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.
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.
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.