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Morning or night? With food or without? - Albuquerque Journal

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Whether multivitamins and other dietary supplements are necessary for the general population is a source of debate. Supplements are still recommended for certain populations with specific conditions, such as pregnant women who should take folic acid to reduce the risk of neural tube defects, or children in developing countries whose diets do not provide enough vitamin A and iron. But recent studies have found there is not enough evidence to recommend multivitamin supplements to the average healthy American, and that in fact, taking too much of certain vitamins can cause harm.

These studies seem to have little effect on the global supplement industry, which is worth an estimated $128 billion, according to 2017 data from the Nutrition Business Journal, or on the American public. Fifty-two percent of respondents to the 2011-2012 U.S. National Health and Nutrition Examination Survey reported using dietary supplements, unchanged from the 1999-2000 survey.

As a registered dietitian, I believe a nutritious diet is the best way to achieve a healthy foundation. Supplements (as the name suggests) can be used as a complement to help a person with certain deficiencies meet their nutrient needs. If you’re taking a supplement because of such a deficiency, you should try to take it in a way that could promote optimal absorption. Supplement timing can seem complicated, so let’s simplify when to take some of the most common dietary supplements and why.

When to take supplements

There is debate about whether taking your vitamins in the morning or at night is best. The theory goes that because you’re getting nutrients throughout the day from food, having your nutrition supplements at night helps your body get some nutrition as you sleep.

But Jeffrey Blumberg, a professor of nutrition science and policy at Tufts University in Boston, says, “Digestion slows down during sleep, so taking your nutrient supplement late at night would not be associated with an efficient absorption.”

Neil Levin, a clinical nutritionist at NOW Foods, agrees that morning is best for multivitamins and any B vitamins. “Multivitamins tend to do best when taken earlier in the day, as the B vitamins in them might stimulate metabolism and brain function too much for a relaxing evening or before bed,” Levin says.

Although morning is probably ideal, the best time of day is the time you’ll remember. Put the supplement bottles on your kitchen counter next to your coffee maker, so they jog your memory when you reach for your morning cup. Or keep them in your lunch bag or briefcase so you’ll remember them.

With food or without?

Most supplements should be taken with food to reduce the chances they’ll upset your stomach and to stimulate digestion and improve absorption. For a select few, it really doesn’t matter if you take them on an empty stomach. So which ones should you pay attention to?

Iron, magnesium and fish oil supplements are the most common culprits for digestive upset when taken on an empty stomach, so take extra care to have these with a meal or snack.

Fat-soluble vitamins A, D, E and K are better absorbed when you have them with a meal or snack that contains at least a teaspoon of fat, about 5 grams. The same goes for your multivitamin, which contains these vitamins. For example, if you’re taking your multivitamin with your breakfast, make sure you’re having some almond butter with your oatmeal or avocado with your eggs and toast.

For probiotics, preliminary research suggests taking them with a meal or 30 minutes before a meal could be better than taking them after eating.

Hydration is also important, Blumberg says. “Fluid intake is especially important for the disintegration of the supplement tablet or capsule and for dissolution of water-soluble nutrients such as vitamin C and B vitamins,” he says. So be sure to wash down all supplements with a tall glass of water.

The main exception to the “take with food” rule for dietary supplements is with certain types of minerals. Only chelated mineral supplements can be taken without food, Levin says. Chelation occurs when a mineral has been bound to an acid, so it doesn’t rely on your stomach acid to break it down. Calcium citrate and magnesium glycinate are the main examples. (If this level of detail is overwhelming, take your supplements with food to cover your bases.)

Better together

Some nutrient dynamic duos include vitamin D to boost calcium absorption and vitamin C to boost iron absorption. That’s why taking in these nutrients simultaneously via supplements or boosting with food sources is ideal. A classic example is having your iron supplements with a glass of orange juice to get the absorption-boosting effects of the vitamin C.

Better apart

Calcium can affect your body’s absorption of iron, zinc and magnesium. I recommend taking any calcium supplements at a different meal than any iron supplements or your multivitamin. Also, your body absorbs calcium more effectively when you take 600 milligrams or less at a time. If you’re taking more than that per day, you’ll want to split up the dosage into morning and evening doses.

Fiber is another nutrient you’ll want to take apart from other supplements and medications because it interferes with absorption. I recommend doing so before bed if you aren’t taking anything else at that time.

If it isn’t practical for you to remember to take supplements at lunch or other points during the day, don’t worry. Have your multivitamin and any fat-soluble vitamins (A, D, E and K) with food that contains some fat, keep your calcium and iron separate, and you’ll be fine. You’ll be even better off if you focus on eating nutritious whole foods, because science suggests that this, rather than supplements, is the optimal way to get your nutrients.

Brissette is a registered dietitian, nutrition writer, TV contributor and president of


Lil’ Bub Shows the World: ‘Different Is Beautiful’

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Lil’ Bub might look different, but she’s one of the most beloved cats on the internet.


The 30-Second, 3-Ingredient "Secret Sauce" I Drizzle Over Absolutely Everything

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What can you do with just five minutes? Actually, way more than you think! Introducing Food52 in 5: your cheat sheet for speedy, delicious recipes, fun mini projects, and more.

I have a secret sauce. It's not the one you're thinking of—though I do love a good Thousand Island riff.

It's a little big spicier, a little bit sharper, and a good deal more garlicky. And I physically can't stop drizzling it over everything:

Warm grain bowls, packed with a combination of roasted and raw, sliced vegetables. Seared salmon. Crispy chicken thighs. Sautéed greens that need a little extra somethin'. Great, hulking sandwiches. Broiler nachos. Salads of all shapes and sizes. And since takes less than a minute and only three ingredients to pull together, it makes the perfect companion most weeknights.

If my secret sauce were giving an Oscar acceptance speech, it'd have to start by thanking Huy Fong, a California-based company that makes and sells chile-based products. Huy Fong is perhaps best known for its Sriracha—the one sold in a tall bottle with a bright green squeeze-tip—but I go through its jars of chili garlic sauce like they're water. The main ingredients listed on the condiment's label offer some clues to its deliciousness (chiles, salt, garlic, vinegar), though the specifics (Are the chiles roasted? Raw? Anything special happening to the garlic?) remain the stuff of my wildest wonderings. "It was quoted by someone that it was easier to get into the Pentagon than into Huy Fong," says the company's website.

Next up, it'd give a shout-out to mayonnaise (haters, look away!), whose composition of emulsified oil, egg yolks, and some sort of acid make it a dreamy base for most any quick dressing. Hat tip to a dash of apple cider vinegar, for the perfect amount of tang.

"It was quoted by someone that it was easier to get into the Pentagon than into Huy Fong."

And that—plus a little salt—is it. Really. My secret sauce is so simple, the Oscars wouldn't even have to play it off the stage:

Do you have your own "secret sauce"? Let me know in the comments!


Fructose (High Fructose Corn Syrup) consumes 2X more Magnesium than sugar – May 2014

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High Fructose Corn Syrup and the Obesity Epidemic Dr. Carolyn Dean

  • it takes 28 molecules of magnesium to metabolize one molecule of sucrose (table sugar).
  • it takes 56 molecules of magnesium to metabolize one molecule of fructose.

See also VitaminDWiki

For more information, see wiki page <a href=" class="regImage pluginImg1843 img-responsive" />
Overview Magnesium and vitamin D has the following 2 charts
Magnesium decline

Reductions in Vitamin D

Note: 2 of the 3 places where low Mg will result in low Vitamin D getting to the cells ARE NOT detected by a blood test

See also web


Episode 429 – Q&A with Robb and Nicki #22

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And now back with more listener question goodness, it’s Episode 429, Q&A #22!

Submit your own questions for the podcast at:

If you want to see the video for this podcast, be sure to check out our YouTube channel.


Show Notes:

1. In & Out of Ketosis…Harmful? [2:10]

Pete says:


I’ve been on and off a keto diet for the past five years or so and when in Ketosis feel fantastic.  I train muay thai and on days that I train I tend to up my carb intake as I just feel better throughout training, similar to you with jiu jitsu.  On Sundays however I do tend to go off the rails a bit and find myself on Monday down around the 0.2 mmol/L level and then by Tuesday night/Wednesday morning back up any where between 1.0-2.4 mmol/L where I stay for the rest of the week.  I have in the past gone several months at a time on a 30-50g carb per day diet on multiple occasions, haven’t done so the past year and half or so. I’ve been hearing a lot lately that this quick fluctuation between low carb to moderate/high carb intake can be very bad for you.  Can you help shed some light on this, am I doing long term damage to my body by fluctuating?



2. Eating Below My BMR [10:48]

Chris says:

Hey guys,

Over the past 7 months, I’ve had great success following the Keto Masterclass.  As far as weight-loss goes, I’ve lost about 42 lbs, and lowered my BF% from about 28% to about 19%. For the first 12 weeks, I ate at a 20% deficit, without a break. I weighed and measured all my food. I made sure I had my electrolytes dialed in, eating lots of potassium and magnesium rich foods, supplementing Na+ as well as Mg+ too. During that time, I was lifting 4x per week as well as a couple (15-20 min) interval workouts per week.  Other than that, I was doing some light walking and playing with my kids.

Towards the end of that initial run, I started to get kind of bitchy (I’m a 45-year old male), and never really experienced the stable energy, or deep, solid sleep that a lot of people mention – two things I was really hoping for.

Recently, I have been alternating 4-week cuts, followed with 2-week “full diet breaks” (a’la Lyle McDonald) at maintenance. During those, carb sources have been clean, paleo foods. Coming off of each of these, I feel better and maintained a stable weight throughout.  I was normally back in ketosis 48-72 hours after switching my carb and fat macros back up, and both times (so far) it has restarted weight loss. Still not great sleep, but I attribute that to having young kids (2 & 6).

After a recent DEXA scan, I was recalculating my macros with the Ketogains calculator (I’m 162# and 19% BF), and it dawned on me that the deficit it was recommending (-15%) was put me BELOW my Basal Metabolic Rate by about 105 calories, per day.  For reference, I used the “sedentary” activity level and don’t add back in workout calories.

So, to my question(s)…

Understanding that the calculator is based off the Katch-McCardle formula, basically giving a statistical norm, but BMR is the calories we need to maintain vital physiological functions, what are your thoughts on recommended deficits putting one below their BMR and what are the longer-term implications of extended diets doing so?  Would it be better to just eat AT BMR on rest days and add back in some (all? a portion?) workout calories (protein & fat) on training days, while still being below TDEE?

It seems to me that BMR should be an absolute floor when it comes to caloric intake – I’m wondering if the aggressive deficits created some diet fatigue and hormonal disruption for me.

Love the podcast and anything the Wolf Pack puts out.  Thanks for everything!

3. Do Calories Matter? [19:58]

Zach says:

Hi Robb-

Long time follower and really appreciate the work you’re doing. I wish I had known about Keto and Paleo when I was younger; I feel my athletic performance could have propelled me to the next level. Either way, I’m happy to have it in my life today as it keeps me thin and healthy. Your Keto Masterclass has been instrumental in guiding me through my Keto/Paleo journey. Thank you!

I’ve been very interested in the low carb diet for 10+ years now and it started with Gary Taubes. Gary Taubes is famous for saying that calories don’t count and in my anecdotal experience, they don’t. I must stress that since it works for me, I’m completely happy with the results. However, when trying to speak intelligently about Keto and low carb, I’m trying to bridge a gap from Gary to Chris Kresser’s podcast with Joe Rogan last week. On Joe Rogan Chris said that you *must* run a caloric deficit to lose weight. Now I am really confused!

I’m an engineer and I’ve taken several thermodynamics courses, so from an energy balance equation I understand that the human body cannot defy thermodynamic principles. But obviously our metabolism is much more complex than an energy in- energy out black box. Furthermore, energy in-energy out does not feel right for a number of reasons such as, for instance, energy expended drinking cold water is not in this equation (that is your body warming the cold water up), energy that is never consumed but rather part of a “defecation event”, etc. I have eaten what I perceived to be a major energy surplus on a ketogenic diet and have still lost weight. My caveat there is that I wasn’t weighing foods, so I cannot really know.

My apologies if you’ve already answered this question, but I could not find it on your blog or searching your website. I’m hoping you can point me to a study, a white paper, a text or some reliable information that will answer the question of who’s right- Gary Taubes or Chris Kresser.

Thanks Robb, you’re a legend.

Zach Kimball

4. Pre and Post-Surgery Nutrition [31:00]

Andrea says:

Hi kids and kitties and Squatchys!

Sooooo, it’s been a little while since I have been devouring each and every single podcast episode and I apologize. My own business focus has put me more into the writing podcast genre recently (but I see Tim Grahl on your interviewee list!?). �

So, my question: have you guys laid out a protocol for extreme nutrient buildup for before and after a scheduled surgery? This would be for someone who is not really paleo: still eats gluten and mostly just avoids sugar and junky foods. So they are not yet on the “rawr sardines nom nom!” bandwagon, sadly.

But if they have a willingness to make some changes to ensure they are in a better place to prepare to recover from their surgery (jaw replacement, if it matters), what would you ‘prescribe’ to them? I’m family, so if this guidance comes from an outside authority that could make the critical difference in their enthusiasm.

P.S. Love to all you guys. You’re doing the ‘chop the wood, carry the water’ and have been for SO LONG I bow in respect. Hope to see you again soon at some rando paleo conference.

Andrea in Burbank

5. CrossFit vs 5 by 5 (ketogains) [38:12]

Matt says:

Robb and Nikki thanks for all that you do. You, your books and podcasts have changed my life. I have done two days a week of CrossFit for just over 2 years and in spite of the amount of rest I get I still end up with knee, shoulder, wrist and elbow injuries and pain. I have recently decided to pause my CrossFit subscription and have replaced it with the three days a week 5 by 5 routine recommended by the ketogains guys. I did your keto masterclass and I’m at 7.5% body fat and try to keep my macros on point with the ketogains recommendations. What do you think about just doing the 5×5 home workout alone? I do like the group element of the CrossFit class but at my age (52) I can’t seem to go for long without injury or constant pain. I feel like the 5×5 program at home is more manageable as I can control the velocity/intensity without so much emotional effort.  What are your thoughts regarding this path?

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Download a copy of the transcript here (PDF)

Nicki: Hey, hubs.

Robb: Hello, wife.

Nicki: Blowing the steam off of your coffee.

Robb: Trying get it down to non-fusion levels to be able to drink it, but yeah, I’ll just wait.

Nicki: You just have to wait a little bit.

Robb: Yeah.

Nicki: What’s new?

Robb: Not too much. Another day above ground, which I call a win, you probably call a loss, because I’m worth more dead than alive. But yeah.

Nicki: No.

Robb: No?

Nicki: No.

Robb: You just don’t want to be left with two kids and a dog and cats.

Nicki: Despite what it may look like, I do actually like you.

Robb: Oh, okay. Well, that’s a plus. That’s a plus. What’s new with you?

Nicki: Let’s see. Not too much, just-

Robb: How’s your Jiu Jitsu going?

Nicki: Jiu Jitsu’s going. Jiu Jitsu’s going. Let’s see, we were working … Where were we working on Saturday?

Robb: Turtle Top.

Nicki: Turtle Top. Yeah. And this chinstrap thing. I don’t think I’m really a fan of that. Kind of hurts.

Robb: Don’t stick your head there, and you won’t get chin strapped.

Nicki: I’m not planning on it, yeah. I’m planning on protecting.

Robb: Cool. Cool.

Nicki: Shall we jump in?

Robb: We should jump in, yeah, because people definitely don’t come here for our play by play.

Nicki: This part, yeah.

Robb: For the most part.

Nicki: Okay. I need to go over here. Questions. Okay, our first question is from Pete on going in and out of ketosis. “Hey Robb, I’ve been on and off a keto diet for the past five years or so, and when in ketosis I feel fantastic. I train Muay Thai, and on days that I train, I tend to up my carb intake as I just feel better throughout training, similar to you with Jiu Jitsu. On Sundays, however, I do tend to go off the rails a bit, and find myself on Monday down around the 0.2 mmol/L level, and then by Tuesday night, Wednesday morning back up to anywhere between 1.0 to 2.4 mmol/L, where I stay for the rest of the week. I have in the past gone several months at a time on a 30 to 50 gram carb per day diet on multiple occasions, haven’t done so in the past year and a half or so. I’ve been hearing a lot lately that this quick fluctuation between low carb to moderate high carb intake can be very bad for you. Can you help shed some light on this? Am I doing long-term damage to my body by fluctuating?”

Robb: It’s a really good question. There have been some studies recently, Bill Lagako’s posted a few of these where people on the ketogenic diet … And, you know, I can’t remember if it was actually human study or animal study. I’ll have to dig around on that. But basically they had a keto-adapted organism, either human or rodent, given some carbs. Blood glucose levels went quite high, high enough that you would anticipate some damage to the vascular endothelium. And so the thought there was, low carb diets are dangerous because when people deviate off the low carb diet then there’s problems.

Robb: And we definitely know that in the low carb state, people become physiologically insulin-resistant, or have a tendency to become physiologically insulin-resistant. What that means is, in general, the muscles and the adipose tissue don’t really take up as much glucose as what they did previously, and the glucose is being spared for the brain and the red blood cells and the tissues that really have to have glucose. But in the context of something like this, the way that Tyler and Louise have recommended for keto gains and whatnot, a low glycemic load titration up in carbohydrates seems to be totally benign. Doing the targeted approach, in which you’re putting 10, 15 grams of glucose into the mix immediately pre-training, we really don’t have good studies on that. But I can’t imagine that that is a net negative. Particularly when I see how well people perform on that, and they feel good.

Nicki: Does it have more to do with how his blood glucose is responding when he jumps to high carb? Because it seems like, with the metabolic flexibility stuff, one who is metabolically flexible should be able to go from one to the other, so-

Robb: You should, and the thing is, we’re only seeing ketone levels here, we’re not really seeing his blood glucose levels.

Nicki: But I guess my question is what he’s at. Is this deviation that he’s saying could be dangerous, is that if the person’s blood glucose levels skyrocket?

Robb: Yes. That’s where the concern is. And we just don’t have enough information here to really know what’s going on. You know, this is one of those tough things though, where is going on a complete hookers and cocaine carb binge while keto adapted a bad thing? Yeah. Is going on a complete hookers and cocaine carb binge a bad thing under-

Nicki: While eating a standard-

Robb: While eating whatever, yeah.

Nicki: -American diet.

Robb: And this is one of the things that I think is quite frustrating, and the vegans, as I’m calling them now, they will cite these studies where you eat a high-fat diet and you get disruption in vascular endothelial function. Any meal causes a disruption in vascular endothelial function. This is why we shouldn’t fucking graze all day, and we should eat a meal here, a meal there, and then have periods of time where we’re not putting calories into our system. Because every time you eat, there’s a systemic inflammatory response, you get a little bit of lipopolysaccharide that goes through the gut barrier into systemic circulation.

Nicki: But not if you’re just eating plants.

Robb: Well, of course, if you’re not eating plants. I’m tired enough right now, that Nicki nearly got a spinning elbow off of that one. Yeah, of course, plants only don’t cause any of these problems. But this is where … And this is something, actually, now I’m thinking about it, would be worthwhile to look at what’s the disruption in endothelial function when somebody’s low carb and each a carb rich real, versus just Joe Schmo is motoring along and then they eat a carb and/or a fat rich meal, and see what the vascular endothelial dysfunction is in that scenario.

Robb: This stuff, again, also it boils down to: are you overeating, both in amount and frequency? This is some stuff that’s also really interesting, where they took people who were caloric restricted, and relatively few meals, like two or three, or calorie restricted and six or eight meals a day. And the calorie restricted plus six or eight meals per day had no real benefit with regards to systemic inflammatory function and a bunch of other biomarkers of aging and inflammation. So eating too frequently is a problem, even when we add in calorie restriction. So you can completely undo that.

Robb: So man, I don’t know. It makes a case for just not being an asshole with your food. If you’re kind of eating low carb, kind of stick with low carb. And particularly in this day and age, if you want some ice cream, get some Mammoth Creamery or some Killer Whey low-carb ice cream. If you want some cookies, get some Nui cookies or something. If you’re generally eating low carb, then generally figure out a fucking way to eat low carb. If you’re not, then kind of work within that.

Robb: But I do think it’s a really good question. Pete raises a great question. And I don’t think we have remotely all the answers on this. There’s a lot of moving parts to it. But it is just kind of a reality. If we don’t overeat, if we not eating at a ridiculous meal frequency, which ironically two or three meals per day seems to be a reasonable meal frequency, and you’re getting enough [inaudible 00:08:04] activation that you don’t totally wither away all your muscle mass and die from Sarcopenia, but you also are not eating so frequently that we’re getting a real, legit, upregulation systemic inflammatory signaling and whatnot.

Robb: So, Pete, I don’t know if I’ve really answered your question there, but there’s a lot going on with this.

Nicki: And also, how far off the rails are you going? Are you doing 800 grams of carbs, or are you doing 200? I think that can play into it too.

Robb: And if it’s post workout or something, it’s a really different story. Our weeks tend to be a little bit more sedentary on the front end. We’re not even really making it to formal Jiu Jitsu class on Tuesday, Thursdays right now because of workload. We’re lucky if we go out in the garage and do a little bit of drilling. So on the front end of the week, I’m not really eating much in the way of carbs. Whereas Friday and Saturday, those tend to be bigger training days, and so I’ll have a couple of oranges for breakfast in addition to all my other stuff.

Robb: And then we’ll do Jiu Jitsu, and then based off of how knackered I am from that Jiu Jitsu training session, I may do … So the two oranges are 40 grams of carbs alone, and then after that I may have the equivalent of three or four more oranges. So I end up with that 100 to 120 grams per day of carbohydrate, but I feel good with that. I don’t get a crazy blood sugar crash. I’m not tracking ketones, but I just kind of dose it appropriate to my activity level. Whereas if I’m just sitting working, I don’t need it. I just don’t need it. I don’t need that many calories; I don’t need that many carbs. And so I just don’t throw it in.

Robb: So to your point, there’s a lot of mitigating strategies that can be employed, like exercise and meal timing and stuff like that.

Nicki: Okay. Our next question is from Chris, about deficits below basal metabolic rate. “Hey guys, over the past seven months I’ve had great success following the keto masterclass. As far as weight loss goes, I’ve lost 42 pounds, lowered my body fat percentage from around 28% to about 19%. For the first 12 weeks I ate at a 20% deficit without a break. I weighed and measured all my food, and I made sure I had my electrolytes dialed in: eating lots of potassium- and magnesium-rich foods, supplementing sodium as well as magnesium too.”

Nicki: “During that time, I was lifting four times per week, as well as a couple of 15 to 20 minute interval workouts per week. Other than that, I was doing some light walking and playing with my kids. Towards the end of that initial run, I started to get kind of bitchy. I’m a 45 year old male, and never really experienced the stable energy or deep solid sleep that a lot of people mention, two things I was really hoping for.”

Nicki: “Recently I’ve been alternating four-week cuts followed with two-week full diet breaks a la Lyle McDonald at maintenance. During those, carb sources have been clean paleo foods. Coming off of each of these, I feel better and maintained a stable weight throughout. I was normally back in ketosis in 48 to 72 hours after switching my carb and fat macros back up. And both times, so far, it has re-started weight loss. Still not great sleep, but I attribute that to having young kids, two and six.”

Nicki: “After a recent DEXA scan I was recalculating my macros with the keto gains calculator. I’m 162 pounds and 19% body fat. And it dawned on me that the deficit it was recommending, about 15%, was putting me below my basal metabolic rate by about 105 calories per day. For reference, I use the sedentary activity level, and don’t add back in workout calories.”

Nicki: “So to my questions. Understanding that the calculator is based off of the Katch-McArdle formula, basically giving a statistical norm, but BMR is the calories we need to maintain vital physiological functions, what are your thoughts on recommended deficits putting one below their BMR, and what are the longer-term implications of extended diets doing so? Would it be better to just eat at BMR on rest days and add back in some I’ll apportion workout calories on training days while still being below TDEE?”

Nicki: “It seems to me that BMR should be an absolute floor when it comes to caloric intake. I’m wondering if the aggressive deficit’s created some diet fatigue and hormonal disruption for me. Love the podcast and anything the Wolf Pack puts out. Thanks for everything.”

Robb: Man. Really good stuff. We read these ahead of time, we actually do, and I was noodling on how to tackle this one, because it raises a lot of questions and is difficult to really … So, we’ve talked about in the past … I think we’ve talked about on here. This is where I’m feeling like an old man that just tells the same story again and again and again.

Nicki: Well, a lot of the questions have similar veins, and so.

Robb: They have similar veins. But also, coming off of FitCon and then paleo effects, I know I told this story several times, and so it’s not like, okay, I think I’ve said this, but I can’t remember. But anyway, the point beings is that I’ve noticed that I seem to motor along with probably about 20, 25% fewer calories than what you would expect based off weight and activity level and all that type of stuff. Louise has mentioned the same thing. We kind of see it within the keto gains community.

Robb: I remember ages ago, Coach Greg Glassman, founder of CrossFit, we were talking about the zone, which, interestingly, when you really look at it in its fully formed format, which Barry Sears did a shit job of explaining the athletic interpretation of the zone, which is about a 60 to 65% fat-fueled diet, mainly from monounsaturated fats, moderate carb, appropriate protein, ironically, I think I end up eating pretty close to what five X fat zone recommendations are, which is fucking ironic, considering all the past and all that stuff around that.

Robb: But what Greg Glassman mentioned is that when people get in, he called it a thermodynamically efficient state. Which can be all kinds of controversial, and I think we have a question later about the thermodynamics in the story calories in, calories out. But he just noticed that people seem to motor about 20 to 25% fewer calories than what you would otherwise expect when they’re eating junk, or maybe not as nutrient-dense. And it’s interesting, because people freak out about that. There’s kind of the Ray Peat camp, and there’s some people that are super geeked out on eating as much as you possibly can short of gaining body weight. And sometimes folks get some decent results off that, maybe they’ve [inaudible 00:14:53] their hormonal profiles.

Robb: But then what’s always interesting about that, when you dig in, what was their training volume really like? Were they really supplementing sodium in an appropriate way? Were they a night shift worker? There’s all these moving parts to it that the blame is always placed on the dietary intervention. Which, maybe it was, but there’s all these other extenuating circumstances that we know can influence this stuff.

Robb: So I guess kind of the main question here is: is it a bad idea to eat below that basal metabolic rate which, is it Pete?

Nicki: Chris.

Robb: Chris pointed out is a guesstimation, it’s kind of a normal distribution. It’s entirely possible, and I think it’s reasonable, that when people eat a more nutrient-dense diet they probably require generally fewer calories to get the same processing done. So I don’t know that this one is really a scenario in which the … People were surprised by how few calories they eat on keto gains. Again and again people are like, “I can’t believe that this is what you guys are recommending.” But when people get in and actually you relax into the process, then they get great results. We don’t see thousands and thousands of people with HPTA access dysregulation, because they make sure to stay on point with the protein and with the sodium in particular, and stuff like that.

Robb: So I don’t know if I’m fully … Yeah, the not great sleep.

Nicki: He’s not had the stable energy or anything.

Robb: And when I hear supplementing, up above he says supplementing sodium. Yeah, but how much? Exactly how much? And are you for sure getting at least five grams a day?

Nicki: Especially given the fact that you’re lifting four times a week and doing interval workouts as well. There are people in the keto gains community doing 10 grams of sodium a day, if they’re active.

Robb: And more.

Nicki: And more.

Robb: Yeah. We don’t talk a lot about that, because as it is, people are all freaked out. But yeah. Yeah.

Nicki: But these individuals find that they perform better.

Robb: Much better. They feel better.

Nicki: Very active.

Robb: Their sleep is better.

Nicki: And that’s where their set point is. So if you’re only doing 1000 or 2000 milligrams of sodium, you might try-

Robb: No, you have to. You have to. And this is Phinney and Volek’s original work, which gets ignored a lot. They mainly focused on adding bouillon cubes and stuff like that. But they recommended a minimum of five grams per day. And that was just for your run of the mill keto type person, and then you start adding in volume and intensity of training and all these other considerations, then we have some problems there.

Robb: So I guess the long and short of that is, I would definitely look at sodium and electrolyte intake as fastidiously as you have your macros, and I’m going to get burned at the stake on the interwebs, but I’m not as … It’s interesting in a time when people are so geeked out about fasting and caloric restriction and all these longevity hacks and everything. So on the one hand, that’s real popular. But then on the other hand, people are concerned that a nutrient-dense diet may actually be a little more thermodynamically efficient. You just literally may not need quite as much food.

Robb: That’s not saying that in Chris’ scenario he doesn’t necessarily need a few more calories. But if the goal is still leaning out, we still need a caloric deficit, and you’ve got to get that by hook or by crook. You could do a more modest caloric deficit; you could do a zig zag pattern, where on training days you do more calories and on non-training days you do fewer. There are ways of breaking that up. But I’m not as concerned about that as what I was in the past. Particularly if people are on point with electrolytes and the food is nutrient-dense and all that type of stuff. And again, the interwebs will crucify us, but that’s okay.

Nicki: They did on the alcohol question.

Robb: Man. Man. Yeah, we’re going to do some outtake stuff on that.

Nicki: We have to do an outtake on that one.

Nicki: Let’s see. Next question is from Zach on energy balance: Gary Taubes versus Chris Kresser. “Hey Robb, long time follower, and really appreciate the work you’re doing. I wish I had known about keto and paleo when I was younger. I feel my athletic performance could have propelled me to the next level. Either way, I’m happy to have it in my life today, as it keeps me thin and healthy. Your keto masterclass has been instrumental in guiding through my keto paleo journey, so thank you.”

Nicki: “I’ve been very interested in a low carb diet for 10 plus years now, and it started with Gary Taubes. Gary Taubes is famous for saying that calories don’t count, and in my anecdotal experience, they don’t. I must stress that since it works for me, I’m completely happy with the results. However, when trying to speak intelligently about keto and low carb, I’m trying to bridge a gap from Gary to Chris Kresser’s podcast with Joe Rogan last week. On Joe Rogan, Chris said that you must run a caloric deficit to lose weight. Now I’m really confused.”

Nicki: “I’m an engineer and have taken several thermodynamics courses, so from an energy balance equation I understand that the human body cannot deny thermodynamic principles. But obviously our metabolism is much more complex than an energy in, energy out black box. Furthermore, energy in, energy out does not feel right for a number of reasons, such as, for instance, energy expended drinking cold water is not in this equation. That is, your body warming the cold water up. Energy that is never consumed but rather part of a defecation event, et cetera.”

Nicki: “I’ve eaten what I perceive to be a major energy surplus on a ketogenic diet, and have still lost weight. My caveat there is that I wasn’t weighing food, so I cannot really know. My apologies if you’ve already answered this question, but I could not find it on your blog or searching your website. I’m hoping you can point me to a study, a white paper, a text, or some reliable information that will answer the question of who’s right: Gary Taubes or Chris Kresser? Thanks Robb, you’re a legend.”

Robb: Man. So, my initial foray into the whole low carb scene was just prior to Gary’s first really popular paper, The Soft Science of Dietary Fat, and a couple of other papers. But this was around 2001 that Gary’s first paper came out. And it was pretty powerful, because it received a lot of attention, a lot of bandwidth. And it was validating for the very nascent and early low carb paleo-

Nicki: Ancestral health.

Robb: -ancestral health scene. There was nobody out there fighting for this or advocating for it. It was really the dark ages of putting these ideas forward. And Gary’s work was really a beacon of hope. And I’ve got to say that, for me, having been on a carbohydrate rollercoaster my whole life prior to this, I was kind of lean but not really lean, and then I went low carb, I would just pour olive oil on my food and eat it, and I was skeletor lean. I was also younger, and I was much more active, and there were all these other factors. But I could eat with pretty much reckless abandon and be as lean as I wanted to be, and I had rock solid energy levels.

Robb: And I think that that is a not uncommon experience for many people. And this is why part of Gary’s idea that he threw out there, that it’s not really the calories, it’s just the insulin, had some stickiness. Because at a macro level, there were a lot of people that their personal experience matched up with that.

Robb: And then even working with clients, we had clients that would just change the qualitative nature of their food, and they were still eating a Costco container of almonds or cashews or whatever as part of their overall eating strategy, and they were still losing weight relative to what they were doing before. To Zach’s point, they still may have been introducing some degree of a caloric deficit in this whole thing.

Robb: At the end of the day, there’s a huge variation, and Zach, you touched on some of these things. Some people absorb more calories out of their diet than other folks do. Just tweaks in the gut microbiome can make people 10, 20% more efficient at harvesting calories out of the food that would otherwise just pass through. People with Coeliac disease, and this is where the gut microbiome gets really interesting, we’re always like, “diversity, diversity, diversity”, but folks with Coeliac disease tend to have a more diverse gut microbiome. And the thought there is it’s kind of a response to the fact that the person is likely suffering nutrient deficiencies because of the gut damage, and so they’re trying to prop up the microbial diversity so that there’s more opportunity to actually harvest nutrients into the gut.

Robb: It’s highly speculative. There’s not a randomized control trial on this, so clearly the Nortons and Aragons of the world are going to take a shit down the back of the whole notion. But it’s really interesting. And there’s a remarkable spread and variation on that side.

Robb: There’s a pretty good spread on just even the way that people manifest calories at the mitochondrial level. I’ve talked about that in my metabolic flexibility talk, where some people are really jammed up in that kind of carb-dependent mitochondrial complex. And those people, they kind of burn more energy inefficiently. They’re producing a lot of reactive oxygen species, but it’s more a more caloric intensive process.

Robb: It’s not necessarily good, though. It’s like, “Oh, I get to eat more food.” It’s like, “Yeah, and you’re aging and oxidizing yourself at a faster rate.” This is part of the benefit of being metabolically flexible and tending towards fat mobilization and fat utilization as a primary fuel source, going through that mitochondrial complex too, you tend to produce fewer reactive oxygen species. Which is arguably more thermodynamically efficient. But at the end of the day, the thermodynamics are legit, but what gets lost in this story is: one person’s thyroid profile is X; another person’s is Y. And depending on the delta between those, one may be far more efficient with calories than the other one. And there’s pluses and minuses to both of those stories.

Robb: So what’s unfortunate, in my opinion, with Gary, I really like the guy, I consider him a friend. But he got wrapped around the axle of proving the insulin hypothesis instead of having that be a potentiality. He really linked his whole wagon and existence to proving that. Versus I suggested ages ago, 10 years ago, when [inaudible 00:26:03] was in its infancy, “Let’s focus on the outcomes and the fact that low carb diets really benefit people. And let’s focus on the outcome driven element instead of being so wed to proving the mechanistic side.”

Robb: Now, I understand the impetus there. In theory, if you can prove mechanism of causation, then we have in theory better control of what’s going on. But this is just a nearly infinite process. At the end of the day, there’s huge spectrums in variation. I was on a podcast yesterday where I was talking about this stuff. And just thinking about caffeine metabolism, there are some people that if you give them 100 milligrams of caffeine, in four hours they have metabolized half of it.

Nicki: Louise.

Robb: So the half-life. Louise, for example. There are other people that the half-life for caffeine for them is 30 hours. So we’ve got nearly a 10 X spread on just the ability to metabolize a common feature of our existence, caffeine. And so we have nearly a 10 X spread. And I don’t think that there’s remotely that big of a spread with regards to the way that calories impact people; but what if it’s a 2 X spread, or a 25% spread? That ends up manifesting hugely over the course of a 2000 calorie diet. It could be the 400 calories plus or minus one way or the other. And I don’t know what the real story is there.

Robb: But we do know that there’s massive variation from person to person. And what is the guy’s name, the Great Randy or whatever? There’s this guy that’s had a million dollar offer for people to prove psychic abilities and paranormal stuff, and it’s been since the mid-80s. And nobody’s been able to do it. So far, paranormal shit doesn’t seem to exist. Everybody has failed to produce it. And so this notion that somehow there’s a workaround thermodynamics in the body is kind of ridiculous, on the one hand. Or maybe not ridiculous, but it’s not being supported over the course of time.

Robb: But then the thing that I think that it fits your macros, and the evidence-based nutrition folks kind of miss is that the complexity of that thermodynamic story is jaw-droppingly complex. And the fact that people overeat due to complex food combinations and hyper-palatable food, stress, and all this other stuff, kind of gets dismissed, and it’s not really woven into a holistic approach to helping people manifest change.

Robb: I know that was all over the place, Zach. It’s just that it’s a really interesting, big topic. But I would have to say that this is a situation in which Gary, in my opinion, got fooled by an observational element, which is that there are some people that just seem able to eat a ridiculous amount of calories on a low carb or ketogenic diet, and either maintain weight or lose weight. But at the end of the day, Kresser’s a bit more on point with this stuff, in that you’ve got to introduce some sort of a caloric deficit to really lean people out.

Nicki: And we see this on keto all the time, because people will be like, “Oh, just eat all the fat and you’ll lose weight.” And for some people it works, and for other people, they gain weight on keto.

Robb: And what we find with that is that the folks that are focusing on fat are under eating protein, and because of the protein leverage hypothesis, we have a decent understanding that if we under eat protein we will be goosed to eat more of whatever is out there in an attempt to get appropriate nutrition. And that could be higher carb or lower carb, but there’s a reality that if we hit that appropriate protein threshold, then people tend to spontaneously reduce caloric intake. And that’s all I’ve got to say on that.

Nicki: Our next question is from Andrea. Has pre- and post-surgery nutrition buildup been covered? She says: “Hi kids and kiddies and squatchies. So, it’s been a little while since I have been devouring each and every single podcast episode, and I apologize. My own business focus has put me more into the writing podcast genre recently, but I see Tim [inaudible 00:30:38] on your interview e-list.”

Nicki: “So my question. Have you guys laid out a protocol for extreme nutrient buildup for before and after a scheduled surgery? This would be for someone who is not really paleo, still eats gluten, and mostly just avoids sugar and junky foods. So they are not yet on the raar, sardines from Nom Nom bandwagon, sadly. But if they have a willingness to make some changes to ensure they are in a better place to prepare to recover from their surgery, jaw replacement if it matters, what would you prescribe to them? And family, so if this guidance comes from an outside authority, that could make the critical difference in their enthusiasm. P.S. love to all you guys, you’re doing the chop wood, carry the water, and have been for so long. I bow and respect. Hope to see you again soon at some rando paleo conference. Andrea in Burbank.”

Robb: That’s awesome. Yeah, some days I feel like sticking my head under the chopping of wood, but-

Nicki: Or in the bucket of water?

Robb: Or in the bucket of water, yeah. Yeah. Man, this is an interesting question. It’s going to be reasonably controversial, but hey, what isn’t that we do at this point? But we noticed something when we moved to Reno. We had a couple of people reach out to us, and they were super excited the fact that we were here. And they ended up being plastic surgeons. And what we discovered was that, through processes that I still am not entirely aware of, people were coming into their program, and they want a boob job or they want this or they want that, and somebody suggested, “Hey, why don’t we do a lifestyle program for these people first?”

Robb: And what it was was a low carb, ketogenic, paleo type deal. And what they noticed that, one, people ended up losing shocking amounts of weight on this program. So people would go in frequently, tummy tucks were the big deal, that’s what it was. Tummy tucks were the big deal, and/or liposuction. People would do this lifestyle deal of eight to 12 weeks of a paleo challenge type gig. They got done with that, and then they’re like, “Wow, I don’t need a tummy tuck anymore.” And so then they’re like, “Well, what about boobs and eyebrows?” And all this stuff.

Robb: And then when they would do the surgery on these people, they were just stunned with how well they recovered. I mean, shocked with how well they recovered. Scarring was virtually non-existent. And something that people don’t really appreciate is that these big glucose spikes and crashes with regards to scar formation are really nasty. With regards to immune response, are really terrible. These big glucose deltas cause suppression in an immune response. So everything that you would want to go into effective healing is fucked up with bad diet.

Robb: I had LASIK done 2007?

Nicki: Or eight, yeah. It was eight, it was eight. It was after we went to Nicaragua. Because you had your glasses when you were trying to snorkel there.

Robb: That’s right, that’s right. Yeah. It sucked. So I went to this guy, he’s one of the best LASIK surgeons on the West Coast. I was ketogenic at the time, because I had read a lot of stuff about wound healing. And it was very early, but in my mind, reduced glycemic load and all that stuff made a ton of sense. Did the surgery, it went great, I was ecstatic. Went back two weeks later, three weeks later, a month, whatever it was, to get checked up, and the doctor literally, so I’m sitting looking in this thing, and he looks, and then he looks around, and he looks in there, and he looks around, and he’s like, “You aren’t fucking with me, are you?” And I was like, “I don’t know what you mean.” And he was like, “It is you, you don’t have a twin?” And I’m like, “No, I don’t.” And then he was like, “You have absolutely no scarring from the surgery. I mean, none.” He could detect no scarring.

Robb: And what’s interesting is, most people with LASIK, they talk about chromatic aberrations where when they drive at night they get these halo effects. And, “Oh, gee whizz, it’s the downside of doing this.” And knock on wood, but I have no problem with that. I get a little bit of dry eye, if the wind blows in my eyes after LASIK, that has been a little bit of a problem, where my eyes will water. But he said that I would need a tune-up on this stuff and/or would need reading glasses five years ago, six years ago. More than that.

Robb: But every once in a while, if I have really fine print, I will pull out some reading glasses. But I had no scarring. The LASIK has lasted way longer than it was supposed to. And we’ve heard similar reports from people.

Nicki: So as far as a prescription, this person’s going into surgery, let’s say three or four weeks from now. Beef, salmon, blueberries.

Robb: Low carb paleo type deal. Even just for the weeks leading up to and the weeks afterwards at a minimum. Again, knock on wood, but it’s really interesting. Shawn Baker is a surgeon. Most of the people that were early to adopt low carb have been surgeons. Because they would see someone change their diet, and then it wasn’t like, “Oh, well, I don’t know. Their cholesterol went up.” And an internal medicine person is like, “I don’t know if it really did all that much.” But a fucking surgeon, they’re looking at suture lines and wound healing and complications, and they’re keeping statistics on that.

Robb: And that’s why the plastic surgeons that we’ve met and have become friends with in Reno, their complication rate just plummeted. It got to a point where they were like, “No, you need to do this lifestyle program first, before I’m going to do anything.” And it became a little bit of a non-negotiable deal there.

Robb: So for this person, it sounds like they still kind of eat poorly. But just trying to get a little bit on top of a lower glycemic load paleo type approach. This might be an argument for an exogenous ketone deal, where they’re using them before, during, and after this process. Because the ketogenic state is itself anti-inflammatory, it tends to promote a lowering in blood glucose levels and whatnot. So this is maybe one of those scenarios where an exogenous ketone-

Nicki: With eating as much nutrients as you can.

Robb: As clean as you can, yeah.

Nicki: As clean as you can.

Robb: Yeah.

Nicki: And sardines. To be on the Nom Nom bandwagon.

Robb: Yeah. Everybody wants to be on that bandwagon.

Nicki: Thanks, Andrea. Okay, our next question is from Matt. CrossFit versus five by five?

Robb: Do I have a phone call right now?

Nicki: I have one in two minutes.

Robb: You have one in two minutes, okay.

Nicki: But I can call him back.

Robb: Okay.

Nicki: Matt says: “Robb and Nicki, thanks for all that you do. You, your books, and podcasts have changed my life. I have done two days a week of CrossFit for just over two years, and in spite of the amount of rest I get, I still end up with knee, shoulder, wrist, and elbow injuries and pain. I recently decided to pause my CrossFit subscription and have replaced it with three days a week of five by five routine recommended by the keto gains guys.”

Nicki: “I did your keto masterclass and I’m at 7.5% body fat, and try to keep my macros on point with the keto gains recommendations. What do you think about just doing the five by five home workout alone? I do like the group element of the CrossFit class, but at my age, 52, I can’t seem to go for long without injury or constant pain. I feel like the five by five program at home is much more manageable, as I can control the velocity and intensity without so much emotional effort. What are your thoughts regarding this path?”


Best supplements for diabetes type 2 - the 55p spice to avoid high blood sugar symptoms - Express

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Diabetes type 2 is a common condition that affects around 3.7 million people in the UK. It’s caused by the pancreas not producing enough of the hormone insulin, or the body not reacting to insulin. Without enough of the hormone, the body struggles to convert sugar in the blood into useable energy. But, you could lower your risk of diabetes symptoms by regularly eating turmeric, it’s been claimed.

Turmeric could help to lower your risk of high blood sugar, according to The Diabetes Council.

Its active ingredient, curcumin, could help patients to improve their insulin sensitivity, it said.

Diabetes patients that take turmeric supplements could significantly lower their blood sugar levels and insulin resistance, it added.

“Curcumin is the yellowish/orangish powder which gives turmeric its beautiful colour in curry powder,” said The Diabetes Council.

“It is widely used in many regions of the world for its pain-relieving features, improving digestion and liver functions.

“A study discovered that curcumin decreases blood [sugar] levels and improved the sensitivity of insulin by reducing serum free fatty acids and increasing fatty acid oxidation.

Supplements containing curcumin significantly decreased fasting blood levels and insulin resistance in type 2 patients.

“Use of curcumin also led to a significant decrease in serum, triglyceride fats, and an increase in lipoprotein lipase.”

Regularly eating turmeric could also help to reduce inflammation in the body, improve digestion, and even boost your weight loss regime, it added.

Its antioxidant properties are crucial in fighting infection and inflammation, said The Diabetes Council.

But, you should speak to a doctor before adding any new supplements to your diabetes diet.

Many people may be living with diabetes without even knowing it, as the symptoms don’t necessarily make you feel unwell.

Common diabetes symptoms include unexplained weight loss, passing more urine than normal, and feeling very tired.

Diagnosing the condition early is crucial, as patients are more at risk of some deadly complications, including strokes and heart disease.

You could lower your risk of diabetes symptoms by eating a healthy, balanced diet, and by doing regular exercise.

Speak to a doctor if you’re worried about the signs of diabetes, or if you think you may be at risk.


Diet Doctor Podcast #16 – Dr. John Limansky

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And then he found out maybe not so, that he was actually pre-diabetic and this was in his 20 so pretty young for that to happen and that set him on this course of becoming a bio hacker which he’ll define for us because that has a lot of different terms. But basically he learned how to use nutrition to heal himself and then tried to use that as a doctor to heal others and that’s a fascinating journey that he’s had.

So I hope you appreciate his story and along the way we’ll pick up some tips about how we can incorporate his lessons into our lives to make things easier and what it means to be a bio hacker, what that means for nutrition and for sun exposure and when that can go a little too far.

So I think that’s really important to keep in reference that a lot of the things we see in terms of bio hacking are expensive and of questionable utility so John is going to help us figure some of that out and figure out how to evaluate that. So it’s a great discussion. We also talk about families and kids which is near and dear to my heart so I hope you enjoy this discussion with Dr. John Lemanski.

Dr. John Lemanski welcome to the DietDoctor podcast. Thanks so much for joining me today.

Dr. John Lemanski:  Thank you for having me.

Bret:  It’s my pleasure to have you here. So your story is unfortunately a story that’s not that uncommon nowadays. Someone who prioritizes their health, is busy in their life. is taking care of themselves and a triathlete and yet finds out despite being in med school, competing in triathlons that you’re not that healthy. Tell me a little bit about that discovery and what that meant for you.

John:  Well, like you said it wasn’t a weight issue with me. It was a question of I’m following what the guidelines are in terms of dietary, I’m exercising probably more than I should be and I am relatively thin and yet the question is I check my lab work and lab work was HbA1c, fasting insulin, and obviously just your basic chemistry found that my insulin level was very high, my HbA1c was relatively normal, but still I was showing signs of insulin resistance just based on my fasting insulin score.

And so the question to me was as a medical students I think I know everything, you know, I am young, I am healthy, I’m doing all the right things that I’ve been told and yet these labs are not showing or not reflecting that. And that was pretty scary, was pretty eye-opening to me at the time. So I wanted to see why is this… is it genetic, is it dietary, am I exercising too much?

Which could be a possibility and really got led down the path of no, it’s actually what I’m eating. That’s driving most of these lab abnormalities. And it was beyond just the lab abnormalities, it was also how I felt. And so I’m sure you can remember back when you’re a medical student, but you’re always tired and you think, “It’s because I’m studying all the time.”

But then I never got better and it was a question of how can I be so exhausted all-time and yet, you know, I’m young, healthy and fit and it must be an answer to that question.

Bret:  So what were you eating at that time? Was it the standard American diet, was it processed foods and chips and sodas or was it healthy whole grains and fruits… like what was the mix?

John:  No, it was mostly healthy whole grains.

Bret:  Quote, unquote.

John:  Right… a lot of quinoa, pasta, bread, a lot of fruits, a lot of vegetables, really no fast food, so it wasn’t fast food, it wasn’t processed food. Maybe, you know, maybe healthy processed food. So whole foods, processed food, that you think it’s healthy, but it’s not. Because it still if you look at the container and you look at ingredients, most of the ingredients are going to be some form of sugar initially.

But, you know, very little protein so I was more kind of a pescatarian, not too much protein and essentially no fat. If I was eating fat it was from olive oil, olives and things like that, but otherwise I was pretty much avoiding that.

Bret:  And this was in your 20s, basically in medical school. So that’s I think so interesting for you, it seems like it’s much earlier than the average person we’ve heard of this happening. So maybe there is a genetic component to it to suggest when it’s going affect us and for you it was earlier, but that kind of diet certainly can affect anybody in anytime.

John:  And I think also you have to take into account some of the other factors at the time. So obviously studying, being up all night, so stress response to be in medical school, being up, the stress of that, also was probably playing a role now that I look back. But I still think genetically and dietary was the main cause of that.

Bret:  And this was like 15 years ago.

John:  Yeah.

Bret:  And so from there was your first intervention, a ketogenic diet to help reverse that or did you have steps along the way?

John:  So there wasn’t much information about keto at that time. I mean it was quite a long time ago. Atkins was kind of in the rebirth phase at the time. I started reading about Atkins, I’ve known a few people who had tried it and had had great weight loss success.

I was a biochemistry major in college and so going back to the biochemistry and understanding how we are actually processing the macronutrients, what’s the process that’s actually happening, Atkins seemed to be a little bit more in the line of I think this is going to be healthier, which is based on simple biochemistry. I didn’t like so much the amount of protein that I was consuming based on that.

If you remember I went from pescatarian, really like 30 g of protein maybe a day, so pretty low on the protein, pretty high on the exercise, so that probably was not a good combination. But going to much higher levels of protein I didn’t feel as good. And then just kind of researching, going to pub med, going to library at the time, you know, Google wasn’t a big search engine like it is now and looking at the research studies that were out there at the time about keto it just made more sense from a physiological level.

So I started kind of transitioning into more of a ketogenic, low-carb I would say initially because I still do like vegetables. And then as time has progressed and now we have ways of really measuring blood ketones, breath ketones, glucose much easier, I’ve got kind of transitioned into going into ketosis quite exclusively and then maybe coming out once in a while, but doing more of a low-carb. So it’s a process I think like most people experienced, it’s not get it right the first time.

Bret:  Well, what’s so interesting is you’re like the perfect person for that to happen to, because you’re in medical school, because you had some knowledge and you are the type of person who wants to dig into things deeper and you’re the self-experimenter. So that’s sort of like sort of kicked off… it sounds like that kicked off your N of 1 experimentation that you continue to keep up with.

John:  Right. I’m always interested in pushing the limit of our understanding of things regardless if it’s sports or health. Yeah, I agree it’s probably a perfect match in that sense.

Bret:  And then to talk about your medical career. So from there you went to be a hospitalist in Mississippi, the heart of the obesity and diabetes epidemic and I’m sure you just saw some horrendous things in the hospital that could’ve been prevented but weren’t.

John:  Correct. So I did internal medicine and my goal… I was young, idealistic, I thought I would change the world in terms of health. I had this understanding of what it could do for me just on the physiological level and I had this understanding of what other people who are using it were experiencing in terms of getting off diabetic medications, blood pressure medications.

So I figured, go to the worst state in the country where it’s a problem that is I think worse than just the statistics would show. And it is devastating in the south and now really in the rest of the country, but one of the main factors in terms of risk factors for most things is age. So if a 20-year-old comes in complaining of chest pain, you’re not going to run to the cath lab with that patient.

Now for a 50-year-old you might think a little bit more in terms of doing that. In the south we would see MIs in people in their 20s and 30s, people on dialysis, people who would have cardiomyopathy with EF of 10%. Maybe obviously genetics is an issue, but really no other factor that we can look at and say, “This is what’s driving this.” So that experience was eye-opening in the sense that I saw the worst possible outcome of everything that you and I are discussing at a very young age.

And so we’re in a situation there where we talk about healthcare for everybody, should we not have Obama care, should we have some new form of healthcare, but the question that I think is never raised is how we’re going to manage chronic medical diseases, which are starting at such a young age and trying to maintain health and happiness for those people. So that experience I think was eye-opening in many ways.

Bret:  Yeah, for some people I think it could be incredibly depressing and make you sort of want to give up and for other people would be empowering to say, “How can I fix this?” And so luckily for you it seems like it was the latter.

John:  Well, I think you get frustrated especially if you have patients that you see over and over and over obviously in a hospital setting. We don’t have follow-up, we don’t see patients in the clinic, but I would see you know patients come back within a few days of being discharged with really no change in their underlying condition. We just happened to tune them up perfectly with the right combination of medications and then four days later they’re right back.

So you get into this question of is that a futility of care? Is there a better option? Is there a way to maybe prevent these things from happening? And should the focus be on that? And for me it was kind of a no-brainer at that point. I felt like I could make more of a difference by preventing what I was seeing in the hospital than necessarily just treating it after the fact.

Bret:  It’s interesting that we use the word “tune-up” a lot, sort of like we are car mechanics, just tuning things up. Not fixing a problem, not reversing the problem, just tuning it up and the words we use matter and reflects our philosophy and for a lot of doctors that’s the philosophy.

John:  Well, it’s frustrating I think, it’s extremely frustrating, because how good of medical care is that where you are just tuning people up? Versus actually really getting down to the root cause and addressing that and then watching those symptoms that are presenting, kind of disappear.

Bret:  So then you have this dramatic transformation from a hospitalist, seeing these types of patients to having more of a one-on-one, I guess you could call it concierge, but that comes in connotations, but an one-on-one personalized approach with patients and frequently using a ketogenic diet in those patients. Now do you use a ketogenic diet in pretty much everybody or how do you approach that and how do you evaluate them to see what diet is that’s best for them, for their situation?

John:  Yeah, great question. I think you see in the conferences this push towards individualization. So everybody is different based on the genetic factors, based on their lab markers, kind of what their goals are. I think nutrition is essential to everybody changing, whether it’s going from a process to fast food diet to just eating real food, I think people will have tremendous success in reversing a lot of their markers. For me it’s a question of what is the goal of the person.

So keto or low-carb I’d say is ubiquitous for the patient population that I take care of initially. And to stress by… based on how metabolically sick they are. And so I think Gary Taubes put the slide up yesterday about this sensitivity to insulin, everybody has a threshold in terms of how many carbs they can consume before they really kind of push the insulin level back up. Same thing happens with the patients that I take care of, it’s really figuring out first what is their threshold. So are they metabolically sick? Do they have diabetes? Which a lot do. Do they have insulin resistance? A lot do.

Do they have high blood pressure? So do they have risk factors that need to be addressed more aggressively initially, then they’ll be ketogenic to begin with. And then eventually it’s a question of can you transition back into more of a low-carb? Because I don’t think everybody needs to be in strict ketosis all the time. But I think it’s an extremely powerful tool to be used for specific situations.

Bret:  And that makes a lot of sense If you’re treating diabetes, if you’re treating insulin resistance. The further you can go on the spectrum the better you’re going to treat it. But at some point people want to change sometimes. Some people love being in ketosis, they feel better, they think better and they never want to do anything differently.

Some people sort of miss some of the lifestyle they had before and want to find a happy medium. So what do you use in your practice to decide is somebody “ready” for that and how do you follow them? Do you do oral glucose tolerance tests? Is it based on their insulin levels A1c? What kind of tools do you use?

So the first thing before we even talk about how to transition I would say a good way to kind of keep people in this situation where they want to stay in ketosis or they want to be restrictive is making it applicable to their cultural situation. So for instance in the south, you know, barbecue, drinking will be a big kind of social gathering factor, so trying to figure out how do you actually make low-carb keto accessible to people who want to stay in those situations? And there’s tricks you can use.

But let’s say just from a clinical perspective if somebody wants to transition from keto to low-carb, a couple of things I’ll look at. So I don’t really like the oral glucose tolerance test. I do like it in combination with the insulin test. So I think that gives you a lot more information. So doing a fasting insulin, doing the glucose tolerance test, doing the insulin test to see… number one is fasting insulin suppressed in general.

But number two, what is the response? So if they’re still having an exaggerated response then their threshold of carbohydrate intake will probably be much lower than somebody who has a normal physiological response. So obviously using metrics like HbA1c is important, blood pressure measurements, high-sensitivity CRP, things like that, but the main ones I would say are have they reached their goal in terms of what they’re trying to accomplish? Do they have an abnormal response to that test? What is their fasting insulin?

Bret:  And so a lot of people will say, I want to be ketogenic to lose weight. And once I hit my weight goal, okay I’m all right, I’ll back off a little bit. So what are your thoughts on weight as a metric versus some of these other metrics you mentioned?

John:  Yeah, I hate weight as a metric. It’s probably one of my biggest pet peeves. I tell people weigh themselves one time initially and I prefer things like Dexa scan or Body Pod to get an actual lean body mass perspective, what’s the visceral fat, because it is much more important, we’re looking at getting rid of visceral fat, obviously some subcutaneous fat, fatty liver disease, we are looking at trying to reverse those things.

So I tell people, “Weigh yourself initially and then don’t weigh yourself for a month.” Inevitably I find that most people come to keto because they want to lose weight, that’s the number one driving factor and it makes sense.

But most people as they transition and they start noticing things are getting better, so their joints don’t heard, they don’t have headaches, they are not frequently hungry, they are sharper, more cognitively sharp, inevitably that becomes really the driving factor I think for most people to want to stay or at least kind of transition in and out.

But in terms of answering a question, you know, everybody has a weight goal that they want to get to. I use body fat percentage as a better metric and I try to encourage the people I take care of to use that as their metric. You know, how is your visceral fat responding to what we’re doing, how is the body fat percentage responding.

And so if we get down to the goal body fat percentage, visceral fat is gone, lab markers are back to normal, then yeah, I think it’s a very reasonable question to say, let’s try some different things, let’s expand your carbohydrate. I think Andreas showed very nicely that in a ketogenic community we also have given carbohydrates a bad name and they’re not necessarily bad. Obviously highly processed ones are going to be detrimental to our health, but incorporating healthy vegetables I think is a perfect way to transition.

Bret:  Diet is a tool and you have to use the right diet for the right job basically. And then of course when we talk about the food we eat we also have to talk about the timing, when we eat and when we don’t eat. So time restricted eating, intermittent fasting gained a lot of popularity, as something that’s been around for ever basically. So what are your stages of helping people using that to benefit their health?

John:  We like to make the old new again and we take concepts that I think have been used for generations and then bring them back and say, look I have this new thing. But ancestrally I mean it’s how we essentially lived. Taking somebody who’s on a western diet and saying, “We will get you into ketosis, we’re going to fast for five days”, you’ll probably lose that person for the rest of their life and never going to do that again.

So initially I think my approach is change your diet, so change it from what you’re eating to low-carb, to keto, get adapted, get fat adapted, actually make the enzymes that you need and then start incorporating some other factors, like time restricted feeding, intermittent fasting, longer-term fast, because I think that’s an extremely powerful way of suppressing insulin.

Plus I think there’s a lot of people who will reach a threshold where they just cannot break through that kind of plateau. And incorporating something like the intermittent fasting tends to help tremendously.

Bret:  You know what’s interesting is people talk about their stalls and their plateaus usually again with weight. But we can see the same things whether it’s HbA1c or glucose tolerance and fasting seems to work for that as well.

John:  Correct, and that makes sense because you’re really again going to the root cause, which is insulin being elevated to trying to suppress those as much as as possible. Plus what I find interesting at this time is that the research that’s going on to support these claims is also extremely powerful. So looking at studies that show that you actually need to have periods of time where you’re not eating to activate enzymes needed to do beta-oxidation.

That makes sense that you’ll be able to deplete your glycogen storage to some degree, start beta-oxidation. So people use weight as metric but that’s the reason, is you are actually going to the underlying cause and addressing it. And for most people I think it’s pretty simple to do an intermittent fast, especially if you do it, you know, early dinner, late breakfast… It makes perfect sense for most people to be able to do that.

Bret:  One of the interesting concepts about intermittent fasting or time restricted eating and the body’s natural circadian rhythm is to try and do them in tune, but what I find is that goes against sort of our social constructs. The traditional intermittent fast is to skip breakfast or have a late breakfast and then have dinner because that’s what fits more with our society.

I want to have dinner with the kids and the family, dinner is a social outing, but it seems like our circadian rhythm would say the other way. We should have the breakfast and skip the dinner. So how do you balance that with your patients?

John:  Yeah, that’s a great question. I think Marty Kendall down in Australia is doing a lot of independent research about the timing of food and his argument would be that from a physiological perspective you should be eating breakfast as your main meal. The way that I kind of make the argument is you’re giving yourself a period of time where you’re not consuming calories.

For me I do it this way where I eat dinner and then during the day I don’t eat much. And I do it because I want to have dinner with the children. So I think in the big scheme in terms of all the different things that you will do to improve your health, if the timing of your main meal is really the deciding factor, then I think we’ve probably gone overboard.

So I would say, and I know I’m kind of hedging on this question, but I would say if it’s going to allow you to do it and dinner is the best way because you want to have family interaction, then I would do it that way. If you don’t have a– let’s say you’re single or you have a girlfriend or you don’t have this kind of idea that you have to eat dinner as a family, then yeah, I think eating in the morning is perfectly fine.

Bret:  And I don’t think it’s a hedgy answer, I think it’s a great answer. You don’t want perfect to be the enemy of good basically. And even if our insulin sensitivity is worse in the evening because of the circadian rhythm, the main goal is having a space between your meals and whatever it needs to accomplish that is the good. And then if you can do perfect, great, if not, it may affect your life.

John:  And interestingly enough I think for people who are kind of type A and have to do a lot of work during the day I find myself personally that if I eat a very heavy meal for breakfast and make that the main meal, I am actually quite lethargic for a good portion of the morning which is when I do most of my work.

So I find it for me because I’m fasting most of the night, you know, I have high ketone levels, I feel very, very sharp when I wake up. I know it sounds monotone but this is me being sharp. But this is me awaken, so for me it works well in that sense and a lot of people that I work with they are also pretty active in the morning and so it works well for them too.

Bret:  Yeah, it makes a lot of sense. So you’ve been known as a keto hacker and a bio hacker. And bio hacking is a term that gets used quite a lot lately and it has different connotations for different people and it can mean a lot of different things. Some not so pleasant to be honest and some pretty basic. And a lot of the bio hacking I hear you talk about seems rather simplistic, but I want to hear you kind of define how you see the term bio hacking and how you use it to help yourself and your patients.

John:  Yeah great question. So I define bio hacking as making the environment work for you instead of against you which is a pretty simple concept. I think on one extreme you have bio hacking which does have a bad connotation in a way because some people are maybe pushing it a little bit too far injecting themselves with iso-tracers or doing stem cell injections which maybe don’t have the scientific backing yet, but on the other hand there are simple lifestyle modifications that are still I think to be considered bio hacking.

And those are the ones that I focus on. You and I as clinicians will talk to our patients about diet and exercise, but I don’t think we necessarily– and I don’t speak for you, but we don’t necessarily go into depth in terms of what that means. So we’ll just say, kind of blanket statement, okay make sure you do that and exercise, but what does that actually mean?

What are some of the simple cost-effective really lifestyle modifications that you can do which actually from a bio hacking standpoint impact your health tremendously, probably even more so than maybe some of the more extreme forms of bio hacking. And I don’t have anything against certain techniques like hyperbaric oxygen chambers and sort of other kind of more advanced bio hacking techniques that are being used but the question really becomes, how can you apply those to the majority of people?

Can you spend $40 a session in a cryo-chamber? Well, most people will say, “I can do it once, but I can’t do that on a regular basis.” So then what’s the benefit of having that? And so I really define bio hacking as what are the things that you can do to improve your health, affect yourself from a metabolic standpoint positively and do it cost-effectively?

Bret:  Like getting out in the sun and getting more sunshine. I mean in some circles that’s considered bio hacking, in some circles is considered common sense.

John:  Yeah, but then you look– You know, EPA came out with a statistic that said 90% of our life is spent indoors. So yes it sounds simplistic, it sounds like common sense and yet we’re not doing it. So the question becomes how do you do it effectively from a time management perspective…? Because we’ll strapped for time. …And then do it without having to spend thousands of dollars on some gizmo?

Bret:  Right.

John:  And so simple things like going outside in the morning and getting sun exposure, getting actually the activation of your SCN, getting your circadian rhythm back in order I think is extremely important, focusing on sleep is extremely important. I just did an experiment where I worked five nights as a hospitalist.

I haven’t worked nights in– I don’t remember when, I don’t want to remember when, to see what’s going be the metabolic impact. And so in five days I gained 7 pounds, not changing anything dietary, so maintained my normal fasting routine, just changed the timing, so there is an impact, so I was eating at night.

Fasting glucose was 15 points higher. So a part of that is probably because of the time of the eating and the sleep pattern was horrible. So sleep has a huge effect on our ability to be metabolically healthy. So simple things like that I think are extremely effective.

Bret:  Yeah, I mean shift workers are a huge problem in this country and a lot of times they don’t have an option, is their life, it’s their job, they can’t change that. So what would you recommend a shift worker do to try and mitigate the negative impact of that type of lifestyle?

John:  That was part of the reason for doing it, is to see, because I get a lot of questions, “I am a shift worker, I work late nights and no matter what I do I cannot lose weight. Why?” I think very similar to the people who were metabolically sick, if you’re in a situation where you’re not a shift worker, you probably have to be a little bit more strict in terms of being in ketosis.

At that point I think getting your circadian rhythm as best as you can is extremely important.

So getting sun exposure during the day, making sure that when you’re sleeping it’s quality sleep that’s being tracked, focusing on some of the other biohacks to really kind of help in terms of pushing the envelope in your favor, because you have this major kind of obstacle which is sleep, which is affecting your cortisol, which is affecting your hunger levels, which is also affecting your desire for craving carbohydrates. So it’s extremely difficult I think for night shifters.

Bret:  So we’ve talked about sun exposure a couple of times and one of the things I think is interesting is looking at the data for sun exposure. It is hard to come up with the perfect level. Like ideally we would just be outside and play and have fun and get good sun exposure but like you said is not happening.

So what I have read it seems like 20 minutes of whole body exposure, not just like face, head, hands, but 20 minutes of whole body exposure seems to be like the minimum threshold that people should be shooting for, people like maximum benefit for minimal effort. So is that what you recommend too or you have a number in mind that you use?

John:  Yeah, I agree with you and I think the data is not that strong either way. But I would say 20 minutes… hopefully people after this are not going on their front yard, you know, fully naked, getting sun exposure, but I think 20 minutes and also the timing of the day is important, so ideally noontime would be the best getting maximum exposure, but not getting too much, then you are at high risk of skin cancer.

Bret:  Right, that’s the balance. And that’s why for people like us who were outside a lot with our athletics, but yet for me at least it doesn’t count for sun exposure, because I had a hat or helmet, I’ve got long sleeves, long pants and I am not getting my sun exposure despite being outside and that’s an important concept to remember. Like I’m outside plenty, I don’t need to worry about that. Well, a lot of times you still do, but there is that balance.

John:  Right, and I think doing it in a way where it’s part of your routine, so I think even if you work let’s say, going outside for lunch, getting some exposure, rolling up your sleeves would be a good way to at least get some sun exposure, at least get some vitamin D production, but otherwise I think 20 minutes is probably ideal.

Bret:  And what I love about that is it’s free, no gadgets, you don’t need anything, just walk outside. Now I see you have two rings on.

John:  Yes, married only once.

Bret:  Yes and then the other I assume is an Oura ring.

John:  Yes, correct.

Bret:  So now we get into gadgets. A bit more expensive and technology. Some people love it, they get into the technology and want more and more and some people are hesitant and afraid of the technology. So is Oura ring sort of one of your basic go-to technologies that you recommend?

John:  Yeah and I don’t have any affiliation with Oura ring, but I think for me, I am more of a data person, I probably should’ve been an engineer like most of the other speakers, but I think data for me helps drive changes in our behavior. So for instance I know I get instant feedback from… let’s say I eat later at night which for me I noticed would cause certain things.

So I wouldn’t have the deep, the REM sleep at levels that I would want to get the restorative sleep. I would notice that my resting heart rate would take a lot longer to come down which makes sense. I would notice that the quality of sleep was not good. So changing timing of diet for me was based on sleep patterns and fasting glucose, but mostly sleep patterns. So I do think there is a balance because there is so much technology.

Which ones are going to be the most effective? In my opinion after nutrition I would say sleep is the second most important factor in people, whether or not that’s science base or not, just my clinical experience, that’s what I’ve noticed. So I think yes there is a cost associated with it, but the amount of feedback that you get to me is tremendous.

Now there’s a lot of other gadgets out there I wouldn’t spend a dime on. And so there is this balance of trying to figure out which ones are going to be useful versus which one are just going to be for fun to show you have a new gadget.

Bret:  And can we do it another way? As if you drink too much alcohol one night or eat too late, it will affect your sleep. You know that, you don’t need a gadget to know that. But if you want to fine-tune it to more detailed or less obvious causes, then maybe the gadget comes into play.

John:  So for most people that I work with they are really looking forward that extra edge I guess in terms of whether or not to improve cognition so that they are more successful in business. For them those little changes do make a difference. But at the same time it’s not a question of just using the data and focusing solely on the data and making changes to improve the data. It’s using as a tool.

Kind of like you would use lab markers as a tool. You could run a plethora of labs that might impress people, but are you going to use those or are they going to be useful for you or is it just going to be an added cost? And so I think it’s really weighing that balance based on your clinical experience what’s going to benefit you.

Bret:  Yeah, that’s a great point that you bring about the labs, because I think it’s pretty clear in contemporary medical practice, they are just scratching the surface of what is available on labs, and no one is checking fasting insulin hardly, advanced lipid testing, but yet on the other side you have some doctors and practitioners who just check thousands of dollars of labs, most of which is not going to have much of an impact.

So you’ve got to find that middle ground as well and the same for technological information with bio hacking our lifestyle.

John:  Absolutely. When I started I was that doctor who would check a plethora of labs. I don’t even know what half of the labs were in terms of interpreting, but I think it also as you gain experience you realize you need less tests, but you need them to be very specific to what you’re looking for.

And so same thing I think applies with the technology. I would rather spend money on something that I think is going to beneficially impact my health and it’s going give me data to do that, but I wouldn’t spend money on something that I think is just another gadget.

Bret:  Like simple sleep hacks could be just an eye mask and, you know, 10 bucks for an eye mask or less and you need that multiple hundred dollar Tom Brady smart pajamas for your sleep hacking.

John:  I’ll take one, but no. Is he selling those?

Bret:  Yeah, I think it was last year, I don’t know if they survived or not, but there were these smart pajamas that’s supposed to you tell you how much you’re moving and your respirations and so forth.

John:  I mean, you can get on the extreme words, a lot of kind of fad tools that are not useful.

Bret:  So one fad tool, or one tool that seems like it could be fad and others swear by it is saunas. And when people think of a sauna, they probably think of you go to the gym, then you go to the sauna, and do sweat it out a little bit and release the toxins as some people say, sweat out the toxins, but now it’s taken on a whole new meaning… infrared saunas, regular saunas, people are buying saunas for their houses.

So again it gets into that next level of this isn’t necessary for everybody, but does the science back up the investment? And some people could say yes, I am curious to get your opinion on that.

John:  So depends on what your goals are. So in terms of most of the science that’s come out on sauna, it’s Scandinavian, mostly from Finnish countries, but that data is really looking at cardiovascular health for the most part and there are some other studies that look at the impact on cortisol levels, on fasting insulin, on heat shock proteins, so there is data that is coming out and I think one of the exciting things about the bio hacking kind of world now is that a lot of research is being done to find out is there actually basis to this?

And the studies that look at cardiovascular health are in my opinion pretty impressive. Does that merit a $4000 or $5000 investment? Probably not for most people. Again going back to cost and cost being cost-effective, most people have a gym membership; whether they use it or not is a different story, but most gyms are going to have a sauna.

And you had asked me a question before we got online as far as biohacks and the way I look at it is number one, is it going to be effective? Number two, is it going to be safe? Are there going to be downsides as far as doing it? And then is it going to be applicable to people? I think when you look at sauna… is it effective? I think it’s effective. I think in terms of a lot of people I work with really focusing on getting their fasting insulin as suppressed as possible. Sauna helps with that.

Bret:  Does it?

John:  Yeah. So it increases a couple of things, but increases insulin sensitivity in skeletal muscles. And so if you can actually impact insulin and fasting glucose, can you impact them metabolically? And I would say that you can. Is there a downside? Is there a risk involved with it? Sure for certain people, if you are elderly, if maybe have some cardiac arrhythmia, get dehydrated… sure, but in general I would say it’s a safe modality that has been used for centuries.

And then is it applicable? I think for most people if they use their gym membership, they can go to their gym sauna they don’t have to have a huge cost expenditure for that and it helps to think for a lot of people who use it.

Bret:  Now I’d hate for someone to hear that and say , “I don’t have to worry about my nutrition. I just have two go hit the sauna and improve my insulin sensitivity.” So I’d imagine the impact it has is a fraction of what it would be for nutrition or fasting or time restricted eating. So would be again taking someone at the good level and trying to get them to a little bit higher level perhaps.

John:  Again in pretty much any talk that I give I will say nutrition is– I hate to use the image of a pyramid just because it’s been butchered.

Bret:  The food pyramid has been butchered.

John:  Yeah, but we’ll call it the keto hacking pyramid, but the base is going to be nutrition. And obviously my experience low-carb keto will be for the majority of people, then it’s really getting to that next level in terms of optimizing your health.

A lot of people I work with are interested in living longer but they also want to live longer and healthier, they don’t want to be dealing with chronic diseases and so for those people implementing certain biohacks like that can help take them to the optimization of what they’re looking for.

Bret:  And to get back to the sauna, when you said that outcomes have been for cardiovascular health, is it mostly sort of endothelial health and vasodilatation and–?

John:  Correct. So most of the studies have looked at those two specific things and then mortality and morbidity which I know you can play with statistics but that’s really the focus of most of the research.

Bret:  Interesting, but I can’t imagine it shows mortality difference for sauna use.

Bret:  No, because it’s such a short study.

John:  And so if you’ll recommend somebody to use the sauna at the gym since it’s there, five minutes, 10 minutes, is there a threshold?

John:  So 19 minutes is a threshold, so 19 minutes four times a day is really kind of the maximal benefit from that versus the trade-off of diminishing returns.

Bret:  All right, interesting. I mean when new technology comes out like that, I think it’s so interesting how to interpret the science and how to incorporate it to see if it works for people and I like your philosophy; does it work and is it safe? Is there downside? That’s always a very important question. And then is it accessible? And infrared saunas, I would not recommend people to get them.

John:  No, not at all. But something like– You know, the question also is, do you get more benefit from that infrared sauna versus a dry or wet sauna? I would say the heat is going to be the most important thing rising your core temperature. There are some added benefits from infrared, but again is it worth the $4000 investment? I would say most people would say no.

Bret:  But in bio hacking circles that’s what a lot of people are promoting. These amazing technologies that are sort of out of reach for most people.

John:  Sure, which doesn’t make sense.

Bret:  We’ve touched on a lot of topics here and I just want to touch one more thing because you are a big family man and I really appreciate that personally and I’m sure a lot of our listeners do as well, but you are taking a little bit different approach on how you’re raising your family and living your life. You’re taking sort of a nomadic approach to things.

John:  Yeah.

Bret:  Tell me briefly about that.

John:  I have always been a big traveler and I have traveled all over the world, I was fortunate enough to be raised by parents who loved to travel and I want to have my children have the same experience I think in a time where especially in the United States we are so polarized, we see things extremely different.

I think you can learn a lot about our country but also about people by being with them in different experiences, by learning what’s driving their understanding of politics or religion or health. And showing how different parts of the country are going to experience a low-carb or ketogenic diet differently, based on resources, based on socioeconomic status, based on– culturally.

So obviously people in the South will have different cultural norms than people in the northeast and yet we can all do some version of low-carb or keto but a bit differently. And I want to show how that’s possible and maybe educate more people along the way.

Bret:  That’s fantastic. So you are just starting your journey now.

John:  Yeah, next month we’ll be going, we are starting in Puerto Rico. We had a really good expense there and so we’re starting there and we’re going to travel up East Coast over probably North and down the West Coast and then in the middle of the country. And then fingers crossed but maybe do that in Europe afterwards.

Bret:  Fantastic, I mean that’s such an unique experience.

John:  I mean it sounds good. Call me in a month and ask me how I am doing, but yeah I think it’s very easy to get stuck in kind of the daily routine and I kind of talked about this, but then the question really becomes are we exposing our children to different cultures, to different experiences? I think if we can do that we will be better off as a nation, we’ll understand each other better, hopefully we’ll get away from kind of the political swings that we’re seeing.

Bret:  In transitions like that, in travel like that, can be tough on health and nutritional routines because we can talk about routines in a negative side, but we can also talk about routines in a positive side that you’re able to take care of yourself better with sleep habits and nutritional habits. So I am anxious to see how you come up with more hacks for that.

John:  Yeah, luckily I have been traveling for quite some time and so I’ve come up with hacks for myself, but it’s a different story when you have three little children who are hungry and they want something different than boiled eggs and, you know, avocado.

So it’s definitely an experience but it’s also a way to show other people who are dealing with children maybe how to actually transition them over to more of a low-carb version. I know that’s a big struggle for many families, is they are low-carb, they’ve seen the benefits, but they transition their children and they don’t have to be ketogenic, but maybe transition them over from the junk processed food… How do you do that? How do you do that when you travel? I think those are topics that are always being brought up.

Bret:  Right, and the age of the kids matters too. I imagine in the teenage years it can get a little more challenging as they need a sort of independence.

John:  Yeah, we have to do it now before they are taller than we are.

Bret:  Right.

John:  That’s the goal, because once they are taller, you know, all bets are off.

Bret:  Right, don’t make it a power struggle, but make it a teaching.

John:  Exactly, make it an adventure, we label it as an adventure and I think at this point they see it that way. And hopefully they will have good memories that will help them mature as good human beings.

Bret:  That’s what’s important. Well, dr. John Lemanski thanks so much for joining me. Where can people learn more about you?

John: and in social media biohackmd is most of it.

Bret:  Great, thanks for joining me on the Diet Doctor podcast.

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DSM Increases Shareholding in Andre Pectin

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Royal DSM, a global science-based company in nutrition, health, and sustainable living, has agreed to increase its shareholding in Yantai Andre Pectin Co. Ltd. (Andre Pectin) to 75%. Andre Pectin is a leading specialty food ingredient producer.  
DSM acquired a 29% stake in Andre Pectin in 2013. After settling a shareholders dispute, DSM has now agreed with the other shareholders to purchase an additional 46% stake in Andre Pectin for a consideration of about €150 million. This will increase DSM’s total shareholding in the company to 75%. The total purchase price for this 75% holding represents an EV/EBITDA multiple of about 13x based on the 2019 expected EBITDA of the company, excluding synergies. The company sales are about €65 million with an EBITDA margin above 25%.
The remaining 25% of shares in Andre Pectin continues to be held by the Shandong Andre Group Co., Ltd, that supplies raw materials and utilities. DSM will closely work with the Andre Group to continuously improve the operational performance of the company, ensuring reliable supply through its global sales network of high-quality (natural) pectin, while ensuring compliance with DSM’s safety, health and sustainability standards in the company’s operations.

In view of the transaction, DSM will consolidate the activities of Andre Pectin in its group results. The transaction is expected to close in Q1/Q2 2019.
Andre Pectin is located in Yantai, Shandong Province in China. The company is Asia’s largest producer of apple and citrus pectin, hydrocolloids providing texture solutions for food, beverages, and personal care, with premier access to the world’s fastest-growing specialty food ingredients market. Andre Pectin employs about 410 employees. The company has strong organic sales and profit growth track record and generates attractive margins. It is a highly innovative company with a strong sustainability profile.
Together with DSM’s majority stakes in DSM Zhongken Biotechnology Co., Ltd. and DSM Rainbow (Inner Mongolia) Biotechnology Co. Ltd., DSM has a strong hydrocolloid product portfolio with gellum gum, xanthan gum, wellan gum, and pectin-based solutions, which DSM offers to the food, beverage, and personal care markets.
Hydrocolloids are thickeners and stabilizers that dissolve, disperse or swell in water to provide a broad range of important functionalities and physical attributes including gelling, texture, mouthfeel, viscosity and suspension. Demand for hydrocolloids is driven by three underlying consumer trends: the quest for convenient foods and beverages, consumers’ increasing demand for dairy and plant-based protein drinks and the trend towards clean labeling.


India Placed in Priority Watch List of USA

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The USA once again inserted India on its ‘Priority Watch List’, due to the absence of adequate quantifiable enhancements to its Intellectual Property (IP) structure on enduring and new difficulties, that has actually adversely impacted American right holders over the previous year.

The workplace of the US Trade Representative pinpointed 11 nations, consisting of India, in its ‘Priority Watch List’. The list headed by China likewise consists of Indonesia, Russia, Saudi Arabia and Venezuela. Apart from this, the United States Trade group has also positioned 25 nations, consisting of Pakistan, Turkey and the UAE, on the Priority Watch List.

  1. In its report, the United States stated that these nations shall be the topic of enhanced diplomatic interaction with the USTR to resolve Intellectual Property (IP) issues.
  2. In the foreseeable future, the USTR will be evaluating the advancements made versus the criteria developed in the Special 301 action strategies for nations that have figured on the ‘Priority Watch List’ for past several years.
  3. For nations that do not address the issues highlighted by the USTR, the USTR will take proper steps, including enforcement steps under Section 301 of the Trade Act or consequent to World Trade Organisation or other trade settlement conflict settlement methods, essential to fight unreasonable trade methods and to guarantee that trading nations implement their global obligations.

Why India Figures on the Priority Watch List?

  • India, in the previous year, has actually taken actions to resolve intellectual property obstacles and enhance its IP safeguards and enforcement.
  • Nevertheless, a lot of the steps have actually not yet converted into substantial advantages for innovators and developers and enduring shortcomings continue.
  • India stays among the world’s most significant economies with regard to safeguard and implementation of Intellectual Property safeguards.

Backdrop of the IP Regulations

In the pharmaceutical and agricultural chemical segments, India remains to lack a reliable solution for safeguarding against the unreasonable commercial usage, along with the unsanctioned declaration, of a concealed test or other information created to acquire marketing sanction for this type of items.

In spite of India’s reasons for restricting IP safeguards as a method to encourage access to innovations, the country preserves exceptionally high customs tariffs in relation to IP-intensive items, such as medical gadgets, prescription drugs, information communications innovation items, solar power devices and capital items.


Skinnytaste Meal Plan (January 14-January 20)

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posted January 12, 2019 by Gina

A free 7-day flexible weight loss meal plan including breakfast, lunch and dinner and a shopping list. All recipes include calories and Weight Watchers Freestyle™ SmartPoints®.

A free 7-day flexible weight loss meal plan including breakfast, lunch and dinner and a shopping list. All recipes include calories and Weight Watchers Freestyle™ SmartPoints®.

This week’s plan I am utilizing leftovers for an easy lunch. This Instant Pot Pork Carnitas makes enough for several meals. I serve them with tortillas but you can also serve them over brown rice or a big salad. I also wanted to share that I will be doing a cooking demo next Friday in Macy’s Chicago, you can find out more here.

If you’re new to my meal plans, I’ve been sharing these free, 7-day flexible healthy meal plans (you can see my previous meal plans here) that are meant as a guide, with plenty of wiggle room for you to add more food, coffee, beverages, fruits, snacks, dessert, wine, etc or swap recipes out for meals you prefer, you can search for recipes by course in the index. You should aim for around 1500 calories* per day.

There’s also a precise, organized grocery list that will make grocery shopping so much easier and much less stressful. Save you money and time. You’ll dine out less often, waste less food and you’ll have everything you need on hand to help keep you on track.

Lastly, if you’re on Facebook join my Skinnytaste Facebook Community where everyone’s sharing photos of recipes they are making, you can join here. I’m loving all the ideas everyone’s sharing!

Also, if you don’t have the Skinnytaste Meal Planner, now would be a great time to get one to get organized for 2019! There was a print error last year, but it’s perfect now! You can order it here!


Breakfast and lunch Monday-Friday, are designed to serve 1 while dinners and all meals on Saturday and Sunday are designed to serve a family of 4. Some recipes make enough leftovers for two nights or lunch the next day. While we truly believe there is no one size fits all meal plan, we did our best to come up with something that appeals to a wide range of individuals. Everything is Weight Watchers friendly, I included the updated Weight Watcher Freestyle Points for your convenience, feel free to swap out any recipes you wish or just use this for inspiration!

The grocery list is comprehensive and includes everything you need to make all meals on the plan. I’ve even included brand recommendations of products I love and use often. Cross check your cabinets because many condiments you’ll notice I use often, so you may already have a lot of them.

And last, but certainly not least, this meal plan is flexible and realistic. There’s plenty of wiggle room for cocktails, healthy snacks, dessert and dinner out. And if necessary, you can move some things around to make it work with your schedule. Please let me know if you’re using these plans, this will help me decide if I should continue sharing them!

MONDAY (1/14)
B: Overnight Oats in a Jar (5)
L: Chickpea Tuna Salad (0)
D: Veggie Lasagna Zucchini Boats (7)

Totals: Freestyle™ SP SP 12, Calories 816*

TUESDAY (1/15)
B: 4-Ingredient Flourless Banana-Nut Pancakes (4)
L: Chickpea Tuna Salad (0)
D: Instant Pot Pork Carnitas** (3) with 2 corn tortillas (3), 2 ounces avocado (3) and Quick and Delicioso Cuban Style Black Beans (1)
Totals: Freestyle™ SP 14, Calories 1,071* 

B: Open-Faced Omelet with Avocado and Pico de Gallo (1)
L: LEFTOVER Instant Pot Pork Carnitas (3) with 2 corn tortillas (3) and 2 ounces avocado (3)
D: One Skillet Chicken with Bacon and Green Beans (2) and ¾ cup brown rice (5)
Totals: Freestyle™  SP 17, Calories 881*

B: 4-Ingredient Flourless Banana-Nut Pancakes (4)
L: LEFTOVER Instant Pot Pork Carnitas (3) over 2 cups shredded romaine (0) and 2 ounces avocado (3)
D: Chunky Beef, Cabbage and Tomato Soup** (3) with 2 ounces multigrain baguette (3)
Totals: Freestyle™ SP 16, Calories 895*

FRIDAY (1/18)
B: Open-Faced Omelet with Avocado and Pico de Gallo (1)
L: LEFTOVER Chunky Beef, Cabbage and Tomato Soup (3) with an apple (0)
D: Shrimp Cakes (5) with Creamy Cauliflower Puree (1) and Roasted Broccoli with Smashed Garlic (2)
Totals: Freestyle™ SP 12, Calories 867*

B: Instant Pot Steel Cut Oats (5)
L: 3-Bean Turkey Chili (0) with 2 tablespoons shredded cheddar (2) and 1 tablespoon light sour cream (1)
Totals:  Freestyle™ SP 8, Calories 543*

SUNDAY (1/20)
B: LEFTOVER Instant Pot Steel Cut Oats (5)
L: LEFTOVER 3-Bean Turkey Chili (0) with 2 tbsps shredded cheddar (2) and 1 tbsp light sour cream (1)
D: Instant Pot Chicken Parmesan (4) with 1 cup sautéed zoodles (0)
Totals:  Freestyle™ SP 12, Calories 811*

*This is just a guide, women should aim for around 1500 calories per day. Here’s a helpful calculator to estimate your calorie needs. I’ve left plenty of wiggle room for you to add more food such as coffee, beverages, fruits, snacks, dessert, wine, etc.

*Freeze any leftover you/your family won’t eat

Skinnytaste Meal Plan (January 14-January 20)

**google doc

Shopping List:


  • 1 medium head cauliflower
  • ½ pound French green beans
  • 1 small bunch baby spinach
  • 6 medium (about 10 ounces each) zucchini
  • 2 large heads garlic
  • 1 ½ pounds broccoli florets
  • 1 medium apple (any variety)
  • 1 small and 6 medium ripe bananas
  • 1 small shallot
  • 1 small bunch/container fresh basil
  • 1 small bunch cilantro
  • 1 large red bell pepper
  • 1 medium red onion
  • 1 small (4-ounce) and 2 medium (5-ounce) Hass avocado
  • 1 small bunch scallions
  • 1 small bunch celery
  • 1 large carrot
  • 1 small bunch/container fresh thyme (can sub ½ teaspoon dry thyme or oregano in One Skillet Chicken, if desired)
  • 1 small bunch fresh Italian parsley (can sub 2 tablespoons scallion greens in Shrimp Cakes, if desired)
  • 1 small head Romaine lettuce
  • 2 dry pints fresh blueberries (can sub 14 ounces frozen, if desired)
  • 1 small and 1 large lemon
  • 1 small and 1 large yellow onion
  • 1 container fresh Pico de Gallo*
  • 1 medium head green cabbage (or 5 cups pre-shredded)

Meat, Poultry and Fish

  • 2 ½ pounds trimmed, boneless pork shoulder blade roast
  • 1 package center-cut bacon
  • 1 pound boneless, skinless chicken breasts
  • 1 pound 90% lean ground beef
  • 1 pound peeled and deveined jumbo shrimp
  • 1 1/3 pounds 99% lean ground turkey breast
  • ¾ pound (4) thin chicken cutlets


  • 1 small container quick oats
  • 1 small container steel cut oats
  • 1 package whole wheat panko breadcrumbs
  • 1 (10-count) package corn tortillas
  • 1 small bag dry brown rice (or 3 cups pre-cooked)
  • 1 (8 ounce) multigrain baguette

Condiments and Spices

  • Extra virgin olive oil
  • Cooking spray
  • Olive oil spray (or get a Misto oil mister)
  • Kosher salt (I like Diamond Crystal)
  • Pepper grinder (or fresh peppercorns)
  • NuNaturals liquid vanilla stevia (or your favorite sweetener)
  • Ground cinnamon
  • Cinnamon sticks
  • Red wine vinegar
  • Cumin
  • Sazon
  • Oregano
  • Adobo (I use Goya)
  • Garlic powder
  • Bay leaves
  • Old Bay seasoning
  • Maple syrup
  • Chili powder
  • Light mayonnaise
  • Dijon mustard
  • Hot sauce (optional, for Shrimp Cakes)

Dairy & Misc. Refrigerated Items

  • 1 dozen large eggs
  • 1 small tub whipped butter
  • 1 pint skim milk (can sub unsweetened soy or nut)
  • 1 (15-ounce) container part skim ricotta cheese
  • 1 (8-ounce) bag part skim shredded mozzarella (I like Polly-O)
  • 1 large wedge fresh parmesan cheese
  • 1 pint 1 % buttermilk
  • 1 (8-ounce) bag shredded cheddar cheese
  • 1 (8-ounce) container light sour cream
  • 4-ounces fresh mozzarella cheese (can sub part-skim in Chicken Parmesan, if desired)

Canned and Jarred

  • 2 (15-ounce) cans chickpeas
  • 1 (6-ounce) can albacore tuna (I like American Tuna)
  • 1 small jar capers
  • 1 small jar/can chipotle peppers in adobo
  • 2 (15-ounce) cans black beans (I prefer Goya)
  • 1 (28-ounce) can diced tomatoes (I like Tuttorosso)
  • 1 (15-ounce) can and 1 (28-ounce) can crushed tomatoes (I like Tuttorosso)
  • 1 (16-ounce) can tomato sauce
  • 1 (4.5-ounce) can chopped chilies
  • 1 (15.5-ounce) can small red beans
  • 1 jar marinara (I like Delallo Pomodoro)
  • 1 (32-ounce) carton beef stock
  • 1 (15-ounce) can low or reduced sodium chicken broth

Misc. Dry Goods

  • Chia seeds (you need ½ tablespoon)
  • 1 small bag chopped pecans
  • 1 bottle crisp white wine, such as Sauvignon Blanc

*You can make your own with 1 cup chopped tomatoes, 1/3 cup chopped onion, ¼ cup chopped cilantro, juice from ½ a lime.

**You can sub gluten-free, if desired