Mark Sisson's Blog, page 165

The 10-Week Countdown to 2018

Today’s guest post is offered up by one of our own, Erin Power. She’s our awesome Student and Graduate Support Lead for the Primal Health Coach Program as well as an amazingly successful health coach in her own right. I love her message of taking the reins of your life today—all the better to enjoy the holidays and meet the coming New Year with unprecedented health and possibility. 

Right around this time every year my inbox explodes. People are already dreading their impending, inevitable holiday weight gain and are wondering if they can somehow get ahead of the curve—make a preemptive strike, if you will. And that’s how it happens…one of the busiest times for my health coaching business, believe it or not, is the weeks leading up to and including the holidays.

“If I sign up with you now,” people often ask, “can you please help me make it through Christmas without packing on 15 pounds—again??”

I’ve got good news. Not only can you make big, bold change in your health and happiness right up to and during the holiday feasting season, but doing so is an incredibly fun experiment with a rewarding outcome.

This is the ultimate n=1 experiment because the lore of “insidious holiday weight gain” is so ingrained in our culture that—at its worst, it becomes a self-fulfilling prophecy. At its best, however, maybe it can become a benchmark against which you can test yourself. Can you buck the trend and finish the holiday season leaner, lighter, healthier, happier, and better than you were before you started?

Upending (Unhealthy) Holiday Tradition

Imagine cruising through the holiday season enjoying your favourite indulgences sensibly, while having absolute control over your hunger, cravings, and willpower, such that an indulgence simply becomes what it was always meant to be: a treat to be savoured and celebrated by all of the senses—not a mindless binge.

Likewise, a slip becomes a moment in time, not a catastrophic setback that needs to be atoned for by attempting to make (and not break!) a host of New Year’s resolutions.

I’m not talking about avoiding your favourite foods. I’m talking about changing the expression of your hunger, such that those treats call to you more quietly. Your enjoyment of them becomes more authentic. Mindful, even.

This mindfulness is one of the most elegant subjective markers of what Mark refers to as metabolic flexibility. Once your body knows how to extract and use a variety of fuels—from the food you eat, and/or from storage repositories in and on your body—the entire experience of hunger and cravings changes.

A rather perturbed client said to me once (after I’d “taken away” all of the cookies, chips, and crackers she had a habit of snacking on in the evenings): “Now what am I supposed to reach for when I come home after an impossibly long day at work/carting the kids around to sports/getting my workout in/doing all the household chores/walking the dog, and I’m rifling through the cupboards ravenously looking for some crackers to tide me over until dinner?!”

My answer: That entire scenario goes away. Your hunger doesn’t present like that anymore. You gain control.

When you’re riding the rollercoaster of “dieting-cheating-failing-self-condemnation-dieting again” it’s incredibly hard to imagine that your sensation of hunger could change like this, that you could have no desire for cookies, chips, and crackers. But I’ve personally witnessed it in my clients time and again—liberation from food fixation.

Just think…if you begin the process of metabolic repair now, you could be this calm, cool, and collected even when Grandma shows up with her world-famous shortbread.

You Have 10 Weeks—Take Action Now

I roll in a lot of nutritionist, dietician, and health coach crowds, and we’re all selling the same thing: “New Year, New You! Beat holiday weight gain! Sign up with me today!”

As a Primal Health Coach, the way I approach this is by tapping into the biochemistry of human fueling, which is beautiful and simple in its relative black-and-whiteness. The body can get fuel from a few different sources. It can use these different fuels in a few different ways. And when the body is fuelled, hunger quite simply changes.

The trick is building the metabolic machinery to help train your body to achieve this flexibility. No weighing, measuring, diarizing, chronicling; no “earnin’ and burnin”—just simply building an understanding of how to get your metabolic machinery functioning in top form again. Trust me when I tell you that it changes the game.

2018 Could Look a Lot Different For You

New Year’s is often fraught with a mix of regret and urgency. How about meeting 2018 from a different angle? When January 1 rolls around, you could feel better about yourself than you ever have before.

Instead of going up a belt notch to accommodate your holiday bloat, you could be down a notch or two or more.

Rather than feeling like an abject failure for exhibiting no control over your cravings, you’ve successfully enjoyed the sensory pleasures of the season while being in control the entire time.

You could have more energy than you know what to do with, having trained your body to utilize a variety of readily available fuel sources.

You can join the gym alongside everyone else if you want to, but you won’t feel like you have to. (In fact, you can wait till March when the prices drop!)

Imagine feeling more connected to your body—to your appetite!—than you ever have before. You’ll know what true hunger feels like. You’ll know how to answer that hunger with satisfying and nutrient-dense foods. You’ll connect back to the long-forgotten feeling of satiety, which, by the way, is different than feeling “full.” There’s no need to unbutton your pants when you’ve eaten to pleasant satiety!

The concept of “willpower” (with its suggestion of struggle) could all but vanish for you. You’ll find yourself calmly in control. You can make a choice to eat one or two of Grandma’s world-famous shortbread cookies, and then stop. Or you can choose to forgo them without obsessive restraint.

Once you’ve adapted to new food habits that support your optimal human experience, you may find yourself continuing to get better year over year. As one of my clients succinctly put it after just 6 weeks on my health coaching program, “I love living like this. I can eat this way forever.”

It Works If You Do—But That Doesn’t Mean You Need to Go It Alone

If you’ve been reading Mark’s Daily Apple for any length of time, you’ll know Mark pulls no punches when he suggests that the act of making these changes is a paradigm shift in body and mind. Not only are you rewiring your body’s metabolic response to some degree, but you’re creating totally new behaviours around food. What you eat. When you eat. WHY you eat.

A Primal Health Coach is trained to educate you on the What and When. The Why becomes a team effort. Your health coach is there to help nurture you along the winding path to behaviour modification, helping you navigate and cultivate resilience through the choppy waters of big change.

If you could have done it alone, perhaps you would have by now.

Accountability is a funny thing. Clients will tell me that they’ve hired me to hold them accountable; however, accountability ultimately comes from within. A great health coach knows how to tease that out of you, so you can feel pride of ownership over your own health.

Eventually, if all goes according to plan, the concept of accountability vanishes. Once your “new” way of eating has become deeply-ingrained habit, you won’t have to hold yourself accountable to anyone. You’ll just live. You’ll just eat. You’ll just move.

Food decisions can casually move out of the intellectual nitpicking back into the automatic realm with all of the other survival mechanisms, like breathing. Your relationship with food changes, once and for all.

If I could give one gift to everyone on my holiday wish list this year it would be the gift of learning how to eat to support metabolic flexibility. There are almost no words to effectively capture the liberation and effortlessness that you can achieve in your relationship with food and your body. You have to live it to believe it.

And if you start now, you could be living it by 2018—and beyond.

What Will You Do with These Next 10 Weeks? 

And what will help you get there?

Are you ready to learn the life-changing lessons of becoming metabolically flexible? Pick up The New Primal Blueprint and/or The Keto Reset Diet (if you haven’t already!).

Are you ready to do it differently this time and invest in personal, Primal-minded support for your health vision? Check out our “Find a Primal Health Coach” directory.

Wishing everyone an awesome holiday season and good health as we move toward a new year—and new possibilities.

Erin Power, CHNC, PHC

Thanks to Erin for a great kick-it-into-gear message this morning. I know I’m feeling inspired! Tell me, who’s got a goal for the next ten weeks? I’d love to hear it, and I know others would love to offer their encouragement. Thanks everyone, and have a great end to your week. 

The post The 10-Week Countdown to 2018 appeared first on Mark's Daily Apple.

How Does the Keto Reset Fit Into the Primal Blueprint?

Today I’m going to address a big question some of you have been asking in the comment boards and via email:

Where does the Primal Blueprint eating plan fit into the Keto Reset diet?

It’s a good question. An expected one. It’s true that I’ve been focusing almost entirely on the Keto Reset in 2017. I’m passionate about it. I truly believe it can help almost everyone, and I want to get the word out to as many people as possible.

When I started out on this keto journey, I wasn’t sure where it would take me. I was completely content with my own diet and the results it gave me. I had energy, good athletic performance and recovery, and good cognitive function. The food was great. I loved to eat and never felt restricted.

Going keto was an experiment to see:

If I was missing anything.
If I could improve the nutrient density of my diet.
If reducing carb intake further could deliver some metabolic or genetic-signaling benefits.
Most importantly, if keto could be an effective option for my readers.

I wasn’t trying to replace the Primal Blueprint. And yeah, it worked out very well, but it still doesn’t replace the Primal Blueprint.

What I realized—from personal experience, reading clinical research, and talking to keto experts—is this: the most powerful effect of ketogenic dieting is that it supercharges your fat-burning ability. Not ketone-burning (although it definitely does that), but fat-burning.

See, one of the most common misconceptions is that ketogenic eating is all about getting into ketosis.

Actually, the most worthy goal of ketogenic eating is to enhance your fat burning abilities. Keto-adaptation begets fat-adaptation. Once you switch over to a  ketogenic diet and your body realizes that glucose is no longer an unlimited resource, it’ll learn to burn the hell out of free fatty acids. But before it can build new fat-burning mitochondria and retrofit the existing ones to take advantage of all the free fatty acids you have at your disposal, your body will rely on ketones for its energy.

Building up that fat-burning machinery takes time. Initially, burning ketones is a stop-gap for your glucose-deprived muscles. And because your brain can’t burn free fatty acids directly, it will gradually transition over to obtaining more of its energy from ketones over the long haul. While a carb dependent brain burns 100 percent glucose, a highly keto-adapted brain can get around 2/3 of its estimated 150 grams of daily energy expenditure from ketones, and the remainder from glucose. Even this paltry 50 grams of absolute necessity glucose doesn’t necessarily have to come from dietary carbohydrate; it can be obtained as a by-product of fat metabolism or from gluconeogenesis (the conversion of protein to glucose).

What this all means is that keto doesn’t replace the Primal Blueprint way of eating. It augments it. It enables it to work even better. Once you build those fat-burning mitochondria and train your old ones to burn fat more effectively, those changes don’t just disappear overnight. You can go back to regular eating and retain those benefits.

In fact, I think most people shouldn’t stay keto for life. There’s no good reason for the majority of people to forever abstain from Okinawa sweet potato and never again eat more than a single slice of a summer nectarine. Food is too good, and too good for you.

However, it’s quite apparent that most people would benefit from going keto some of the time. And that’s where the Keto Reset fits snugly into the realm of the Primal Blueprint way of eating. By increasing metabolic flexibility, building new fat-burning mitochondria (and training existing ones to get better at it), and getting off the sugar-burning roller coaster, keto is a supplement to the standard Primal way of eating. Like nutritional supplements, the Keto Reset doesn’t replace Primal. It fills in a hole. It increases the effectiveness of Primal-style eating. It makes sticking to a Primal/paleo/low-carb eating style easier and more productive.

If I had to make a blanket recommendation, I’d suggest anyone interested in long-term ketogenic dieting spend most of their time in the “keto zone.” That’s where your diet is fluid. You’re regularly slipping in and out of ketosis. You’re a bit higher carb one day to help with an intense training session and go right back to lower carb the next. And throughout it all, because you’ve put in the work necessary to build up that fat-burning machinery, you’re always great at burning fat and you retain your ability to burn glucose/glycogen when needed.

That’s where I am these days—the keto zone. From the outside, it’s actually not that far off from how I ate before the keto reset. Same basic foods promoted and eliminated. Similar macronutrient ratios. But with my newfound metabolic flexibility and the improvements in mitochondrial function, it feels different. I eat a little less. I’m a little more efficient with my calories. And I’m not getting any of the negative effects usually seen in diehard adherents to calorie restriction. I’m still killing it in the gym, on the board, and on the Ultimate field. I’m sleeping great. My cortisol levels are in a good place because my body isn’t perceiving this way of eating as a stressor. I’m productive and busier than ever.

Honestly, my increased metabolic flexibility really does seem to give me more flexibility; I can fast for 24-hours traveling to Greece, get there and indulge in much higher carb consumption than my baseline with fewer ill effects than with past carb binges, and generally allow for much more intuitive eating instead of regimented eating.

The integration of keto into your dietary arsenal goes to show the special power of the Primal Blueprint—as a jumping off point for interesting nutritional experiments, and as a safe and reliable home to which we can return after extensive forays into the wild around us. It is, after all, the foundation of eating our species rests upon.

Thanks for reading, everyone. I’d love to hear how you have (or haven’t) integrated keto into your Primal way of eating.

The post How Does the Keto Reset Fit Into the Primal Blueprint? appeared first on Mark's Daily Apple.

A Call to Endurance Athletes and Being Coached By Your 80-Year-Old Self

Competitive endurance athletes: It’s time for reflection and formulating a winning 2018 plan….

For endurance athletes, the colder and darker days of fall coincide with the winding down of the race calendar. Whether lofty goals were achieved or struggles predominated over victories, there is always a big sigh of relief for a break from the grind of training and the pressure of competition. There is also a sense of satisfaction that regardless of whether arbitrary goals were attained, at least you put yourself out there on the start line and gave it your best. The off season is also a time for reflection and recalibration. A competitive athlete is always looking for ways to learn from experience and improve.

The Primal Endurance Online Mastery Course is our effort to provide you with all the tools you need to implement a winning training and lifestyle strategy for the 2018 season and beyond. The Primal Endurance approach will help you avoid the incredibly common and disastrous mistakes that most endurance athletes make again and again. I’m talking about chronic exercise/overstress patterns leading to breakdown, stagnant performances and burnout. Instead, I want you to envision a refreshing new approach where you protect your health even in pursuit of ambitious fitness goals and you experience uninterrupted improvement instead of hit and miss performances.

The details and tons of freebie content to help you make an informed decision are housed at primalendurance.fit.

I also think you might enjoy this insightful video from Olympic triathlon gold and silver medalist Simon Whitfield—an excerpt from much more content in the Mastery course—where he offers the unforgettable advice to be “coached by your 80-year-old self.”

Simon reached the very top in his career, but he also struggled and had to reflect and recalibrate often. I encourage you to do the same: don’t accept the flawed conventional wisdom that struggling and suffering is a necessary component of your athletic experience. Strive to get smarter, learn from the experts, but always let your intution be your main guiding force.

The off season is a good time for self-reflection, obtain further education from experts, and formulate a precise plan of action to execute in the future. Hopefully, the Primal Endurance Mastery Course can help—as can engaging with fellow Primal enthusiasts on the Primal Endurance Facebook Group. Email info@primalendurance.fit if you have any questions.

Thanks for your interest, everybody. In the meantime, I’d love to know what you think of Simon’s perspective as well as any questions about training or fitness you’d like me to take up in future posts.

Have a great week!

The post A Call to Endurance Athletes and Being Coached By Your 80-Year-Old Self appeared first on Mark's Daily Apple.

Dear Mark: Gum on Keto, Acacia Fiber, Cramping, and Keto Body Odor

For today’s edition of Dear Mark, I’m answering four questions. First, is sugar-free gum okay to chew without worrying about insulin spikes? Next, is acacia fiber a good choice for a keto person trying to get more fiber and reduce constipation? Third, what can a person who has tried seemingly everything do for nighttime muscle cramps? And finally, why might a person’s body odor get worse on keto?

Let’s go:

Hi I hope this is not a dumb question but Will chewing sugar free gum cause an insulin spike? I’m currently going keto (loving the new book by the way!!) I work in close contact with the public and am always aware of breath freshness so I chew a lot of gum and just worried that it may be defeating my good intentions

You should be fine depending on the type of sweetener.

Most sugar-free gums use xylitol and/or erythritol, neither of which have any significant effect on insulin release. There’s certainly no spike.

Sometimes you’ll find other, artificial sweeteners on the label. Although the effects of these on insulin responses are mixed or inconclusive, there are other reasons to steer clear of them.

I’d suggest checking your labels and opting for varieties that are sweetened solely with sugar alcohols. And there are no dumb questions!

Carla wondered:

What are your thoughts about acacia fiber? I have chronic constipation and that has helped me in the past

Acacia fiber is great. Tremendous source of fiber, and not many people know this, but it’s a prebiotic fiber. So you get the bowel movements that are just out of this world and your gut bacteria will be very, very, very happy. The gut motility it promotes, let’s just say your gut has never been more motile.

I know a guy—great guy, did a little business with him back in the 90s—who beat a week-long case of keto constipation using acacia fiber.

Add it to yogurt and that yogurt is better at treating IBS than regular yogurt.

In diabetic mice, acacia fiber improves kidney function.

Donna asked:

I have been experiencing pretty severe leg cramps while sleeping. I take a magnesium supplement. I’ve been drinking Natural Calm at night. I eat avacodos almost daily. I drink plenty of water. The cramps are all through the night very disturbing. I’ve been on the keto diet for 6 weeks. Any suggestions what else I could do?

First, you’ve got most of the relevant electrolytes handled. I’d make sure you’re eating enough salt, too—add salt to taste whenever you cook or eat, drink salty broth or bullion.

You’re doing the water.

You’re doing the magnesium.

And nothing’s working. The cramps keep coming. Is that right?

I’m actually not very surprised that you’re still having cramps. Contrary to popular belief, studies find that neither electrolyte status nor hydration status predict your propensity to cramps. And the evidence for magnesium’s effect on cramping is mixed. Can’t hurt to take it. Just don’t count on it for the cramps.

What does work?

Sour, pungent, spicy flavors.

For example, pickle juice works against cramps, and not by restoring hydration or electrolytes. It actually reduces active cramps faster than you absorb the water and electrolytes by triggering a set of activators in the brain known as TRP ion channel activators, which influence skeletal muscle contractions.

Other TRP ion channel activators are found in cayenne pepper, ginger, and cinnamon, and researchers have created a blend of extracts from all three plants called Hot Shot that shows efficacy against muscle cramps. 

Finally, Charlotte Root asked:

Hey Mark, I’m wondering if you can speak to the body odor side effect that many of us have been talking about: experiencing increased body odor in ketosis, especially underarm (people talk about breath but that’s not my primary concern atm). Is there an imbalance that you know of that causes this? On fbook groups people point to detoxing from previously poisonous foods, but I’ve been strict paleo/primal for 6 years, so not sure that’s what it is for me.

The literature on diet and body odor is pretty thin.

In 2006, Czech researchers placed men on either a diet containing red meat or one without red meat, then had them sweat. Women smelled and rated the sweat. Across the board, the red meat dieters produced less attractive body odor. When they had everyone switch to the other diet, the results persisted: Those who had switched to a no-red meat diet produced better-smelling sweat.

It sounds damning, but before you stop eating beef and lamb, check out the details. The non-red meat diet differed from the red meat diet in many ways. The non-red meat dieters weren’t just avoiding red meat; they also ate way more fruits, vegetables, eggs, cheese, and soy than the meat eaters. The researchers failed to control all other aspects of the diet, instead focusing only on the meat.

I’ve said many times before that keto dieters tend to eat less produce, either because they don’t like it and see keto as a free pass for near-carnivory, they worry about the carbs in produce throwing them out of ketosis, or they somehow think plants are restricted on keto. These are mistakes. Common ones. You can eat plenty of produce on keto. You should eat plenty of produce on keto. Mushrooms of all kinds. Leafy greens. Cruciferous veggies like broccoli, cauliflower, bok choy. Low-carb fruits like berries. Anything fibrous.

A more recent study seems to confirm my suspicions. Both produce and meat, cheese, and egg consumption predicted better-smelling body odor. You know what predicted worse body odor? High carbohydrate intakes.

I haven’t seen any legit reasons why a keto diet in particular would increase body odor. Try eating more plants and reassess in a week.

That’s it for this week, folks. Thanks for reading, and be sure to add your own comments down below!

The post Dear Mark: Gum on Keto, Acacia Fiber, Cramping, and Keto Body Odor appeared first on Mark's Daily Apple.

Weekend Link Love — Edition 474

Research of the Week

Men who receive blood donations from ever-pregnant women (women who have been pregnant at least once, not women who are perpetually with child) are at a higher risk of dying.

“Human faeces contain appreciable quantities of vitamin B12 or vitamin B12-like material presumably produced by bacteria in the colon, but this is unavailable to the non-coprophagic individual.”

Cannabis users are more creative than non-users (though the cannabis probably isn’t a causal factor).

Stress and junk food have similar effects on (mouse) gut bacteria.

Healthy oldsters maintain the gut biomes of 30-year-olds.

New Primal Blueprint Podcasts

Episode 191: Dr. Steven Gundry: Host Elle Russ chats with Dr. Steven Gundry, an accomplished surgeon whose current mission is to help patients avoid the operating table.

Each week, select Mark’s Daily Apple blog posts are prepared as Primal Blueprint Podcasts. Need to catch up on reading, but don’t have the time? Prefer to listen to articles while on the go? Check out the new blog post podcasts below, and subscribe to the Primal Blueprint Podcast here so you never miss an episode.

Gender Bias in Medical Research: How it Operates and Why it Matters
The Lowdown on Keto Side Effects: What’s Real, What’s Not, and What’s Helpful

Interesting Blog Posts

The death of lipid research.

It turns out that Americans have been following dietary guidelines.

Media, Schmedia

How the Middle East is showing male infertility to be a medical problem, not a masculinity problem.

Obesity among American adults is at an all-time high. C’mon, people.

Colorado teens are too heavy to make the military.

Everything Else

At least this squirrel won’t be depressed for the foreseeable future.

Stonehengers loved their honey-fed pork and cheese.

Richard Dawkins explores the evolutionary purpose of religion.

Easy on the raw kale.

Inconvenient facts about animal agriculture.

Why cryonics might make sense.

Where the olive trees grow.

Farming: inevitable and miserable.

An anarchist wants people to make their own meds.

Things I’m Up to and Interested In

Event I think you’ll love: Chris Kresser is hosting a Rally to End Chronic Disease event and book launch party to support his upcoming title, Unconventional Medicine, in Berkeley, CA on November 6.

Primal Kitchen® is partnering for a Beauty Bundle Giveaway. You have until Sunday (October 22nd) to enter and win Primal Kitchen products, two cartons of Pique Tea, two jars and one stick of PiperWai’s All Natural Deodorant, and a corchicle to keep your iced tea cold and frosty!

Fossil find that surprised me: The one that could rewrite human history.

I would do this workout and be fairly content for life, if pressed: The minimalist’s strength workout.

My thoughts exactly: The hell is he doing?

I’m excited to announce: Collagen Fuel is back in stock!

Recipe Corner

For a carb refeed, try these “PB&J” energy balls.
You’ll want to put this steak tips hash all the way into your mouth.

Time Capsule

One year ago (Oct 22– Oct 28)

16 Ways to Increase Neuroplasticity (and Why That’s Important) – Don’t worry, it’s BPA-free.
Should You Eat Less Protein? – What are the arguments for reducing your protein intake?

Comment of the Week

“Could it be possible we will be offering up to the world a generation of metabolically ‘near-perfect’ humans?”

– Actually, Ontario, I’m planning to raise an army of optimized humans with perfect metabolic flexibility. The whole keto thing is meant to make them so efficient at burning body fat that I barely have to feed them or maintain a supply chain when they’re on campaign.

The post Weekend Link Love — Edition 474 appeared first on Mark's Daily Apple.

Primal/Paleo Brownies

Serious chocolate lovers, this one’s for your. Dark chocolate + cacao powder deliver an intense dark chocolate flavor that puts these brownies over the top. Sweetened with dates and made with just a half cup of almond flour, these aren’t chewy, overly sweet brownies. Rather, they have pure bittersweet chocolate flavor and smooth truffle-like richness, thanks to butter and eggs.

Choosing chocolate that has at least 70% cacao (but ideally, closer to the 85% range) for this recipe means you’ll enjoy brownies that are rich with antioxidants. Combining the melted dark chocolate with cacao powder boosts the antioxidant level even higher. So, relish every bite of these divine morsels. Primal brownies are so chocolately and so rich, even the most fanatical chocolate lover will be satisfied by a small square.

Servings: 16 brownies

Time in the Kitchen: 25 minutes, plus 20 minutes to bake

Ingredients

½ cup unsalted butter (120 g)
6 ounces dark chocolate, coarsely chopped (170 g)
1 teaspoon vanilla extract (5 ml)
10 pitted dates (86 g)
2 eggs
½ cup finely ground almond flour (45 g)
2 tablespoons cacao powder (12 g)
¼ teaspoon salt, plus sea salt to sprinkle on top (1.2 ml)

Instructions

Preheat oven to 350º F/177º C.

Line the bottom of an 8×8 square baking pan with parchment paper.

Grease the parchment paper with butter.

In a small saucepan over very low heat, begin to melt the butter. When the butter is halfway melted, add the chocolate, stirring until melted and smooth. Turn off the heat right when the chocolate is melted, so it doesn’t burn. Stir in vanilla. Set aside to cool.

Cover dates with hot water and let soak 3 to 5 minutes. Drain water from dates. Blend the dates a food processor to chop up into small pieces. Stop and scrape down the sides once or twice.

In a small bowl, whisk together almond flour, cacao powder and salt so there are no lumps. Add to the food processor and blend with the dates for about one minute. During this time, a smooth paste will form, and then the paste will into a ball of smooth dough.

Use a spatula to push the ball of dough down flat, and spread it evenly around the bottom of the food processor bowl.

Add butter and chocolate mixture. Blend until very smooth.

Add eggs, pulsing to combine.

Use a spatula to scrape the batter into the prepared 8×8 pan. Sprinkle a little bit of sea salt on top.

Bake 20 minutes.

Cool completely before removing from pan.

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Being Keto-Adapted Is One Helluva Ride!

It’s Friday, everyone! And that means another Primal Blueprint Real Life Story from a Mark’s Daily Apple reader. If you have your own success story and would like to share it with me and the Mark’s Daily Apple community please contact me here. I’ll continue to publish these each Friday as long as they keep coming in. Thank you for reading!

My name is Aaron. I’m 35-years-old. I live in the Lehigh Valley of PA where I am the only custom tailor. This is my story of how an innocent foray in LCHF (low carb, high fat) turned into a full blown keto lifestyle shift. What a journey it’s been and I’m only just getting started!

Ok, so let’s get the junk out of the way first. Last summer, I was freshly divorced. I had to move into a shoebox sized apartment where I fed myself a steady diet of ramen noodles, Captain Crunch, heavy imperial stouts, and copious amounts of sour candy….usually fueled by alcohol driven hunger and a new little appetite tweaker I discovered…cannabis and the munchies. It only took a few months of this type of living for me to feel incredibly sick.

When I wasn’t smoking, I was incredibly nauseous and couldn’t eat. So, I used cannabis to give myself the munchies so I didn’t feel like I was going to die. I found myself in a cycle that I didn’t like. I liked the weed, but I didn’t like the munchies. Was it the munchies or the bad food that was the problem? One night it just hit me….I hit the blunt and then thought to myself, “whoa, like maybe I should fix my diet.”

Brilliant revelation, right??

Rewind a few years back to when I was 25. I was in fairly decent shape and pretty lean. I worked out heavily and had the results to show for it. I won’t blame marriage for getting me fat, but I did indeed get fat once I got married. Steady typical SAD diet for the entire duration.

So, near the end of 2016 everyone is thinking about New Year’s resolutions to lose weight. I’m busy drinking, chasing women, and getting stoned—eating a ton of sugar and was nowhere near making that kind of resolution. I just didn’t believe I’d ever be that in-shape again. I tried working out again but it was unbearable. Geez, to even walk a few blocks on a 40 degree day made me sweat profusely so how the hell was I gonna be able to work out in a gym?! Do I just give up the booze for awhile? How about the weed? What about sugar? Admittedly, I was lost and a little hopeless but man did I love the taste of whipped cream in cappuccinos.

That got me thinking….

I had heard somewhere about adding fat to your diet and removing carbs, but from my earlier gym days, I just couldn’t make the connection. I was stuck rooted in the old, using exercise to lose weight and create a calories burned vs calories consumed thinking. Even though I never could piece together how that exactly worked, I was willing to give adding fats and cutting carbs a shot…

Enter my first foray into making bulletproof cappuccinos around mid February this year…

Delicious as ever. Never would’ve thought butter, coconut oil and stevia would taste so good in coffee. I was enjoying waking up every morning to one of these, but what surprised me was the longer period of time I could go before having to eat. I also noticed a few pounds gently slipping away and got curious…what if I add more butter to everything else? Started doing exactly that.

So, late February 2016 I was doing BP coffee every morning and butter loaded tomato soup (and crappy Campbells too!). My appetite went away, and I just let it. Little did I know that I was basically doing an intermittent fat fast. I was getting to a point where I was adding up to 6 tbsp of butter and oil plus frothed heavy cream AND egg yolks in the cappuccino but really had no idea if it was actually healthy or not, so I Googled “effects of eating too much butter” and landed on a forum post at, you guessed it, MDA.

I saw a 60-something ripped dude named Mark on the front page, plus a success story of an even older guy who was also ripped. The competitor in me thought, “Hey if these old dudes are ripped off whatever this diet is, then wtf is my excuse?!” So I read and read and read until I had the start of the puzzle completed in my mind. I knew I had to act.

Upon realizing that this was a whole foods diet, I knew I’d need to learn how to cook. What a mountain of learning that was. I went crazy. Purged my cupboards of all sugar, grains, and bad oils. Stopped eating out almost immediately and started cooking. Wow, to eat whole foods even fruits and not get violently sick to my stomach? Oh what a feeling.

By the end of March 2016, I had dropped nearly 45 lbs. My girlfriend left for a 2 week trip to Mexico in early March. She had noticed the weight loss but we had no idea what was actually happening. When she left early March, I was wearing 38s. When she got back I was in 34s.

I thought I was done there and, quite frankly, if that’s where my weight loss journey had stopped, I would’ve been quite content and proud of myself. Everyone around me was complimenting me and some even expressing concern that I was getting too thin too fast. I thought there was no such thing and I could still see good amounts of fat deposits that I would be happy to be without so I kept it up. More primal cooking and eating. I was on my way to becoming fat adapted and I wouldn’t be stopped!

I didn’t exercise once during the first 2 months. I was basically sedentary. I really didn’t have the energy to do anything but that changed pretty fast. I tried mountain biking again and felt like I was some kind of super human. However, the next few times I rode, I experienced really bad bonking and wondered what was going on. How did I have energy before but now I’m bonking periodically? I now know I was pushing too hard during the fat adaptation phase creating a demand for glucose….I used a bit of fruit to push through this.

By late April 2016, I was looking and feeling good but I was also plateaued. I could see more fat needed to come off but wondered why the BP coffee and whole foods diet wasn’t working as well. I researched more and discovered the power of real intermittent fasting.

I kicked out the BP coffee in place of lightly sweetened black coffee in the mornings then did a typical fast-breaking in the afternoon with a salad or eggs etc then a more legit meal later on in the evening. I also started sprinting.

By early summer I was wearing my jeans on an 80 degree day and realized that I wasn’t sweating hardly at all. The man that used to sweat on a 40 degree day was now borderline cold in the middle of the summer. Oh well, I saved on my AC bills and got over it. I also noticed that those jeans felt a little loose. I thought, “no way I’m actually in 32s now.” Sure enough, I was able to fit nicely into 32s. Lesson learned…when you’re on the keto weight loss slide, wait to buy a lot of new clothing.

By midsummer, I returned to my lifting habits. Thankfully, I had a base of knowledge on how to lift so I experienced results very quickly. My thinking during all of this was, “let’s see how low carb I can actually be without experiencing real fatigue.” In essence, I only wanted enough carbs as I possibly needed and not one gram more. I found myself able to ride my bike and lift with a fair amount of intensity…even in a fasted state!

By late summer (August 2017), I wondered again if it was just my new stretchy skinny fit 32s needed to be washed and dried to give them that tight-ish post dryer fit again or if, God forbid, my entire new stash of 32s was too big. Sure enough, I went and tried on a pair of 30s and whoa they fit! I figured since I can see feel my pelvic bones poking off the sides of my hips along with a full blown 6 pack looming to 8 pack abs (and also the total extinction of my ass) that I must be at that often desperately sought after “ideal body composition.” The ripped guy you see in the after pics was taken on that day.

BOOM! I knew I had arrived. I knew I was fat adapted. I had developed a system of food shopping and meal prep to fully support it. I knew my life from there on out would never be the same. Going Primal is one of the best decisions, if not the best decision, I have ever made for my personal health.

But….what about the ketogenic diet? I was very curious about it, but it seemed like a fringe version of primal to me and a lot of the recipes I looked up were loaded with strange ingredients that didn’t seem to be in line with a Primal way of eating. However, right around this exact time (about a month or so ago), I started seeing Mark posting a lot about keto and his own experiment with it. When the announcement came for the The Keto Reset Diet book, I knew I was on the right track.

The Keto Reset Diet was released on my birthday. I don’t like to read but I got it for free by starting up with Audible. Listening to the book gave me a much better understanding of how each of the various macros affect the brain and the body. I realized that my eating habits were pretty close to what was in the book so I decided then and there that I will likely stay in the “keto zone” for the rest of my life. I will be going in and out of keto for the purpose of maximizing metabolic efficiency. Wow…it seemed so crazy that it was even possible that I went from being a completely sick and depressed fat guy knowing nothing about food to a ripped fat- burning beast who’s not so bad in the kitchen in the span of half a year!

On my birthday, I posted the before and afters to my Instagram and announced that I would be adding keto-based weightloss consulting to my services as a tailor. I have a lot of fat clients who have no time but lots of money, so why not monetize my experience, make money off of helping them lose the weight and make even more money selling them new clothing?! As if I wasn’t niched out enough…

So there ya have it. Now I’m off to the keto races, and I think I’ll change a few lives and get a little richer while I’m on the way there. Yes, that means I signed up to become a Primal Health Coach.

Here are a few bullet points of the positives and negatives I have experienced along the way plus a few tips:

Positives:

– Way more energy

– Much better sleep

– Obvious improvements to physique and exercise performance

– Super speedy recovery times and no jet lag!

– Effortless appetite management

– Ability to fast for 24, 48, or even 72 hours…at will

– Radically improved cognition

– No more depression

– The tug of other “addictive behaviors” significantly reduced. In fact, I quit drinking permanently on August 1st of this year.

– I still partake in cannabis consumption regularly and indulge in the munchies right along with it….guilt free! It plays well with this diet!

Negatives:

– Getting fat and losing weight is expensive. The food replacements, cooking equipment, and time spent figuring it all out and dialing in how much to buy and eat was a costly endeavor top to bottom.

– I completely rendered a large custom wardrobe useless and had to replace all of it. So will you.

– I’m definitely one of those annoying health nuts now and have had to figure out all kinds of social behaviors to manage the awkwardness.

– There really aren’t many other negatives.

Tips:

– Read The Keto Reset Diet

– Let the diet do the work. Stay low and slow and don’t try to exercise too hard until you’re ready especially in the beginning. You will feel the energy surging through you but ignore it for a while and take it easy.

– Get your macros right and don’t slouch on green veggies, salt and other minerals.

– Watch your protein intake. No need to raise it to the roof.

– “Fake Keto” recipes out there for replacing common comfort foods usually using high amounts of dairy and almond/coconut flour and fruit are only for the truly fat-burning, keto-adapted, carb-tolerant beasts among us. Do yourself a favor and go therapeutic keto from the start with proper macros and fats from mainly animal sources. Eat those greens!

– Ditch the artificial sweeteners and train out sweet tastes from your palate at least for awhile.

– Fasting protocols maybe work better for men. Women might want to start eating proper macros and let the brain/body do the work before getting into IF protocols (just my opinion).

– Sprint while fasted to bust plateaus.

– Got the keto flu? Eat some avocados or supplement with apple cider vinegar, pink sea salt, and cream of tartar (high potassium) mixed in water. Then get over it and go sprint.

– Stop waiting and get on board the keto train! Being keto-adapted is one helluva ride!

Aaron H.

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Autoimmunity Factors: The Question of Th1 and Th2 Dominance

With autoimmune conditions, the most universally effective strategy you can employ is to reduce the inflammation response in the body. Eat Primal. Stop overtraining. Stop shortchanging sleep. Reduce stress. While going Primal slashes pro-inflammatory inputs and provides the body with ample anti-inflammatory influences, some folks benefit from—at least temporarily—taking it a few steps further with specific autoimmune protocols.

But what if you have been taking all these steps and your body is still not responding? Readers occasionally ask me about Th1 and Th2 dominance in relation to autoimmunity. What does it mean if you are T1 or T2 dominant? What nutrients respond best to both? Researchers are gaining a better understanding of cytokines and T helper cells and their role in immune responses. Let’s take a closer look.

What Is Th1 and Th2 Dominance?

Generally speaking, autoimmune conditions play out through imbalances in the immune system. Frankly, the research out there regarding Th1 and Th2 dominance is fairly limited and a bit controversial, but I think it’s worth a conversation.

The terms Th1 and Th2 refer to two major populations of T-helper cells, which is a subset of lymphocytes that plays a key role in optimizing the immune system. The balance between Th1 and Th2 mediated immune response appears to play a significant role in immune system regulation. When the immune system is balanced, there is an equilibrium between Th1 and Th2 cells. However, with autoimmune conditions there are certain cytokines that become inflamed and can interfere with this delicate balance. Theory suggests that some folks have Th1 dominant immune conditions, while others have Th2 dominant immune conditions.

What Roles Do Th1 and Th2 Dominance Play in Autoimmunity?

T helper cells can differentiate into either Th1 or Th2 cells, depending on the type of pathogen that has triggered the immune response. Th1 cells are imperative for protection against intracellular viruses, bacteria and protozoa, whereas Th2 cells make interleukin required for IgE production and activation of mast cells and eosinophils important for eliminating extracellular parasites. Unusual Th1 responses have been associated with inflammatory and autoimmune conditions, whereas Th2 responses are strongly implicated in atopy and allergic inflammation.

Th1-type cytokines tend to produce pro-inflammatory responses in an attempt to kill intracellular parasites and bacteria. The main Th1 cytokine is interferron gamma. Th1 Dominance is characterized by overstimulation of immune cells, and inflammation that stems from past infections, environmental conditions (diet playing a role here), and food sensitivities. Typically, Th1 dominant folks are said to struggle with brain fog, fatigue, and autoimmune conditions such as Hashimoto’s, rheumatoid arthritis, irritable bowel syndrome, psoriasis, celiac, crohns, PCOS, lupus, MS, and lyme. In other words, pretty much most inflammatory-type autoimmune conditions.

The Th2-type cytokines include interleukins 4, 5, and 13, which are associated with the promotion of IgE allergies and food allergies, lower inflammation (we’re not looking to snuff out all inflammation, which has a critical role in healthy functioning). It’s thought that these folks tend to produce antibodies to food. In excess, Th2 responses will counteract the Th1 actions. Therefore, the optimal scenario would be that a person would have a well balanced Th1 and Th2 response. Some conditions associated with Th2 dominance include lupus, dermatitis, allergies, asthma, IBS, and chemical sensitivities.

Some food for thought: Th1 and Th2 cells are each associated with specific immune responses based upon the cytokines they secrete. For some pathogens, the presence of Th1 cytokines (IFN-gamma and TNF-beta) are considered necessary. Conversely, for large extracellular parasites such as helminths, Th2-type cytokines are considered most necessary.

And another interesting tidbit of knowledge… A fetus can switch on an immune response in utero, early in pregnancy. Pregnancy is a Th2 situation, so babies tend to be born with Th2 immune responses. However, responses can be switched rapidly in the infant, under the influence of microbiological exposure or can be enhanced by early exposure to allergens. These researchers hypothesized that people who develop full blown allergies may have been born with a weaker Th1 response.

Inconsistencies in the Th1/Th2 Dominance Discussion

Human cytokine activity rarely falls exclusively into pro Th1 or Th2 patterns. Many autoimmune conditions that have been classified as Th1 or Th2 dominant fail to meet the set criteria. Th1 polarization can easily switch to Th2 dominance just through glutathione depletion. Mercury, for example, depletes glutathione, thus polarizing towards Th2 dominance. Th1/Th2 balance is also influenced by hormones and nutrients such as probiotics, selenium, zinc, plant sterols, and other hormones. Omega-3 fatty acids significantly help with a wide variety autoimmune conditions, yet have no specific effect on Th1 or Th2.

It sounds to me like a delicate dance exists between the T helper cells, and it isn’t black and white. I’m not a believer in the ability or wisdom of definitely categorizing an individual on this basis. However, there may be value in determining if an individual tends to show characteristics that lean towards either Th1 or Th2 dominance. Physicians can order a Th1/Th2 cytokine blood panel, which can help determine if you are dominant in one or the other.

What Foods, Supplements, and Lifestyle Changes Theoretically Stimulate Th1 and Th2?

A limited amount of research suggests that there are various supplements, foods, and lifestyle changes that can stimulate either Th1 or Th2—thus, in theory, balancing the two systems. I’m on the fence about some of this, but since most are recommendations I make anyway for healthy Primal living, I’d say they’re worth considering. Even if the experiment isn’t successful, you can at least know it’s safe. As always, don’t overdo—particularly with supplementation. Add slowly, and share your plans with your doctor—especially if you’re pregnant, nursing, or being treated for any health conditions.

According to the folks at Self-Hacked, strategies for inhibiting Th1 (if you are Th1 dominant) can include avoiding lectins, exercising without overtraining, and aligning your sleep patterns with circadian rhythm. (You’ll get no arguments from me here.) Likewise, suggestions also include taking vitamin A (retinol), D3, CBD oil, astaxanthin, fish oil, chromium, and choline. Spices that help inhibit Th1 include cinnamon, cardamom, fennel, mustard and black cumin seed. Food recommendations highlight fish and avocado. I can get on board with those.

Common recommendations to inhibit Th2 (if you are Th2 dominant) include sun exposure, probiotics, cold exposure, intense exercise, and oxytocin boosting through skin to skin contact. Bee products like royal jelly, honeycomb and raw honey, as well as B6, folate, B12, vitamin C, vitamin E, selenium, zinc, copper, and iron are suggested, as are kiwi, cocoa, and coffee. (If you don’t respond well to caffeine, skip the coffee for sure.)

Medicinal mushrooms are also known to stimulate the immune system. Certain medicinal mushrooms like reishi and shiitake, and maitake can act as Th1 stimulators. Whereas, chaga and cordyceps sinensis (Cs-4) may help balance the Th1/Th2 immune systems.

For any immune concerns, I believe we all benefit from grounding, play, stress reduction, sleep, and Primal nutrition. Although I’m not ready to discount inconsistencies or ignore the limited research on the question of Th1/Th2 balance, I also acknowledge it may speak to readers who are looking for answers where traditional Primal and autoimmune protocol methods haven’t panned out.

I’m curious what your thoughts are. Have you delved into the Th1/Th2 literature or employed the suggested strategies (those above or any others)? I’d love to hear your experiences, so please share. Have a great day, everybody.

 

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The Lowdown on Keto Side Effects: What’s Real, What’s Not, and What’s Helpful

With more people enthusiastic about the ketogenic diet comes more talk about potential adverse side effects. Upon closer examination, almost all of the complaints can be traced to a flawed approach. Granted, if you are coming to the game with significant metabolic damage from decades of carbohydrate dependency, or not paying attention to some common sense best practices, such as choosing healthy foods instead of blindly focusing on macros, you will likely struggle with something as stringent as keto.

Let’s cover some of the common keto complaints being bantered about these days, examine what’s really going on, and discuss strategy for how to avoid any adverse side effects to going keto.

Keto Flu

The keto flu refers to feelings of general malaise and even immune disturbances in association with dietary modification. Commonly cited symptoms include feeling lethargic (especially in the afternoon), feeling hot, feeling achy in joints and muscles, among other related sensations.

Here are eight important tips for avoiding the keto flu. Check out the full post for further details.

Get sufficient omega-3s, from oily, cold water fish or supplementation.
Consume an extra five grams (1 teaspoon) of sea salt or Himalayan pink salt per day when going keto.
Consume foods rich in potassium and magnesium. Avocado is the magnesium king with 1,000mg.
Make an extra effort to hydrate strategically, especially around workouts.
Consume more healthy, natural fats to replace the carbs you are cutting out.
Consume MCT oil (from coconut oil or MCT oil supplements) to stimulate external ketone production.
Move frequently and conduct cardio sessions at low heart rates.
Try a gradual reduction in carbs if an abrubt reduction seems problematic or you experience keto flu symptoms.

Finally, wait it out. Certain folks who do everything by the book and follow every bit of good advice may still get a few symptoms of the keto flu. This usually comes in the initial three weeks of entering nutritional ketosis, and things get much better very quickly. Trust that your lull will pass and your energy will increase substantially—usually within a few days.

Keto Poop

Someone asked me this the other day on a podcast: What’s the deal with keto poop? A disconcerting number of people on keto diets appear to be having trouble with their poop—or lack thereof.

The biggest issue is that some people consider keto to be a free pass to skip the green stuff. Either that, or they assume “vegetable=carb” and avoid them. Without plants, it’s tough to eat enough fiber, especially the fermentable, prebiotic kind that sustains our gut bacteria. We don’t need bowel-rending quantities of fiber. We shouldn’t take pride in the ability to fill the toilet bowl with perfect coils of crucifer corpses. These are unnecessary at best and downright harmful at worst.

But we still have to feed our gut bacteria. We still have to poop. We don’t want to strain and come up empty. Humans are industrious apes; we like to produce, not work in vain.

What else is going on, besides the lack of fiber?

You may need more water. Going keto causes an initial reduction in fluid retention in cells throughout your body. Your digestive tract requires water to keep the fecal matter soft and moist. As you aspire to consume more fluid, be sure to add a pinch of salt to each cup of water you drink, and to sip steadily throughout the day instead of binge chugging. These measures will help you better absorb additional fluids instead of excrete them.

Take magnesium. Magnesium helps regulate gut motility, and magnesium deficiencies are a common cause of constipation. Magnesium needs tend to rise on keto as well. Some experts recommend taking 400 mg in supplemental magnesium per day when going keto.

Take resistant starch. A starch that acts like fiber, RS is one of the most potent prebiotic substances around. Raw potato starch is an easy, dependable source of RS. Start slow with a teaspoon into your smoothie or full-fat yogurt; work up to at least a tablespoon per day.

“Deflated” Muscles

When your glycogen stores are topped off and your muscles are full of water—each gram of glycogen is stored with 3-4 grams of water—they’re bigger. More pronounced. Fuller. Going keto, which depletes muscle glycogen and reduces fluid retention, can give your muscles a “flat” or “deflated” appearance.

You can accept it for the time being. As time goes on and your body calibrates itself to the new metabolic pathway, you won’t shed as much water. Your muscles will return to normal.

You can work carbs into your diet before, during, or after hard training sessions. Anything intense enough and long enough to burn through muscle glycogen allows carb consumption without knocking you out of ketosis.

You can try creatine. Creatine is also stored in the muscle alongside water, so it may increase muscle fullness. Creatine also has the benefit of increasing muscle phosphocreatine energy stores, which we use for quick movements and brief feats of strength.

Low Energy

Some people just won’t do as well as others on a ketogenic diet. In particular, high energy demand athletes often choose to consume more nutritious carbs than advised per keto guidelines. Females with metabolic damage from a history of yo-yo dieting, or thyroid or adrenal dysfunction, also report difficulty with prolonged carb restriction to promote keto.

Again, with an optimized approach, things might come out great for virtually everyone who tries keto. Realize that since going keto opens up an entirely new energy pathway without limiting your ability to access the previous pathway, low energy is actually a pretty rare complaint. If it crops up with you, here are some things to watch out for:

Chronic exercise patterns: Fat-based metabolisms are great for long, slow movement, quick bursts of speed with rest in between, and feats of explosive strength. In other words, making your way through the world, doing some strength training, going for hikes, playing with kids, running some sprints, and are all tenable on keto. Heavy CrossFit training or anything else that burns a lot of glycogen at a lot of workouts each week, however, might pose issues. Resolve this by either scaling back the training or eating some carbs before, during, or after your workouts.

Inadequate calories: Keto’s satiating qualities are a double-edged blade. They help us eat less and lose body fat without really even trying, but they can also sometimes lead us to eat too little. This can cause a reaction in your body to slow down metabolic function and make you feel generally less energetic at rest. One solution is to cycle periods of generally increased caloric intake, and increased intake of nutritious carbs by default. This suggestion is totally different from the suggestion to engage in purposeful carb refeeds, where you binge on nutrient-devoid carbs in the name of a cheat day. This is never advised for any reason.

Unrealistic expectations: If you’re five days into your keto experiment and about to give up because you yawned after lunch, have a little patience. Things take time to change.

Hair Loss

The diet’s going great, you’re dropping inches, you have good energy levels, increased clarity of mind, but every time you take a shower or brush your hair or join a gorilla grooming circle, you’re losing hair. What gives?

You’ve lost weight. By far the most common cause of unexplained hair loss is simply rapid weight loss or dietary change. This disrupts the normal growth and decline cycle of your hair follicles, shunting a greater proportion of them into the “rest” phase to be pushed out by incoming hairs. Even though you may see extra hair in the shower or on the brush, your actual hair thickness shouldn’t change much.

Check your thyroid. As I wrote in a previous post, certain incarnations of keto (high in omega-6, low in supportive nutrients like selenium and iodine) can lower T3 levels, and this can cause premature hair loss.

High Cholesterol

The doc hands over the printout.

Last week, he’d expressed major skepticism over your new diet. “Sure, you’re losing weight, but let’s see what it’s doing to your arteries.” Today, you already know. His smirk says it all.

“You’ve got high cholesterol.” He’s beaming. Why the hell is he so happy?

It’s a fairly common scene for new keto dieters. Aubrey Marcus recently referenced a highly-disturbing stat that 25% of physicians still equate consuming dietary cholesterol with increased blood cholesterol, an association that has been unequivocally refuted by recent science. But before you accept AHA-sanctioned diet advice, determine if there’s actually a problem.

Check your ratios. Total cholesterol/HDL ratio is a good indicator of how long LDL is hanging around in the blood and remains the best standard assessment of heart disease risk. Another good one is triglyceride/HDL ratio, which is a strong surrogate marker for insulin resistance. In both cases, lower is better. An ideal T/HDL ratio is 1:1. I’d say 2:1 is about as high as you want to go. An ideal TC/HDL ratio is 3.5:1 or lower.

Stop grazing. Allowing time to pass in between meals, or getting crazy and deciding to skip a meal or two, has been shown to improve cholesterol numbers.

Don’t gorge on fat. Remember that the best things happen when you’re consuming your own body fat. You don’t need to melt a stick of butter in your coffee every morning to keep your membership in the keto club.

Balance your fat. Saturated fat has received a terrible rap in the literature, but that doesn’t mean it’s the only fat you should consume. Look to the fatty acid ratios of ruminants like beef and lamb—or your own adipose tissue—for guidance. They have about equal amounts of saturated and monounsaturated fat with a small amount of PUFA. Mix up the butter and cream with olive oil and avocado oil.

Give it time. Your body’s still adjusting to the new energy pathway. Give it a few more weeks before you worry (and even then, don’t worry too much).

Those are six of the most commonly cited adverse side effects of going keto. As you can see, sometimes they’re real and you need to make changes, sometimes they’re a misinterpretation and you need to look more closely, and sometimes you just need to relax and let the process take care of itself.

Thanks for reading, everyone. Any thoughts to add on your transition to keto? Take care.

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Gender Bias in Medical Research: How It Operates and Why It Matters

Some months ago the issue of gender bias in medical research came up on the comment board. It was certainly an issue I’d occasionally read about. But I’m also a proponent of lifestyle design and intervention. I don’t spend as much time as others on the nitty-gritty of medical treatment for good reason, but the conversation got me thinking. Maybe it was time for an article after all….

And, so, the questions started coming. How does gender figure into medicine, and what exactly is gender bias in this context? How does it operate? How has it been measured? What consequences are there? How much should it influence our trust in medical literature and subsequent recommendations—the validity of findings, the efficacy of treatment, the safety of drug prescriptions? And, finally, what if any progress are we making or can we count on in the near future?

That Was Then, This Is Now: The Beginnings of Gender Bias 

Bias is a form of systematic error that influences scientific investigations and distorts the findings. Bias will always be present in some form during a study, but the goal is to minimize it to the point where the results can still be trusted. Gender bias, then, refers to errors that arise due to differences between male and female participants or target subjects.

Way back when, gender bias was rife in the medical community. Up until the late 19th century, women were commonly diagnosed with “hysteria,” a (very convenient) condition to imply emotional instability was at the core of any complaints, particularly when related to the female reproductive organs. Thus, where medical practitioners were faced with female patients they couldn’t (or couldn’t be bothered to) diagnose, it was accepted practice to chalk it up to her mental state. Surprisingly, this medical mindset remained entrenched up until at least the 1970s, where a 1972 textbook titled Gynecology and Obstetrics, Current Diagnosis and Treatment suggested that nausea during pregnancy was the result of resentment and ambivalence towards childbearing.

In response, legislation was passed in the same decade to prevent gender discrimination in research in an attempt to ensure studies included box sexes and thereby maintained “equality.” Despite this, the emotional and cultural misconceptions that had skewed female-related medical research and treatment for centuries remained very much entrenched, while women were still regularly left out of trials for fears of pregnancy-related complications…despite the fact that drugs were still being administered to pregnant and breastfeeding women.

Then in 1994, there came the big break that gender-aware researchers had been hoping for. The U.S. National Institutes of Health (NIH) issued a guideline for the study of gender differences in clinical trials to ensure those drugs were suitable for both sexes.

The guideline addressed the exclusion of women from trials based on unfounded safety reasons, forcing researchers to consider the fact that men and women can have very different responses to the same drug. As a result, an estimated 80% of prescription drugs were withdrawn from the US market due to newly uncovered women’s health issues.

These days, there’s more women than men enrolled in clinical trials. Nonetheless, to some extent gender bias continues to underpin many aspects of medical research.

An Issue of Equality and Inequality

So, what are the different forms of gender bias still prevalent in today’s medical research realm? Let’s dig in here….

A Swedish study conducted from 1997 to 1999 sought to uncover the reasons behind why researchers excluded women from clinical trials. Based on 26 different case studies, they determined that the reasons behind these exclusions were:

lack of knowledge regarding the physiology and metabolism of women of childbearing age
a continuing desire to base repeat studies on former (male) study populations, and
tight research budgets that enabled inclusion of men but not women

Today, the almost universal inclusion of women in clinical trials might give the impression that things have improved markedly, but there’s plenty of problems still operating under the radar. A 2017 meta-analysis of 2,742 case reports showed a “statistically significant gender bias against female case reports,” while the Society for Women’s Health notes that the richest charities aren’t pushing for the inclusion of more women in medical research and that only 3% of grant proposals measured sex differences.

Ultimately, these biases exist due to polarizing assumptions of equality and inequality. On the one hand, researchers have long entertained the assumption that men and women suffer from the same symptoms and similar disease risk factors. Many clinical trials on men carry the assumption that the findings can be equally applied to women.

Despite this, those trials that compare the effects of drugs and treatments between men and women continue to highlight marked differences in the way women metabolize drugs and respond to treatments. Thus, the assumption of equality puts women at risk, not only reducing disease treatment efficacy but also risking exposure to unforeseen adverse side effects.

There’s also the valid point that men and women (as a whole) differ in environmentally and culturally influenced risk behaviors and exposures, and perhaps in their varied perception of symptoms. These are all valid concerns when it comes to clinical trials, but the biomedical model that governs most medical and clinical research tends to brush over this consideration—men and women are simply biological entities separated by hormonal and muscular variations.

At the other end of the spectrum, assumed inequalities occur when physicians consider women’s complaints to be less severe than men’s, due to the cultural notions of male stoicism and the fact that men have a lower average life expectancy and higher rates of mortality. This is reinforced by more frequent research into male-centric chronic diseases, which solidifies the notion that men are more “at risk.” This assumption contradicts the fact that women have higher rates of non-fatal chronic conditions which seriously impact their quality of life, particularly during those “additional” years when they’ve statistically outlived their male counterparts.

Consequences of Systemic Assumptions

The repercussions of this long-standing sex bias in the research realm are sneaky but far-reaching. For starters, larger proportions of women are diagnosed as having “non-specific symptoms and signs,” perhaps reflecting a disease classification system more suited to men than women. These same women might actually be suffering from a fully identifiable illness, but practitioners fail to diagnose it, due at least in part to traditionally male-based diagnostic criteria or to female-centric complaints that aren’t highlighted or even understood by historically (predominantly) male-based research. As a result, many women may receive no or improper treatment of their unidentified disease, something that can be frustrating at best and downright dangerous at worst.

Next, despite the fact that primary healthcare is used more by women than men, research indicates that short-stay and emergency hospital services may be more accessible to men. In one study of patients with the same ultimate diagnosis, women waited longer in emergency rooms and were admitted less often.

Then there’s the issue of incorrect drug dosages arising from insufficient trials on women. Eight of the ten prescription drugs that were withdrawn since 1997 posed greater health risks for women than men. Half of those drugs were withdrawn not because more women took them than men, but because their effects on women weren’t well known prior to FDA approval. For example, antihistamines Seldane and Hismanal and gastroprokinetic Propulsid “can in some circumstances prolong the interval between the heart muscle’s contractions and induce…a potentially fatal cardiac arrhythmia. Women have a higher incremental risk of suffering an arrhythmia after taking these drugs than do men probably because (1) the interval between heart muscle contractions is naturally longer for women than for men and (2) male sex hormones moderate the heart muscle’s sensitivity to these drugs.”

At a less morbid level, the FDA recently reduced female doses of Ambien, a common sleeping aid by half. Ambien and similar products had been on market shelves for years, but it wasn’t until the FDA completed tests on a new sleeping aid, Intermezzo, that they realized women metabolized the active ingredient much more slowly than men. Up until that point, it was assumed that women had the same response to the drug as men, and therefore that the recommended dosages should also be the same.

Because of lingering research bias, I’d say women probably have ample (more) reason to be more skeptical of pharmaceutical recommendations. 

Gender Bias In Literature and Practice
Coronary Heart Disease

Despite the fact that coronary heart disease is very much a disease of both genders, its role in female mortality rates is arguably under-appreciated. Women with coronary heart disease tend to have worse outcomes than their male counterparts, and they generally receive less evidence-based treatment than men with CHD.

A 2014 study that examined access to care for 1123 admitted patients exhibiting coronary symptoms found that men were more likely to receive faster care compared to women. Researchers also observed that, when women were anxious, doctors tended to underplay the severity of their condition, while anxious men were still admitted quickly. Even more interestingly, both men and women with “feminine character traits” were less likely to receive timely care than those with masculine traits.

Statins and NSAIDs

In a review of 27 trials of statin use for CHD and 25 trials of NSAIDs for osteoarthritic pain, the two drugs showed a huge difference in inclusion of women. While NSAID trials reflected the population in which they were used, only 16% of women were included in trials despite 45% of statin users being female.

These statistics become even more alarming when we consider the fact that women are often more at risk of adverse side effects from statin use than men. Elderly women, for example, face a higher risk of developing muscular disorders following statin use, while postmenopausal women are at an increased risk of developing diabetes mellitus from statin use. 

Animal Studies

This is where things really get interesting. Many specialists now theorize that the high rate of adverse drug reactions in women may stem from biomedical research at its earliest stages—animal trials.

While over half of NIH-funded clinical research participants are women these days, the same progression in recognizing gender bias has not been reflected in animal research. Women have more strokes than men, but only 38% of animal studies on stroke used females. Many thyroid illnesses are up to ten times more prevalent in women, yet only 52% of animal trials used females. And studies that use mice and other rodents to test new drugs typically use only males, despite there being marked differences between the way men and women absorb and process drugs.

There’s plenty more where that came from. A 2011 review of gender bias in research on animals in 10 biological fields found that male bias was present in eight disciplines and most prominent in neuroscience, where male studies outnumber female by 5.5 to 1. According to researchers, in recent years male bias in human studies has declined while increasing in animal studies, and this doesn’t bode well for the safe development of drugs and disease treatments further down the line. This preponderance of males in animal research unfortunately runs the risk of obscuring key gender differences in clinical studies, preventing reproducibility in human studies, and is especially concerning given women experience higher rates of adverse drug reactions than do men.

Some Final Thoughts…

Clearly, there’s much that still needs to be addressed regarding gender inequalities in the medical research world, but we’ve thankfully come a long way from the days of “hysteria.” Women can now participate in phase one, two and three clinical trials, and the NIH continues to roll out legislation and training to ensure researchers don’t overlook or underplay the importance of including women in their trials. And in the animal research sector, the NIH has now enacted policies requiring a balance of genders in all future trial applications, unless sex-specific inclusion is unwarranted.

Unfortunately, however, many aren’t sure the solution is as simple as requiring equal gender representation in every study. As this opinion piece points out, “modifying experiments to include both males and females costs money and requires a duplication of time and effort—time that researchers might not have to spare or that might be better spent conducting other research—that is rarely practical or scientifically warranted.” The question appears to be one of practical resources, but I’ll admit something in me isn’t fully comfortable with this answer. A lot hinges on the definition of “unwarranted.”

Can we effectively prioritize funding for research where analyzing differences between the sexes promises to provide substantiated benefit—and opening the conversation more for defining that “benefit”? We’ll see. Providing the necessary funding for female or mixed-gender studies should at least ensure that scientists no longer have reason to exclude women from trials. And mandating disclosure when a study uses only male or female animals in the title should improve transparency and assist drug and treatment approval processes.

Thanks for reading folks. What say you? Are there issues and/or solutions you’d add to the mix? I’d love to hear your thoughts. 

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