at how much is too much. I have a handful or two almost every day, and not supplementing with O3 ( although just started an experiment with daily supplements or fish). Too much?
Thanks as always for the excellent post—I’ve been wondering about alcohol too!

Don’t get me wrong. Almonds are a nutrient-dense whole food. They’ve got tons of magnesium, prebiotic fiber, polyphenols. Their health effect profile is impressive:

But they are high in linoleic acid. Absent fish, two handfuls a day is probably excessive. Having some fish fat will balance it nicely.

Try this: Replace one of your handfuls of almonds with a can of sardines or smoked oysters.

Does keto cause liver insulin resistance? Just saw this study and don’t want type 2 diabetes…

https://physoc.onlinelibrary.wiley.com/doi/10.1113/JP275173

First of all, it’s a mouse study.

Second of all, it was a three-day study designed to look at the short-term transitory effects of going keto. Anyone who’s gone keto knows that the early days are a bit rough. Your mitochondria aren’t good at burning fat or ketones yet. You haven’t built the metabolic machinery required to extract the energy you need from the new balance of macronutrients. This period of transition coincides with the “keto flu”—that period of fatigue, listlessness, and headaches.

If you stick with the diet and make it through to the point where you can crank out and utilize ketones, everything changes. You can suddenly start making ATP from all that body fat you’re burning off, giving you a virtually limitless supply of energy at all times. It’s great.

But in the meantime, for that early period it’s rough. You’re insulin resistant, yet unable to burn much fat. Your liver is perpetually overloaded with energy, making insulin resistance almost unavoidable (if transitory).

Third, the composition of this study’s “keto” diet was about as bad as you could get (PDF). The fat came from Crisco—the classic trans-fat laden version—rounded out with a bit of corn oil. Trans-fats and omega-6 linoleic acid. Does this look like the diet you’re eating? Does this look like the keto diet anyone is eating? If the researchers set out to get the worst possible results for the keto group, it wouldn’t have looked any different. almost looks like they were trying to get the worst possible results.

Alcohol in ketosis is just one aspect of alcohol use in a healthy lifestyle. For me personally I perceive alcohol to play not a vital but an extremely useful role.

I drink about 40 gm of ethanol just about every day in the form of a classic gin martini made with 3.5 oz of premium gin (healthy fats in that olive, brother). I consider gin to be a very special spirit because it is comprised of water, ethanol, and botanical substances like the l-terpenes from juniper berries which are known to have a tonic effect on the human organism – and none of the hundreds of dubious organic chemicals (referred to as “cogeners”) contained in whisky or tequila. I always consume this martini between 5:00 and 7:00pm, and I very rarely drink anything else at any time of day or night. I have this drink immediately before and with the evening meal which I personally prepare from scratch with fresh ingredients and consume with my wife of 51 years.

The martini seems to me to punctuate and enhance the transition from “doing” – being responsible, making things happen, solving problems, exerting myself – to “not doing” – resting, refreshing, nourishing, regenerating. Subjectively, I feel like this one drink, consumed with food, stimulates the parasympathetic nervous system. The alcohol research, so-called, tends to produce the opposite result, but in my opinion, virtually all of the alcohol effects research is dreadful – just about the junkiest junk science you can find anywhere.

I will be 80 on my next birthday, my resting heart rate, measured with a Polar FT7 heart rate monitor as an average over 3-5 minutes is 51-52. I ride a mountain bike on intermediate level trails – often in a fasted state – and recently recorded a maximum heart rate of 167. This is considerably higher than the HRmax predicted by any of the recently validated formulas. My GGT level is 16, so I have to conclude that my liver thrives on classic gin martinis. I take no prescription medications and no over-the-counter medications. I am not trying to brag here, I am just trying to document that by just about any measure my health and physical condition is exceptional for a person my age.

My personal belief is that alcohol in the right form and used properly is a health food. This conclusion is based on my personal experience, but I dearly wish that some enterprising biochemists, neurologists, and social psychologists would get together and design a quality research program to examine alcohol’s health effects under various real-world conditions. People like to drink, but a lot of what they drink is full of cogeners and sugar and genuinely toxic crap. Almost nobody has a clue what is in what they are drinking and what its health effects – positive or negative – might be. Millennials are currently destroying their livers in droves and even killing themselves with booze at distressingly early ages. Beliefs about alcohol and drinking in our culture are pathetically primitive.

I think I’ve got it figured out for me, but I think it would wonderful for the rest of the world to know the score.

I’m highlighting Daniel’s words even though he wasn’t asking a question. This man gets it. This is how to approach, appreciate, and consume alcohol. He’s drinking with complete lucidity, total awareness, and mindfulness. Alcohol isn’t “just” something you use to get loaded. It’s a sacred chemical that marks the transition from “doing” to “being.”

Many people blur the lines, drinking for the hell of it. Make it more of a special occasion, consume it mindfully and purposefully. Having a couple glasses of wine at night because I’m bored will ruin my sleep and throw off my tomorrow. Having those same two glasses of wine and some conversation with my wife or dear friends over cheese and olives has an entirely different physiological—not just psychological—effect. My liver actually processes the wine consumed with mindfulness differently.

That’s it for this week, everyone. Thanks for reading and be sure to chime in down below with your own comments, answers, or concerns.

Take care!

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The post Dear Mark: Choline Supplementing, Too Many Almonds, Keto and Insulin Resistance, and How to Drink appeared first on Mark’s Daily Apple.

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After my recent post on keto for women, I got a lot of feedback. One of the most common themes: “But what about menopause?” I heard from dozens of women in both the comment section and in emails who were having trouble losing weight and dealing with the varied symptoms of menopause. Was keto the answer? Was Primal? Were they doing something wrong?

Rather than start with the assumption that going keto or Primal is the best way to deal with menopause, I figured I’d start from ground zero, drawing on the extensive scientific literature on diet and menopausal symptoms to see if I could arrive at some general trends and make recommendations.

But first, why do we even experience menopause? In the big picture, menopause is rather rare. Besides humans, orcas and pilots whales are the only other species where the females live significantly beyond their reproductive age. The average age of menopause hovers around 50, and most women can expect to live another 30 years or so. That indicates its importance. It wouldn’t have been uniquely established and preserved in just a couple species if it didn’t provide huge benefits to those species. And sure enough:

  • The presence of grandmothers in a population enhances maternal survival during childbirth.
  • They provide childcare so parents can be more productive, whether it’s going back to work in the office or foraging for nuts and tubers in the bush.
  • They impart wisdom to the youngsters—and to the community as a whole.
  • And, though parents probably wouldn’t count this as a positive, they spoil grandkids rotten.

To boot, many women I know say menopause ushers in the most focused, creative time of their lives. If their reproductive years (particularly perimenopausal ones) were characterized by hormonal chaos, they often find themselves grateful to be free of the perpetual fluctuation. But mostly they say they’ve entered a time of life when they feel more confident and self-possessed. (Joan Erikson, wife of noted psychologist Erik Erikson as well as author, psychologist, teacher, and artisan, writes insightfully about this transition.)

All this said, menopause can also present its share of physical difficulties for many, if not most, women at some point. But do these effects need to be as unpleasant as they often are? I’d venture to say no. I have a few posts in mind here, but let’s dig into dietary strategy today.

First, let’s establish what changes physiologically during menopause. What are the most common symptoms of menopause? And what does the evidence say about how diet affects those symptoms?

Weight Gain

This might be the most common complaint women have during and after menopause: Weight goes on more easily and is harder than ever to scale back. Nothing seems to work, even the dietary interventions that previously did.

Why is weight loss so hard after menopause?

  • Energy expenditure and basal metabolic rate both drop with menopause.
  • Lower levels of estrogen increase appetite and reduce satiety.
  • Lower levels of estrogen reduce activation of brown fat, the metabolically-active body fat which burns energy.
  • If you’re experiencing another common side effect of menopause—insomnia—your sleep-deprived brain’s reward system will be more susceptible to the allure of junk food.
  • You’re older. As we age, weight becomes easier to put on and harder to remove for both men and women.

Despite these roadblocks, there is hope. Something has to work. And even if it doesn’t work as well as you’d like, there’s something that works less badly than the others.

For one, glycemic load matters. Many studies find that the glycemic load of a postmenopausal woman’s diet is a strong predictor of her fat mass. Remember that glycemic load is often a roundabout way of indicting carbohydrates without saying “carbohydrates.”

What really does seem to work is the classic paleolithic diet: lean meat, fruit, nuts, vegetables, eggs, berries, and fish with no grains, legumes, sugar, dairy, potatoes, or added salt. 40% of energy from fat, 30% from protein, 30% from carbohydrate. Over 24 months, menopausal women on a paleo diet lost more fat, more waist circumference, and more triglycerides than those on a standard “healthy” diet.

Perhaps it’s the protein. Another study found that postmenopausal women who ate the least protein (under 0.8 g protein per kg bodyweight) had the most body fat and were physically weak. Those who ate the most (over 0.8 g per kg, 1.1 g/kg on average) had the least body fat and were more physically capable.

What’s clear is that weight loss has beneficial effects on menopause symptoms. It reduces inflammation, improves cancer biomarkers, regulates sex hormones, and improves endothelial function—to name a few. What’s also clear is that weight loss can have negative second-order effects in menopausal women, like bone mineral loss and loss of lean mass. So, it’s worth doing, and doing right. You have to strike a fine balance between losing weight and avoiding muscle loss. As your satiety signaling is likely thrown off, you might have to make a more conscious effort to track your food intake and make sure you’re not overdoing it.

Heart Disease

Before menopause, most women are protected against heart disease, at least compared to men. Once menopause sets in, a woman’s heart disease risk goes way up. A good diet for menopause, then, would have to reduce heart disease risk. What does the evidence say?

In overweight post-menopausal women, high-fat diets (where the fat came from cheese or meat) improved atherogenic biomarkers compared to a high-carb diet. Both the cheese-based and meat-based diets increased HDL and Apo-A1; the high-carb diet did not.

Meanwhile, high-carb diets were persistently linked to chronic low-grade inflammation and an elevated risk of heart disease in postmenopausal women.

Moving beyond broad macronutrient ratios, are there any specific foods or nutrients that play an outsized role in menopasual women’s heart health?

Dark chocolate may help with reduced endothelial function, another risk factor for heart disease. Postmenopausal women who consumed high-cacao chocolate saw their endothelial function improve in one study.

Green tea appears to help postmenopausal women reduce fasting insulin, a major but underappreciated risk factor for heart disease (and a host of other bad conditions).

Bone Loss

As estrogen plays a big role in the maintenance of bone mineral density and overall bone health, bones get weaker and lose density during menopause. A woman’s risk of osteoporosis, fractures, and other bone-related incidents skyrocket during and after the transition.

Intake of long-chain omega-3 fatty acids—found in fish, shellfish, and fish oil supplements—is associated with higher bone mineral density at the hips and spine (the most crucial parts for aging people) in osteopenic women. Osteopenia is lower than normal bone mineral density. It isn’t quite osteoporosis, but osteopenia can often progress into it.

Glucose loading actively impairs bone remodeling in postmenopausal women. The problem doesn’t go away just because you exercise, either. And it gets worse the higher your postprandial blood glucose goes.

The normal bone-relevant nutrients become even more relevant after menopause:

  • One study in postmenopausal women found that yogurt fortified with vitamin D3 improved bone mineral density, while regular yogurt without the vitamin D3 worsened it.
  • Another found that a gram of calcium a day wasn’t enough to stave off bone mineral loss in menopausal women during weight loss; they needed at least 1.7 grams per day.
  • Another study found that a collagen supplement increased bone mineral density in post menopausal women.

Brain Fog

Everyone’s heard of “pregnancy brain.” There’s also “menopause brain.” It’s characterized by brain fog, memory loss, lack of focus, and other cognitive symptoms.

Postmenopausal women who ate low-glycemic breakfasts had better cognitive function than those eating high-glycemic breakfasts.

Some research also suggests a role for micronutrient supplementation in menopausal cognitive symptoms:

  • Vitamin C can help. In one study, postmenopausal women who took 500 mg of vitamin C a day improved verbal recall, naming, and repetition. These improvements were accompanied by reductions in beta-amyloids linked to Alzheimer’s disease.
  • Resveratrol may help. In one study, it increased cerebral blood flow and improved overall cognitive performance during a series of tests, particularly in verbal memory.

Hot Flashes

Both fish oil and soy isoflavones have been shown to reduce hot flash occurrence, with soy acting faster on severe hot flashes and fish oil doing a better, but slower job of targeting both moderate and severe hot flashes.

Folic acid supplementation reduced the severity, duration, and frequency of hot flashes. A better source for folic acid are folate-rich foods, like leafy greens or liver.

Breast Cancer

A woman’s risk of breast cancer rises after menopause. After menopause, the inflammatory status of the breast goes up almost as a general rule. This explains at least part of the elevated risk for breast cancer postmenopausal women exhibit, and it’s true whether or not the woman is overweight or not. Menopausal breast fat is inflammatory fat.

Among Japanese women, those who ate the most noodles and other carbohydrates had higher levels of estradiol, which other studies have found correspond to a higher risk of postmenopausal breast cancer. Those who ate the most fish, fish fat, and saturated fat had lower levels, which correspond to a lower risk. Of course, the authors opine that this suggests eating more fish and say nothing about saturated fat, but we can’t really expect them to contradict decades of propaganda—I mean, evidence.

Oxidative Stress

Menopause is generally inflammatory; along with waist circumference, menopause status is an independent predictor of low-level inflammation and elevated hs-CRP (one of the most fundamental markers of inflammation). There’s a low level simmer going on, and it can cause a lot of problems. Diet can make it worse, or make it better.

High-glycemic diets—also known as diets high refined carbohydrates—are associated with more oxidative stress in post-menopausal women (for what it’s worth, the same is true in premenopausal women). Intakes of insoluble fiber and PUFA, including omega-3s and healthy sources of omega-6s like nuts, were linked to lower levels of oxidative stress.

Paleolithic diets, on the other hand, reverse inflammatory markers in postmenopausal women.

Folate supplementation reduces oxidative stress and normalizes blood pressure in postmenopausal women.

Genetics matter, of course. A growing body of evidence indicates that various genetic variants can influence the effects of some of these dietary interventions on the symptoms and risks associated with menopause.

Among Japanese and Japanese-Brazilians, for example, soy isoflavone intake protects against breast cancer only in those with certain genetic variants. It’s neutral otherwise.

There’s more to managing menopause than just diet, of course. Lifestyle decisions matter too. But that’s beyond the scope of today’s post. Maybe in the future.

So, can we make any recommendations? What are the takeaways? We see some trends emerge.

Dietary Takeaways

Avoid Refined Carbohydrates

Pretty much every study that looked at fast-digesting, low-nutrient sources of carbohydrates found they have a negative effect on most concerns of menopause, including bone health, breast cancer risk, heart health, weight gain, inflammation. Now more than ever, don’t eat them.

Limit Carbs To Only What You Use

If you’re an incredibly active woman, someone who CrossFits and runs sprints and swims laps and plays with grandkids, you can get away with more carbohydrates, and may even thrive with a few extra. But make sure you actually need those carbs.

Soy Isn’t a Bad Idea

I know, I know. Soy is evil, or something. But a number of studies indicate that soy can improve the overall menopause experience. Stick to whole soy vs isolated soy components. (And avoid GMO.) If you can include something like natto—fermented soybeans—a few times a week, you’ll get the benefits of soy isoflavones and vitamin K2.

Drink Green Tea

Several studies show that green tea (or green tea extracts) counters or ameliorates multiple menopause symptoms.

Eat Leafy Greens

Greens are a great source of folate and calcium, critical nutrients for postmenopausal health.

Eat Adequate Protein

1.1 g/kg should be the lower limit.

Eat Fish

A can of sardines (bone-in) provides omega-3s, calcium, and excellent protein.

Lean Toward a Higher-Fat-AND-Protein, Lower-Carb Diet

Make sure to stick with Primal foods.

Menopause isn’t easy for most women. Things are changing, hormones are in flux, and eating strategies you once employed may no longer work the same way. There’s no magic diet that fixes everything, but there are lots of little changes that can tilt the scales in your favor.

Try them out and let me know what you think.

In the meantime, I’d love to hear how you’ve handled menopause via diet. Thanks for reading, and take care, everybody.

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The post Metabolism and Menopause: What Does Research Suggest Is the Best Dietary Strategy? appeared first on Mark’s Daily Apple.

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