Supplements for Insulin Resistance

Welcome to Everyday Wellness podcast. I'm your host, nurse practitioner, Cynthia Thurlow This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives This is Bonus Monday, your most downloaded favorite podcast. I love that this community runs the gamut from medical professionals, research scientists, science writers, personal trainers, and more. These are your favorite, most loved podcasts of the last five years. I could not be more proud of The diversification of guests that appeal to all of you. Thanks for tuning in Today I had the honor reconnecting with Chris Irwin We recorded earlier last year on episode one hundred seventy five. He's a nutrition researcher, writer and educator, specializing in low carb dieting for metabolic health and human performance He's the author of Keto Answers, one of my favorite Keto resources to recommend to clients. And he's also the chief markarketing offfficer at BioCoach. Today, we dove into differences between micro and macronutrients, therapeutic uses of keto, low carb, herermormesis, and carnivore diets The role of metabolic health, the value of protein. Balancing longevity and sarcopedia What happens when you over fast Orestrict and create too much stress on the body. We dove deep into listeners' questions, including answering The role of low carbon ketogenic diets and the net impact on cholesterol panels. low carb keto and endurance How to troubleshoot with digestive distress The role of protein excess favorite gadgets and supplements. I hope you will enjoy this podcast as much as I did recording it Chris, it's so nice to reconnect with you on the podcast Yeah, thanks for having me on today, Cynthia. It's been what, I think the last time we spoke was like right before your book launch, right? That was the last time Yeah Yeah. it's hard to believe that book has been out for two and a half months. and The last six months have been so wonderfully chaotically busy that I'm kind of excited to be going on vacation with my family in exactly two weeks from tomorrow and I'm gonna just disisconnect forewarning my team, completely disconnecting But I wanted to bring you back because you're such an incredible resource talalking about the value of keto and low carb diets. And I know last year you had a carnivore cookbook that came out. and so I'd love to kind of start our conversation today talking about some of the therapeutic benefits because I think a lot of people, when they think about carnivore as an example, they're like, oh, I know it's anti inflammatory and I know it can be beneficial. And obviously, I did straight carnivore for nine months after being hospitalized because my body literally could not handle anything else but really starting the conversation and talking kind of broadly about some of the therapeutic benefits of these diets Because it's not just about weight loss. I think that's unfortunately where people like focus their energies, but there's so much beyond the obvious that really can be very, very therapeutic. Totally, yeah. And I think so I guess to kind of start, we can go a little bit broader and just say like low carb diets as a broad category. and then we can kind of get down into the specifics of like keto and carnivore Each one of them does kind of offer its own unique benefit, especially therapeutically. So you I think when it comes to low carb diets, the weight loss portion, it is a big piece of the puzzle, but it's not the only piece. But you know we do know that you know body weight is and body fat, I guess I should say, is a really big predictor of a metabolic disease. It's a big predictor of a lot of different chronic diseases. So if you're losing weight know, you're inhntly going to be reducing your risk of a lot of chronic disease. But you I think a lot of times that's a little bit too reductionist of a view on things. know there's obviously different ways you can lose weight, some are much better than others. You know you can go super low calorie and eat essentially no nutrients and lose a ton of weight and also lose a ton of muscle and not be healthier or you can, do it the right way, maintain muscle, burn body fat, have a really micronutrient rich diet, and be healthy with the weight loss. So the weight loss really is just kind of I really look at it as almost a side effect of a low carb diet. I think when you're following any sort of low carb diet, you are restoring your metabolic health. and that's really where it comes in as it relates to chronic disease and the therapeutic application of it. know If you look at all of our most common chronic diseases we're looking at cardiovascular disease, diabetes, metabolic syndrome, cancer, and then even some of these, you know, neurodegenerative diseases like Alzheimer's and Parkinson's and things like that. All of these diseases are if not caused by they're at least rooted in metabolic dysfunction or impaired metabolic health, which kind of really breaks down to if you really want to simplify it, it's blood sugar being out of whack, it's you chronically high insulin levels. It's triglycerides being, you know all over the place and our cholesterol not being at the right ratio or with the right type. Kind of all the hallmarks that you think about when people say metabolic syndrome, which is kind of a little bit too broad But all of those things are kind of what's roped into about ofk health. And when you look at any of these diseases, you see that something's off, and usually know, blood sugar and insulin, I think are kind of the two biggest ones. And you know especially if you look at diseases like type two diabetes where it's very common for people to, you know, if they start off with prerediabetes or type two dietes, it's very common for them to get secondary, you know, third fourth, fifth, chronic diseases that will kind of add on to the type two diabetes. It's really common for cardiovascular disease to come into play. So it's really no secret anymore that these areas are really important when it comes to our health. And that's kind of where a low carb diet shines is that, you know, if you are not metabolically healthy. If you're insulin resistant, your blood sugar levels are always high. You have chronically high insulin levels, then you don't metabolize carbohydrates very well. And in fact, if you continue to consume them, you kind of further exacerbate these problems. You kind of continue this cycle of spiking blood sugar and raising insulin and all of kind of the downstream effects of that So simply put, when you follow any low carb diet, you're cutting out the kind of the main problem. And it is only one of the problems. We can kind of get into some of the other things too, but you're cutting out a major problem. And know a lot of people like to argue that and say, okay, you it's not carbs that cause we'll take diabetes, for instance or just insulin resistance kind of more generally speaking. They'll say carbs don't cause insulin resistance. It's X, Y or Z All of that may be true, but I think rather than getting wrapped up into the chicken or the egg, it's like what actually works for these people and what doesn't work. And we know that putting people on a carbohydrate based diet when they're dealing with metabolic disorder, it's kind of setting them up for failure. They don't see progress very quickly. If they do see progress, it usually means that they had the calories back really far so they're consuming a really low calorie You know, low protein diet, which inherently is going to be lower in micronutrients. you're just not getting as much opportunity to get those things in. So it's, you know, it just doesn't really make sense to go that route. Low carb, it kind of it gets a catchall for a lot of these issues. att least at the start, right? There's, I don't think that anybody dealing with a chronic disease has to necessarily go low carb forever, but it's a great way to kind of get things kicked off, get that blood sugar back in check Get those insulin levels back in check. And then from there, you know, you can adjust the diet and go different directions. know Maybe you go even stricter into something like keto or cararnivore or maybe you, you know go like carb cycling or you know, you do a little bit of I'm a big fan of Jessie andaspe with her new book that just came out where she talks a lot about just different hacks that you can use to, you know, even while you're consuming carbohydrates to kind of reduce your blood sugar spike Those can all be great things. But you're really, if you're kind of at like that peak of insulin resistance, you know none of those things are going to be all that effective until you get that back in check with a low carb diet. And I think the thing that's fascinating and most interesting and encouraging for people is that you can see dramatic improvements in a really short period of time, you know with fasting, with keto, with carnivore you can see improvements in your fasting blood sugar, which is a huge marker that we use, maybe not as important as we make it out to be, but it is a really big marker of metabolic health. You can see improvements in a couple of weeks in that area. Same thing with insulin. know A one C is the number that we see improvements in in a very short period of time. So I think to me, that's exciting because I know a lot of times peopleeople either think that, hey, it's going to be really quick and easy to solve this problem or it's going to take forever. And it's not quick and easy but it is a lot quicker than what, you know, some people let on. So that's why I always like to take that approach. I think you know, most times if you're dealing with some sort of chronic issue, if you're able to start with cutting out carbs, you're going to be able to create space within your health and within your lifestyle to kind of start making continuant improvements. So I really like that to kind of be like the baseline for a lot of people who are trying to use nutrition as a remedy for chronic disease. Well, I think you bring up some really excellent points. I mean, obviously my whole background in cardiology and You know, I got to a point where I had prescription fatigue because so many of the issues I saw in my patients, you know, worsening diabetes, you know, increasing vascular disease, et cetera. Yeah, maybe I could control symptoms, but we weren't really fixing the problem. And in a lot of ways, we've led patients to believe that every symptom necessitates a prescription medication We've also not prioritize talking about nutrition with our patients. and so My mindset has always been it all starts with food, and yet, you know food can be such a therapeutic modality. And unfortunately, I think a lot of people fear when you say low carb, they're talking really, you know like under thirty grams of total carbs. And I always say, listen, if the average Americans consuming two hundred to three hundred grams of carbs a day, average, getting you under one hundred is going to be an effort but it's not something that's not going to then not be sustainable. And so I think when people start eating more nutrient dense whole foods, and by that, I mean whether you're going low or carb is a starting point you're eating you're eating carbohydrates from nonstarchy vegetables and loowlycemic berries and maybe you are carb cycling. and so maybe you have squash or sweet potato, you're getting away from the processed carbs, the ones that get us into trouble because even with as diligent as I am If someone gives me gluten free bread at a restaurant, I have to like work very hard not to eat it because one piece becomes two and you slather it with butter, and all of a sudden, you you're derailing all the hard work that you do, which is not to suggest we're not encouraging people to find some degree of moderation. But I think it's also important to kind of identify that each one of us may do something a little bit differently, but moving towards a lower carbohydrate diet, especially with the degree of rampant metabolic inflexibility and poor metabolic health that we're seeing. And certainly, I presented at an event in Salt Lake in April. And when I was looking at the statistics over how much weight people have gained over the during the pandemic That's pretty significant. I mean, most people gained anywhere from fifteen to twenty pounds, but there was even a fairly good percentage of people that had gained more than fifty because it was a time when a lot of people felt powerless. and there were many people that were finding solace in food Yeah. It certainly a really kind of important starting point for our conversation. You know, you touched on protein. And I think this is probably for me the macronutrient I talk about the most, probably secondary to carbs, but really emphasizing for people not to fear protein. Now when you have people that come to you because your moniker is the ketologist, and I think there's this misnomer or misrepresentation that if you're eating keto, you're not eatingough protein. And that really hasn't been the case for me. What I typically see is people eating too much fat Fat is delicious, right? Right. Whether it's avocado or nuts or cheese or whatever it is that people are indulging in Let's touch on the value of protein, why that's so important? And then maybe we can dovetail into talking about some of the research And we're not all in agreement on this about longevity versus sarcopenia, the muscle loss with aging, that I find really fascinating and how we can kind of bridge the gaps conceptually on these topics Yeah, it's a great question because it's kind of been, I mean, ever since I've been in low carb in the low carb space, this protein conversation just keeps coming up. And there's a lot of disagreement. And you know, actually just the other day, I had a friend from back home text me and he's just started a keto diet and he was saying he's like, oh, I'm having a really hard time hitting my macros. And I knew when he said that, I knew what what the problem was. I knew is that he thought he needed to eat a lot less protein And he was because he's a guy he hunts, you know, so his fridge is stocked up with all kinds of, you know, deer and, you know, the local beef and everything like that. So I ask him I say, you know, what' you going out the macroros? What are you having a hard time with? And He goes, I'm not getting enough fat and I'm getting too much protein. I was like, well, send me what your numbers are becausecause I knew he was tracking. And he was like thirty to thirty five percent protein and like sixty to sixty five percent fat. And I'm like, dude, you're perfect.ike, don'tange a thing. You're crushing it. know And he's also a guy who works out a lot. So there's kind of a demand for it. But you know, the fear of protein, I think, it kind of is two foold Generally speaking, I think there's a fear of protein from, well, kind of a bigger picture. and what we'll get into this later is the longevity standpoint, But that's not really why most people fear. So we'll talk about that separately. But I know there's kind of this general assumption that protein's bad for our kidneys. I remember like when I was growing up going to my pediatrician and wanting to start drinking protein shakes and her saying, Oh you don't want to have too much protein. It'll be damaging to your kidneys. And you know, I was never really one to take kind of standard advice on things, so it didn't really stop me. But you know, it's kind of this idea that it's bad. And if you look at the research on it, it's very clear that even if you have damaged kidneys, you can still tolerate a good amount of protein. You do have to be a little bit more careful if you have like a kidney disease or if you're suffering from something in that area. But for somebody who's healthy, you know, that's fear of protein for that sake it's just not there's no reason for it. But then kind of the bigger reason why I think there's a lot of fear of protein in this low carb keto space keto especially is this idea that if we have too much protein that we're going to be converting that protein into sugar. gluconeogenesis is kind of the famous sciencey word that people like to throw around. It's a real thing, you know It's a process that does exist in our body. It's a process that takes amino acids which are what's found in protein and it converts them to glucose. And you know I think the idea, because logically it makes sense is that if we consume too much protein, that we will then have too much amino acids in our blood and that those amino acids will have to be shuttled to something and that it willll get converted to glucose. And I think a reason why people who test their numbers may kind of they'll test in a way that almost agrees with this because they'll test right after they eat food and they'll say, o That was a pretty protein heavy meal. I saw an increase in blood sugar, what's going on there? But if we look at the research, it's also pretty clear that this is more of a and I love this phrase gets thrown around all the time, but it's a really great way to look at is that it's a demand driven process and not a supply driven process. So just providing more amino acids from a supply perspective is not going to increase rate in which we convert it to glucose. But if there's a demand for it, it will. So this is the reason why your blood sugar doesn't go to zero if you don't consume carbs, right? You can consume a zero carb diet. your blood sugar never goes to zero. And there's a reason for this. We need to have there's certain cells in our bodies like our red blood cells and even portions of our brain that are better on glucose. So we need to have glucose available for those We also need to have glucose available as a reserve for in case there's you know the fight or flight, like we need energy right now. Our body is way quicker at metabolizing glucose or sugar versus like fat and ketones. So you we take it in and we can use it really quickly if say, you know, this is kind of a little bit more evolutionarily speaking, but if we need to run from something right, run for our lives But even in our lives today, if we're really stressed about something, you know, be having a glucose source to pull from, so we don't go hypoglycemic and start getting the shakes in a stressful situation, right? Those are all kind of So it's a good thing that we have this. But the research is very clear that even in the most metabolically damaged people, so you look at like diagnosed type two diabetics and there's studies where they give them massive amounts of protein, like fifty, sixty, seventy grams of protein per feeding, which is a lot, eightight ounces of meat is, you somewhere between like forty and fifty grams. It's a lot of protein. And And even with them, we only see maybe a modest increase in blood sugar in a group that we would expect to kind of see some blood sugar dysregulation. And so the fered really doesn't match up. And I think for anybody who is testing, you know, they're testing their blood sugar right after they're eating, you're going to get some sort of post parenial blood glucose response with most things that you consume, even if you were to just have a ribeye steak That's super fatty, you know, it's just protein and fat, you're going to see some response there. Really, it's like unless you have a really small amount of fat, you're going to see some sort of increase in blood sugar typically, you know, from consuming anything. So I think a lot of times we kind of test in a way that like makes us think that, hey, this actually is going on. We're seeing this increase from it. So you know putting those two things aside, like you know, those are the reasason why we have this fehere of protein. That's why so many folks are eating you know, fifteen percent, twenty percent, which is also kind of what's recommended on a keto diet. Like if you so go on Most of the major websites we're looking we're seeing protein at fifteencent to twenty percent. And a lot of physicians will say, well, hey, that's actually really high protein compared to the original version of keto, which was like ten percent protein. But then what we have to think about is what's the application of this, right? So the original application of keto was for pediatric epilepsy And it was, you know, they really need to be in a deep state of ketosis. There wasn't as much of of maybe a need for protein. And they just knew that that worked, right? Being at ten percent protein was effective for that But then you know this twentycent to twenty five percent recommendation didn't really come from anything too much, right? There wasn't like somebody sat down and did a big randomized control trial and said, hey, twenty to twenty five percent is like where we should be for a keto diet when it comes to protein. But for some reason this is taken on. and if you go online, you see this everywhere. And really, I think it's a problem You know, one, and we'll talk about the benefits of protein. protein's so beneficial, but it, you know, a generalized recommendation like twenty percent to twenty five percent doesn't take into consideration what somebody's goals are For somebody who's exercising, and there was a great study published a couple of years ago on this where they had men and women resistance training following a standard keto diet I think it was twenty five percent protein. And they were resistance training a few times a week. and they lost muscle, especially the men in the group, they lost muscle. And this is something we don't want, right? Like you mentioned Sarcopedia, we'll get into that a little bit later Muscle is really important. Even for somebody who thinks you don't wan to gain muscle, you do wan to gain muscle. Everybody needs to have muscle. It's metabolically active tissue. It makes you know we talked about metabolic health at the beginning of this. It makes you metabolically healthy. Getting enough protein is essential for this. So we don't w to be losing protein. And you know, if you're exerc like for somebody who maybe you're living a sedentary lifestyle You're not eating you're not like getting a lot of exercise in, you're not putting a lot of physical strain on your body. Maybe the twenty percent to twenty five percent protein may work for you, right? That may be something that would align with what your goals are. But since most people should be exercising and I think everybody can benefit from resistance training, then that just really isn't going to cut it. You know, outside the muscle loss, you're also talking about You know, just poor recovery from the gym. so maybe going to the gym one day and now you have a hard time getting back the next day because you're so sore. But then, you know, even outside like we're talking about performance, but then there's the just lifestyle component. like, you know I can't tell you how many times I've talked to and usually this one's with women because it's kind of a double where it'll be low protein and low calorie and they'll say, you know, oh, their mood is just really bad and they're having really bad anxiety and they don't know why And you know, you look at their protein intake, and it's like,, well, you're consuming about sixty grams of protein a day. Let's bump that up a little bit and see what happens. And so often I see just that small change alleviating a lot of those issues. So And then I think the other thing too, if you look at a little bit more practically, if you're consuming a quality source of protein, which in my eyes is red meat. I think fatty fish is good too And there's some white meat that has its pros and cons. but I think the kind of the gold standard best is red meat from you things like bison and beef and know elk, any rumin an animal like that. This is also really nutrient dense. So when you prioritize that food, not only are you getting protein, but you're getting everything that comes with that protein, which is all of the micronutrients, the quality fat cholesterol, saturated fat, things that we're also afraid of that we need. And you're getting them in a form that is more natural. It's kind of in a form that like the ratios are beneficial to one another, and you're getting it in a form that's more bioavailable or more easy for you to digest as a human. It's kind of more aligned with our biochemistry. So you know there's also that side of it too that like if you're eating low protein and it's not just that that one macronutrient protein is low, it's also likely that all of your micronutrients are going to be low and your quality fat intake is going to be low And this is where, you know you see a low carb diet where , they're doing a lot of added fat, right? You're putting a lot of oils and stuff like that onto your salads or anything like that. Like know some of those things are fine, but that's not going to bring as much benefit as like a fatty ribbeye that has all of these micronutrients in it, right? So you're much better off getting all of that from a whole food protein source versus adding it in other ways Something I hear constantly from women in our community and something I understand personally is this Nothing about your effort has changed and yet our bodies are responding differently Your midsection feels different. your blood sugar is much less stable and your cravings may have shifted. And let's be honest, your energy probably isn't what it used to be As a nurse practitioner with over twenty five years of experience, I want to be completely transparent with you about why Estrogen is one of the body's master regulators of metabolic health. It influences how we store fat, how our tissues respond to blood sugar changes, and how efficiently our metabolism functions at the cellular level Eestrogen shifts during perimenopause and menopause, the same lifestyle choices, diet, exercise, sleep, genuinely do not produce the same results. This isn't a failure of effort. It's a precise biological transition, and most solutions don't address the root causes. That's why I want to tell you about might acute hormonal metabolic control It's formulated with S equL, which is a highly bioavailable phytoestrogen that supports healthy estrogen signaling. We know that eighty percent of women cannot produce S equL naturally because it requires specific gut bacteria most of us just do not have This formula bypasses this entirely. It also includes a particular bacterial strain B breve, which works via the gut hormone access to support estrogen pathways and help ease occasional bloating program to support healthy blood sugar balance This is a targeted cellular support for the transition we are all in and it's designed specifically for women in perimenopausea menopause and built around what actually is effective Go to wWW dot mitoQ d. com slash Cynthia and get ten percent off your first order Again, that's m IT oq dot com slash Cynthia to get ten percent off your first order I think you bring up a lot of really good points, but one thing that I really want to illuminate is the Kind of phenotypic and this is just a woman north of thirty five who is over restricting her calories, likely over exercising, probably over fasting. And I'm starting to see this type of woman so consistently that I'm literally every guest. I just spoke with Rob Wolf last week and we had a conversation about it too Because it's such a problem because you these women are developing these really broken metabolisms. And I've now taken on co hosting duties of the IF podcast Melanie Avalon, which has been great because it's a totally different format. And a lot of the questions that are coming in, it's evident, these are women who don't even realize they're chronically under ereatating They're over fasting, they're probably over exercising. I'm not sure what's going on with their sleep. And so are you seeing the same phenotype with greater frequency? I think it's people who are well intentioned, but they just don't realize like over time you can't be in a deficit all the time. like you actually whether it's carb cycling or I use the word refeding, but it's not like you eat everything in the world on that day. but maybe you're having a wider feeding window, but I'm starting to see this happening more with women because they're a little more open. I'm either not hungry for a second meal. It's what I hear or You know, I like my OMAad and I don't want to deviate from that. And so I always go back to the same thing. Can you get your macros in In your feeding window. And don't I can't think of any women that can have one meal and get one hundred grams of protein in. And so they're chronically kind of in this state of deprivation in a negative way, not in a positive way, like okay, I've reduced my chloric intake. I've adjusted my macros. I'm not overe exercising, but when I'm starting to see these women that are living in this chronic state of deprivation Yeah, and I am seeing it a ton too. and it's I think the reason why it happens too is I think for the longest time, you know, the talk was calories, right? It was all about calories. Cut your calories low, you know, eat less, move more, makeake sure you're exercising a ton. And I think a lot of women took this advice so that, you know, at their baseline, they're already exercising a ton, probably doing a lot of cardio probablyably not doing a lot of resistance training and then they're also eating low calorie. And then you know, what ends up happening is that it doesn't work. surprisingly, this calories in versus calories out sole approach isn't really all that effective. And you see a lot of women who, you know, hey they' not eating, they're eating super low calorie, they're exercising a ton and they're still not reaching their health goals. They're still not reaching their weight loss goals. So then something like intermittent fasting comes along and they say, okay, well, let me try intermittent fasting. So they add intermittent fasting to the mix. and now they're eating even less calories. And you know to be honest, our bodies are super adaptive. so we will adapt to Like, you know, it's not if you eat really low calorie for a day, yeah, you might be really hungry. But if you eat really low calorie for months, you will adjust and your body really won't have a lot of hunger. and you'll end up being somebody that you can do OMAad and you know, it's really easy for you to do and that may make it feel natural. And then so you know, now you've added fasting to the mix and then somebody tells you that fast exercise is great. So now you're doing those two things together You know, then somebody says that keto is also great. so maybe I should do that. And then OMAad's even better than fasting, so I'll cut it back to even just one meal a day. And it's just a cycle that gets worse and worse. And to your point, yeah, you end up with this you're super calorie restricted, which is a massive stress around the body. And know if you look at the research on calorie restriction, we know there's absolutely benefits to calorie restriction. There's plenty of good to come from it But chronically doing it is where the problem really arises. And the micronutrients side, I think is the biggest reason why. L energy like yeah, energy is a big component, but our bodies are pretty darn good at tapping into our own energy sources. You know Even if you were consuming a higher carbohydrate diet that was really low in calories, we would still expect you to be tapping into know, your body fat and producing some ketones a little bit just due to the calorie restriction. And you know we know even the leanest people out there have like twenty to twenty five thousand calories stored away in fat. So from an energy perspective, like we can get away with it. But like you said, can you get your macros? Can you get your micros in during this time when you're doing OMAad or fasting or just calorie restriction And that's I think, what's happening is is not only are you calorie restricted, but you're micronutrient restricted because you just can't possibly get enough in, right? And mayaybe you use supplements and things like that, but we know that one, supplements maybe depending on the supplement, aren't as well absorbed or well utilized in our bodies as they are consumed in the whole food form. So I think that's obviously an issue, or they're just completely useless in general, right? Like some synthetic vitamins and things like that are just nowhere close to being what we would find them in the whole food form. I think that's kind of the biggest issue with it. So I think it's important for us to, we don't want to throw the baby out with the bathwater, right? Like calorie restriction can be beneficial. And if you want to calorie restrict for a couple of weeks, I think that's fantastic. But what you need to do is you need to know that there is a period where now I need to go into maintenance, not maintenance. I think a lot of people hear maintenance and they think, oh, that means I'm not losing any more weight or I'm not going to be progressing towards my goal. Maintenance just means bringing up your calories out of being restricted, right I mean, there's a lot of studies. There was a really cool study years ago that showed you after a keto diet, coming into like a Mediterranean style diet where they increased calories a little bit. and they actually continued to lose weight even during that phase. Now they did lose it at a slower rate, but they were still losing weight during that phase. So maintenance doesn't mean that you're stopping your progress. It just means that you're coming out of that calorie restricted state And then I think even eating in a surplus is beneficial for folks at certain times, especially if a surplus means consuming quality food right? Like a surplus of donuts is not great. a surplus of steak and organs and eggs and things like that. It's fantastic, right? So I think you know, that's another thing to take into consideration. But the besides so you know, you have the micronutrients, you have the lack of macronutrients, your're calorie restrictive, but then it's the stress that gets put on the body too. So you know all of these things are acute stressors. Even a low carb diet can be an acute stressor. ketosis can be an acute stressor And it's a stressor in a way, like we talk about hormesis, That's another popular word that's being thrown around now. Hormesis, it's kind of like the stress that you experience during exercise, right? With you're lifting weights, It's stressful, but it's a good stressful because your body adapts. That same kind of thing is happening with calorie restriction with low carb dieting, with any of those diets where you're kind of restricting some aspect of your nutrition And this is a good thing because our body adapts, but we can't do it all the time. just like you can't exercise all the time, right? If you were to just lift weights every single day all day, you would get to a point where it wouldn't be beneficial. It would actually be harmful to you. And this is what's happening on the nutrition side too. So I just recommend for like anybody out there who's doing it, just know that it doesn't you don't have to go that far to see progress. I think that most women, if they would instead of even thinking about calories, if they were to just focus on quality protein intake, eating whole foods, you know, and then if you like the fasting thing, I'm a little bit torn on. I think fasting can be great from like a lifestyle perspective. I love fasting for like the mental boost, but I realized a couple of years ago when I was fasting and not tracking that like I was eating a really low calorie for a long time and I didn't know that. So I had to kind of decide when it was appropriate for me to fast and when not to fast because you know, at my size, I can't be eating one thousand five hundred calories a day for, you know a year straight, right? Like that's going to be harmful to my health at some point I think if you were to just focus on those things, intermittent fast, as far as it allows you to be able to still get an appropriate amount of calories in, get an appropriate amount of micronutrients in, hit your protein, everything like that, then that can be beneficial. But you know we don't have to hit everything. We don't have to do all of the things and put all the stress on our body. You'd be surprised what your body would feel like if you put it in a state of abundance and you actually provided it withith all of the fuel that it needs to perform optimally, and then you know you may notice to, hey, I'm actually crushing it in the gym. A lot of these other symptoms that I thought were kind of a symptom of you know my body composition or other things were actually just related to like my nutrition intake. And all these things start fixing in themselves and you realize they're like, wow, I was able to do this without having to hate my life, which I think is pretty important No, I have to agree and, you know, the term hormesis, which I talk about a lot, you know, beneficial stress in the right amount at the right time This is why I've started doing more conversations like this where You know, each one of us are bioindividuals and even myself, like I have a minimum threshold of fifty grams of protein when I eat a meal Like I just had a very large chicken breast. I don't eat a lot of chicken, but we grilled chicken over the weekend and I had that with a bunch of peppers and onions and I had some homemade guk and that was my lunch But it's also the understanding that For me, the threshold is always one hundred grams of protein a day. However, I have to get that in. But I also acknowledge like I have at least one day a week where I will have a twelve hour feeding window. and my kids think it's bizarre, but I will like sit with them and have breakfast and then, you know we may or may not eat lunch together, but we all eat dinner together on the weekends. and it's reminding my body I'm not starving. So if you're listening to this and you've been doing fasting twenty four seven for several years, you probably need to take your foot off the accelerator and you may need to do some degree of I hate using the word refeeding because it gives this negative connotation Yeah. or even You know, you talked about maintenance mode, but I think about reverse dieting and really it could be that you're having a hundred additional calories per day of protein. Like it's really a small amount, but it's slowly kind of monitoring And for anyone that's interested, I did a podcast with the Mana Nyberg earlier this year talking about reverse deting. But I think it's important for us to know like we don't want to be in ketosis twenty four seven. We don't want to be rigidly dogmatic because I think if people have success with one particular paradigm, whether it's keto, low carb, carnivore, pescetary, whatever it is, people assume that's the only thing that they can do. And I encourage people to change things up. like whether it's exercise or you know, how you're managing your stress or your eating schedule, like you definitely don't want to be doing the same thing or the fasting schedule all the time. You want variety in your life. It's very important. Our bodies are very smart. and they need to have some variety because that's actually how you get stronger. You don't get stronger by doing the same thing every single day Mhm. Yeahah. And I think too to like add to that is You know When we think about nutrition a lot, I think we always just think about what we cut out of our diets. It's like don't eat this, don't do that, don't eat during this time. But what we put into our bodies is equally important, right? And that's where some of these more extreme you know, OMAad and things like that can be difficult because you're not allowing yourself sufficient space to be able to, you know provide yourself with enough of those nutrients. So I think that's That' kind of something that we need to think about. And on the refeeding side too, I think that was you brought up a good point there, adding in the protein. know, because I think one component to calories, especially for people who have restricted calories for a long time, it's a mental barrier to increase them, right? If you've been restricting them for a long time and you're tracking them and you know, hey, I typically only eat one thousandteen hundred calories, and that's all I've been doing. there can a mental barrier for a lot of folks where it's like, wow even going to fif thousandteen hundred calories, that seems like I'm going to gain weight. I'm going to get fat, likeike I can't do this. So if you're kind of dealing with that, St with protein specifically because one, the protein is, you know, we need more of it anyway and if you're calorie restricted, you're probably not getting enough. so that's important. The other side of that too is that there was some studies done earlier, probably been about ten years or ago now where they did massive overfeeding of protein, where they were just just crazy amounts, like past what somebody's like calorie limit would be, where you would expect them to gain fat and they didn't gain fat, which I think is super interesting, right? So one of the things we see about protein is it's really hard to gain weight on when you just add protein in, even from you if you're consuming more calories than what you were used to. So I think for a lot of people If you're kind of dealing with that mental barrier and you're not sure like, you know, hey, if I increase this, I'm worried that I'm going to gain fat. startart with the protein, increase it there, and then kind of see that, hey, actually I think you'll notice that you feel better, but then also you'll just kind of see that like, hey adding another hundred, two hundred, three hundred calories into my diet is not going to cause me to get fat. And then now maybe you can kind of start to add in some other, you know, maybe it's more fat mayaybe it is a little bit more carbohydrates too, depending on what your goal is I think it's such an important point and it's really a degree of experimentation and as much as I'm someomeone that doesn't purport that people be a slave to the scale. If you are going through a reffeeding, you probably want to be doing measurements, kind of staying on track or staying attuned to changes that you're seeing in your body Now I got a lot of questions from people on Instagram when they knew that we were connecting. And one that I heard multiple times was there's a fear of eating low carb or keto because they have quote unquote high cholesterol. And I wasn't able to get them to delineate. It was it didid they have elevated triglycerides or HDL? But I suspect it's the total overall cholesterol. And for anyone that's listening know working in cardiology, a lot of the medications that I was prescribing were very strong specifically to addressing cholesterol. And so we don't want our cholesterol to be too low. It's actually a predictor of morbidity and mortality. And I want you to think high level, when we're talking about cholesterol, what gets cleaved from cholesterol? What is created from cholesterol? We're talking sex hormones All of the men that were on these really high, you know, max doses of statins that had a total cholesterol of one hundred to get their LDLs really low really you know, within this specific range all ended up having issues with erectile dysfunction and just not feeling very motivated and you know, they were sarcopenic And we're wondering where all these things come from. So what are your thoughts when someone expresses concerns about being on a ketogenic or a low carb diet and noticing that their total cholesterol goes up Yeah, it's a great question. And I think like you know this is one of those other like most common fears against the diet, right? Because the whole reason why keto was crazy in the first place is that it was a high fat diet. And there's this assumption that consuming dietary fat is going to increase your cholesterol. And so I think there's a few important things to point out. You pointed out one of them, which is that most times people are referring total cholesterol, which is just notot a full picture of what's going on with your health. You know total cholesterol doesn't take into consideration HDL versus LDL, which I will not call good in bad cholesterol because that is not true. You can like too much you know HDL is always called good, but too much HDL is bad. LDL is always called bad, but know too little of LDL is a bad thing. So know, I won't refer to that, but there's two different types of cholesterol that make up total cholesterol. and when you're just looking at that number, you're not getting a breakdown of that. But even if you are getting a breakdown of that, there's a couple other issues with that. Sometimes what willll happen is the doctor will only calculate HDL and then they will calculate LDL just based off subtracting that from total cholesterol, which is not very accurate. So that's one issue with it. And then the other one is that even if you are calculating LDL, you're not looking at particle size So and this is something there's way more, you know you're more educated in this area. and's probably tons of folks on this podcast are much more educated in this area. But particle size matters for LDL. LDL as a whole is not a reliable predictor of cardiovascular disease. But with that being said, this is something that we typically are looking at, right? This is a blood marker that's always getting measured, this cholesterol, wh whatever ske of those numbers you're getting from your doctor. you're always getting those things tested. So it's a legitimate concern. And you know, we see one of two things typically on keto. We'll see some people will start keto and their total cholesterol will drop, which is it's usually kind of LDL dropping down. Maybe it's a slight increase in HDL or maybe HDL dropping too if it was already high, but we'll see a drop down. and most people say, hey, that's a good thing But then there is this occurrence where we'll see total cholesterol go up. And this is where the fear comes in says, hey, I saw my total cholesterol go up based on what the doctor's telling me, they're going to put me on a statin or you based on what the research says, you know, this puts me at increased ris of cardiovascular disease. But I think there's kind of two things here within that subcategory of people. One is that you get some folks where the total cholesterol is only going up because they're seeing a modest increase in HDL To the good point, right? I know I said too much HDL was a bad thing, but seeing an increase in HDL is can be a good thing in the right level, right? So if you're seeing an increase in total cholesterol because HDL is raising, that's not necessarily a bad thing. But then there are sometimes where we will see that it's LDL that's increasing. And you know I know Dave Feldman has done some really great work out there looking at this what is he call mass hyp response? Y Y.yher. you are, yeah, yeah. That's right. I think we talked about that last time on the podcast. So you saw what did you see? you saw LDL go through the roof when you started? Yeah, LDL went through the roof and I had to keep asking for a vap, so an advanced lipid analysis to look at particle size. And so for the benefits of listeners, if they're familiar with this You want light and fluffy, you don't want these kind of dense small particles. And so because mine were light and fluffy my practitioner kind of like let me be But I do know for a lot of people, you, they may only have a traditional lipid panel drawn. And so I always say to people, what that really speaks to is that we need more information. And obviously, if you have diabetes, you've got vascular disease, you're at a different risk stratification than than I am just because I'm not in that risk gratification. So I think there's a lot of components that you have to take into account But it doesn't mean one lab test is like for the rest of your life. It's always with the context of you know, getting more information, changing your diet and lifestyle choices, but Obviously, I would love to get your input as well. Yeah, no, totally. And I think like that's typically what we'll see too is that you know even in the folks where maybe their LDL is increasing, if we look at the if we're fortunate enough to be able to look at the particle size, we will typically see that it's skewing more in favor of the more lighter, less dense particles that aren't going to be as big of a problem as it relates to cardiovascular disease But you bring up a good point. I think this is kind of the biggest takeaway is that we can't base something as complex as our cardiovascular system on one single reading. I think anytime you see I think it's fine to use some of these markers like high LDL as a proxy to say, hey, we should continue looking at other things, but we should not use it as a proxy to say, here's medication to get this number lowered because That doesn't make sense. And we can get into StTNs too. I think StATNs, when you look at the research there, they hilariously underperform, especially compared to what they're marketed as. you know, there's some really there's just some real just mess of people messing with data to make it look a certain way. It's just crazy. But you know, we have to look at these other markers. And I always tell people like, you know, the one, a lot of people talk about the triglyceride to HDL ratio. I think that's really important. That's a great predictor of insulin resistance and metabolic health as a whole So that I think is more important. I think triglycerides as a whole is more important. I think if you're sitting at really high triglyceride levels after you've gone through the keto adaptation phase, I think, you know, if you're a couple weeks into keto, we'd probably expect those numbers to be higher But if you're a little bit more adapted, I think the goal is for those to kind of get into a lower range. And if you're not seeing that, then that could be cause for concern. But then the other one that nobody tests for, which I really like to see is C reactive protein, which is a big marker of inflammation. becausecauseuse to me, that's what really determines if this LDL is a problem or not If we look at what LDL does in the body, LDL is actually like I always, you know, we talked about the bad label that it gets. LDL is great. It's really important for us. It goes through. It helps repair, you know, a lot of things in our blood vessels. It helps, you know, if we have some damage in our arterial walls, it's able to kind of deliver the nutrients that are required to repair it. But what's, you know, what becomes the issue is that when inflammation is high This is where LDL is more likely to be able to get embedded into our arteries or we're more likely to have atherosclerosis, which I always limp through saying that word. It's like the hardest word in the world for me say. But you know, that's where this starts becoming a problem. So you know, what we speculate and what we're starting to see, you know, thanks to folks like Dave Feldman who are looking at this more is that even if LDL is really, really high If triglycerides are low And CRP is low then which if you're eating an appropriate keto diet or an appropriate carnivore diet, a whole food one that's, you know, you're not consuming pro inflammatory foods, then it's not necessarily a problem, right? And that's what should happen if you're eating the right diet is that you should see your CRP coming down, you should see your triglyerides coming down. So now this LDL isn't necessarily a problem. looking you know, always The reference that I love, and I forget where it originally came from, it might have been Diet doctor who originally said it, but it's like to look at LDL as kind of the cause of cardiovascular disease would be like you coming home and your house is on fire and you blaming the firemen for the house being on fire, right? Like If you have cardiovascular disease, you will have high LDL, more than likely, right? And That's another reason why we see this correlation, right? If we look at research people who' have been diagnosed with cardiovascular disease and we measure their LDL, we will see typically high LDL, which makes people think that. But if we understand what LDL does in the body Well, we should look at this and say, hey, there's a reason why LDL is elevated And the reason why it's elevated is likely because of inflammation or high triglycers or whatever. And then now that's where we should be putting our focus on is fixing those two markers instead of looking at really what is kind of a symptom of this issue. So what I always tell people like to go back that's a long winded way, to go back to your original question, which is if somebody who's doing keto and they see their cholesterol go up, what should they do I think that you should try to get a further blood analysis done. I think if you can get particle size for your LDL, that's really important. If or at least get a breakdown of HDL versus LDL. If you're not getting that, then it's really hard to get much out of it. But get that breakdown, get your triglycerides, get your triglyeride HDL ratio, which you can usually always get because you usually are most blood tests cardi blood tests are going to be measuring your triglyceriz and HDL, so you should be able to do that. And then the CRP, that one I've seen, you know, I've seen some people say, you know, the doctor had no idea what it was when they brought it up. But you I know if you go to your own blood work, you can usually ask for that measure to be made. And really, in my opinion, that's kind of the biggest one is that CRP. L if my CRP is low and my triglycerides are in check, then I really don't have any concerns about that cholesterol level Well, a couple things. So I did a podcast with Dave at the tail end of twenty twenty and I had the opportunity to meet him in person in Salt Lake. He is probably one of the smartest people I've ever met. We a conversation. Yeah. He was trying to explain something to me and it was like ten minutes into the conversation. I was like, Dave, you've completely blown past even my understanding on a cellular level of what's going on. I was like, you just need to bring me back to reality. So he's absolutely brilliant. He's changing the way clinicians are looking at Cholesterol, LDL, et cetera. And he is doing research in this area as well. doctor Brettchher was a guest earlier this year and he is an integrative cardiologist. He has a lot of great content. If you have a desire to learn more or want to kind of point your healthcare practitioner towards some additional resources, and I'm assuming you're talking about a high sensitivity CRP as it pertains to a CRP And so this is a very specific and it is something covered by insurance, it's not unusual, it's not weird. You can absolutely positively ask your healthcare practitioner to order this for you. I don't ever get pushedback about that. I would say in the context of asking for additional information, I think that's completely reasonable. And you can also make the argument like maybe we want to look at a homeomocystine, maybe we want to look at a saidedite like to kind of get a sense for what inflammatory markers might be dysregulated. Now a couple more questions, but things that I made sure the ones that were asked multiple times that we talked about, there are keto endurance athletes who are concerned that They're going to negatively impact their power output, their times by being in a depleted a glycogen depleted state, although based on like what little research I was looking at last night, that seems to not be the case. And so could you speak to your experience looking at the research for individuals that are doing endurance work? So not just someone that's doing like a sprint but maybe someone who's doing triathlons or doing, you know, marathons been your experiences in that area in particular. Yeah. so I think there's two things. I mean, if we look at the research, Before we get into research, I'll say one of the issues, I think is this not following the right ketogenic diet is kind of the first issue. So if you're an endurance athlete, your keto di is going to need to look a little bit different from somebody who's not an endurance athlete. So you know going low protein, super low calorie, low nutrient, that's going to affect your power output, right? So let's just assume that we're talking about somebody who's following kind of a keto diet that's been optimized for them and their goals If we look at the research and Jeff Bolich has always kind of been the best on this. It's been you know now it's been probably six years since that study came out, but he had a really awesome study that he was looking at keto adapted athletes versus non keto adapted athletes on carbohydrate intake and endurance performance. addaptation part is really important because anybody out there who's tried keto, if you start keto tomorrow and you go try to run and you think that you're going to know put up the same number that you put up when you were a carb athlete, like it's not happening in that first day. L you usually feel that crap, you know it takes your body time to adjust. So the keto adaptation period is important because it does allow your body to get accustomed to using these other fuel sources and everything like that. But the other thing that we see after keto adaptation is that you do have glycogen. That was kind of one of the most interesting things from this study is that Not only do these athletes have glycogen without eating carbohydrates, but even post exercise, they replenish glycogen to the almost the same rate as the ones who are consuming carbohydrates. So it's this adaptation that your body's gone through because your body does want to have glycogen. We talked earlier in the podcast about kind of having this glucose store for when it needs it. So you know, we do want that. So it's a good thing So you know, the fear of the low power output is because of this fear of glycogen. I think that's kind of a misplaced fear because we just don't really see that being a problem. And really if you look at like it's so funny you asked this question because I almost thought that we were past this point on the endurance side because I've always look at like, you know, endurance and keto. It's like I thought we kind of we checked that one off the list. like everybody was in agreement that one's awesome Especially when somebody like Zach Better, you know, who's a low carb athlete like broke the world record for like ultra Marathon time. But you know, it's kind of it's more of the other sports where I think there's maybe some more legitimate concern. But when it comes to endurance athletes, it's very clear. L if you are able to get keto adapted, you are able to allow your body to tap into a fuel source that is more abundant, that doesn't require you to have to load up on sugary gels the whole time, which can cause GI distress. It's a fuel source that produces an additional fuel source of ketones, which is great for your brain when you're trying to perform. So there's so many good things that come with it. And there's also this added benefit. and I think for a lot of endurance athletes, it's something to consider is that you can take kind of a dual fuel is what people say the dual fuel approach to it, where you know if you are adapted, you can use carbohydrates and what's a beautiful about being adapted is that you can have carbohydrates before an endurance event because carbohydrates no doubt can be an ergogenic aid. They can boost sports performance. We know that. you don't need them. That's important to know too, but let's say that you're really trying to you're an elite endurance athlete and you're trying to be that top one percent where just a small amount of time makes a big difference. you can use carbohydrates strategically, but the beauty in being keto adapted is that when you burn through those carbohydrates, you'll be able to transition back to burning fat very efficiently. whereereas somebody who's just and this is why you'll see carb athletes, you know carb based athletes having to continually load up on sugar is that once they burn through whatever they've consumed There's a delay between them being able to really like tap like the insulin level go down and they can tap into like burning body fat. And this delay is what causes the performance to dip. It's what causes them to have to reach for another pack or in some cases, it's what causes them to bonk, right or you, pass out from the activity. So I think, you know, when it comes to Keto for sports performance endurance really is best sport for it. And I'll also add to it, you know, I don't know what your take is on it, but The HVMN product for endurance, you know, they have a Ketone Eester product that Ketone IQ that's recently come out and half of the Tour de France teams are using that product. So this, you know, obviously, these are endurance athletes that are using it. And anecdotally, I'll say too that like I've, you know, yesterday I took it before I played basketball and I was running up and down the court and I had like, you know, three or four possessions in a row where I just had to sprint like and it was max effort like all out print sprint sprint like, four down and backs, and then there was like a dead ball and I stopped and I kind of realized like, I'm not even breathing heavy. Like I'm breathing like I am right now. Like this is insane. You know, I'm in good shape but I'm not in that good of shape. likeike what's going on? So there are some really cool sports products like that that are coming out. I think that can be beneficial, especially for those athletes that are kind of in that upper echelon of like You know, you're trying to be elite, you're trying to be, you, top notch performer, you know adding those in conjunction with. Now I don't think that it's a replacement by any means. I think that it's best in conjunction with a good low carb diet. But yeah, I think there's other things like that too that you can do to kind of further optimize your endurance performance. I you brought up a lot of good points. and really it comes down to metabolic flexibility. I'm glad that you brought up Ketone IQ because I've talked about it a couple times on the podcast, but for me, obviously not I'm athletic, but I'm not an athlete. I use it when I'm going to do public speaking because Id like to speak in a fasted state because I feel like I have all my My neurons in my brain firing. I don't have to you know, struggle to find words, et cetera. Certainly when I see you at Keto Con, I think I'm the first speaker on the first day. I will most definitely be taking it as the speaker for sure. Yes. Nice segue into talking about digestive distress with keto, especially, I heard this multiple times People that are consuming protein and fat or just fat by itself, they feel like, you know, they consume that and then they have, I'm assuming, loose stools or diarrhea or just even like an upset stomach What are some of the things that you like to recommend to your clients? Yeah, it's a great question. And I think a couple things just to get into why that's happening. I think there's typically I'd say maybe two reasons why you're seeing some digestive distress. One is going to be an electrolyte deficiency. So you this may not be a cause of loose stool, but this would be a cause if you're having some GI distress. If we were deficient in electrolytes, which is very common on a low carb diet. if you're not replenishing them, then this can cause you to have some GI distress and maybe like kind of make your bowel movements a little bit more infrequent. So that would be the first thing is making sure that you're like staying hydrated and replenishing electrolytes, especially magnesium is going to be an important one there Pdium and potassium also going to play a bigger role. So I think that's usually the first thing I'll recommend. But if it's a loose stool problem, it's kind of interesting because we see this one with cararnivore a lot too, right? A lot of people on carnivore will say, you know that like their bowel movements after they started have been a little bit different. And there's like there's two things I'll kind of like to look at is like one, if you're comparing it to your bowel movements on a standard American diet That's a lot different diet, right? So on a standard American diet, you're probably going a lot more frequently, probably going several times throughout a day. And there's also going to be a lot more bulk in it because you're consuming a lot of carbohydrates. So on a low carb diet, we would expect there to be less bulk But on a keto diet, you know, you can if it's something where like it's not necessarily a problem. I think that's kind of the first thing to point out. Some people will assume that it's a problem. It's not necessarily a problem. but if it's something that you're uncomfortable with, you can obviously on a keto diet, you can alleviate it with, you know, adding some fiber and rice. If you want to add some like leafy green vegetables or something like that, that can be a good way to alleviate it. If you're doing carnivore, obviously you can't turn to that So you don't really have much of a choice there. But typically, I see with carnivore, you know, we're talking a week or two maybe of that being an issue and then it kind of resolves itself, which I think for a lot of folks that are dealing with it on the low carb keto side of it, they'll see the same thing because you outside of the fact that maybe you're electrolyte deficient and outside of the fact that maybe you know you're not getting enough like fiber or you're not getting as much bulk I shouldn't say enough fiber because I'm not like a huge fiber advocate. but if you're just not getting enough things in your diet that provide bulk to your stool, outside of those being the cause of it, it's also that like your body's cleaning out a ton of stuff. Like you're finally allowing your digestive system to like take a break and to kind of clear everything out. I know you know when I talked to' probably been a year ago now, I did a podcast with Benzotti and He was talking about a study that I was like shocked by that he was talking about like how long food stays in your digestive system. So if you're somebody who is always Well if you eat a meal every, you know, six hours, right or you wake up first thing in the morning and you eat and you're always eating, you have this backlog of food that you're always processing. So you're going to be going to the bathroom more and there's going to be a lot more bulk. But let's say that you're not eating bulky foods anymore and you're doing intermittent fasting, now your body has more time to kind of clear out its digestive system and kind of get back on track And this may be, you know, it's going to be one of those things where there's a lot of stuff garbage to clear out. You know, if you've been eating the standard American diet for thirty, forty, fifty years, there's a lot of sludge for lack of a better term that's kind of backed up in there that you're going to be kind of clearing out. And you're also going to be seeing some shifts in your gut microbiome, you know during this time. So when you change what you eat, you're also seeing a change in gut microbiome and this change can come with little side effects like you know, like having some loose stool or just kind of impaired bowel movements. So you know, those are kind of my recommendations is like sometimes you just have to like stick through it. It's really not as big of a deal, but staying hydrated and taking electrolytes is always going to be beneficial. And then if you really don't, you know, if it's something that's really uncomfortable for you and you're not enjoying it, adding a little bit of fiber here and there can be helpful It's interesting because I find more often than not, when people go low carbor keto, they actually get constipated. And so it's like you talk about all the biileuppive foods and bitters and I think this is as unique as each of us are. And if you're eating a more nutrient dense diet, you may go through this period of acclimization. and I agree with you, the electrolytes piece. I tell everyone, if you are fasting and or also doing low carb or keto, you have to replace the electrolytes. In fact, the irony is I had surgery about a month ago, and of course, like my HRV data was a mess. know, I knew this was going to happen, of course. Even though I sleep looked okay on my aura. And so I was actually saying to Ro, it's like I just started using more sodium. I was add more electrolytes. and I said it was amazing, like almost instantaneously My sleep scores got better, my HRV got better. and so I think the answer is to kind of start with I mean it's not just electrolytes, but also like salting your food. you know, red is Usually the company I always say, they're U you know they're a US. based company, they're good people, defefinitely always like to mention them. A couple more questions. I want to be respectful of your time. So Hashimoto's or thyroid issues and low carb. There's almost this thought process that You can't consume a low carb diet and have healthy thyroid function, orr if you end up developing Hashimoto's, which is the most common It for of hypothyroidism here in the United States, especially for women, It's like eighty to eighty five percent of hypothyroid patients are actually Hashimot's, which is not immune issue And I hear, well, women have to eat a certain amount of carbohydrates to be able to convert T four to T three. And that hasn't really been the case. I mean, obviously, I have Hashimoto's, which is in remission But I just think if we're looking at a population of people that are largely metabolically unhealthy, to suggest that a low carb or ketogenic or carnivore diet is somehow harmful To me is completely contrary to everything I've experienced as a clinician or as a human being. T And I think this is a really complex topic because you know we do see some mixed results, right? where we'll look at some studies and maybe some studies will show a decrease in thyroid hormones. some will show an increase, some will show it stays the same. Some of that's just a difference in what the diet is that they're actually following. But one thing I will say is that I think we need to look at thyroid hormones simimilarly to how we look at like insulin. So know if we look at insulin as a hormone, we have in our mind that there's this like our you know, we have these medical recommendations of this is the baseline number of insulin that this is kind of where your healthy reference range is, right? But then we know if you eat a low carb diet, that reference range changes. You don't need to have as much insulin as what would maybe be in that reference range And I always wonder what other hormones that applies to. So I do think there's something to that with you with thyroid hormones where it's like maybe because you're healthier in other ways, you don't need like for some of the studies that may show that there's a decrease in it, that you don't need as much thyroid hormone because your body's doing things efficiently, maybe your cells are responding more efficiently to that hormone Everything else is in check. So I think there's a component to that that could be out there, but I haven't seen any research on it. It's just kind of one of those things like logically, you know I think there could be something there. And there's also, you know, there's been some studies that look at or more reviews of the research, I should say that kind of show that ketones themselves can do a lot of the same actions that a thyroid hormone does as well. There's also this thought of maybe when you're in a state of ketosis with elevated ketones, that you may not need to have as high of thyroid hormones as you need. But Really what I think is going on in most of the cases where people are saying, hey, I noticed my thyroid hormoness gone down or I'm experiencing some problems with it. It's because they're following that version of the diet that you mentioned probably twenty minutes ago now. It's the women that are following intermittent fasting, OMAD, they're on the treadmill all day, they're super calorie restricted, eating low protein Like that's going to be a big cause of thyroid hormone being low, right? You're in a super restricted state. And I think most of the time when I talk to women who are experiencing some sort of problem or they have some sort of concern in that area because it does actually happen. It's not just a myth, right? Like some women will follow a keto diet and they will see a decrease in that thyroid hormone. And if it's not the first example I gave of maybe there being a decreased need then it's usually if you ask them, hey, what's going on with your diet? you'll find out, hey, they're eating a thousand calories a day and they're on like the treadmill for an hour and a half. So know all of that to say that when somebody's eating an appropriate keto low carb carnivore diet with nutrient dense foods, they're consuming an appropriate amount of protein. I think protein's actually really important when it comes to our thyroid hormones If they're doing all of those things, then we typically just don't see a problem. And I think that's why somebody like yourself has seen so much success because you're doing it the right way. If low carb was supposed to ruin somebody's thyroid hormone, then what the heck would a carnivore diet do to it, right? There's no way that you should have seen you know any sort of improvement when you were following a carnivore diet. So it's one of those things and I get so frustrated with this one too because You're telling a lot of times they're telling you, and maybe this is maybe I'm jumping the gun on this, but it seems like a lot of women who are suffering from thyroid issues are dealing with a lot of other issues as well. They may be dealing with infertility. they may be dealing with insulin resistance, they may be borderline, PCOS, different things like that. And now you're recommending against a dietary strategy that would be dramatically improving all of those different aspects, right? So I get really bothered by this kind of general consensus that women should be consuming know a certain amount of carbohydrate or something like that. Now I do know there's some really great folks out there like Dr. Cerry Brown and Dr. Stephanie Estema who are doing good research around like carbohydrate consumption, around like your menstrual cycle and things like that which I'll let them be the experts on that side of things. But you know, and I think there's definitely some validity to that, but just to generally say that a woman should have They need X amount of carbohydrates to maintain this proper hormone function in their body. I think is just I haven't found any research to back it up. And anecdotally, I haven't seen anything that supports it Well, and I always tell people that you know, if your thyroid function is stable, you're on medication or your labs are stable, you can absolutely Adjust your mac. If you're someone where your Hashimoto's, your thyroid antibodies are high, you haven't been able to manage and mitigate them, you know you're still consuming gluten, maybe you're you know, and we've talked about molecular mimicry on other podcasts most recently with doctor Amy Horneman, but when we're talking about unstable thyroid function, that's very different. I wouldn't then add in the stressor of you changing everything you're doing about your diet. But if you're doing well, I think it's certainly reasonable. Now, two other questions, Oes that came in multiple times. numberumber one, what are your favorite gadgets for metabolic flexibility? I'm gonna guess I know some of them already. I'm very transparent that I love my continuous glucose monitor and glucometer because I think that builds awareness. I love my aura ring because it helps me track data. But what are your favorite ones? I know, you know, you're closely affiliated with BioCoach and I think this is a really Interesting way to be able to track, you know additional blood glucose metrics. What are some of your favorite products that you utilize or ye right behind your? Yeah as gonna to say, I'm a bioach here. So yeah, you know I use, I think measuring blood glucose is like the most important marker for metabolic health. So I really like to pay attention to it. You know, I think the CGMs and everything that are out there are great. They're just maybe not the most practicice for a lot of folks because they're a lot more expensive But I'll say know the thing with BioCoach is just to give a quick thing on like this device, there's a lot of devices out there that'll do the same thing as this. What's really cool about what we're doing at BioCoach is kind of the app that's built into it that this will report to that provides a lot of insight and coaching and help with grocery shopping and all of that. So that's really why I like this. It's not just necessarily the device, it's also the app that kind of comes with it So I really like testing blood sugar. I think, and really it comes down to like if you're somebody who has a really good grasp on yourself and biochemistry and nutrition, all those things, then and you can afford a CGM, I think that you can get a ton of great information. I've used a CGM in the past to just get you know as much info as I could, but then I know what to do with it, right? So that's kind of I think the difference. If you don't know what to do with that information Like if those would just be data points that would be useless to you, then I think something more like what we're doing at BioCoach would be beneficial. I also have, and I've messed with it a little bit in the past, but I have one coming in is the Lumen device, I think is interesting as well. And the reason why I kind of think that device is interesting is because one of the kind of fundamental features of all these devices is that you're giving feedback for people. You're giving them a chance to see what's going on in their bodies, which from a behavioral change standpoint, like you mentioned, It's really important. So I really like, you know Lumen's ability to kind of show you at a high level where your metabolism is at if you're burning carbohydrates or burning fat because you know, not that like I don't think it's practical to use a device like that and then say, oh, I'm burning carbs. I need to go make a drastic change. But it's a good way to say, okay, given how I'm living my life currently, this is what's going on in my body And now if I live my life like this, this is how it's going so you can kind of figure out what's working best for you. So I like that. Sleep trackers, I think are great too. Aura Ring is something that I've always used in the past that I've been a big fan of, but there's a new company that's coming out called Circular that has a ring that I've been doing some testing with and they're kind of just coming ono the market. and I really like them because they're They have a little bit more insight on the exercise side of things. So not only sleep, but then they provide a little bit more on the exercise side, which I love. And kind of same thing, you know, an app that will provide a lot of insight into the data and not just kind of give you raw data points. So I would say those are kind of my big three that I will use like on a reoccurring basis. You know, I think there's some other like with my Apple Watch, I do like to track you know, my heart rate throughout the day, especially during exercise. I like to keep an eye on that HRV, especially post exercise as it relates to my recovery. I know you can do that with Aura and you can also do that with your Apple Watch if you do a little, know, back of the label or back of the envelope math So yeah, those have kind of been my favorites. I'm really just kind of getting into this tech space when it comes like the wearables. I'm fascinated by wearables. I think that like The direction that they're going, I think could be really interesting. I would love to see a continuous cortisol monitor. I would love to see you know glucose check that you could use the photo sensors to, you know, not have to be invasive at all. I think some of those really exciting things are coming in the future. So I'm like really kind of just getting into it. now. I've always been like really traditional with folks when people would ask me these questions. I'd be like I don't know, just eat steak like you'll be fine, you know. But now I'm starting to see a lot more of the utility and these kind of wearables and the feedback that they can provide. So yeah, I'm liking it. And I think it's always helpful. It's a question I oftentimes like to ask gu because I know for me, I'm very quantitative focused anyway And to me, it doesn't stress me out to have the information. Whereas I do have some clients who will say, know, I don't want to see my blood sugar spike because I'm playing tennis. I don't want to see my blood sugar spike after having a dessert. Whereas last night and this is for full transparency Very rarely do I eat dessert. I like dark chocolate, but that has a pretty negligible impact on my blood sugar. but it was Memorial Day and we had a big steak dinner. And so I made gluten free brownies and you know, teenage boys. they ate most of it. I had a small piece, but I watched my blood sugar go from like ninety one hundred and sixty and it came back down very fast. I mean, that's what you're really looking for. But I said to my husband, I was like, I so rarely see blood sugar spikes ever. Like I keep between, I mean, maybe it's like twenty points up and down throughout the day. It's very nominal. And so it was very interesting to see that. I said, you know, what's most important to me and seeing that kind of outlier is How quickly did my body recover? And it was very quick. It was like one, I think it's one hundred sixty, and then it was back down like ten minutes, you know, ten or fifteen minutes later, it was already coming down, which is what you want to see if you're metabolically flexible But I would say if we have a barent data that you know, goes outside our norm, like don't freak out about it. Just say, okay, well what did you do differently? I know I had dessert. I don't generally do that. I also shouldn't do that at the end of the day. If I'm going to have a dessert, it should be the middle of the day so that I can I have moreul as we know, we have more insulin sensitivity during the day. Last question What are your favorite supplements? And the reason why I'm asking this. two people ask in the context of how to address insulin resistance We could go down that rabbit hole, but we're always going to talk about the lifestyle piece first. But are there specific supplements you like to use personally? ones that are your favorites? Like I have favorites that I probably talk about a lot But what are your favorites? Yeah, so I'd say my favorites right now, electrolyte supplement every day, especially I live in Florida and I sweat a ton. I play basketball. I hit the sauna. like, yeah, you can see me now I'm sweating. So I'm a big electrolytee guy. Two brands I like to use perfect keto, which I actually formulated that product. So big fan of that one, especially as a That one's been formulated to be like a general electrolyte supplement. so I start my day with that. And then I love the element electrolytes, especially for after sauna and basketball because I sweat a ton. The difference there is the element is a lot higher sodium. So that one's I think, especially good for after exercise or even before exercise. So those are a daily supplement. We mentioned ketone IQ. This is one of the first supplements that I've ever tried that have made like a noticeable difference on the way that I feel, like especially cognitively You know, I take one shot of that and it's like I can either sit here and have a podcast and just feel like my brain is firing at all cylinders or I can go for a run and crush it. It's like a wide variety of benefit that it provides. So I really like that one. And then you know, a couple of other little ones, like I do use a protein supplement after I work out because trying to get more protein in my diet. So I'll do like a beef protein is kind of my go to brand for that. know, I like to do collagen protein as well, especially before bed, so I'll do a little bit of collagen. I like to use perfa keto for those. So those are kind of like my general ones. but as it relates to like insulin resistance, you know, I think generally speaking, if you're following a low carb diet, those can all be great supplements for you. But as it relates to insulin resistance, I think that berberine is supplement that gets you know gets me really fired up We had a product at Perfa Keto that had it, but we had to get rid of it because, you know the old government decided that anything targeting blood sugar was going to be really heavily regulated and they didn't like us having that product. So we ended up having to get rid of that one. But I really like blood sugar supplements, blood sugar regulating supplements like that. and Berberine, you know, some of the research on it has shown that it can be, you know, just as effective as metformin, which is the commonly used medication for pre diabetics and diabetics without a lot of the side effects that come with it. So you know, I really like that. There's you can get berberine as a standalone powder. It tastes like crap. so you probably want to figure out a way to you know get it in a capsule form if you can or mix it in with some sort of flavoring. But I think that's the really and there's a couple others too. I know that chromium can be really solid as well. and some other supplements out there will combine these things. But really berberine, I think is like as it relates to insulin resistance, I think is like the best one that you can use Yeah, I even have it at my house and if I have a day where I have more discretionary carbs on a day that I haven't lifted, I will actually take some berberraine. I like anocetol because that can also be beneficial for sleep and then chromium GTF. But I feel like chromium GTF isn't particular like in the continuum, Burbering in and Astetol, I've had much better luck with with patients and clients as opposed to chromium. like I feel like we're pissing in the wind. I'm not sure it it's really all that efficacious. It's pretty benign, but I agree with you that There's so many options for people. And when I think about how many of my patients were on oral diabetes medications and yet we've got thingsings like berberine that can be as efficacious It's really something if you are insulin resistant, talk to your healthcare practitioner about whether or not this is appropriate for you to use. and especially if you're tracking metrics, if you've got a glucometer, you've got a CGM and you can track Your blood sugar, you may see an appreciable difference. It's not something you want to take forever I do believe that you need to take breaks, but I think it can be helpful for a lot of people. And given the amount of people, at least here in the United States and a lot of other westernized countries that are insulin resistant without even realizing it Knowledge is power for sure. Yeah. if I can add one more to that too, I think And this is one that I haven't seen a lot of research on yet, but I want to would be Ahwalanda for blood sugar because and you know, I've always liked Ahwaganda as a general, you know lowering of stress and actually, you know, in a higher dose it can boost sports performance as well, like strength performance. But the ability for it to impact cortisol, I speculate would allow it to be really beneficial for blood sugar levels, especially when taken chronically. So that's not something that I've been able to measure yet and I haven't done research on it. But generally speaking, it's a great supplement for a lot of different reasons. If insulin resistance is something you're looking to combat, that could be another great one to throw in there Yeah, I love adaptogens. I mean, they're plant based compounds and they have so many benefits and Ashroganda is unique and that It can be stimulating and also calming. And so understanding the physiology of the body and how these plant based compounds can have a really positive net effect on quieting the sympathetic nervous system is always a benefit. Well, obbviously, Chris, I could talk to you forever. I'm sure we have a third podcast in our future. Let listeners know how to connect with you. Obviously, we'll put links to all the things that you talked about. You've got your own podcast that I've been fortunate enough to be a part of, but let people know how to connect with you on social media Yeah. so on social media, you can find me at the ketologist I'm on Instagram, Twitter. I think I'm out there in the TikTok sphere, but I'm not really on there. So it's just kind of floating account out there. Instagram is really the main account where I engage with and answer questions and whatnot. Then I have my newsletter, which is on sububstack. It's called Thinking Health The link to that is in my Instagram bio so you can pop over there. And then the podcast is the Keto Answers podcast, which you can find on the Apple podcasting app. you can find it on Spotify, YouTube, any of those places. So Awesome, Chris, always a pleasure to connect with you. Thank you again Yeah, thanks for having me on. If you love this podcast episode, please leave a rating in review, subscribe and tell a friend