Who Does Best On Keto?

Who Does Best On Keto?

You may have heard the term fat-burner. By consuming limited carbohydrates, the body begins using fat for energy. This is a normal physiological process.  Fat is more satiating so if keto is done properly people tend to need to eat less but feel full. 

What I see often see in clinic is people who don’t eat enough protein.  Keto tends to help with this because you start by tracking your protein intake.  Protein has higher nutrient density than other foods.  It also more satiating for this reason.  When people are low in protein they are also low in essential micronutrients as well. This can cause cravings and a hunger that seems to never end.

Blood Sugar Dysregulation 

Keto is stabilizing stabilizing for blood sugar.  Those with insulin resistance or hyperglycemia can benefit from a ketogenic diet.  Just to be clear, metabolic ketosis is what we are talking about.  Don’t confuse this with ketoacidosis, an acute condition that can occur to diabetes.

Both conditions involve ketone production but the second happens because insulin is unavailable at the cellular level. This dangerous condition produces much higher levels of ketones and is a medical condition that looks much different than metabolic ketosis.  Blood sugar dysregulation is very common.  I see it almost daily in my practice.  

If you have followed my work you’ll know how important blood sugar regulation is for maintaining physiological homeostasis ranging from hormones to brain health.  

Epilepsy & Neurodegenerative Diseases

We have known for a long time that a ketogenic diet has excellent outcomes for certain conditions. Drug resistant epilepsy is one especially when used in children.  The side effects of seizure drugs have some of the worst side effects.  Using diet to avoid long-term use has changed the lives of epilepsy patients. Other neurodegenerative diseases like Alzheimer’s and Parkinson’s also show promising results.

Cancer Research

This is an area that requires more research however we’ve know of anecdotal evidence where cancers disappear with extended metabolic ketosis. Interestingly the method used to detect cancer uses a radioactive form of glucose.   This reflects the fact that cancers use more glucose than normal tissues.  

Digestive Disorders

Patients with recalcitrant gastrointestinal issues like SIBO (small intestine bacterial overgrowth) and IBD (like Crohn’s and Colitis) tend to benefit from a lower starch diet.   In many cases keto or intermittent fasting provides symptom relief so people are doing this intuitively.  Keep in mind that simpler sugars (monosaccharides) are sometimes easier for these people to tolerate.  Fruit is a better source of simple sugar than processed foods which are what some people reach for when they are in pain but require energy.  Energy from fat can be a good solution that is actually helping with recovery from the infection or inflammation. 

Keto 101

Protein is the best place to start.  Most organisms do not overeat protein.  We have a hard-wired cut off point for protein because of how satisfying it is.  If you don’t get enough protein, you’ll try to find nutrient minimums by eating larger amounts of other foods that likely don’t have as good a nutrient profile. 

The next step is to limit carbs to 20-30 grams per day.  There are tools to help you learn how to do this that I go into below.  Once you get started it becomes just a new way of eating.  In the long-term carb cycling can be better for gut health.  This means choosing a day or two a week where you increase carbs. By including some of the resistant starches and prebiotic fibres you replenish the beneficial bacteria. 

The last step is to fill the rest of your energy needs with healthy fats.  For gut health use a variety of fats, not just saturated fats. I’ll talk more about who benefits from “a mediterranean keto diet’ in a follow-up article.  Basically everyone benefits from consuming adequate amounts of EPA/DHA from fish and MUFA (monounsaturated fatty acids) from olive oil & nuts. 

Understanding Macronutrients

We know humans can thrive on any macro nutrient ratio. There is evidence of populations like the Inuit thriving on a fat-based diet. This is also true of a high protein or a high carbohydrate diet. We are highly adaptable! This is not one-size fits all, meaning any diet needs to be individualized & will change depending on activity levels, stage of life, lifestyle etc. 

I’ve trialed a few different tools for tracking macronutrients. Initially these make it much easier to get a sense of what you are eating. MyFitnessPal is a popular one that many of my patients use.  I prefer Cronometer.  It give you a sense of your micro and macronutrients and is easy to use.  Check it out and let me know what you think!

In the next couple articles I’ll address who should be cautious when trying a ketogenic diet and why electrolytes are so darn important!  

 

 

 

Low-carb is bad but Ketones are good?

Low-carb is bad but Ketones are good?

Let’s bust some health myths around low carb diets and ketone supplements.

Low Carb is Bad? What the heck!

Research that a low carb diet is dangerous recently hit mainstream news. If you look closely at this study you’ll notice the method used is one of the most inaccurate ways to draw conclusions.  This subject is already difficult to research mostly because people are notoriously bad at reporting what they eat.

The Lancet study is an observational study based on questionnaires.  There is no control in this kind of research.  Only twice were the participant’s diets assessed in the 25 year period of the study. Specific interventions are not directed on the subject (ie a low-carb diet) to discover the outcome. Instead, the researchers just look at populations of people to make guesses about the effects of a diet or lifestyle variable.

Correlation is not Causation

We simply can’t draw conclusions from this kind of study.  We can only generate hypotheses. Why?  Because correlation is not causation.  For instance, take a look at this statement, “Students who get extra help at school do worse on exams.”  Obviously students who need extra help will improve the score on their own exam.  This doesn’t mean they’ll score highest in the class.  We can’t draw conclusion because correlation is not causation.

Given the sheer number of randomized control trials that show benefits for epilepsy, diabetes, hormone imbalance and irritable bowel, its worth taking a deeper look at this study that hit the headlines.

The Healthy Bias & Other Flaws

The healthy participant bias is real and is rarely controlled for.  Behaviours that are popularly perceived as healthy like exercising, not smoking, avoiding sugar and red meat are all lumped together.  Therefore in the general population anyone who eats red meat also has multiple risk factors already.  The nuance of those who eat grass-fed meat as part a whole food diet and a healthy lifestyle gets missed.

Other problems are people tend underreport foods socially considered bad, like meat and alcohol.  They overreport foods considered good, such as vegetables and fruits.  Ingredients in restaurant or prepared foods are often unreported or unknown.  Most people don’t measure portion sizes and forget some of what they eat. Tracking every bite and meal is inconvenient so a lot gets left out.

Finally, diets change over long periods of time and this study went on for 25 years. Researchers only had to control for 3 variables out of these: age, sex, obesity, diabetes, hypertension, hypercholesterolemia, cardiovascular disease and family history of cardiovascular disease.  What this means is someone could have up to 5 major risk factors and still be part of the study.  This explains why the outcomes they came up with were so bleak.

Macronutrients, Whole Food & the Ancestral Diet

We have significant evidence from much more reliable studies that people can thrive on any macronutrient ratio when eating unprocessed foods similar to what our ancestors ate.  Low carbohydrate with high fat or protein can result in a thriving population.  High carbohydrate for shorter periods of time also works.  In fact, one population consumes honey as its main source of nutrient for part of the year.

Eating in a way that is adapted to your environment, the seasons, activity level and social support system is key.  We are incredibly resilient. Why low carb works so well in our day and age is because the amount of processed junk we have access to is mostly carb based foods that are highly palatable.  By simply avoiding these we also avoid a long list of health complications.  It also makes us thrive and allows us to give back to our communities.  Win, win!

So a Ketone Supplement is Good?

When a number of people approach me asking about a new supplement my eyebrows go up a bit. Ketosis is a approach to nutritional therapy that is not new however there is a resurgence in its popularity right now.  In fact its searched in google more than any other diet right now!  I have colleagues who have been using it with patients for nearly 30 years.

Here are the thoughts I had for the people who asked me about ketone salts. The first question I asked about this particular supplement is how is it being marketed? Is it direct sales/multi level marketing? Does it say its safe and effective for everyone? Do they want people using it long-term? Yes, yes and yes.

Another question I have is does it contain caffeine? Yes.

Finally its worth noting that electrolytes are important for anyone going into ketosis but supplementation is not.  One patient who tried this supplement reported feeling very thirsty from it.  I wonder why a ketone supplement would create thirst.  It should do the opposite.

Sleep & Metabolic Disorders

Caffeine is going to make most people feel better temporarily. It is also going to inhibit appetite and sleep.   What many don’t realize is that 50% of people don’t metabolize caffeine so it doesn’t clear the system. Insomnia is a major contributor to metabolic disorders like insulin resistance and diabetes.  Lost sleep will increase inflammation and also make it more difficult to maintain a healthy weight. Missing meals inhibits your ability to rest, rejuvenate and experience deep sleep.

Three sign of pre-diabetes are increased thirst, hunger and urination.  One of the people who asked me about this supplement told me she experienced all three.

Today’s Biggest Health Concerns 

High stress, insomnia and blood sugar dysregulation. They are connected. A caffeinated supplement is not the answer.  For someone who is healthy and metabolizes caffeine well this supplement may not cause harm.  I’d rather have people learn to manage their stress, sleep better and eat regularly in a way that supports their lifestyle than rely on any supplement.

I do have patients who are in ketosis. Usually these are people with very low stress like those who are retired. Occasionally its a person struggling with a serious illness where ketosis is indicated as a viable intervention. I don’t recommend ketosis to parents, business owners or those who are very active.  The benefits roll out for those who are in the right stage of life to do it.

Success with PCOS

Success with PCOS

Over this past year I’ve been working with PCOS patients.  Nearly always there is an underlying blood sugar dysregulation, gut issue, inflammation and hormone imbalance.  Thyroid can be implicated as well especially if autoimmunity is a contributing factor.  I’m delighted when I haven’t heard from someone in awhile and then receive a note saying a baby is on the way.

It is possible to conceive before your health is perfect.  I always ask patients to give me 2 months to focus on their health prior to conception.  We can get a lot done in 8 weeks.  Its enough time to get the gut working, optimize micronutrients and open the pathways for hormone balance.

The woman who I hadn’t heard from in awhile had a hormone retest showing a marked  improvement on many levels. Although we hadn’t resolved everything, the most important markers were in range.

What are the most important markers?

I want to see total and free cortisol in range.  I also want to see the three month blood sugar marker under the functional level.  When insulin resistance is primary than we’ll want a more in depth panel.  If inflammation has come down then we know we are on track.  These are the three big ones.  Then there is ferritin.  Before conceiving we want to see healthy levels of iron stores along with folate.

When androgens are primary then checking to see the metabolite pathways is important but again sex hormones are downstream the big three I mention above.

Lifestyle

Building in stress management and a dietary routine prior to baby coming is so important.  These will be what carry you through any difficulties that may arise in the first months of parenting.  They also set the stage for the child’s health and habits which are easier to influence earlier rather than change later in the game. 

Some of my favourite, effective supplements for PCOS

  1. Inositol: balances blood sugar, prevents gestational diabetes and metabolic syndrome.  Effective for treating anxiety and other mental health issues.
  2. Alpha Lipoic Acid: an anti oxidant that balances glucose levels.
  3. Glycine: an amino acid that supports good digestion, calms the nervous system and promotes restful sleep.  Best to test your levels before doing higher doses.  (see note below)
  4. Heme Iron: the most bio avalable and absorbable form of iron.
  5. Omega 3’s:  found in fish, grass fed meats and pastured products these are anti-inflammatory.
  6. Nettles:  increases the production of SHBG (sex hormone-binding globulin) which reduces levels of free testosterone in the blood.   SHBG is often low in PCOS.
  7. Reservatrol: a polyphenol found in red wine and grapes that helps counter the effects of androgenic activity that is commonly found in PCOS.

Testing for Optimal Health

Basic blood work and hormone testing is important.  The organic acids lab work looks deeper.  By giving another view of gut health and nutrient absorption we can see more of the underlying cause for illness.  It’s proving more accurate for yeast and fungal overgrowth for instance.  

Often patients are come back after the initial treatment.  They want to do another next layer of work.  The Organics Acid test can act as a yearly check-up.  Its an overview not just of the gut but also the brain, fatty acids and cellular energy production. 

If you’ve been hearing about mitochondrial health then this how you can get a peek into yours.  Is your DNA is replicating well?  What micronutrients are low?   Is your liver functioning optimally? This test provides insight in tough cases or tweaks treatment plans for anyone wishing to thrive.

Going back to fertility, both parents can use this test to address lingering health concerns prior to conceiving.  Retesting after the first few months or years after birth can be a good check-in.  Ensure you have the energy to enjoy your little ones through all their stages!

 

 

 

 

Heart Health 101

Heart Health 101

Suppressing symptoms with pharmaceuticals to treat high blood pressure or cholesterol means missing the investigation as to why these are high in the first place.

 

We know that blood sugar issues and metabolic syndrome contribute to heart disease. In fact there are multiple factors that affect heart health and its worth looking into because often these can be treated and pharmaceuticals can be avoided along with the side effects.

Low cholesterol is known to contribute to disease and death in those with brain disorders and with mental health problems. Low levels are also dangerous for women and the elderly but we rarely hear about this. Conventional medicine is still treating cholesterol as though it is the problem when we know it is not. This obviously leads to more problems. 

Cholesterol is carried on lipoproteins. Science used to believe that it was the concentration of cholesterol on these particles that led to CVD but recent studies have disproven this. Damage to arterial walls occurs not by the cholesterol carried in these particles but by there being too many particles in the blood at once particularly LDL particles.

Those who are at highest risk of heart disease may have normal or low cholesterol but high LDL particles. If one of these people only has their cholesterol tested it may seem that they are in the clear. Those with high LDL-C but low LDL-P are still given statins to lower cholesterol and these drugs have some of the worst side effects.

Our body needs a certain amount of cholesterol. LDL-P carry both cholesterol and triglycerides. When there are more trigycerides then there is less room to carry cholesterol and so more LDL-P are produced. Checking triglyceride levels is crucial as is looking at thyroid health as this can also increase the LDL-P. Thyroid hormone increases LDL receptors. It is also involved with cholesterol production in the liver and cholesterol absorption in the intestines.

Speaking of intestines would you be surprised if I told you there is a link between the markers we’ve been talking about and gut infections? Cholesterol, LDL-P, tryglycerides and low HDL are all linked with H. Pylori infection to name one culprit. In fact treating the gut can result in lowered LDL-P with no other interventions.

Soluable Fiber: Plant Food

Want to improve your life span and quality of life? Soluable fiber increases clearance of LDL, improves insulin sensitivity and binds to cholesterol. It is found in most root veggies, some that grow above ground and in some fruit.

Healthy Fats and Good Chocolate

Macadamia nuts, almonds and olive oil provide excellent sources of good monounsaturated fat. Dark chocolate lowers blood sugar and LDL. It also improves insulin sensitivity.

CoQ10 and Polyphenols

Organ meats and vegetables have plentiful anti-oxidants. They along with polyphenols are protective. Eating a range of colorful vegetables, spices and teas are provides enough and supplementing from reputable companies is also good.

Fish is better than Statins?

Once study showed that eating cold water fatty fish was more effective at reducing death than Statin drugs. The benefits of consuming enough EPA, DHA and long chain omega 3 fats has several benefits to cardiovascular health. Keep in mind that recent studies show that fish is better than fish oil.

Sleep and Move

Of course having fun, feeling connected and enjoying life are crucial for heart health. Sleep duration needs to be between 7-9 hours per night for adults. College age, adolescents and children require more sleep. Devices have no place in the bedroom as the light exposure interferes with the suprachiastmic mechanism in the brain and is disruptive to deep sleep cycling.

Lower Stress, Increase Productivity

Lower Stress, Increase Productivity

Smart Ways to Work and Play

We all know that sitting a lot isn’t good.  You may have heard the phrase ‘sitting is the new smoking’.  Its true that blood sugar and cardiovascular risks go up significantly for people who find themselves in sedentary jobs.  How can we mitigate these health complications when life requires a certain amount of work at a desk?

Continual activity throughout the day is more beneficial for improving glycemic control than a single bout of structured exercise. Just meeting recommended levels of physical activity isn’t enough. By spending the rest of the day sedentary, people are still at risk for insulin resistance leading to diabetes and a disrupted gut microbiome.  Here are a few tips to keep in mind:

  • Avoid sitting for extended periods.
  • Engage in frequent light activity breaks throughout the day.
  • Set up a standing desk and alternate with sitting.
  • Treadmill desks can improve focus and productivity.
  • Ensure that your leisure activities do not involve screen time.

Skipping Meals, Caffeine and Stress

I love my work. When I have a lot to do I often can forget to stop and eat.  This in combination with sitting at a desk increases my stress.  On the weekend I have no trouble with blood sugar but this isn’t true when I’m sitting which confirms what the research is saying.

Packing enough of a lunch and starting my day with some movement helps tremendously.  I go for a walk, a swim or do some resistance training.  On my research days I also have a yoga mat out in my office so I can take creative breaks or do some push-ups.  Putting on dance music can also inspire me when needed.

I hear this from many of my patients about how caffeine is a contributor to stress.  The connection between memory loss, blood sugar dysregulation and caffeine addiction is very real for many people working in tech.  The rise in young people with memory loss is not separate from the rise in diabetes.

Life is better when you move

Activity breaks can include taking a walk outside over the lunch hour, or simply getting up to walk to the water dispenser every hour.  Include some social time as this helps to regulate our nervous system.  Having a fun activity to look forward to does as well.  This may be the most important part of your work day.

Of course activity breaks can’t be considered a replacement for other physical activity. Recent research recommends that activity breaks be used daily in the context of an overall healthy lifestyle.  Aiming for 150 minutes per week of moderate to vigorous intensity exercise is essential as a baseline.

Understand Your Hormones:  Feel Great Again

Understand Your Hormones: Feel Great Again

Fatigue, depression, and irritability can caused by a hormone imbalance. Getting to know the key players can help. The endocrine system rules hormones and I’ll explain a little about how they all work together. The metabolites tell us about how the body is responding and excreting each one. This is important information for preventing disease and feeling better.

 Androgens are important in maintaining bone and muscle strength. DHEA and testosterone are two I look at closely. DHEA-S can indicate inflammation. Androgen metabolites will push one way if there are PCOS like symptoms like acne, head hair loss or facial hair growth on women. Anxiety and depression in men can be due to low testosterone. Specific botanicals and nutrients can shift the metabolism to a more favourable path. GLA, zinc and saw palmetto are some key ones I use.

Estrogens are essential for female characteristics as well as brain, bone and heart health. The pathways for estrogen have been studied extensively.   Preference for certain metabolite pathways may prevent breast and ovarian cancer. Excess estrogen can cause weight gain, heavy cycles, fatigue and irritability. Depending on the pattern, we can support the 2 methoxy pathway with diet and supplements from cruciferous veggies. Boron can support estrogen or testosterone when these are low in women. Perimenopausal women will have a different healthy hormone profile.

Cortisol affects all of the other hormones so when we are looking at testosterone for example we must also assess the role cortisol is playing. Cortisol is anti-inflammatory. It manages immune function, blood glucose, energy and metabolism. Depending on the pattern there are several nutraceutical grade supplements that can balance cortisol. Adaptogens are not always the answer. In Functional Medicine we use the phrase, “why guess when you can test?”

Progesterone balances estrogen and also is protective of brain, bone and heart health. It’s essential for menstruation, fertility and pregnancy.   Estrogen dominance is when progesterone is low in relation to estrogen. Increased consumption of healthy dietary fibres can improve estrogen elimination. Phytoestrogens like flax seeds are excellent because they block xenoestrogens from accumulating in the body. These are prolific in our environment especially if you use any conventional beauty care products or have plastics in your kitchen.

Melatonin is often thought of as the sleep hormone. It’s secreted from the pineal gland and regulates the sleep-wake cycle. Its lesser known that melatonin is an anti-inflammatory and antioxidant. It works with serotonin. Adequate sleep is important for reducing pain and cravings. These are actions of serotonin. Micro dosing melatonin can see better results. Trytophan or 5HTP can support serotonin.

Medications like opioids, steroids and Accutane can damage the endocrine system.  For example, a common acne medication is known to destroy cells in the hypothalamus.  Another example is thyroid medication at too high of a dose can cause increase total cortisol.  Its important to do thorough testing and if you need to take a medication please have it monitored.

Other Safe supplements for balancing common hormone imbalances include nettle, broccoli sprouts, food high in zinc, inositol, fibre from whole foods.  Nettle works on the increasing androgen metabolism down the 5a reductase pathway which is good for anyone with PCOS like symptoms. Broccoli sprouts contain a chemical called sulforaphane. This is one of the most potent antioxidants and detoxification substances that we know of. Inositol balances blood sugar which at the root of many hormone issues.  Zinc is often deficient and can be found in oysters, pumpkin seeds, spinach and a variety of pastured meats.  Fibre from root vegetables, flax and chia seed and gluten-free supplements can help clear excess hormones.

Treating PCOS Effectively: What is the Real Cause?

Treating PCOS Effectively: What is the Real Cause?

What is PCOS and why should you care?

Polycystic ovarian syndrome affects 10% of North American women in their child-bearing years. It’s the leading cause of infertility and is on the rise. Syndromes are a group of symptoms that conventional medicine groups together.  PCOS is more of a pattern than a disease. Cysts on the ovaries are not always present. Acne, irregular cycles, weight-gain, facial hair growth and loss of head hair can be part of the presentation.

The Underlying Cause

Blood sugar plays a huge role in PCOS. Insulin is a hormone and it helps regulate sex hormones. PCOS is really an imbalance in hormones.

Stress has a huge influence on all our hormones. Environment also is a key factor, more than genetics even. Genetics express if triggered by an exogenous factor so we are back at lifestyle, nutrients and yes meditation. The habits that lead to blood sugar dysregulation are not genetics.  These are choices that we can change  PCOS is an epidemic and there is a lot we can do as far as education to influence this.

Insulin Resistance & Female Hormones

Insulin pulls sugar out of blood and escorts it to our cells. Eating refined foods means our bodies will stop responding to the massive overload that hits the blood at once.  Fibre in whole food is really protective on so many levels and this is one of them. The pancreas will continue to produce insulin despite high levels accumulating in the blood because insulin is overwhelmed and not responding. So now we have high sugar and high insulin in the blood.

FSH and LH are two important female reproductive hormones that are affected by insulin directly. Then in turn these affect progesterone and estrogen.  We have so much more control than the medical model suggests in terms of understanding how an individual is adapting.  Comprehensive hormone testing that includes metabolites of progesterone, estrogen and the androgens including testoterone.  Looking at blood sugar levels in at least two ways is also important.  A diagnosis can be helpful but only if the patient feels like she has options and is in control of her treatment.

Weight Gain is a Cause? Or a Symptom?

Old school doctors will tell patients to just lose weight. The problem with this is how? By any means? This will likely exacerbate the symptoms because the majority of weight loss measures promoted are extremely problematic.

Plus weight gain is not the cause! It’s a symptom. Yes weight gain, inflammation and other factors are part of the vicious cycle of insulin resistance and PCOS. But keep in mind certain hormonal imbalances make it very difficult to lose weight.  So what works for most people won’t make a dent no matter how hard a woman tries.  This is insanity.

A few important steps anyone can take to regulate blood sugar are:

1. Eat enough protein: our body has an innate stop button when it comes to protein. You will know when you’ve had enough. When we are nourished with longer burn foods, we don’t crave simple carbs and sugar.
2. Root veggies: get your carbs from the veggies that grow below ground. These also have a longer burn, are packed with vitamins and support the health of your colon. This is where we eliminate excess hormones like testosterone. Another problem of refined food is that it results in poor colon function and these hormones will be reabsorbed and recirculated.
3. Clean up all your beauty products especially beware of scents. Look through your cleaning products too. Our detox system is burdened by all of these and make it harder to eliminate hormones. They are full of xeno estrogens (xeno is bad). Stay away from plastics as much as possible.
4. Eat more healthy oil and fats. Omega 3’s are especially important. Studies show that androgens are lowered by diets higher in omega 3’s. They are also anti-inflammatory meaning less pain.
5. Chromium helps regulate blood sugar. It can be found in a variety of foods including grass-fed beef, eggs, broccoli and sweet potatoes. Most of us are deficient. Cinnamon regulates blood sugar too. Yes, food is medicine!

Conventional medicine has lost sight of prevention and treats PCOS as though it’s a disease that needs life-long medication. Birth control and metformin are often prescribed.  What is needed is a deeper look at what’s going on. In fact there are many ways to address PCOS that are natural.