Does Red Meat Give You Colon Cancer?

Have you heard? There’s a new “red meat will kill you” study. This time, it’s colorectal cancer.

Here’s the press release.

Here’s the full study.

I covered this a couple Sundays ago in “Sunday with Sisson.” If you haven’t signed up for that, I’d recommend it. SWS is where I delve into my habits, practices, and observations, health-related and health-unrelated—stuff you won’t find on the blog. Anyway, I thought I’d expand on my response to that study here today.

How the Study Was Conducted

It’s the basic story you see with most of these observational studies. Around 175,000 or so people were asked to recall what they ate on a regular basis—a food frequency questionnaire. This is the exact questionnaire, in fact. The research team took the answers, measured some baseline characteristics of all the subjects—socioeconomic status, exercise levels, whether they smoked, education level, occupation, family history of colorectal cancer, and a few others—and then followed up with participants an average of 5.7 years later to see how many had developed colorectal cancer.

What the Study “Showed”

Those who had moderate amounts of red meat had a 20% higher chance of getting cancer.

And in the end, the increased risk was a relative risk. It wasn’t a 20% absolute increase in risk. It was a relative increase in risk. The subjects started with a 0.5% risk of getting bowel cancer. In those who ate the most processed meat and red meat, that risk increased 20%—to 0.6%!

From 0.5 to 0.6%. Sure, that’s an increase, but is it something to overhaul your entire diet for? To give up the best sources of zinc, iron, B vitamins, protein, carnosine, creatine? All that for a measly 0.1% that hasn’t even been established as causal?

Study Findings Most News Outlets Won’t Include

One head scratcher that leaps out: the link between unprocessed red meat and colon cancer was not actually statistically significant. Only processed meat was significantly linked to colon cancer.

Another head scratcher: red meat, whether processed or unprocessed, had no significant association with colorectal cancer in women. Why didn’t they highlight the fact that in women, eating red meat was completely unrelated? That’s half the world’s population. That’s you or your mom, your daughter, your grandmother, your girlfriend. And unless they were to look at the full study and read the fine print, they’d never know that red meat actually had the opposite relationship. You’d think the authors would want to mention that in the abstract or see that the press releases and media treatments highlighted that fact.

It’s probably because mentioning that red meat was neutral in women and had no statistically significant link to colon cancer in men and women would have destroyed their case for red meat as an independent carcinogen. See, carcinogens are supposed to be carcinogens. There are many meaningful differences between men and women, but a poison is a poison.

What’s the proposed mechanism for red meat triggering colon cancer in men but not in women? If they didn’t have one (and I imagine they wouldn’t have mentioned it if they did), then there’s probably something else going on.

Besides, the literature is far from unequivocal.

What Other Research Says About Red Meat and Bowel Cancer

In analyses that include consideration of cooking methods and other mitigating factors, red meat has no relationship with colon cancer.

Or what about this study, where colon cancer patients were more likely to eat red meat, but less likely to have type 2 diabetes? Should people avoid red meat and work toward getting diagnosed with type 2 diabetes?

Or how about this study, which found no difference in colorectal cancer rates between people who ate red meat-free diets and people who ate diets containing red meat? Shouldn’t the diet without any red meat at all have some effect?

Or this classic study, where rats on a bacon-based diet had the lowest rates of colon cancer. In fact, bacon protected them from colon cancer after they were dosed with a colon cancer promoter, while rats on normal “healthy” chow were not.

The Blind Spot In Red Meat Research

I don’t need to go into all the confounding factors that might predispose conventional red meat lovers to bowel cancer. Nor will I mention that it’s impossible to fully control for variables like the buns and bread and fries you eat the red meat with and the industrial seed oils it’s cooked in.

That last bit is crucial: the seed oils. It’s what nearly every cancer researcher misses. It’s not just a minor variable; it’s quite possibly the most important determinant of whether meat is carcinogenic in the colon or not. Heme iron—the compound unique to red meat that usually gets the blame for any increase in cancer—is most carcinogenic in the presence of the omega-6 fatty acid linoleic acid.

In one study, feeding heme iron to rats promoted colon cancer only when fed alongside high-linoleic acid safflower oil. Feeding MUFA-rich and far more oxidatively-stable olive oil alongside the heme prevented the colon carcinogenesis.

Another study had similar results, finding that meats containing medium to high amounts of heme—beef and beef blood sausage—promoted carcinogenic conditions in the colon when the fat sources were linoleic acid-rich corn and soybean oil.

And most recently is this paper. Mice were split into three groups. One group got heme iron plus omega-6 PUFA (from safflower oil). One group got heme iron plus omega-3 PUFA (from fish oil). The third group got heme iron plus saturated fat (from fully hydrogenated coconut oil, which contains zero PUFA). To determine the carcinogenicity of each feeding regimen, the researchers analyzed the effect the animals’ fecal water (which is exactly what it sounds like) had on colon cells. The fecal water of both PUFA groups was full of carcinogenic indicators and lipid oxidation byproducts, and exposing colonic epithelial cells to fecal water from PUFA-fed mice was toxic. The coconut oil-derived fecal water had no markers of toxicity or lipid oxidation.

I never see these (animal) studies cited in observational studies of meat and colon cancer. I think that’s a huge blindspot, and it’s one of the reasons I rarely put any stock in these scary-sounding studies.

That’s it for today, folks. Thanks for reading. Now go enjoy a steak.

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References:

Bylsma LC, Alexander DD. A review and meta-analysis of prospective studies of red and processed meat, meat cooking methods, heme iron, heterocyclic amines and prostate cancer. Nutr J. 2015;14:125.

Alsheridah N, Akhtar S. Diet, obesity and colorectal carcinoma risk: results from a national cancer registry-based middle-eastern study. BMC Cancer. 2018;18(1):1227.

Rada-fernandez de jauregui D, Evans CEL, Jones P, Greenwood DC, Hancock N, Cade JE. Common dietary patterns and risk of cancers of the colon and rectum: Analysis from the United Kingdom Women’s Cohort Study (UKWCS). Int J Cancer. 2018;143(4):773-781.

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Top 10 Fasting Mistakes and How to Avoid Them

Folks, you know I’m a long-time believer in intermittent fasting for longevity, autophagy, mental clarity, fitness performance, metabolic health, and more. I’m excited that Dr. Jason Fung has stopped by the blog today to share a bit about common fasting mistakes. Enjoy!

So, you’ve decided to add some fasting to your lifestyle. Excellent. No matter how much you have (or haven’t) read on the topic, you’re likely to find aspects of fasting to be challenging or even frustrating. It can be hard to stay on track when you’re feeling hungry, irritable and not really noticing any changes.

It’ll become tremendously easier once you begin to experience the health benefits of fasting, but we all know it takes a little while for that to happen. Benefits like mental clarity and improved energy will show up sooner than significant weight loss. Plus, the benefits you experience will depend on what kind of fast you’re doing and how well you stick to it.

But if you’re making fasting mistakes, you might never accomplish the benefits you were hoping for. . Before you throw in the towel, I want to help you identify some possible fasting pitfalls you might not be aware of and also help you avoid them. Plus, don’t miss the Number One reason fasts fail, shared at the end of this article.

1. You’re Snacking or “Grazing”

Look, the entire purpose of a fast is to contain your eating within certain windows of time. Snacking or “grazing” all day long is basically the opposite of fasting, so stop thinking that you can get away with it. Fasting is “on” or “off”—there is no gray area. Even having “just a bite,” no matter how healthy or how little, will almost invariably kick your body out of fasting mode and will interfere with the healing process responsible for fasting’s many benefits. It also creates a situation where your body is producing insulin all day long. Bad idea.

Avoid grazing by putting snacks and food out of sight. The phrase “out of sight, out of mind” really applies here. You’ll be amazed how much easier it is to bypass snacking when the food isn’t sitting right in front of you. If you snack out of habit, get creative and find new, non-food based habits. If your snacking comes from genuine hunger, you may need to re-evaluate the meals you eat during your eating window. Make sure you’re getting enough healthy, unsaturated fats with each meal as these will keep you satiated for longer.

2. You Aren’t Drinking Enough Water

This is not only a common fasting mistake, but a mistake most people make no matter what their diet is. Drinking a minimum of eight glasses of water daily is essential to staying hydrated and healthy. Some signs that you aren’t drinking enough water include dizziness and lightheadedness, feeling tired, or constipation.

Even worse, when you don’t drink enough water, your brain may try to trick you into thinking that you’re hungry, so you get the vitamins and minerals you’re lacking. Minerals like potassium and magnesium are essential to your brain health. So don’t be surprised next time you feel hungry but find that drinking a glass of water makes the appetite disappear. Various kinds of tea are also a satisfying way to hydrate, or try some bone broth if you’re truly struggling.

3. You Aren’t Consuming Enough Salts

Speaking of vitamins and minerals, appropriate salt intake is vital to your health. Now, when I say “salt,” I’m not talking about the kind you put in a shaker. I’m talking about electrolytes, which are essential to your diet. Sodium (Na), which is also commonly known as table salt, is one of these electrolytes, along with potassium (K), magnesium (Mg), calcium (Ca), and chloride (Cl).

How can you tell if you’re low on electrolytes? Some symptoms of electrolyte deficiency are anxiety, irritability, trouble sleeping, muscle spasms, fatigue, digestive issues, and dizziness. If these are the kinds of symptoms you experience during your fast, lack of electrolytes could be the answer. Try taking some pink Himalayan rock salt and placing it under your tongue to dissolve. You can also try drinking some pickle juice — just make sure it’s from high-quality natural pickles and not the kind made with sugar.

4. You’re Eating Right Before You Go To Sleep

Your body needs time to digest all the food from your last meal before you go to sleep. If you’ve scheduled your eating window to happen right before bedtime, your body will be taking all the time you’ve allotted to rest to digest instead. That takes energy, and instead of waking up feeling restored and ready to take on the day, you’ll just feel tired.

When you’re following a fasting plan, a seven-hour window is an ideal amount of time to leave between your last meal and when you go to sleep. Even three or four hours is enough to make a difference. Unfortunately, with crazy work schedules and early mornings, a lot of people aren’t able to stick to that three- or four-hour window. It’s more like get home, eat dinner, and go straight to bed. If this is you, the next best thing is to eat a light meal, like salad, and avoid a meal filled with carbohydrates and protein.

5. You’re Eating Too Much of Some Food Groups

When we cut certain foods from our diet, especially carbs, it’s easy to rely on other food groups, like nuts and dairy. They’re readily available and a staple of most diets.

Nuts are a low-carb, healthy fat option, but only in small amounts. They’re great to add to fruit or veggie salads, and they’re easy to grab a handful of when you need a quick snack. But those quick snacks can add up, especially on top of eating full meals. Nuts are high in good fat, low in carbs, and are a good source of protein, but too much protein can be detrimental to your fast. Excess protein that your body doesn’t need is converted to glucose and stored as fat. If you’re fasting to lose weight, this is the exact opposite of what you want.

Dairy, the other easy food group that too many people defect to, can cause inflammation, upset stomach, bloating, gas, and other kinds of discomfort. If this is a pattern you’ve noticed with your own health and eating habits, try cutting out dairy for a few weeks and see if these symptoms improve. If you haven’t noticed these symptoms, be more mindful of your eating habits and track how you feel after eating dairy.

6. You Aren’t Eating Enough of Certain Food Groups

As easy as it is to eat too much of one food group, it’s equally easy to not get enough of another. Just because you can eat “whatever” you want during your eating window doesn’t mean you should. Empty calories and junk food are momentarily satisfying, but they don’t fuel your body. Eating the right foods provides your body with the nutrients it needs to thrive throughout the day; these foods will also keep you feeling fuller, longer.

Vegetables are one of the best food groups to keep you nourished and thriving. They’re low calorie and they provide different vitamins and minerals like potassium, fiber, folate, vitamin A, and vitamin C. Fruits are also healthy, but don’t overdo it, as most are high in sugar. Fruit juices typically have added sugar as well. Naturally flavored drinks and teas are the healthiest option. Nuts are high in fat and a good source of protein, as are eggs. Refined carbohydrates and sugars are highly unnecessary for your body and if you’re going to include them in your meals, there should be very little.

7. You’re Pushing Your Body Too Hard

Did you dive off the deep end and go from zero fasting to attempting 24-hr fasts every other day? Back up and take a more moderate approach first. Don’t expect fasting to be easy right away. Not only will your body need time to adjust, but your mind will, too. If you’ve been accustomed to three square meals a day, plus snacks and calorie-filled drinks, your body has gotten used to this routine.

Your body needs time to adapt. First it burns through stored sugar and then it will start burning body fat for energy. Start slow and get a feeling for this new practice. You can start with a twelve-hour fasting period and twelve-hour eating window. When eight hours of that fast are during your sleeping hours, this window is relatively easy. Once you’ve become accustomed to this schedule, you can reduce your eating window to ten hours. Continue decreasing your eating window by two hours every one to two weeks, until you’ve hit the fasting period you want.

8. You Have the Wrong Mindset

Fasting provides your body with everything it needs to thrive, but without the right mindset, you’re bound to fail. Focusing on the negative, like not being allowed to eat certain foods or at certain times, will easily spiral into other negative self-talk. The harder you are on yourself, the more difficult it is to achieve success.

Rather than thinking about how hard the fast is, focus on the positive that will come out of it. Fasting allows your body to heal. Fasting can help you lose weight. You’ll feel more energized and have a clearer mind. Whatever the reason you’ve chosen to fast, focus on that. Fasting with a friend, family member, partner, or online community is another way to hold yourself accountable and can be very helpful.

9. You’re Too Stressed

When you’re stressed, your body releases a hormone called cortisol. Cortisol is problematic when fasting because it can prompt your body to break down muscle tissue instead of fat. When fasting, your body should tap into stored body fat and preserve your healthy muscle tissue.

If you’re stressed on occasion, this shouldn’t cause much of a problem. But if you’re chronically stressed, that constant release of cortisol can lead to a breakdown of muscle tissue.

Not sure if you’re stressed? Here are some symptoms:

  • Teeth grinding
  • Muscle tension
  • Headaches
  • Apathy
  • Anger
  • Digestive problems
  • Fatigue
  • Trouble concentrating

Alleviate stress with deep breathing, positive visualization, an epsom salt bath, and stress-relieving teas. If you can, take some time off from work. If you’re an outdoorsy person, relax in nature.

10. You’re Inactive

Being inactive is one of the biggest mistakes people make during their fast. If you aren’t eating, you should rest and save your energy, right? Wrong. Exercise is a great way to improve your fasting. Activity increases fat burning and boosts circulation. Going outside and getting some sunlight and fresh air can improve your mood, making you more likely to stick to your fast. Movement generally makes people feel better than sitting on the couch inside all day; being inactive makes you cold, tired, and unfocused.

Since a lot of people work sedentary jobs that tie them to a desk all day, exercise isn’t a convenient way to stay active. But taking a short walk or stretching are two easy ways to get your blood flowing throughout the day.

Fasting shouldn’t be synonymous with suffering. If you’re feeling deprived during your fast, be sure that you aren’t making any of the above fasting mistakes. Ease yourself into your fast, stick with it, and enjoy the results when they come with time.

But there’s one more—in fact, the number one reason fasts fail….

Can you guess what it is?

***Giving Into Cravings

Which is why I want to tell you about my new favorite secret weapon for staying fasted longer and with less difficulty: Pique Fasting Teas. Why tea? The combination of catechins and caffeine gives you a higher chance of experiencing tangible benefits from fasting. It suppresses hunger cravings, boosts calorie burn and supports malabsorption of unhealthy fats and sugars.

These Fasting Teas include ingredients targeted at maximizing the fasting experience:

1) Organic highest ceremonial grade matcha, which increases levels of l-theanine to calm and tide you through your fasts with ease. 2) Organic peppermint, which is a natural appetite suppressant with calming properties. 3) Proprietary blend of high catechin green Tea Crystals, which regulate the hunger hormone ghrelin and increase thermogenesis (burning fat for fuel). This helps you to stay fasted and see quicker results. 4) Additional plant ingredients including ginger and citrus peel to support digestion and enhance autophagy.

As with all of Pique’s teas, you can rest assured these are pure and Triple Toxin Screened for pesticides, heavy metals and toxic mold. For a limited time only, if you order through the Mark’s Daily Apple link, you can get up to 8% off and free shipping (U.S. only).

Thanks again to Dr. Jason Fung for today’s post. Have questions on fasting protocols or missteps? Share them below, everybody, and have a great day.

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Keto and the Menstrual Cycle: Is There Reason To Worry?

It seems every “keto for women” forum abounds with stories about menstrual cycles gone wild in the first few months of keto. Irregular cycles, breakthrough bleeding, and periods lasting much longer than normal are common complaints. Sometimes these stories are cited as evidence that keto isn’t good for women, at least not premenopausal women, and that we need carbs for healthy hormones. Yet, many women don’t notice any changes in their menstrual cycles at all, while others report improvement in PMS symptoms and cycle regularity from the get-go.

What gives? Why do some women’s cycles apparently become wacky when they start keto, while others feel like keto is the key to period bliss? Can keto “mess up” the menstrual cycle?

We know that diet—what and how much we eat—can profoundly affect our hormones. This is true for both women and men. One of the reasons people are so excited about ketogenic diets is specifically because keto shows promise for helping to regulate hormones and improve cellular sensitivity to hormones such as insulin and leptin.

At the same time, women’s hormones are especially sensitive not only to dietary changes but also to downstream effects such as body fat loss. Furthermore, one of the ways women’s bodies respond to stressors is by turning down the dial on our reproductive systems. It’s reasonable to hypothesize, then, that women might have a tougher time adapting to or sustaining a ketogenic diet. Keto can be stressful depending on one’s approach, and that might negatively impact women’s reproductive health. But do the data actually bear that out, or is so-called “keto period” more misplaced hype than genuine fact?

Note that throughout this post, I’m going to use the term “reproductive health” to refer to all aspects of women’s menstrual cycle, reproductive hormones, and fertility. Even if you aren’t interested in reproducing right now, your body’s willingness to reproduce is an important indicator of overall health. When your reproductive health goes awry—irregular or absent periods (amenorrhea) or hormone imbalances—that’s a big red flag. Of course, post-menopausal women can also experience hormone imbalances that affect their health and quality of life (and low-carb and keto diets can be a great option for them).

Menstrual Cycle 101

Let’s briefly review what constitutes a normal, healthy menstrual cycle, understanding that everybody’s “normal” will be a little different. A typical cycle lasts from 21 to 24 days on the short end to 31 to 35 days on the long end, with 28 days being the median. Day 1 is the first day of your period and begins the follicular phase, which lasts until ovulation. Just before ovulation, levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), and estradiol (a form of estrogen) spike. Next comes the luteal phase covering the approximately 14 days from ovulation to menses. LH, FSH, and estradiol drop, while progesterone rises. Estradiol bumps up again in the middle of the luteal phase. If a fertilized egg is not implanted, menstruation commences, and the whole cycles starts over again. All this is regulated by a complex communication network under the hypothalamic–pituitary–gonadal (HPG) axis, which is closely tied to the actions of the adrenal (the A in HPA axis) and thyroid glands.

Across the cycle, fluctuations in body weight are common as fluid is retained and then released along with shifts in estrogen and progesterone. Changes in blood glucose are also normal, and insulin-dependent diabetics often find that they need to adjust their dose at different times of their cycles to keep their blood sugar in check. The most common pattern is higher blood glucose readings in the pre-menstrual period (the second half of the luteal phase), and lower readings after starting your period and before ovulation. This is generally attributed to the fact that progesterone, which is highest during the luteal phase, is known to reduce insulin sensitivity. However, different women experience different patterns, which can also be affected by other factors such as oral contraceptive use.

Normal fluctuations in insulin resistance and blood glucose can mean that women get lower ketone readings at certain times of the month than others. When these occur premenstrually—and so they tend to coincide with a period of (transient) weight gain and food/carbohydrate cravings—women often feel as though they are doing something wrong. Rest assured that these variations reflect normal physiology.

The many factors that affect your cycle and the levels of your sex hormones include: other hormones, gut health and microbiome, metabolic health (e.g., insulin sensitivity), environmental toxins, stress, sleep, immune health, nutrient deficiencies, activity level and energy expenditure, and age. Each affects the others, and all (except age of course) can be affected by diet. It’s no surprise, then, that it can be extremely difficult to pin down a root cause of menstrual changes or reproductive issues.

What the Research Tells Us About Keto and Menstruation

As I said at the outset, there are lots of anecdotes, both positive and negative. In my experience, most women whose cycles seem to go crazy when they start keto find that things get back to normal—and often a better version of normal—after a few months.

First, it’s tricky to determine the effects of keto per se, since many people combine a ketogenic diet with calorie restriction (intentionally to lose weight or unintentionally due to the appetite suppressing effects of keto) and with fasting (intermittent and/or extended). Each of these can independently impact the factors listed above, lead to weight loss, and affect the menstrual cycle and reproductive health.

So, is there any evidence that keto itself causes changes to menstruation?

The scientific evidence is scant….

The one statistic you’ll see floating around the interwebs is “45% of (adolescent) females experience irregular menstrual cycles on keto.” This statistic comes from one small study of adolescent girls using a therapeutic ketogenic diet to treat epilepsy. Six of the twenty girls reported amenorrhea (loss of period) and three were diagnosed with delayed puberty. However, the ketogenic diet used for epilepsy is different and usually much stricter than an “everyday” keto diet needs to be, and epilepsy is frequently associated with menstrual dysfunction regardless of diet.

To extrapolate the findings of this study and argue that nearly half of teenage girls (or women generally) are likely to experience menstrual problems from going keto is a huge leap.

The fact is, I’m unable to find any studies done in healthy human females (or mice for that matter) demonstrating that otherwise normal menstrual cycles are disturbed by going keto.

5 Ways Keto-Related Factors *Might* Affect Your Menstrual Cycle

With the limited amount of research looking directly at keto and menstruation, let’s look first at whether there are direct effects of carbohydrate restriction or elevated ketone production on the menstrual cycle. Those are the defining characteristics of keto and what differentiates keto from other ways of eating. Then we can examine indirect effects that occur due to factors such as weight loss. These are not unique to keto, though they might be more likely on a ketogenic diet compared to other ways of eating.

Carbohydrate Restriction

There is no real body of evidence that looks at ketogenic levels of carb restriction and menstruation, but there are some clues. In this small study, functional hypothalamic amenorrhea (FHA) was associated with dietary fat restriction; women with FHA actually ate non-significantly more carbs than matched controls and nearly identical total calories. Likewise, in this small study, FHA was associated with lower fat intake but no significant difference in carb intake.

This meta-analysis looked at the effect of low-carb (not keto) diets on markers of reproductive health among overweight women. The researchers found four studies that examined effects on menstruation; all showed improved menstrual regularity and/or ovulation rates. Of six studies that looked at levels of reproductive hormones, five reported significant improvements.

Carb restriction also results in decreased insulin production. Hyperinsulinemia and insulin resistance are frequently associated with polycystic ovarian syndrome (PCOS), one of the leading causes of female infertility and a frequent cause of menstrual irregularity. There is currently a lot of interest in using keto to treat PCOS, but only one small study has so far directly tested the effectiveness of a ketogenic diet to treat PCOS, with positive results.

Ketones

No studies have looked at the direct effects of ketones on menstruation.

Weight Loss

Of course weight loss is not unique to keto, but keto can be very effective for weight loss. Some women experience rapid weight loss when first starting a keto diet. Weight loss in and of itself can impact menstruation through a variety of pathways (and, of course, keto isn’t the only way people lose weight). A key way is by reducing the hormone leptin. Leptin’s main job is to communicate energy availability to the hypothalamus—high levels of leptin tell the hypothalamus that we have enough energy on board, which also means we can reproduce. Low leptin can disrupt the menstrual cycle and is linked to hypothalamic amenorrhea.

Body fat loss can also affect estrogen levels since estrogen is both stored and produced in adipocytes (fat cells). While fat loss in the long term will decrease estrogen production, it is possible that rapid fat loss might temporarily raise estrogen levels and can also affect estrogen-progesterone balance. These transient changes in estrogen levels might underlie some of the menstrual irregularities women report.

Stress

Stress can impact the menstrual cycle in myriad ways. Cortisol acts on the hypothalamus and pituitary glands, affecting hormone levels, sleep, immune function, and gut health, to name a few. Diets can be a source of stress, both at the physiological and psychological levels. Keto has a reputation for being especially stressful because it is more restrictive than other low-carb diets, but this can be mitigated by following the Keto Reset tips for women.

Thyroid Function

Thyroid dysregulation is another common cause of menstrual irregularities, and there remains a pervasive belief that keto is bad for thyroid health. Indeed, the thyroid is sensitive to nutrient deficiencies and caloric restriction, and thyroid hormones, especially T3, do frequently decline on keto. However, as Mark has discussed in a previous post, changes in T3 levels might not be a problem, especially in the absence of other problematic symptoms. Moreover, many practitioners now use keto as a cornerstone in their treatment of thyroid disorders.

What Should I Take From These Findings?

The first takeaway: there just isn’t much direct evidence about how keto might affect your menstrual cycle, positively or negatively. We have some studies suggesting that low-carb diets improve some aspects of menstruation and reproductive health, but keto is more than just another low-carb diet. Ketones themselves have important physiological properties, such as being directly anti-inflammatory, which might positively impact women’s reproductive health.

Second, the ways that keto is likely to (negatively) affect menstruation aren’t unique to keto, they’re common to any diet: hormone shifts mediated by energy balance, stress, and weight loss.

Furthermore, since keto is so often combined with caloric restriction, time-restricted eating, and fasting, even the anecdotal evidence might not be able to tell us all that much. If a woman is eating ketogenically, in a big caloric deficit, and doing OMAD (one meal a day), and her leptin plummets, how are we to know what really caused it? We don’t have good evidence that otherwise healthy women start a well-executed ketogenic diet and end up messing up their menstrual cycles.

That said, women do need to be cognizant of the sum total of the signals they are sending their bodies when it comes to energy availability and stress. A lot of women come to the keto diet with a history of adrenal, thyroid, metabolic, and reproductive issues. It’s important that they’re extra careful about how they approach keto. Done correctly, it might be just what the doctor ordered. I encourage any woman who’s dealing with other hormonal issues to work with a medical practitioner to tailor a keto diet to her unique needs.

But I’m Telling You, Keto Made My Period Go Haywire!

Ok, I believe you, really! But changes do not necessarily equal dysfunction. It is normal to experience hormone fluctuations when you make a massive—or even a relatively small but important—shift in your nutrition. Sometimes those fluctuations are unpleasant or unwanted, such as a period that lasts 14 days or one that arrives a week before you planned while you’re on vacation. However, that doesn’t make them bad from a health perspective. We need to respect that our bodies are dynamic systems. Changing the input will invariably change the output, and the system might need a few months to adapt to a new normal.

If your cycle goes wonky but you’re otherwise feeling good, give it a few months to sort itself out. If after a few months it’s still all over the place (or definitely if you’re having other disruptive symptoms), enlist help. In the meantime, check to make sure you’re not short-changing yourself nutritionally or calorically. Scale back on fasting efforts, and consider shifting more toward a traditional Primal way of eating.

At the end of the day, if you go keto and experience negative effects, stop. Keto is super hyped right now, but if your body is sending you clear signals that keto is not a good approach for you at this time, don’t do it. You can always try again later. It might be that your first attempt at keto didn’t work, but with a few adjustments and some experimentation over time you can find a version of keto that works for you.

Thanks for reading, everyone. Do you have comments, questions, or feedback? Let me know below.

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References:

Comninos AN, Jayasena CN, Dhillo WS. The relationship between gut and adipose hormones, and reproduction. Human Reproduction Update 2014; 20(2): 153–174.

Fontana R, Della Torre S. The Deep Correlation between Energy Metabolism and Reproduction: A View on the Effects of Nutrition for Women Fertility. Nutrients. 2016;8(2):87.

Klok MD, Jakobsdottir S, Drent ML. The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Obesity Reviews 2007;8(1):21-34.

Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A, Maciejewska-Jeske M. Functional hypothalamic amenorrhea and its influence on women’s health. J Endocrinol Invest. 2014;37(11):1049–1056.  

Tena-Sempere M. Roles of Ghrelin and Leptin in the Control of Reproductive Function. Neuroendocrinology 2007;86:229-241.

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What Breaks a Fast: Supplement Edition

Last week, I explored the impact of all the various foods, beverages, and food-like substances people consume while fasting—and hoping to maintain a functionally fasted state. Does MCT oil break the fast? What about coffee, tea, or bone broth?

There were more than a dozen, and I even did a follow-up. Today I’m going to discuss whether commonly-consumed supplements break the fast.

Let’s go:

Fish Oil

Fish oil is pure fat. If you’re taking the average supplemental dose of 1-2 grams of fish oil, it’s not a problem. That’s not even a teaspoon. It’s about 9-18 calories.

You may burn slightly less fat than you would otherwise, but in the grand scheme of things, a few grams of fish oil won’t break the fast.

Cod Liver Oil

Cod liver oil is fish oil with extra vitamin D and vitamin A. As long as you keep the doses low enough, cod liver oil won’t break the fast.

Multivitamin/Multimineral

Multivitamins do not break a fast. They are usually non-caloric. However, not all of their components will be absorbed very well on an empty stomach, so keep that in mind.

If you’re still not on board, note that in the older studies with really overweight people who fasted for upwards of a year straight, they usually supplemented with a multivitamin.

Food-Based Multivitamin

A popular one I’ve seen around—Alive, made from kale and raspberries—has just 2 grams of carbs per dosing. It’s not ideal, but it’s not a deal breaker—or a fast-breaker.

Gummy Vitamins

Gummy vitamins have the potential to be about 5-6 grams of sugar, a gram of protein (from gelatin), and a gram of fat (if including omega-3s) per serving, so they’d arguably break the fast. Plus, they taste like candy and are likely to stimulate cravings and make fasting harder.

Gummy vitamins break the fast.

Potassium

Potassium is non-caloric and does not break the fast. In fact, it can help you handle the fast better by replenishing electrolytes.

Potassium doesn’t break the fast.

Creatine

Creatine contains no calories and has no effect on insulin secretion (or glucose in the absence of calories).

Creatine does not break the fast.

Protein Powder

Protein powder provokes an insulin response, which opposes autophagy, which means you’re breaking your fast. Plus, protein powder contains calories.

I’m going to say “yes, protein powder breaks the fast.

Collagen

If you’re strict and technical, then yes, collagen breaks a fast. There’s evidence that glycine—the most prominent amino acid in collagen—can inhibit autophagy, but it was a convoluted animal study where inhibiting autophagy with large doses of glycine after brain injury actually improved outcomes. It probably doesn’t apply to someone adding a scoop of collagen to their coffee. Besides, even if it slightly reduces autophagy, a little collagen won’t negatively impact ketosis, fat-burning, or energy intake.

I’m going to say “technically yes,” but “realistically no, collagen doesn’t break the fast.” Avoid if your main focus is autophagy, however.

Branch Chain Amino Acids (BCAAs)

BCAAs trigger an insulin response and thus stop autophagy…and the fast. That said, many proponents of fasted training recommend using BCAAs before a workout to help preserve muscle and improve the post-workout anabolic response.

I’m going to say “yes, BCAAs break the fast.”

Vitamin D

Vitamin D is fat soluble and thus comes packaged in an oil carrier, but the dosage is so small that it won’t affect your fast.

Unless you find that 1/8 teaspoon of olive oil ruins your fast, vitamin D won’t break a fast.

Probiotics

Probiotics contain no calories and will not break a fast. However, they are best absorbed in the presence of food—the food protects them as they travel through the digestive system, and most probiotics occur naturally in food—so taking them during a fast is probably, mostly useless.

Probiotics don’t break a fast, but why take them during one?

Prebiotics

Pure prebiotics will not break a fast, as they contain no digestible carbohydrates. Prebiotic-enriched foods will break a fast, as they do contain calories.

Adaptogens

Adaptogens are compounds, usually herbs or herb derivatives, that modulate your stress response. They improve your ability to tolerate and respond to stressful situations; they don’t blindly inhibit the stress response if the stress response is warranted. They keep you honest and counter unnecessary stress responses. They contain no calories, unless you’re chowing down on a big hunk of maca or ashwagandha root. In fact, most adaptogens have traditionally been consumed in tea form, extracting the active compounds and leaving behind any calories. Have at ’em.

Adaptogens do not break the fast.

Mushroom Extracts

Medicinal mushroom extracts come from mushrooms, which are technically food. But the amounts you take are so low—usually no more than a teaspoon—that they won’t impact your fast or provide any significant amount of caloric energy. Four Sigmatic has those “mushroom coffee” blends you add to hot water. They can get up to about 30 calories per serving, but even that’s going to let you maintain most of the fasting benefits.

Mushroom extracts don’t break the fast.

Melatonin

I used to keep the old Trader Joe’s melatonin on hand because it was half a milligram, whereas most other melatonin supplements are in the 3-5 mg range. It was also sweet, tasting like those white Valentine’s Day mint hearts you used to get back in the day. I haven’t come across any sweetened melatonin supplements since Trader Joe’s phased those out, but that’s the only thing I’d worry about on a fast.

Melatonin does not break a fast.

Final Note: Most supplements are okay to take on a fast, though the lack of food may make absorption more difficult. If you have any other questions about supplements on a fast, drop them down below. Thanks for reading, everybody.

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Dear Mark: What Breaks a Fast Followup

For today’s edition of Dear Mark, I’m answering a round of questions drawn from the comment section of the “What Breaks a Fast” post. You folks had tons of follow-up questions about whether other types of foods or compounds break a fast. Does a teaspoon of honey? Does elevated insulin from BCAAs? Does coconut milk? Does pure prebiotic fiber? What about longer fasts—are they recommended? And how about unsweetened cocoa powder? What explains my ability to predict your questions? Do sausages break a fast? Does liquor? How should you exercise?

Let’s dig right in:

Hey, what about honey? 1 tsp in morning tea?

A teaspoon or less of honey is fine and won’t negate the benefits of fasting. I alternate between doing collagen coffee and coffee with cream and teaspoon of sugar (which was my typical morning coffee for over a decade). No reasonable person should fear a teaspoon of sugar or honey.

For what it’s worth, honey isn’t “just” sugar. It elicits a more beneficial (or less negative) metabolic response than other forms of sugar.

I’m shocked about the BCAA. I used to fast and take BCAA’s (yes, to continue dynamic exercise). I used to find it extremely difficult to fast compared to now when I fast without taking them. Does that mean that the insulin response made fastic more difficult?

It’s possible. Insulin impairs lipolysis—the release of stored body fat into circulation for energy usage—and the success of fasting depends on lipolysis. Without lipolysis, you can’t access all that stored energy.

Thank you very much for this info!! I am a butter-coffee-for-breakfast drinker, and I always worry about the ingredients breaking a fast. Could you please comment on coconut milk (in the can)? I love putting that in my coffee/breakfast.
Thanks.

Coconut milk is a less concentrated source of medium chain triglycerides, or MCTs (as in MCT oil). MCTs convert directly to ketones, making MCT oil and to a lesser extent coconut oil or coconut milk a potential “boost” for fasting. Still, energy is energy, and any energy you take in is energy you won’t be pulling from your body.

I find MCTs and coconut to be more useful when someone is just getting the hang of fasting or ketosis—as a nice boost to get things moving in the right direction.

Keep your coconut milk under a tablespoon and you’ll be fine.

Does prebiotic (resistant starch) fiber break a fast? Acacia senegal or potato starch? Thanks!

No. If you’re worried, test your postprandial blood sugar after eating the fiber.

Great input Mark as someone 3days into a 7day water fast with electrolytes of course what’s your view on longer fasts.

Check out the post I wrote on long fasts. Potentially beneficial but the risks accumulate the longer you go. You just have to be even more careful and methodical.

How about unsweetened cocoa?

A tablespoon runs just over 12 calories (depending on the brand; some cocoa powders contain more fat and thus more calories), with around a gram of net carbs and a gram of fat. Also a nice source of potassium and magnesium, along with a ton of polyphenols which can have fasting-mimicking effects on their own.

Eating enough unsweetened cocoa powder to knock you out of your fast would be incredibly repulsive. Probably impossible.

Cocoa is definitely a nice addition.

Okay it’s almost creepy the way Sisson answers my questions before I even ask them! I was wondering about this yesterday and then this post popped up in my inbox.

How does he do that…? ?

Kraft-Heinz has a strong relationship with Google and Amazon, and the Kraft acquisition gave me access to Alexa/Google Home datasets and the ability to predict what my readers are wondering about.

Just kidding, though it’s scarily not out of the realm of possibility anymore.

What about a small snack of paleo sausages, smoked or dried? So meat and fat (beef, pork or lamb), and some spices. Maybe 100g worth.

Well, that’s a legit snack bordering on a small meal. That will break the fast, but it’s not all for naught. There is the whole “fasting-mimicking diet,” where you eating very few calories for several days out of the week and retain many if not most of the benefits of full-on fasting.

Let’s just say if you ate a small snack of paleo sausages on your “fasting” days, you’d still be way ahead of 99% of people.

But do try a full-on fast at least once. You might surprise yourself.

Great post! What about alcohol? Specifically, a shot or 2 of liquor. I would assume beer and wine would break a fast, but what about whiskey or tequila?

When alcohol enters the system, utilization of all other energy sources is suspended until the alcohol is burned. Back in 1999, researchers did a study where they gave fasting adult men the equivalent of a couple shots of liquor. They stopped releasing stored body fat, stopped burning body fat, and began burning way more acetate (a product of ethanol metabolism). They didn’t exactly “break” the fast, but all the metabolic trajectories we love about fasting took a big pause.

Good morning Mark,
How does one exercise in the morning while fasting? When to eat?

You can exercise any way you like, but I change how I train based on when I’m going to break the fast with food.

If I’m going to break the fast with a meal right after, I train any way I like. I’ll do sprints, HIIT, weights, anything.

If I’m going to keep fasting after the workout, I like to stick to strength training and low-intensity movement (walking, hiking, standup paddling). The strength training is essential during a fast because it’s an anabolic signal to your muscles—move it or lose it. Simply lifting heavy things during a fast can stave off muscle loss.

That’s it for today, folks. Stay tuned later this week for “What Breaks a Fast: Supplements Edition.”

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13 Keto-Friendly Fiber Foods

While some keto or low-carb proponents claim fiber is useless at best and actively harmful at worst, I come down on the side that says fiber is probably helpful for most people. Some folks have persistently better responses to low- or no-fiber keto diets, and I won’t argue with that—I’ve seen it happen and I’ve read the studies where de-emphasizing fiber can actually improve constipation, for example.

I’ll just say that I have an opposite reaction, and, most importantly, I love eating a variety of plant foods that also happen to contain a ton of great nutrients in addition to fiber.

Do I buy into the idea that fiber is important because it is every human being’s responsibility to produce as much colonic bulk as humanly possible? No.

Do I think we should be consistently pushing the limits of our digestive tracts, performing feats of bathroom heroism so momentous they border on Herculean, and making sure the toilet bowl buckles beneath us? No.

The real value of fiber lies not in its coarseness, its tendency to form colonic bulk, to keep us topped off. The true value lies in its fermentability. A fermentable fiber is a prebiotic fiber—fiber that feeds our gut bacteria.

I won’t get into the many roles our gut bacteria play in our health today (I’ve covered that before. 1, 2, 3).

I will, however, explain why we need to be feeding our gut bacteria. Our gut bacteria form a physical barrier against incursions and colonization by pathogenic bacteria; they take up room along the gut lining so pathogens can’t. If we don’t feed our gut bacteria with prebiotics, it won’t be around to protect us. After antibiotic treatment where both good and bad gut flora are indiscriminately targeted and wiped out, pathogenic obesity-promoting bacteria take advantage of the open space. That’s a worst-case scenario, but it shows what can happen when the harmony of the gut is disturbed by antibiotics or, to a less extent, a lack of fermentable prebiotic fibers.

When our gut bacteria eat prebiotics, they also give off metabolites like butyric acid—a short chain fatty acid that our colonic cells use as an energy source and which improves metabolic health.

Gut bacteria also convert antinutrients like phytic acid into nutrients like inositol. The almond meal-obsessed keto eater would do well to have a powerful gut biome set up to convert all that phytic acid to inositol.

Now, some writers will come up with specific blends of fibers, powders and gums to create the “optimal” prebiotic diet for your gut bacteria, but that’s pretty silly. The gut is a complicated place. We’ve barely begun to even identify all its inhabitants. To think we know the precise blend of isolated fiber that will make them flourish, and then act on that, is a mistake.

A better option is to eat foods that contain fiber. Some of the prebiotic fibrous foods with the best nutrient profiles also happen to be extremely keto-friendly.

1) Almonds and Pistachios

Nuts are usually favored in health-conscious circles for a few reasons. They like the monounsaturated fat. They like the mineral profile, or the complete protein, or their ability to dissemble into nut meals and form baked goods. But what gets short shrift is the fiber content. Now, I can’t speak for other nuts, but almonds and pistachios in particular contain fiber with potent prebiotic effects. People who eat almonds and to an even greater extent pistachios end up with improved gut bacteria profiles.

2) Green Bananas

Ripe bananas are difficult to squeeze into a ketogenic diet. The green banana—an unripe one—is mostly resistant starch, a type of starch that cannot be digested and travels untouched until colonic bacteria metabolize it. It’s one of the best stimulators we know of butyric acid production. And sure, you could do a spoonful of raw potato starch to get your resistant starch, but the beauty of the green banana is that it also provides potassium, another nutrient that some find difficult to obtain and stay keto.

3) Wild Blueberries

Blackberries, boysenberries, raspberries, and strawberries are all loaded with fiber, and you should eat them. They’re lower carb than you think, they’re loaded with polyphenols, and topped with some real whipped cream they make a fantastic dessert. But wild blueberries are special. They’re smaller than other berries, which increases the amount of skin per ounce you get, and skin is where all the polyphenols and fiber lie. Heck, even the blueberry’s polyphenols have prebiotic effects on the gut biome.

4) Mushrooms

A few years ago, I wrote a whole post on mushrooms. Suffice it to say, they’re quite wonderful, bordering on magical. I did not discuss the fiber they contain. It turns out that all the various mushroom polysaccharides/fibers, including beta-glucans, mannans, chitin, xylans, and galactans also act as potent prebiotics that improve the health of the host.

5) Avocado

Your standard avocado has about 12-15 grams of fiber, if you eat the whole thing. I

6) Jicama

Great with chili powder, salt, and lime juice, jicama is about 11 grams of carbs per cup, but half of those are inulin, a potent prebiotic fiber with a tendency to really ramp up butyrate production.

7) Onions

Onions are another fantastic source of inulin. They go into almost every dish of every cuisine, so there’s no excuse not to be eating onions.

8) Garlic

I’ve been known to treat garlic like a vegetable, roasting an entire cast iron pan full until brown and sweet and chewy. They’re another great source of prebiotic fiber.

9) Leeks

Leeks have more inulin than onions. Try them crispy in egg scrambles.

10) Broccoli

Broccolini is a major part of my favorite meal of the day—my Big-Ass Keto Salad. Broccoli (and cruciferous vegetables in general) has been shown to have modulatory effects on the gut biome.

11) Sauerkraut

Kraut gives you two in one. It’s a fermented food, which is great for the gut biome. And it’s cabbage, which is very fibrous. Even pasteurized kraut improves gut health.

12) Dark Chocolate

Dark chocolate, the good stuff with a high cacao content (85%+) and low sugar content, is an incredible source of prebiotic fiber. Eat more of it.

13) Animal Fiber

Obligate carnivores like cheetahs who don’t eat any plants (willingly) still have gut bacteria. These gut bacteria thrive on “animal fiber,” the gristle and cartilage and other bits of connective tissue that comprise a good 20-30% of the walking weight of a prey animal. Humans are not obligate carnivores, but eating the entire animal has been a mainstay of advanced hominid existence for millions of years. I find it very likely that something, someone, somewhere inside our guts is breaking down the animal fiber we eat—so you’d better be eating some!

Not so tough, is it? It’s not like I’m suggesting you load up on bran muffins, psyllium smoothies. I don’t want you dumping flax meal into everything or munching on those awful fiber gummies. Just eat some basic, healthy, low-carb plant matter—foods that don’t really scream “fiber”—and the rest will take care of itself.

What’s your favorite low-carb source of fiber? Let me know down below.

Thanks for reading, everyone.

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References: 

Hernández E, Bargiela R, Diez MS, et al. Functional consequences of microbial shifts in the human gastrointestinal tract linked to antibiotic treatment and obesity. Gut Microbes. 2013;4(4):306-15.

Ukhanova M, Wang X, Baer DJ, Novotny JA, Fredborg M, Mai V. Effects of almond and pistachio consumption on gut microbiota composition in a randomised cross-over human feeding study. Br J Nutr. 2014;111(12):2146-52.

Jiao X, Wang Y, Lin Y, et al. Blueberry polyphenols extract as a potential prebiotic with anti-obesity effects on C57BL/6 J mice by modulating the gut microbiota. J Nutr Biochem. 2019;64:88-100.

Jayachandran M, Xiao J, Xu B. A Critical Review on Health Promoting Benefits of Edible Mushrooms through Gut Microbiota. Int J Mol Sci. 2017;18(9)

Nielsen ES, Garnås E, Jensen KJ, et al. Lacto-fermented sauerkraut improves symptoms in IBS patients independent of product pasteurisation – a pilot study. Food Funct. 2018;9(10):5323-5335.

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Hemp Oil: How Should You Take It?

The burgeoning CBD hemp oil scene has made finding a product easier than ever, but it’s also made choosing a product harder. If you recall my post from years ago on decision fatigue, you’ll know what I’m talking about: the paralysis of too many choices…. I know my readership, and I know you’re the type of people who will wonder about optimizing their CBD ingestion. This stuff isn’t cheap, and it’s perfectly rational to want to get your money’s worth.

While the compound itself—cannabidiol, or CBD—doesn’t change from product to product, the way it’s administered does.

There are oral hemp oil supplements—gummies, capsules, infused teas, chocolates. Things you eat and drink and digest.

There are sublingual hemp oil supplements—sprays, tinctures, lozenges. Things you swish and swirl around your mouth.

There are topical CBD—creams, lotions, and balms.

There are patches—things you rub and attach to your skin.

There is high-CBD cannabis and CBD-only vape juice. Things you can vaporize and inhale.

But how do you choose? What are the differences between the various routes of administration?

What To Consider When Choosing A CBD Product

Speed of absorption. How quickly do you want the CBD to take effect?

Intensity. How powerful do you want your CBD “experience” to be?

Duration. How long do you want it to last?

Effects. Where do you want it to take effect?

CBD Product Choices: The Rundown

Oral

Oral CBD is the most common method of administration. It’s simple, easy, and intuitive. Everyone swallows pills, eats food, and drinks fluids. There’s almost no way to mess it up (choking aside).

Oral CBD is readily absorbed. Like most everything else that travels through the digestive system, it goes to the liver to be metabolized and converted into different metabolites. The liver is so central to oral CBD that people with poor liver function actually end up with higher serum CBD after taking it orally, since their livers aren’t as good at metabolizing it into different compounds. This liver route also means it takes longer for oral CBD to take effect, but it lasts longer.

Taking an acute oral dose every once in awhile is less effective than consistent dosing because of the liver’s tendency to regulate its bioavailability. When you take it on a regular basis, CBD—being fat soluble like other cannabinoids—gathers in your adipose tissue where your endocannabinoid system can theoretically utilize it on an ongoing basis.

  • Speed: Slow
  • Intensity: Low to moderate (depending on dosage)
  • Duration: Long
  • Effects: Systemic

Sublingual

Sublingual CBD goes under the tongue for absorption via the mucosal membranes in the mouth, which are highly permeable. From there, it bypasses the portal vein—the passage that leads from the digestive tract to the liver—and heads straight for the blood. And then whatever’s left over and not absorbed sublingually gets swallowed and makes it into the digestive tract, so nothing’s wasted.

You have several sublingual options….

Tinctures: Little dropper bottles.

Sprays: AKA oromucosal spray; think CBD-infused Binaca (anyone remember Binaca?).

Lozenges: CBD lozenges that slowly dissolve in your mouth and enter through the mucosa.

The longer you let the CBD sit in your mouth, the more you’ll absorb. 60-90 seconds appears to be the most commonly recommended period of time.

  • Speed: Fast
  • Intensity: Low to high (depending on dosage)
  • Duration: Moderate
  • Effects: Systemic

Inhaled

The original way to get CBD, inhaling CBD, is the fastest-acting and the most intense (with intensity meaning “effectiveness,” not “this will get you messed up, man,” since CBD is not psychoactive). The vapor or smoke enters the lungs, whose alveoli act as a direct conduit to the bloodstream. Inhalation is also the most legally precarious (depending on where you live) because many inhalation CBD products also contain THC, which remains illegal in most places.

You can smoke cannabis bred to be very high in CBD and low in THC, but there will always be some THC present. You couldn’t exactly call this non-psychoactive (or legal in most places) either due to the THC.

There’s also CBD-only vape juice/E-liquid that you can vaporize and inhale.

It’s certainly effective, though if you’re going for efficiency it’s not “optimal.” Your lungs can’t absorb all the CBD in the smoke or vapor; a significant portion is exhaled and lost to the atmosphere. Plus, there’s the whole fact that filling your lungs with smoke is a major stressor. Vapor might be safer, but I’m skeptical.

  • Speed: Fast
  • Intensity: Low to high (depending on dosage)
  • Duration: Shorter
  • Effects: Systemic

Topical

Like other cannabinoids, the CBD molecule is highly hydrophobic and thus cannot pass through the aqueous layer of the skin to reach general circulation. However, if you lather enough of it on to an isolated patch of injured rat skin, it can interact with peripheral cannabinoid receptors that reduce pain and inflammation at a local level. This hasn’t been confirmed in live humans, but anecdotal reports are positive.

  • Speed: Fast
  • Intensity: Unknown
  • Duration: Unknown
  • Effects: Local

Which One Should You Choose?

I don’t have a dog in this fight. I don’t use CBD myself (though I’m not opposed to it and am open to incorporating it in the future if it proves to be uniquely helpful). As a result, I don’t have any strong personally motivated opinion about specific products. What I can give is my objective take on the available evidence, which is fairly light and preliminary:

The best-studied CBD administration methods are oral and sublingual. The majority of human studies have utilized those two routes. There are quite a few positive studies on smoked or inhaled CBD, too, but those often include THC and fail to isolate CBD. If you’re only interested in CBD and not in THC (or it’s illegal where you live), those studies probably don’t apply to you.

In the large set of case studies that found CBD helped patients improve their sleep, the subjects took CBD capsules.

In a study on CBD and pain, the subjects used an oromucosal spray.

In epilepsy patients, oral CBD capsules were incredibly effective.

For general use, whether it’s for anxiety, inflammation, pain, or “general wellness,” oral and/or sublingual use seems to be the real ticket. You know how much you’re consuming. You get a long lasting, fairly fast-acting duration of action. You get the quick absorption into the bloodstream of inhaled CBD without losing any due to exhalation. And if you don’t absorb it all through your oral mucous membranes, you’ll simply swallow and digest the rest. Nothing is lost.

What about you, folks? I know there are some experienced CBD users out there reading this. What’s your favorite method of administration, and why?

Take care everyone.

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References:

Taylor L, Crockett J, Tayo B, Morrison G. A Phase 1, Open-Label, Parallel-Group, Single-Dose Trial of the Pharmacokinetics and Safety of Cannabidiol (CBD) in Subjects With Mild to Severe Hepatic Impairment. J Clin Pharmacol. 2019;

Lattanzi S, Brigo F, Trinka E, et al. Efficacy and Safety of Cannabidiol in Epilepsy: A Systematic Review and Meta-Analysis. Drugs. 2018;78(17):1791-1804.

Richardson JD, Kilo S, Hargreaves KM. Cannabinoids reduce hyperalgesia and inflammation via interaction with peripheral CB1 receptors. Pain. 1998;75(1):111-9.

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How I Take My Coffee (+ Ultimate Coffee Giveaway)

I’ve got another awesome success story coming up later this morning, but first…coffee.

As I said on Friday, I take my coffee very seriously. So, no April Fool’s here. Just a great giveaway for any coffee lover out there…

I’m not a breakfast eater as many of you know. As a result, my morning coffee is important to me. It’s a sensory experience I enjoy as well as a ritual that kicks off my day. Sure, the caffeine offers a little pick-me-up, but I make it count nutritionally with a collagen boost, too.

I love Caveman Coffee, and it’s my favorite brand of beans to start with. After grinding those fresh (one of the great sensory pleasures of human existence), I pour them into my French press—the only way I make coffee. Once I add the hot water, I’ll let that sit for a couple minutes. In the meantime, I put one scoop of Vanilla Collagen Fuel in my cup and add just a bit of my prepared coffee—not quite a 1/4 cup. I’ll stir it up (the best way to blend everything in my experience), then pour in the rest of my coffee and enjoy!

Here’s what it all looks like, plus a little commentary on coffee and collagen for a morning fasting routine.

Now For the Giveaway…

The Prize:

Everything you need to make a great cup of Collagen Coffee and then some…

  • Variety Pack of Caveman Coffee (Blacklisted, Mammoth, Mammoth Plus, and Sabretooth)
  • $100 of Primal Kitchen products, including 2 Canisters of Primal Kitchen Collagen Fuel
  • Le Creuset Stoneware 27 oz. French Press
  • Primal Kitchen Yeti Tumbler

How To Enter:

Simply enter your email below. Your information won’t go anywhere other than to our newsletter list and Caveman Coffee’s newsletter list, either of which you can opt out of at any time. (If you’re already a subscriber, still enter your email address to enter.)

But, wait! Get a *bonus entry* while you’re at it by following us @marksdailyapple and @cavemancoffeeco on Instagram. Follow both and comment on the Mark’s Daily Apple giveaway post to tell us you’ve entered.

Deadline:

Closes April 8th, 2019, midnight PDT.

Eligibility:

Open to those in the U.S. only on this one. Must be 18-years-old+ to enter.

How the Winner Will Be Chosen:

I’ll choose one random winner from those who enter before the deadline. The winner will be contacted on 4/9/19 and will also be announced on social media.

Good luck, everybody. And in the meantime, let me know how YOU take your coffee. (I’m always up for new ideas.) Have a great week.

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The Best 17 Keto-Vegan-Paleo Recipes

Thanks to the good folks at Paleohacks for today’s recipe.

Is it possible to go keto while omitting all dairy and animal products as well? It might seem difficult, but these 17 keto-friendly vegan and Paleo recipes can get you started.

The biggest challenge to going keto (and otherwise restricting your diet) is the frustrating perceived lack of variety when it comes to meals. We’re here to prove that even when following the keto, Paleo and vegan diets, you can still eat well.

From breakfasts, to snacks, to lunch, dinner and dessert, there’s something for every meal of the day. Enjoy fluffy coconut flour flatbread to sandwich your favorite toppings, or healthy mint chocolate fudge for a treat. You’ll find inspiration all over this list.

These five-ingredient, five-minute low-carb crunch protein bars are basically healthy candy bars. Plus, there are lots of modifications you can follow to best suit your diet.

This easy, fluffy flatbread will fool anyone—it’s just as good as the original, gluten-laden kind. Psyllium husk functions as the “egg-like” binder in this recipe, making it totally vegan in addition to Paleo and keto.

This simple Shamrock shake recipe is way better than the fast food original, but just as (naturally) green—thanks, avocado! Vanilla and mint extracts lend the shake its distinct flavor.

Need a craving-busting chocolatey treat? These chocolate espresso bombs use whole ingredients, including cacao powder, nut butter and espresso powder. They’re full of healthy fats that will keep you satiated in between meals.

This inventive bento box assemblage includes seaweed “noodles” with your choice of raw or toasted almonds, an herbaceous heirloom tomato and cucumber salad, protein-packed guacamole and chunks of coconut and carrot. It makes for one refreshing, colorful and healthy lunch!

Packed with Mexican spices like cumin and cilantro, this Mexican cauliflower rice makes the perfect accompaniment to any main dish.

Silky mint chocolate fudge that’s dairy and sugar-free? It’s true! This simple recipe is ready in under an hour and requires only a blender and a fridge.

The secret to these crunchy, chocolate mint, no-bake protein bars is the crunchy almond butter—but smooth almond butter will also work in a pinch. Adorn your bars with chia seeds, coconut, cacao nibs or almonds for added flavor and texture.

These chocolatey-coffee-nutty treats will keep you satiated all day long, thanks to the addition of almonds, flax meal, hemp seeds, almond butter and coconut oil. Be sure to omit the maple syrup or swap in a keto-compliant sweetener.

Don’t be fooled by the pictures—there’s no actual pasta to be found here! Kohlrabi noodles make for a flavorful, healthy dish, while a homemade, dairy-free Alfredo adds an ultra-creamy mouthfeel. This recipe uses pre-prepped noodles and cauliflower rice, but you can always make those at home with a food processor and spiralizer.

These fat bombs are loaded with puckering citrus flavor from lemon juice and zest as well as coconut butter, coconut oil and low-carb blueberries—or whatever berries you prefer.

Need a big bowl of comfort, with none of the guilt? This low-carb mac and cheese recipe uses hearty cauliflower in place of noodles, while tahini, olive oil and spices make it super creamy and tasty.

Well-spiced, creamy spinach gets whipped up quickly in the Instant Pot. Opt for coconut oil over ghee to keep it vegan, and serve over a bed of cauliflower rice.

These simple, uber-creamy and chocolatey fudgesicles take minutes to prep. Opt for stevia over the maple syrup and add more coconut milk to keep it keto.

Need a big bowl of Mediterranean-inspired, veggie-packed goodness? This salad boasts cauliflower, artichoke hearts, bell pepper, cucumber, tomatoes and more.

This simple tabbouleh recipe subs in cauliflower for traditional grains. It’s herbaceous, lemony and perfect to dip all your favorite vegetables in.

Missing bread on your restricted diet? This magic, low-carb mug bread comes together in minutes and requires only a handful of wholesome ingredients. Be sure to use a vegan egg substitute to keep it vegan.

Thanks again to Paleohacks for the awesome recipe list today. Have your own favorite low-carb plant-based favorites? Share below. 

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Top 12 Keto Blogs

With the explosion of keto, there’s an ever growing constant stream of new information about the significant benefits, supposed risks, and varying “rules” for how to adopt a keto diet. As with most things, it’s easy to get sucked into information overload. (And that doesn’t even take into account the hype that unfortunately gets distributed like wildfire around the Internet.) You want sources you can count on for facts, reason, and utility. Here are twelve solid sources I’d recommend for intelligent commentary, sound science, and useful ideas.

1) Mark’s Daily Apple

Sure, this isn’t an exclusively keto blog. It’s a Primal living blog—with attention to all the components that figure into a healthy lifestyle and fulfilling life. But keto is a powerful tool I use within the Primal Blueprint template. As most of you already know, I approach keto specifically through a Primal lens—what I call a Primal-keto approach to keto living that prioritizes optimum nutrition with the least amount of pain, suffering and sacrifice. I know it’s been working for a lot of people, and I’ll continue to to write on it as well as all the other elements of a healthy life. Four particular resources I’d suggest to folks new to keto: the MDA Keto Hub, our Keto Recipes, the Primal Blueprint Keto Podcast, and our private Keto Reset Facebook Group. They’re all free resources for anyone to use and enjoy. For those who want to receive an additional Mark’s Daily Apple monthly email with exclusive information and commentary on keto, you can sign up below for the Keto Reset Digest (also free).

2) Virta Blog

Virta is a groundbreaking health organization using keto to treat—even reverse—type 2 diabetes and associated metabolic disorders. The Virta Blog is an must-read, providing a mix of cutting edge science, easy to understand articles regarding practical aspects of going keto, and inspiring success stories.

3) Tuit Nutrition

I love Amy Berger’s common sense approach to keto on Tuit Nutrition. She calls her approach Keto Without the Crazy, and that about sums it up. Her articles are long but very worth reading.

4) Ruled.me

At Ruled.me you’ll find mostly long-form articles that contain a ton of information about the keto diet. The site also provides an extensive recipe collection and other resources.

5) Healthful Pursuit

Healthful Pursuit is the home of Nutrition Educator and keto guru Leanne Vogel. Leanne provides a blend of blog posts, videos, and recipes to help you go keto in a healthy way. Much of the content is focused on keto for women, but men and women alike can benefit from the info provided.

6) Calories Proper

At Calories Proper, Dr. Bill Lagakos covers a wide range of topics related to nutrition, fasting, circadian biology, and much more. While it’s not a keto blog per se, keto is a frequent topic. In any case, you’re sure to learn a lot from the content here, which is heavily focused on reviewing and critiquing empirical research studies in an understandable way.

7) Ketogenic Athlete

Ketogenic Athlete is a well-rounded blog for strength and endurance athletes who are interested in using keto for training and performance.

8) The MAF Files at philmaffetone.com

Dr. Phil Maffetone has been using low-carb and keto diets to help athletes achieve breakthrough athletic performance for decades. His 180-age formula is a cornerstone of my Primal Endurance approach to become and fat- and keto-adapted athlete. The MAF Files covers a variety of topics that will be of interest to Primal and keto athletes.

9) HVMN

HVMN offers the only commercially available ketone ester supplement. The blog reflects their target audience: athletes and other high performers who are interested in using diet and lifestyle modifications—and possibly exogenous supplementation, of course—to harness the power of ketones.

10) Elana’s Pantry

Elana Amsterdam has long been one of my go-to sources for healthy, delicious paleo recipes, but more recently she has been using keto as part of her strategy to address her MS. I’ve never made an Elana’s Pantry recipe that wasn’t excellent. She also writes about a variety of topics related to health.

11) Castaway Kitchen

Christina Kurp shares how she used a combination of AIP and keto to fix her own health issues. Part wellness blog, part scrumptious recipe collection, Castaway Kitchen is a great resource for anyone looking for food inspo, especially if you have dietary restrictions.

12) Cast Iron Keto

Plainly put, Cast Iron Keto has food I like to eat: simple, delicious, keto-friendly. You’ll find lots of keto-fied classics here suitable for kids and non-keto types (making dinner that much easier).

Thanks for stopping in today, everyone. Have a favorite you didn’t see here? Share down below. Take care.

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