Weekly Link Love — Edition 26


Research of the Week

Scientists generate speech from brain recordings.

In the U.S., sedentary behavior has remained stable or gotten more prevalent.

Visualizing coffee might be enough (not buying this one).

Pigs who eat chicken generate more lipid oxidation products than pigs who eat beef.

When we sleep, our brain distinguishes between important and unimportant sounds.

Thinking of your future self as similar to your present self produces better outcomes.

20 minutes of nature is enough.

New Primal Blueprint Podcasts

Episode 330: Gary E. Foresman, MD: Host Elle Russ chats with Dr. Foresman about heart disease, statins, and more.

Episode 331: Brad Kearns and Brian McAndrew Talk Carnivore and Balance: Host Brad Kearns chats with Primal video whiz Brian McAndrew about carnivory and balancing being strict with being happy.

Health Coach Radio Episode 9: Lauren Schwab: Lauren has mastered the art of the wellness retreat, not an easy task.

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

Media, Schmedia

First they came for the hot dogs and bologna, and I was silent….

Salt limits get even lower.

Interesting Blog Posts

How a knee bone that almost disappeared is coming back.

A novel tactic for getting teens to spurn junk food.

Lowering cholesterol with psyllium at every meal: one experience.

Hilarious.

Social Notes

If you’ve had success with the Primal Blueprint, Keto Reset, or any of the advice offered on this site, send in your success story. All submissions will receive a discount code for use on Primal Blueprint or Primal Kitchen.

Got named one of Healthline’s “Best Men’s Health Blogs.”

I hope this guy follows me.

Everything Else

If you’re not eating whole rattlesnakes, you can’t call yourself paleo.

Human composting up for a vote in Washington state.

A man’s beer-only fast for Lent ends up working out.

“The sudden passionate happiness which the natural world can occasionally trigger in us,” Michael McCarthy writes, “may well be the most serious business of all.”

“So I had a piece of salmon and my brain felt like a computer rebooting.”

Things I’m Up to and Interested In

This is awkward: Using CRISPR to edit DNA also causes off-target RNA alterations.

Article I found interesting: Neuronal life after death.

Video I enjoyed: 3 pro soccer players vs 100 kids.

I’m not surprised: Wildlife-friendly agriculture increases yield.

Why everyone needs to lift: Having muscle protects against progression from healthy to metabolically unhealthy.

Question I’m Asking

What’s the best book you’ve read in the past year?

Another Question I’m Curious About

What would you do with a bunch of extra arugula?

Recipe Corner

Time Capsule

One year ago (Apr 21– Apr 27)

Comment of the Week

“I don’t think we should be drinking teas grown in ‘Shady Conditions’…
all kidding aside, magnesium works well for me until about after 5pm, and then it wires me up and I can’t sleep.”

– You haven’t had tea grown in places with gunshots going off, discarded syringes littering the ground, and human fecal matter smeared everywhere? It’s the best, nocona!

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Weekly Link Love — Edition 24

Research of the Week

The common food additive TBHQ, a synthetic antioxidant used to preserve freshness, appears to impair the immune response to influenza.

Maori people have a greater insulin response to fructose than BMI-matched Europeans.

There’s a new DNA editing tool in town.

Good dog.

Dog owners tend to be more happy than cat owners.

New Primal Blueprint Podcasts

Episode 325: Gary John Bishop: Host Elle Russ chats with Gary John Bishop, personal development coach and author of Unf*ck Yourself and Stop Doing That Sh*t.

Episode 326: Dr. Lindsay Taylor: Host Brad Kearns chats with Dr. Lindsay Taylor about silly six-packs and going by how you feel rather than how you look.

Health Coach Radio Episode 7: Michael Rutherford: Michael Rutherford is a veteran health coach who focuses on an underserved population—truck drivers.

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

Media, Schmedia

Twitter CEO Jack Dorsey sounds like he’s been reading this blog.

Researchers find a new human species, a tree-climber with curved toes who lived in the Philippines 60 thousand years ago.

Interesting Blog Posts

Ancient methods for preserving olives.

Icing may not work, may hurt.

Social Notes

I had a good time on the Taste Radio podcast, talking about my history as a serial entrepreneur and how it made growing the blog and brand into what they are today possible.

I also had a blast with Aubrey Marcus on his podcast, talking about our shared vision for changing how the world eats and the importance of learning from failure.

Everything Else

Chinese scientists insert human brain genes into monkeys.

It’s possible to get too much vitamin D.

Norway hospitals offer forest therapy.

Cashews come with a price.

Things I’m Up to and Interested In

New study: Dietary saturated fat unrelated to heart disease risk.

Topic I found interesting: How Alzheimer’s patients usually have more going wrong in the brain than “just” Alzheimer’s, and what it means for treatments.

As someone who has experience with both, I can agree: Exercise makes you happier than money.

I hadn’t thought of this angle: Is work more fun than not working?

Seems likely: Will space colonization be fully automated?

Question I’m Asking

What’s your opinion on the “money vs. exercise for happiness” question?

Recipe Corner

Time Capsule

One year ago (Apr 7 – Apr 13)

Comment of the Week

“Now that you mention it in your Sunday with Sisson, I think I’ve always thought of the pushup more as a toe-as-fulcrum rotation rather than an up-and-down activity. I mean, this perspective naturally follows if you are already doing pushups with a ridged plank from head to toes and focus on only moving your arms to raise your body up and lower it back down slowly, as if you were a plank of wood a single person was lifting up and down from the floor while standing at one end of the plank. Visualization and imagery can provide key insights into form and technique.”

– Great description and apt point, Aaron.

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Weekly Link Love — Edition 22

Research of the Week

GMO soybean oil (made to have less PUFA and more MUFA) causes less obesity than conventional soybean oil

12 weeks of keto improve cognitive function, eating behavior, physical performance, and metabolic health in obese people.

Older adults are still capable of growing new neurons, except if they have Alzheimer’s.

More inflammation, more impulsivity.

Want to bulk up your pet mouse’s colon tumors? Give him American cola, not Mexican.

A combo of EGCG and ferulic acid reverses cognitive deficits in mice with Alzheimer’s.

New Primal Blueprint Podcasts

Episode 322: Dr. Robert Glover: Host Elle Russ chats with Dr. Robert Glover, author of No More Mr. Nice Guy.

Health Coach Radio Episode 5: Ste Lane: Hosts Laura Rupsis and Erin Power chat with Ste Lane, a Primal health coach highlighting the importance and vitality of mindset in the pursuit of health and fitness.

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

Media, Schmedia

The plaintiffs in an ongoing trial against Monsanto allege that the agrochemical company planted a mole in an independent lab to fake safety data for Roundup.

Primatologist Frans de Waal on human exceptionalism.

Interesting Blog Posts

How the timing of your training affects circadian rhythm.

These forest monks have it figured out.

Social Notes

Another “vegan” Youtuber got caught eating animal foods. You’ll never guess what happened next.

In last week’s SWS, I mentioned a product Kickstarter for Thin Ice, a wearable cold vest that claims to trigger thermogenesis. I want to make clear that I wasn’t recommending it, just expressing interest in the concept. I have no connection to the brand and no clue if the product actually does what it claims.

Everything Else

Look for a coffee-related giveaway this coming Monday on the blog. Has nothing to do with April Fool’s. (I never joke about coffee.)

Why are we “still waiting” for a male birth control pill? Maybe because the only viable one they’re trying to push lowers (an already historically low) testosterone.

Workism isn’t working.

Shmita, the ancient Jewish practice of agriculture.

Things I’m Up to and Interested In

We can do epidemiology, too: A new study on carb consumption and heart disease finds that “strong and probably causal” links between coronary heart disease and glycemic load/index “exist within populations.”

Concept I found interesting: Sex differences in pain sensations.

This is worrisome: A “sex recession.”

I’m intrigued: “In order to reveal how ‘peculiar a creature we are,’ Stewart-Williams offers an alien scientist’s perspective on modern human civilization, studying us as we would study animals in the wild.”

I’d send my kids here (if I had anymore of the right age): The first USDA-certified organic high school where learning to farm is a graduation requirement.

Question I’m Asking

Men: Would you take a birth control pill that lowers testosterone? Women: Would you want your men to take a birth control that lowers testosterone? And I guess this follows, too…how do you feel about women’s birth control pills’ effect on your own hormonal picture?

Recipe Corner

Time Capsule

One year ago (Mar 24– Mar 30)

Comment of the Week

“‘Physiological Functions and Metabolism of Endogenous Ethanol and Acetaldehyde in the Reindeer’ is a bit of light reading that pairs well with a smokey single malt from Islay on a cold winter night.”

– I’m waiting for someone to bottle endogenous reindeer moonshine, Aaron.

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The Definitive Guide To Autophagy (and 7 Ways To Induce It)

Biological systems are self-maintaining. They have to be. We don’t have maintenance workers, mechanics, troubleshooters that can “take a look inside” and make sure everything’s running smoothly. Doctors perform a kind of biological maintenance, but even they are working blind from the outside.

No, for life to sustain itself, it has to perform automatic maintenance work on its cells, tissues, organs, and biological processes. One of the most important types of biological maintenance is a process called autophagy.

Autophagy: the word comes from the Greek for “self-eating,” and that’s a very accurate description: Autophagy is when a cell consumes the parts of itself that are damaged or malfunctioning. Lysosomes—members of the innate immune system that also degrade pathogens—degrade the damaged cellular material, making it available for energy and other metabolites.  It’s cellular pruning, and it’s an important part of staving off the worst parts of the aging process.

In study after study, we find that impairment to or reductions of normal levels of autophagy are linked to almost every age-related degenerative disease and malady you can imagine.

  • Cancer: Autophagy can inhibit the establishment of cancer by removing malfunctioning cellular material before it becomes problematic. Once cancer is established, however, autophagy can enhance tumor growth.
  • Diabetes: Impaired autophagy enables the progression from obesity to diabetes via pancreatic beta cell degradation and insulin resistance. Impaired autophagy also accompanies the serious complications related to diabetes, like kidney disease and heart failure.
  • Heart disease: Autophagy plays an important role in all aspects of heart health.
  • Osteoporosis: Both human and animal studies indicate that autophagy dysfunction precedes osteoporosis.
  • Alzheimer’s disease: Early stage Alzheimer’s disease is linked to deficits in autophagy.
  • Muscle loss: Autophagy preserves muscle tissue; loss of autophagy begins the process of age-related muscle atrophy.

Okay, so autophagy is rather important. It’s fundamental to health.

But how does autophagy happen?

The way it’s supposed to happen is this:

Humans traditionally and historically lived in a very different food environment. Traditionally and historically, humans were feasters and fasters. While I don’t think our paleolithic ancestors were miserable, wretched, perpetually starving creatures scuttling from one rare meal to the next—the fossil records show incredibly robust remains, with powerful bones and healthy teeth and little sign of nutritional deficits—they also couldn’t stroll down to the local Whole Foods for a cart full of ingredients. Going without food from time to time was a fundamental aspect of human ancestral life.

They worked for their food. I don’t mean “sat in a cubicle to get a paycheck to spend on groceries.” I mean they expended calories to obtain food. They hunted—and sometimes came back empty handed. They dug and climbed and rooted around and gathered. They walked, ran, stalked, jumped, lifted. Movement was a necessity.

In short, they experienced energy deficits on a regular basis. And energy deficits, particularly sustained energy deficits, are the primary triggers for autophagy. Without energy deficits, you remain in fed mode and never quite hit the fasted mode required for autophagy.

Now compare that ancestral food environment to the modern food environment:

Almost no one goes hungry. Food is cheap and plentiful, with the tastiest and most calorie-rich stuff tending to be the cheapest and most widely available.

Few people have to physically work for their food. We drive to the store and walk a couple hundred steps, hand over some money, and—BOOM—obtain thirty thousand calories, just like that. Or someone comes to our house and delivers the food directly.

We eat all the time. Unless you set out to do it, chances are you’ll be grazing, snacking, and nibbling throughout the day. We’re in a perpetually fed state.

The average person in a modern society eating a modern industrial diet rarely goes long enough without eating something to trigger autophagy. Nor are they expending enough energy to create an energy deficit from the other end—the output. It’s understandable. If our ancestors were thrust into our current situation, many would fall all over themselves to take advantage of the modern food environment. But that doesn’t make it desirable, or good for you. It just means that figuring out how to trigger autophagy becomes that much more vital for modern humans.

Here are 7 ways to induce autophagy with regular lifestyle choices.

1) Fast

There’s no better way to quickly and reliably induce a large energy deficit than not eating anything at all. There are no definitive studies identifying “optimal” fasting guidelines for autophagy in humans. Longer fasts probably allow deeper levels of autophagy, but shorter fasts are no slouch.

2) Get Keto-Adapted

When you’re keto- and fat-adapted, it takes you less time to hit serious autophagy upon commencing a fast. You’re already halfway there.

3) Train Regularly

With exercise-related autophagy, the biggest effects are seen with lifelong training, not acute. In mice, for example, the mice who are subjected to lifelong exercise see the most autophagy-related benefits. In people, those who have played soccer (football) for their entire lives have far more autophagy-related markers of gene activity than people of the same age who have not trained their whole lives.

4) Train Hard

In studies of acute exercise-induced autophagy, the intensity of the exercise is the biggest predictor of autophagy—even more than whether the athletes are in the fed or fasted state.

5) Drink Coffee

At least in mice, both caffeinated and decaffeinated coffee induce autophagy in the liver, muscle tissue, and heart. This effect persists even when the coffee is given alongside ad libitum food. These mice didn’t have to fast for the coffee to induce autophagy.

Certain nutrients can trigger autophagy, too….

6) Eat Turmeric

Curcumin, the primary phytonutrient in turmeric, is especially effective at inducing autophagy in the mitochondria (mitophagy).

7) Consume Extra Virgin Olive Oil

The anticancer potential of its main antioxidant, oleuropein, likely occurs via autophagy.

Disclaimer: The autophagy/nutrient literature is anything but definitive. Most studies take place in test tube settings, not living humans. Eating some turmeric probably won’t flip a switch and trigger autophagy right away, but it won’t hurt.

Autophagy is a long game.

This can’t be underscored enough: Autophagy is a lifelong pursuit attained by regular doses of exercise and not overeating every time you sit down to a meal. Staying so ketotic your pee tests look like a Prince album cover, doing epic 7-day fasts every month, fasting every other day, making sure you end every day with fully depleted liver glycogen—while these strategies might be “effective,” obsessing over their measures to hit some “optimal” level of constant autophagy isn’t the point and is likely to activate or trigger neurotic behavior.

Besides, we don’t know what “optimal autophagy” looks like. Autophagy isn’t easy to measure in live humans. You can’t order an “autophagy test” from your doc. We don’t even know if more autophagy is necessarily better. There’s the fact that unchecked autophagy can actually increase existing cancer in some cases. There’s the fact that too much autophagy in the wrong place might be bad. We just don’t know very much. Autophagy is important. It’s good to have some happening. That’s what we have to go on.

Putting These Tips Into Practice

Autophagy happens largely when you just live a healthy lifestyle. Get some exercise and daily activity. Go hard every now and then. Sleep deeply. Recover well. Don’t eat carbohydrates you don’t need and haven’t earned (and I don’t just mean “earned through glycogen depleting-exercise”). Reach ketosis sometimes. Don’t eat more food than you need. Drink coffee, even decaf.

All those caveats aside, I see the utility in doing a big “autophagy session” a few times a year. Here’s how mine looks:

  1. Do a big training session incorporating strength training and sprints. Lots of intense bursts. This will trigger autophagy.
  2. Fast for two or three days. This will push autophagy even further.
  3. Stay busy throughout the fast. Take as many walks as possible. This will really ramp up the fat burning and get you quickly into ketosis, another autophagy trigger.
  4. Drink coffee throughout the fast. Coffee is a nice boost to autophagy. Decaf is fine.

I know people are often skeptical of using “Grok logic,” but it’s likely that most human ancestors experienced similar “perfect storms” of deprivation-induced autophagy on occasion throughout the year. You track an animal for a couple days and come up short, or it takes that long to make the kill. You nibble on various stimulants plucked from the land along the way. You walk a ton and sprint some, then lift heavy. And finally, maybe, you get to eat.

If you find yourself aging well, you’re on the right track. If you’re not progressing from obesity to diabetes, you’re good to go. If you’re maintaining and even building your muscle despite qualifying for the blue plate special, you’ve probably dipping into the autophagy pathway. If you’re thinking clearly, I wouldn’t worry. Obviously, we can’t really see what’s happening on the inside. But if everything you can verify is going well, keep it up.

That’s it for today, folks. If you have any more questions about autophagy, leave them down below and I’ll try to get to all of them in future posts.

Thanks for reading!

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References:

Yang ZJ, Chee CE, Huang S, Sinicrope FA. The role of autophagy in cancer: therapeutic implications. Mol Cancer Ther. 2011;10(9):1533-41.

Barlow AD, Thomas DC. Autophagy in diabetes: ?-cell dysfunction, insulin resistance, and complications. DNA Cell Biol. 2015;34(4):252-60.

Sasaki Y, Ikeda Y, Iwabayashi M, Akasaki Y, Ohishi M. The Impact of Autophagy on Cardiovascular Senescence and Diseases. Int Heart J. 2017;58(5):666-673.

Florencio-silva R, Sasso GR, Simões MJ, et al. Osteoporosis and autophagy: What is the relationship?. Rev Assoc Med Bras (1992). 2017;63(2):173-179.

Li Q, Liu Y, Sun M. Autophagy and Alzheimer’s Disease. Cell Mol Neurobiol. 2017;37(3):377-388.

Jiao J, Demontis F. Skeletal muscle autophagy and its role in sarcopenia and organismal aging. Curr Opin Pharmacol. 2017;34:1-6.

Schwalm C, Jamart C, Benoit N, et al. Activation of autophagy in human skeletal muscle is dependent on exercise intensity and AMPK activation. FASEB J. 2015;29(8):3515-26.

De oliveira MR, Jardim FR, Setzer WN, Nabavi SM, Nabavi SF. Curcumin, mitochondrial biogenesis, and mitophagy: Exploring recent data and indicating future needs. Biotechnol Adv. 2016;34(5):813-826.

Przychodzen P, Wyszkowska R, Gorzynik-debicka M, Kostrzewa T, Kuban-jankowska A, Gorska-ponikowska M. Anticancer Potential of Oleuropein, the Polyphenol of Olive Oil, With 2-Methoxyestradiol, Separately or in Combination, in Human Osteosarcoma Cells. Anticancer Res. 2019;39(3):1243-1251.

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Falling Off the Mountain and Climbing Back Up

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

My primal story all started while hiking one day back in 2009. Hiking has always been more than exercise for me. It has always been a place to clear my thoughts and think of new ideas. On a late summer day when hiking one of my favorite trails, I asked myself the question. “What would I eat if I lived out here?” I took a mental inventory: pine nuts, rabbits, chipmunks, some berries, and a deer if I was lucky. I started thinking that nothing out in the wild really represented anything I would find at my local store. I would have a hard time finding rabbit and chipmunks at the Mega-Mart, if you know what I mean.

This idea sparked my interest so much I went home and started searching everything online I could find on wild human diets etc. and eventually landed on Mark’s Daily Apple. I was hooked from the first words I read. (I eventually read all of Mark’s books too). I was all in from that day forward. I told my wife I finally figured it out, she said “what” I said “everything” and I told everyone. It all became so clear to me. Not just the diet but the lifestyle in general. It seemed the Primal Blueprint answered all of the problems of modern living.

I started cleaning out the pantry, went grocery shopping, and the next day and started my new life. It was really that easy to be honest. I had a bit of a headache and a few cravings here and there, but after that it was smooth sailing.

At the time I weighed 210 lbs on a large 6’1” frame and thought I was in good health. I hit 185 lbs after the first six months of my life altering experience, and maintained 175 to 185 it for 3 years. I was down 25 lbs, and never felt better. I was hiking about 40 miles a week things were great. All my blood markers were good, my blood pressure was low, and resting heart rate was under 50 bpm. I felt on top of the world, I was invincible.

I maintained the Grok lifestyle until 2012, and then things took a turn. I changed jobs, and moved to Hawaii. Don’t get me wrong—Hawaii was great, but the stress of being so far from family, and the hustle and bustle of a million people on one little island started taking its toll. All the great new foods didn’t help either. Who can’t resist a piece of Haupia Pie now and then? I still followed the primal eating principles for the most part probably 75/25. However things were changing for sure. I started drinking more beer and eating less than ideal (this is not the best way to handle stress). I gained most of the weight back and then some over the next three years.

While living in Hawaii we had a few deaths in the family (this was the breaking point really). So my wife and I decided to move back to the Mainland. The job search was on and I ended up taking a position for a company in the same town we lived before. Sounded great, ended up the worst decision I ever made. The job was a terrible fit, high stress, and I never took so many trips to the HR office in my entire life. To compensate for the stress, I started drinking more (if that was even possible), and eating polar opposite of the Primal Diet—SAD. I also quit hiking. Life was going downhill fast.

I finally hit rock bottom (so I thought). It was late 2015. I had fell off the Primal Wagon and bounced three times. I started having issue with heart palpitations to the point where I would almost pass out. I went to the doctor to get things checked out. The diagnosis was not good. I was up to 233 lbs, had too much bad cholesterol, triglycerides sitting at 180, borderline hypertensive, and well on my way to being a type II diabetic. The good thing through all of this, I was never prescribed any medications, and my echocardiogram looked good.

In the spring of 2016 after a year and a half of pure hell, I quit that horrifying job without notice. The good news, the heart palpitations went away almost the next day, and I slept better than I have for a few years. I started hiking again off and on but I would get a lot of pain in my legs and hips. The bad news, I was drinking even more beer.

Unemployment was not treating me well and I was in a really dark place. Death was not out of the question and an option for me. After 6 months of beer drinking and unemployment I blimped out to 245 POUNDS. I was fat, had leg and joint pain and just wasn’t there mentally. I was afraid to go to the doctor and get things checked out. I really thought the end was near. Then the end of 2016 I interviewed for a great job at a good company and got it. The position started in January 2017. I’m just grateful a good company took a chance on a fat unemployed alcoholic.

I have to admit from 2015 through 2016 had a tremendous negative effect on my family. I don’t wish it on anyone. My wife and kids stood by my side however and supported me, I love them. If not for their support, understanding, and love the difficult times would have been unsurmountable.

2017 was a big year of change, I turned 50, and started getting my head back on straight. I fell off the top of the mountain and needed to start climbing back up. I knew that I needed to make some big lifestyle changes to make the summit. I wanted to be there for my wife, kids, myself, and future grandkids well into my 80s. The first thing I did was quit drinking, cold turkey August 1st 2017. After 25 years of drinking this was one of the most difficult things I have ever undertaken. After I went through that, I figure I can make it through anything!!

After I beating the drinking problem, wanted to start back down the Primal Path. It was difficult at first. I attempted and failed a few times through 2018. Slowly but surely I got back on track. January 7th 2019 I was full on following the Primal Blueprint again. I started with The Keto Reset for the first month and it worked great. I now practice intermittent fasting a few times per week as well. I keep my carb intake around 50 grams per day now. I started at 244 lbs and now I’m down to 220 as of February 18th 2019. My target weight is probably 175 to 180 (this is where I feel best). I’m back on track to hardcore hiking too.

My first grandchild will be born this year and I can’t wait to teach him or her how to live like a Grok Child (payback for my daughter’s teen years). I have also enrolled in the Primal Health Coach Institute, I’m just over 30% complete. I plan on coaching, and helping people for the next 25 years or more. I first need to pass the comprehensive and challenging course however. The Primal Blueprint was great for me the first time. The second time is personal, and I never plan on looking back. I am looking forward to living a happy healthy life well into the future.

The readers featured in our success stories share their experiences in their own words. The Primal Blueprint and Keto Reset diets are not intended as medical intervention or diagnosis. Nor are they replacements for working with a qualified healthcare practitioner. It’s important to speak with your doctor before beginning any new dietary or lifestyle program, and please consult your physician before making any changes to medication or treatment protocols. Each individual’s results may vary.

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Dear Mark: How Does LDL Even Penetrate the Arteries, New Zealand Farmed Salmon, Elevated Ferritin

For today’s edition of Dear Mark, I’m answering three questions. First, can LDL actually infiltrate the arteries, or is there more to the story? Malcolm Kendrick says there’s more to the story, so I dig into some literature to see if they corroborate his position. Second, is New Zealand farmed salmon good to eat? And finally, what should you do about elevated ferritin levels—and why else might they be elevated if not because of your iron?

Let’s go:

My reading of this post by Malcolm Kendrick MD is that LDL particles cannot infiltrate the endothelial lining of our arteries:
https://drmalcolmkendrick.org/2018/08/16/what-causes-heart-disease-part-52/

Great read. Malcolm Kendrick is consistently fascinating, insightful, and enlightening.

He’s basically suggesting that LDL particles can’t manhandle their way into the artery wall, which are equipped with tight junctions—the same kind that regulate passage through our gut lining. Something has to “allow” them in. The something he finds most plausible is injury, trauma, or insult to the endothelial lining (artery wall, for lack of a better phrase).

A free public textbook available on PubMed since last month called The Role of Lipids and Lipoproteins in Atherosclerosis tackles the topic head on. In the abstract, they say:

Population studies have demonstrated that elevated levels of LDL cholesterol and apolipoprotein B (apoB) 100 [note: ApoB is a stand-in for LDL particle number, as each LDL-P has an ApoB attached to it], the main structural protein of LDL, are directly associated with risk for atherosclerotic cardiovascular events (ASCVE). Indeed, infiltration and retention of apoB containing lipoproteins in the artery wall is a critical initiating event that sparks an inflammatory response and promotes the development of atherosclerosis.

This seems to posit that infiltration of the LDL particle into the artery wall is a critical initiating event. But is it the critical initiating event? Does something come before it? How does the infiltration happen, exactly? Moving on:

Arterial injury causes endothelial dysfunction promoting modification of apoB containing lipoproteins and infiltration of monocytes into the subendothelial space. Internalization of the apoB containing lipoproteins by macrophages promotes foam cell formation, which is the hallmark of the fatty streak phase of atherosclerosis. Macrophage inflammation results in enhanced oxidative stress and cytokine/chemokine secretion, causing more LDL/remnant oxidation, endothelial cell activation, monocyte recruitment, and foam cell formation.

If I’m reading this correctly, they’re saying that “arterial injury” is another critical initiating event—perhaps the critical initiating event, since the injury causes “endothelial dysfunction,” which in turn modifies (or oxidizes) the LDL particles. But wait: so they’re saying the LDL particles are already there when the arterial injury occurs. They’ve already made it into the endothelial walls, and they’re just…waiting around until the arteries get injured. Okay, okay, but, just like Malcolm Kendrick points out, nowhere in the abstract have the authors actually identified how the LDL particles enter the endothelial lining. Maybe it’s “common knowledge,” but I’d like to see it explained in full.

Moving on:

In atherosclerosis susceptible regions, reduced expression of eNOS and SOD leads to compromised endothelial barrier integrity (), leading to increased accumulation and retention of subendothelial atherogenic apolipoprotein B (apoB)-containing lipoproteins (low-density lipoproteins (LDL)) and remnants of very low-density lipoproteins (VLDL) and chylomicrons)

Ah ha! So, in regions of the arteries that are prone to atherosclerosis, low levels of nitric oxide synthase (eNOS)—the method our bodies use to make nitric oxide, a compound that improves endothelial function and makes our blood flow better—and superoxide dismutase—an important antioxidant our bodies make—compromise the integrity of the arterial lining. The compromised arterial lining allows more LDL particles to gain entry and stick around. So, are low levels of nitric oxide and impaired antioxidant activity the critical initiators? That’s pretty much what Malcolm Kendrick said in his blog post.

Still—high LDL particle numbers are a strong predictor of heart disease risk, at least in the studies we have. They clearly have something to do with the whole process. They’re necessary, but are they sufficient? And how necessary are they? And how might that necessariness (yes, a word) be modified by diet?

I’ll explore this more in the future.

In regards to the oily fish article (and more indirectly given the omega 6 concern- the Israeli Paradox) What do you think of NZ farmed salmon? I’m in Australia, & occasionally like a fresh piece of salmon- there are no wild caught available here sadly, but I am wondering how it measures up as an alternative?

Last year, I explored the health effects of eating farmed salmon and found that it’s actually a pretty decent alternative to wild-caught salmon, at least from a personal health standpoint—the environmental impact may be a different story.

I wasn’t able to pull up any nutrition data for New Zealand farmed salmon, called King or Chinook salmon. Next time you’re at the store, check out the nutritional facts on a NZ farmed salmon product, like smoked salmon. The producer will have actually had to run tests on their products to determine the omega-3 content, so it should be pretty accurate. Fresh is great but won’t have the nutritional facts available. I don’t see why NZ salmon would be any worse than the farmed salmon I discussed last year.

According to the NZ salmon folks, they don’t use any pesticides or antibiotics. That’s fantastic if true.

I used to eat a lot of King salmon over in California, and it’s fantastic stuff. Very fatty, full of omega-3s. If your farmed King salmon comes from similar stock, go for it.

ok can someone tell me how to reduce ferritin? Is is just by giving blood?

Giving blood is a reliable method for reducing ferritin. It’s quick, effective, simple, and you’re helping out another person in need. Multiple wins.

Someone in the comment board recommended avoiding cast iron pans in addition to giving blood. While using cast iron pans can increase iron intake and even change iron status in severe deficiency, most don’t have to go that far. Giving blood will cover you.

Ferritin is also an acute phase reactant, a marker of inflammation—it goes up in response to infections (bacterial or viral) and intense exercise (an Ironman will increase ferritin). In fact, in obese and overweight Pakistani adults, elevated ferritin seems to be a reliable indicator of inflammatory status rather than iron status.

Thanks for reading, everyone. Take care and be well!

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References:

Birgegård G, Hällgren R, Killander A, Strömberg A, Venge P, Wide L. Serum ferritin during infection. A longitudinal study. Scand J Haematol. 1978;21(4):333-40.

Comassi M, Vitolo E, Pratali L, et al. Acute effects of different degrees of ultra-endurance exercise on systemic inflammatory responses. Intern Med J. 2015;45(1):74-9.

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