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Research of the Week

Listening to Mozart daily reduces seizure frequency.

A Mediterranean ketogenic diet makes changes to the cerebrospinal fluid profile indicative of a lower risk of cognitive decline.

A low-carb, high-fat diet works for people with type 2 diabetes. Again.

More omega-3s, more strength (in older adults).

Links between personality traits and where a person spends their time.

New Primal Blueprint Podcasts

Episode 428: Jerry Wolf: Host Elle Russ chats with Jerry Wolf, a personal trainer and body worker with over 15 years of experience

Primal Health Coach Radio: Taking Your Fitness Off the Ground with Jenea Sutton

Media, Schmedia

Woman dies after drinking 2 liters of soda and 1 liter of energy drinks each day for years, but somehow it’s the caffeine that’s the problem.

Interesting Blog Posts

The global slowdown hasn’t budged the rise of CO2 emissions, at least according to Mauna Loa data.

Respiratory infections are still a big mystery.

Social Notes

Underrated dip station: old walker from the thrift shop.

Paleo lawn mower.

Everything Else

Dairy adoption through Europe was mostly genetic. Central Asian dairy adoption was mostly cultural.

Sprinters’ stride length drops as they age.

If you have to get up in the middle of the night, a quick burst of exercise may improve your subsequent sleep.

I’d go here.

Things I’m Up to and Interested In

My kind of pesticide: Ducks.

Interesting paper: Sex differences in immune responses to COVID-19.

Video I liked: The Mozart piece used in the seizure study linked above.

Paper I’m still reading through: “Quantifying the contribution of Neanderthal introgression to the heritability of complex traits.”

I’m not surprised: Gouda good for coronavirus.

Question I’m Asking

What’s your favorite wilderness area?

Recipe Corner

Time Capsule

One year ago (Jun 7 – Jun 13)

Comment of the Week

“Mr. William Shakespeare wrote some great stuff during a pandemic, in his lifetime. There are opportunities here…”

Nocona speaks truth.

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Hi folks, in this week’s edition of Ask a Health Coach, Erin dives into your Primal Blueprint questions, helping you wrangle your dark chocolate addictions, navigate self-sabotage, and find workouts that don’t feel like a chore. Keep your questions coming in the Mark’s Daily Apple Facebook Group or in the comments section below.

Cam asked:

“I’ve done really well with the Primal Blueprint so far. I don’t mind changing my eating, but I can’t stand exercise. I know I need to do it, but what can I do to make working out less of a chore?”

I hear you Cam. Most of my clients do great ditching grains, sugar, and industrial oils, but when it comes to working out, they have a harder time getting on board. What I’m hearing you say is that exercising feels like work. Let me ask you this though. Is it possible that there are certain types of exercises you could do that wouldn’t feel that way?

No one says you have to do push-ups, pull-ups, planks, and squats — even though they’re considered essential movements of the Primal Blueprint. If you don’t like doing them, there are about a million other forms of exercise you can do.

As I’m sure you know, one of the main PB pillars is play. By applying your fitness to real-life (and really fun) situations, you can help dissipate some of the negative effects of being chronically stressed out. Side note here, if traditional exercises make you feel stressed out, they kind of defeat the purpose.

So, what would be some activities you’d consider play? Maybe you like to go bike riding with your kids. Or playing ultimate frisbee. Or tennis. Or making obstacle courses in the backyard? These are all forms of exercise — and you could actually be getting a solid dose of sprinting and lifting heavy without even realizing it.

I’d also ask you to think about why exercising is important to you. Is it because it’s something you’re “supposed to do” per the PB playbook? Or is that you want to lower your risk of heart disease, drop weight, slow down muscle loss, or climb a flight of stairs without breathing hard?

Having a reason why can help you reframe your situation. Sure, exercise might not be your favorite activity, but achieving your goal might end up being the best feeling in the world.

Lisa asked:

“I like that the Primal Blueprint’s 80/20 rule accommodates my cravings for dark chocolate, but I can’t seem to stop at a square or two. What gives?”

There are lots of reasons your chocolate cravings feel out of control. I have a hunch about what it might be though. But let’s back up and have a quick talk about dark chocolate. While it certainly isn’t considered a health food, dark chocolate does have quite a few health benefits, including the ability to lower blood pressure, lower stress, and improve circulation.

Remember, with the Primal Blueprint, we’re aiming for a higher percentage of cacao. The sweet spot is 85% — that’s when the benefits really start to add up.

So, here are a few things to look at. Chocolate is a great source of magnesium, and if your cravings are really strong, your body could be asking for more of that mineral, which by the way, can also be found in leafy greens, nuts and seeds, and avocados. Chocolate is loaded with tryptophan as well, the precursor for serotonin, which is the feel-good neurotransmitter that regulates anxiety.

There’s also the possibility that you’re using chocolate as a reward. “I made it through the day without quitting my job/yelling at the kids/eating a box of donuts. I deserve this dark chocolate!” Sound familiar? It might sound really familiar if you habitually aren’t eating enough during the day.

The combo of being overly hungry, overly stressed out, and eating a trigger food like dark chocolate can become a customized recipe for relief that you don’t want to end after 2 squares.

I always tell my clients, if you can’t control yourself around a certain food (even a food with health benefits), it’s not the right food for you.

Josh asked:

“I’m on the road a lot. Even when I plan to follow the Primal Blueprint, I ended up eating things I shouldn’t or just overeating in general. I’m a good planner, but if I have a choice, I usually opt for the less healthy stuff.”

Josh, you’re not alone. I probably hear this once a week in my own health coaching practice. My clients tell me they’ve stocked up their kitchens, prepped healthy foods, and they’re 100% committed. But then, in the moment, something different happens. The opportunity to do something perceived as taboo, becomes more exciting than sticking to the plan.

Basically, you’re engaging in the act of self-sabotage.

When your logical, conscious mind has a goal (like eating the raw almonds you brought on the road with you) is at odds with your subconscious mind (the side of you that believes life won’t be the same if you don’t stop for a double cheeseburger), your subconscious or “inner critic” tries to protect you and keep you safe from potential failure by sabotaging your efforts.

Make sense?

In the moment, you have two choices. You can give in to your inner critic or decide that your goals are worth sticking to. Think about previous times when you’ve decided to stick to your plan. How does that feel? Pretty good, right? And in comparison, how does it feel when you let your self-sabotaging inner critic win? When you think about it, probably not that great.

Of course, it’s not always that simple. Usually, self-sabotage is an in-the-moment thing— meaning it’s not premeditated. It’s fueled by instant gratification. And if you’ve suddenly become dead-set on veering off into the drive-through, just thinking about making a different choice might not be enough to deter you. If that’s the case for you, what are other ways you can stop your inner critic from taking the wheel (no pun intended)?

Simple things like listening to an audio book or podcast can help change your thought pattern. Sure, these distractions help you focus on something other than food, but they’re also engaging you, providing a much-needed shift in your mind and your mood.

In an instant, you can go from obsessing over curly fries to feeling peaceful, calm, and content. Some of my other favorite ways to shift mindset include meditation and deep breathing exercises, but you have to find the method that works best for you.

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I am hoping this letter helps, if even just in reading that others have felt this same kick in the teeth as they are this week.

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guide to proteinProtein is an incredible essential macronutrient. Fat is plentiful, even when you’re lean, and there are only two absolutely essential fatty acids; the rest we can manufacture from other precursors if required. Carbs we can produce from protein, if we really must, or we can just switch over to ketones and fats for the bulk of the energy that would otherwise come from carbs. Protein cannot be made with the raw material available in our bodies. We have to eat foods containing the range of amino acids that we need.

In other words, protein is incredibly important—which is why today I’m writing a definitive guide on the subject. After today’s post, you’ll have a good handle on the role protein plays in the body, how much protein you need to be eating, which foods are highest in protein, and much more.

First, what roles does protein play in our bodies?

It helps us build muscle.

We use it to construct new cells, muscles, organs, and other tissues.

It’s a chemical messenger, allowing us to turn on and turn off genes.

It forms the fundamental substrates used to manufacture enzymes, DNA, and hormones.

It can even be a fuel source, either directly or through conversion into glucose.

Now, am I saying that the steak you eat directly becomes a thyroid hormone? Does chicken breast turn into DNA?

No. But the strings of amino acids and peptides that make up proteins are eventually broken down and cobbled back together to fulfill all the roles I describe. Every bite of protein you consume contributes toward maintenance of your physiology. And we can’t make new protein. We have to eat it.

What’s the Recommended Daily Protein Intake?

If you go by the official numbers, the Recommended Daily Allowance (RDI) for protein is 0.8 grams of protein per kilogram of bodyweight, or 0.36 g protein/lb. That’s what the “experts” say to eat. That’s all you “need.” I disagree, and I’ll tell you why down below, but there’s the official answer.

Sufficient is one thing. Optimal is another. In reality, the amount of protein required for optimal health and performance is different for every population.

Protein Intake for Athletes and Exercisers

Athletes need more protein than the average person, but perhaps not as much as most fitness enthusiasts think (or consume). A 2011 paper on optimal protein intakes for athletes concluded that 1.8 g protein/kg bodyweight (or 0.8 g protein/lb bodyweight) maximizes muscle protein synthesis (while higher amounts are good for dieting athletes interested in preserving lean mass), whereas another settled on “a diet with 12-15% of its energy as protein,” assuming “total energy intake is sufficient to cover the high expenditures caused by daily training” (which could be quite high).1 2 One study even found benefit in 2-3 g protein/kg bodyweight (0.9-1.4 g protein/lb bodyweight) for athletes, a significant increase over standard recommendations.3 That said, I wouldn’t be too quick to discount anecdotal evidence or “iron lore.” A significant-enough portion of the strength training community swears by 1-2 g protein/lb bodyweight that it couldn’t hurt to try if lower amounts aren’t working for you.

Protein Intake During Weight Loss

Weight loss involves a caloric deficit (whether arrived at spontaneously or consciously). Unfortunately, caloric deficits rarely discriminate between lean mass and body fat, while most people are interested in losing fat, not muscle/bone/tendon/sinew/organ. Numerous studies show that increasing your protein intake during weight loss will partially offset the lean mass loss that tends to occur. In obese and pre-obese women, a 750 calorie diet with 30% of calories from protein (about 56 grams) preserved more lean mass during weight loss than an 18% protein diet.4 Another study in women showed that a 1.6 g protein/kg bodyweight (or 0.7 g protein/lb bodyweight) diet led to more weight loss, more fat loss, and less lean mass loss than a 0.8 g protein/kg bodyweight diet.5 Among dieting athletes, 2.3 g protein/kg bodyweight (or a little over 1 g protein/lb bodyweight) was far superior to 1.0 g protein/kg bodyweight in preserving lean mass. And, although specific protein intake recommendations were not stated, a recent meta-analysis concluded that high-protein weight loss diets help preserve lean mass.6

Protein Intake When Injured

Healing wounds increases protein requirements. After all, you’re literally rebuilding lost or damaged tissue, the very definition of an anabolic state, and you need protein to build new tissue. One review recommends around 1.5 g protein/kg bodyweight or close to 0.7 g protein/lb bodyweight for injured patients.7 Children recovering from illness or injury may need up to 2.5 g protein/kg. If you mess this up and undershoot your protein intake during recovery, you will compromise your healing.

Protein Intake for Seniors

The protein metabolism of the average senior citizen is compromised. They need more protein to do the same amount of “work.” The protein RDA is simply not enough for seniors, who lose thigh muscle mass and exhibit lower urinary nitrogen excretion when given the standard 0.8 g protein/kg bodyweight.ref]https://www.ncbi.nlm.nih.gov/pubmed/11382798[/ref] What’s good for the goose may not be good for the elderly, frail gander. More recent studies indicate that a baseline intake of 1.0-1.3 g protein/kg bodyweight or 0.5-0.6 g protein/lb bodyweight is more suitable for the healthy and frail elderly to ensure nitrogen balance.8 That said, active seniors will do better with even more and evidence suggests that increasing protein can both improve physical performance without necessarily increasing muscle mass and increase muscle mass when paired with extended resistance training in the elderly.91011

How Much Protein on Keto?

What about another population entirely: ketogenic dieters. We’ve got a lot of those around here, so this is important. If you’re on a keto diet, should you restrict protein? I mean, doesn’t extra protein just convert directly into glucose?

Our livers only convert protein into glucose when we—for whatever reason—need more glucose. It’s demand, not the supply. And since keto-adapted people are running mostly on fat and ketones, they have a lower requirement for glucose and are much less likely to trigger the kind of perceived glucose deficiency that necessitates gluconeogenesis.

Extra protein can however impair ketogenesis by contributing oxaloacetate donors to the Krebs cycle. With oxaloacetate, fatty acids enter the Krebs cycle and are fully oxidized and turned into ATP, the body’s energy currency. Without oxaloacetate, fatty acids can’t enter the Krebs cycle and are instead converted into ketones to generate energy.

If you’re dealing with cognitive decline, elevated inflammation, or any other condition that requires or may improve with deep ketosis, aim for a lower protein content (10-15% of calories). Get those high ketone levels, see how it feels, and see if that’s the protein intake for you. Start low, really revel in those high ketone readings, and stick with them if you’re improving.

If you’re losing weight (or trying to), eat closer to 15-30%. For you, the ketone readings aren’t the biggest focus. How you look, feel, and perform are your main concern. Eating slightly more protein will increase satiety, making “eating less” a spontaneous, inadvertent thing that just happens. It will also stave off at least some portion of the lean mass accretion that occurs during weight loss; you want to lose body fat, not muscle.

If you’re trying to gain large amounts of muscle, eat closer to 20-30%.

Understand, however, that everyone is unique. For some, protein is deeply anti-ketogenic—eating too much protein will knock you out of ketosis almost immediately. For others, protein has little to no effect. Or if it has a momentary nullifying effect, you can quickly slip back into ketosis. Unless deep ketosis is medically necessary, don’t worry about protein too much either way. There are studies of “modified ketogenic diets” where protein goes as high as 30% of calories and subjects still get the benefits.12

High Protein Benefits

Beyond supporting the basic underpinnings of human physiology, eating more protein than the RDI offers extra benefits.

Protein Satiety

As a fundamental biological motivator, hunger can’t be ignored forever. Eventually you crack, and the diet fails. Eventually, you’re going to eat. Where extra protein helps is adding satiety. Successful fat loss comes down to managing your hunger; protein helps you manage it without relying on sheer willpower.

Protein For Muscle Gain and Muscle Retention

To increase muscle protein synthesis, you need two primary inputs: resistance training and protein intake. You can lift all the weights in the world, but if you’re not eating enough protein, you won’t gain any muscle. You can’t make extra, it has to come from outside sources.

And then during active weight loss, upping your protein intake will minimize the loss of muscle that usually accompanies fat loss. In women, for example, cutting calories while keeping protein higher than normal led to better lean mass retention than cutting the same number of calories and keeping protein low.13 Simply put, more protein tends to enhance fat loss and preserve muscle.

Protein to Increase Energy Expenditure

Metabolizing protein is costlier than metabolizing fat and carbohydrates: it takes extra energy to process protein than it does to process the other macronutrients. This increases the amount of calories you expend, simply by eating more protein. Thus, higher protein diets increase energy expenditure relative to diets lower in protein.

Higher Micronutrient Intake

While we love our fat-soluble vitamins around here—your vitamin Ds, your vitamin K2s, your retinols, your vitamin Es—we musn’t forget about our B-vitamins and minerals. Those latter two groups come bound in the muscle meat. The more whole food-based protein we eat, the more micronutrients we’ll take in.

Protein Foods: Where to Get Your Protein

The best sources of protein for humans are animal foods. Meat, fish, fowl, shellfish, eggs, and dairy all contain the most bioavailable form of protein: animal protein. Makes sense when you consider that we are animals, and we use the protein we eat to build new animal tissues in our own animal bodies. Of course animal protein will be better and more efficient at doing protein-y things than plant protein.

  • Following resistance training, soy protein blunts testosterone production in men.14
  • In both the young and the elderly, whey promotes greater muscle protein synthesis than soy protein.15
  • Compared to milk, soy protein results in less hypertrophy following resistance training.16
  • Women who consume animal protein have greater muscle mass than female vegetarians.17

We can also confirm this by studying the Biological Value (BV) of a given protein source. The BV describes the proportion of protein in a food that becomes incorporated into the consuming organism’s tissues, with 100 being best.

  • Egg protein: 100 BV
  • Whey isolate: 100 BV
  • Milk protein: 91 BV
  • Beef: 80 BV
  • Casein: 77 BV

And then:

  • Soy protein: 74 BV
  • Wheat gluten: 64 BV
  • Pea protein: 65 BV

Another factor to consider is that animal protein is complete; it contains all essential amino acids—those amino acids which we cannot produce ourselves and must obtain from outside sources. Plant proteins tend to be incomplete. No individual plant protein is complete, except for perhaps potato protein (but the absolute levels of protein in a potato are too low). If you want to go all plant, you have to combine different ones to hit all the amino acids you need.

So in theory you could get your protein from an algorithmically-derived blend of gluten powder, pea protein, rice protein, and fermented free range soy. Or you could just eat 5 eggs for breakfast (30 grams), a Big Ass Salad with a can of oysters (11 grams), some cheese (8 grams), and a can of sardines (24 grams) on top for lunch, and a ribeye for dinner (40-80 grams, depending on size).

I know what I’d choose. I know what’s easier, what’s more delicious.

Collagen Protein

Collagen protein is the type of protein you get from connective tissue in meats. You can slow-cook tougher cuts of meat until they’re tender, or simmer a batch of bone broth to get your collagen.

Collagen is so important that I consider it the fourth macronutrient. It contains amino acids that aren’t as plentiful in muscle meats and other protein sources, so it helps your body complete the amino acid chains that would otherwise be limited. You get more benefit out of the other protein you eat by eating collagen-rich foods or supplementing with a hydrolyzed collagen protein supplement. You can read more about collagen here.

How about you, folks? How do you get your protein? How much do you eat per day?

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Most people spend little to no energy pondering their naval, except of course, for a little housecleaning. However, if belly button pain strikes, it may be time to take a closer look. There are many reasons behind belly button pain. It could come and go, be sharp or dull, and stem from a simple, resolvable […]

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Being good at a sport doesn’t mean you should be to overly specific with your training.

Specificity is an overused training philosophy for most lifters. I know this is a controversial statement in strength training communities, but I’m still not sorry for saying it. It’s the truth, and this quarantine is offering us a unique moment to put that theory to the test.

 

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training for COVID-19Today we welcome guest author Dr. Ronesh Sinha, internal medicine physician and expert on insulin resistance and corporate wellness, author of The South Asian Health Solution. He is a top rated speaker for companies like Google, Oracle, Cisco and more. Check out his media page for lectures, interviews and articles from Dr. Sinha.

Most of us have been sheltering-in-place for a few months now, and we have evolved into an unprecedented state of fear and hyper-vigilance in this pandemic. After a long period of being cooped up, we are now gradually released into the wild, which introduces us to a whole new level of anxiety. Public health recommendations appear to be flip-flopping regularly, and we are learning on the fly as the situation evolves.

In today’s post, I’d like to share some thoughts on how we can regain some control of our lives. Rather than duck and cover for several more months, we can face this beast head-on. I don’t mean being careless and reckless and not following social distancing and hygiene protocols. Instead, we can adopt a mindset that we will do what is necessary to minimize our risk of a severe COVID-19 outcome. I titled this post “Training for the COVID-19” to help you reframe this pandemic in your mind, and view it like a warrior approaches an enemy on the battlefield or an athlete faces an opponent in a competition.

Cognitive Reframing Coronavirus: From Fear to Readiness

Cognitive reframing isn’t just some touchy-feely behavioral technique. Viewing the world through a more positive lens has a beneficial impact on your immune system, which is potentially relevant to COVID-19. One study shows that participants who were cognitive reappraisers, identified by a 10-item Emotion Regulation Questionnaire, and then exposed to an experimental cold virus (rhinovirus not coronavirus) had reduced nasal cytokine release compared to individuals who were emotional suppressors.1 As you’ll learn in a moment, excessive cytokine release is a crucial mechanism by which COVID-19 imparts significant lung and tissue damage. As with rhinovirus, the nose is a primary portal through which coronavirus accesses our body.

So as you read this post and continue to keep getting bombarded by pandemic news media, remember the lens through which you view this content. Your external world has a direct impact on how your immune system might respond to an infection like COVID-19. Let’s start by summarizing COVID-19’s basic operating system for you.

Fear of the unknown is one of the single most significant stressors to our nervous system. I want you to read this with the attitude that “I will acquire the knowledge I need to understand this virus and defend myself and my loved ones against its effects.” Rather than, “Oh my God, the extra fat around my waistline will be the death of me.”

One way I view our pandemic and its relationship to our individual health is by splitting it into external viral load vs. internal cytokine load. Refer to the image below.


Excerpt from the Free COVID Guide

The left side of the image shows how the COVID-19 virus enters a cell by gaining access through the ACE-2 receptor, which hijacks our cell’s reproductive machinery (think 3D printer). Then, it makes copies of itself. This is the external viral load.

The right side of the image illustrates our immune system response. NLRP3 is an alarm sensor in our cells that gets turned on when an infectious pathogen like COVID-19 knocks on the door of our cells, specifically by attaching to the ACE-2 receptor. Once the alarm sounds, a rush of immune system chemical messengers called cytokines comes rushing inside to thwart the attack. NLRP3 is a critical gatekeeper to the cytokine surge. If you want to learn more about how it works and how it’s connected to other common health conditions, watch my 4-minute explainer video here.

The volume of this cytokine response is what I refer to as the internal cytokine load. An optimal cytokine load would be sufficient to thwart an attack by an outside offender. Still, an overzealous cytokine response (aka “cytokine storm” or “fire”) would damage and destroy our cells through a process called pyroptosis, which is literally cellular death by fire.

I want to highlight that cytokines are not the enemy in this process and are an essential part of our innate immune response. It’s excessive cytokine release that inflicts damage and destruction. Fortunately, our cytokine response is something that we can control through targeted lifestyle changes. Just a reminder that these are the same cytokines I mentioned at the beginning of the post, which were released in excess amounts in the noses of emotional suppressors vs. cognitive reappraisers exposed to the cold virus. So what’s the link with obesity?

Obesity is so intimately tied to our risk of a severe COVID-19 outcome that I refer to this association with the term, “Covesity,” which I write about in detail here.2 Specifically, it’s the central visceral fat (aka “belly fat”) that is an especially insidious storehouse of proinflammatory cytokines like IL-6 and TNF-alpha, which fuel the cytokine fire.

Another reason fat cells may increase risk is through the ACE-2 receptor shown in the above image. Fat cells have an abundance of these receptors, and their affinity for COVID-19 means they may serve as a viral storehouse. So fat cells not only provide more entry points for COVID-19 but also ready access to an ammunition supply of cytokines.

ACE-2 also puts the brakes on the enzyme angiotensin II, which, if left unrestrained, can contribute to the more severe manifestations of COVID-19 (like acute lung injury, heart damage, etc.). Angiotensin II levels appear to rise in severe COVID-19 infections due to a downregulation in ACE-2 (the “brake pedal” for Angiotensin II). In the case of obesity, angiotensin II increases further by visceral fat cells that secrete angiotensin II in addition to the cytokines we just discussed.

So fat cells provide the fuel to ignite the cytokine fire and release excess amounts of angiotensin II, which can further provoke damage and destruction of vital organs. We also know that obesity increases our risk of chronic health conditions like diabetes and high blood pressure, which are additional risk factors for a more severe COVID-19 infection.

Again, I don’t want this information to set you into a state of panic if you are struggling with extra weight or other COVID-19 health risks. I assure you that this is not a disease where the only people left standing at the end of the pandemic will have single-digit body fat percentages and 6-packs. Fit, lean individuals who are experiencing chronic stress and sleep issues might have a higher risk than slightly more substantial, less fit individuals who are physically active and better manage their sleep and stress. No matter where we are in our health journey, we need to identify our own gaps (physical, mental, social, etc.) and make key changes that will markedly reduce our cytokine load and overall risk.

One common question I get during lectures and in the clinic is, “how do I know if my fat is the inflammatory type?” This is an important distinction. Some of us might be above the recommended BMI (body mass index) cutoff, but not have as much inflammatory adipose tissue. In contrast, others might be underweight but have visceral fat cells packed with proinflammatory cytokines. This is why body weight and BMI can often be a misleading marker. Some clues that you might have more inflammatory adipose tissue are below. Just a reminder that NLRP3 is the alarm sensor that COVID-19 turns on and triggers the cytokine surge.

  • Increased belly fat: ethnic waistline cutoffs are here and to learn more about body fat and the impact of ethnicity, read my post here.
  • High triglycerides: aim for triglyceride levels to be closer to 100 mg/dL or below
  • Low HDL (healthy cholesterol): males should target an HDL>40 mg/dL and for females, HDL>50 mg/dL
  • High triglyceride/HDL ratio is even better than looking at individual triglyceride and HDL, aiming for a ratio of less than 3.0 (lower the better)
  • Elevated blood glucose (prediabetes, diabetes)
  • High blood pressure: More recent research is showing that hypertension may be an inflammatory condition and the NLRP3 inflammasome might be a key switch as discussed in this study.3
  • Fatty liver: Learn more by reading my post here. 4 This mouse study 5 is linked to NAFLD (non-alcoholic fatty liver disease) and blockade of this pathway leads to regression of fatty liver.
  • Elevated hsCRP: this is a test for inflammation that is not indicated in all patients and can give an elevated result for various reasons. Many of my patients with insulin resistance have elevated hs-CRP, and research 6 mentions the strong link between CRP and NLRP3, where NLRP3 appears to be predictive of elevated hs-CRP levels.

Some of you might recognize many of the items on this list as being criteria for a condition called metabolic syndrome, 7 whose root cause is insulin resistance. Many of us have become disconnected from our health care providers and systems as a result of shelter-in. I strongly encourage you to track the risk numbers applicable to you. For example, I’m putting a growing number of my at-risk patients on continuous glucose monitors (CGMs), especially given studies 8 showing a strong correlation between glucose control and COVID-19 severity. I wrote a detailed post on how to get your health care provider to order a CGM here.

I’m seeing many patients losing track of their waistlines since they’ve been living and working in stretchy pants for months. It might be time to dust off those jeans or work pants, so you regain some waistline awareness. Tracking your risk numbers and making appropriate lifestyle changes is a powerful way to regain control of your health.

Lifestyle Changes

So now that you understand COVID-19’s operating system and COVID-specific risk factors more logically and less emotionally, how do you specifically train for the COVID-19? First, we need to understand what type of event we are preparing for. Is this an event based on strength and power, or is it more of an endurance event?

We know major target sites for COVID are the lungs and heart. When you talk to patients that have had a moderate or severe outcome, they report feeling like being dragged underwater or dropped on top of a mountain and asked to run a marathon. There is a distinct sensation of what we call “air hunger,” and this is something we can actually train for without having to live at least 7,000 ft above sea level.

In other words, surviving and even thriving through COVID-19 likely depends on how fast you can walk or run a mile rather than how much you can squat, deadlift, or bench press. We can improve our tolerance to low oxygen (aka hypoxic) stress if we can improve our aerobic fitness through movement and exercise. Tying this back to cytokines and inflammation – hypoxic stress is a powerful trigger for inflammation. It is mediated by several different chemicals referred to as HIFs (Hypoxia-Inducible Factors) as reviewed in this study. 9 This makes sense given we can live around three weeks without food, three days without water, but only 3 minutes without air.

Any time our body senses a lack of oxygen, the resulting cytokine surge’s intensity and volume are significant. This is a medical code blue or a five-alarm fire signal to our immune system, and there’s a link to our body fat. This study 10 shows that hypoxic (low oxygen) stress specifically unlocks cytokines from fat cells. So, if you are carrying extra inches around the waist and are also aerobically deconditioned, then that’s a double whammy for fueling a cytokine storm.

Now that we understand the type of event we are preparing for, let’s turn to our training plan. I have three main principles for COVID-specific training, which I outline as the “ABCs.” “A” is for Activity, “B” is for Breathing and “C” is for cardio. Most of my patients might be doing one or two of these, but rarely is anyone doing all three. I strongly recommend that you do all three of these to improve your resilience to COVID-19.

Activity: Moving Throughout the Day

For activity, I’m referring to regularly staying active throughout your day since interrupting prolonged sitting has been shown in numerous studies to increase the release of proinflammatory cytokines. You might know this already, but our COVID-19 environment takes on a whole new level of significance. Mark refers to these as “microworkouts”, which you can read about in his post here. I refer to it as exercise snacking (not my term). I am teaching my patients to stock their “exercise pantry” with at least 10 different movements they can perform throughout the day. I have 20+ different work positions and mini-exercises that I do while I’m on business calls or doing creative work.

Personalize your pantry to target problem areas. For example, I have struggled with tight hamstrings for many years, so I’m always working in positions like the one below, which has made a huge difference.

Ronesh Sinha MD

Now, after hours of work, when I decide to do something more intense, my legs are limber, warmed up, and ready to go. Work to me is a combination of a light interval workout with flexibility and warm-up drills that have my body prepped and ready to transition to something more intense at any given moment. My patients that do this are more energetic during work hours and less sore after workouts because they are already warmed up.

For more examples of my work positions, refer to the end of my free Covid Survival Guide here. Since I’m doing lots of remote patient visits now during our medical group’s shelter-in, I’m teaching some of my patients how to integrate workouts into their work hours.

Deep Breathing Exercises

Breathing is next on the list and is the item that is most commonly overlooked from my ABCs. Improved breathing is something we can easily practice at rest as well as during exercise. I’ve been teaching many of my patients to nasal breathe, nasal hum, and even do exercises like alternate or single nostril breathing. Alternate nostril breathing is one of my absolute favorites and I made a video on how to do it here. Even Hillary Clinton swears by it here in her interview with Anderson Cooper.

These types of breathing exercises help activate our diaphragm, which turns on our parasympathetic nervous system (rest or relaxation response) and also improves our breathing mechanics so we can improve oxygenation at rest and during exercise. Recall how I mentioned the sensation of breathlessness or air hunger as being a tremendous stressor to our nervous system that can open the cytokine floodgates, especially from fat tissue.

Despite being a lifelong exerciser, I (like many of my patients) have struggled with aerobic fitness and only recently discovered that a major root cause was a poorly conditioned diaphragm. I’m also a recovering emotional suppressor, and we suppressors tend to bottle up our emotions and breathe more from our chests than our bellies. Emotional suppressors also produce more cytokines and I explain the link in this video here, along with my own strategies on dealing with emotional suppression.

Finally, recall that I mentioned how coronavirus appears to produce a sensation of being dragged under water or dropped on top of a mountain. The physiology of COVID lung disease is complex, but appears to mimic some form of high altitude lung disease. As a result, I’m actually training for it like a high altitude endurance event. Unfortunately I don’t live above 7,000 feet, but am using my high altitude training mask as a substitute. These masks all sold out on Amazon after I did a few interviews and blog posts on the topic, but you can use your medical mask as a hack.

Nasal breathing, single nostril breathing, or using a mask are ways of limiting oxygen intake so your lungs adapt to exercising in a slightly hypoxic environment. I call this “oxygen fasting” which you can read about in more detail in my Oxygen Fasting and Biohacking Breathing post. If you’re not used to it, it will feel suffocating at first, but then you adapt. The reason this is important is that if your lungs are exposed to an infection like novel coronavirus, because you are partially adapted to a lower oxygen environment, it will not be a novel threat that causes a huge surge in stress hormones and cytokines.

Interestingly, right after I submitted the draft for this post I noticed MDA released a guest post on nitric oxide by Nobel Prize winning scientist, Dr.Louis J.Ignarro, where he mentions nasal breathing. I am a HUGE fan of nasal breathing and nasal humming for optimal health, and wrote a detailed post on this a while back which you can read here or just watch my short video on nasal breathing and nitric oxide here.

Back to biohacking breathing, I actually have been using masks as a training tool in my patients. I had an older high risk female patient who absolutely could not tolerate wearing an N95 mask for even a few minutes. By doing some breathing exercises and viewing her mask as an opportunity to improve her aerobic fitness, she increased her “mask tolerance time” enough so she can effortlessly grocery shop and do other errands with her mask in place. This allows her to minimize external viral load exposure by allowing her to comfortably wear her mask more often when needed, while also improving her internal cytokine load and aerobicfitness.

Cardio: Building your Cardio Fitness for COVID-19

Cardio is the final link in the training for COVID-19 protocol, and I already alluded to some of this in the breathing section since the two are intimately linked. The only thing I would really emphasize for type A exercisers like myself, is to not overtrain, especially in our current environment. Mark’s personal story as a former burned out world class endurance athlete definitely had an impact on how I view exercise and fitness. He also introduced me to the work of Phil Maffetone, whose heart rate principles I use and prescribe to patients to help them dose exercise just like we would dose medication. Yes, exercise (like food) is medicine and must be dosed properly to optimize immune system function.

As a result of shelter-in, some of my patients are under-dosing exercise with more sedentary behavior, while my Type A exercisers are overdosing on more high intensity workouts. I am using the extra time to work on range of motion and recovery so I can perform better when I do train. I’ve also been consistently breaking personal bests with daily lower intensity walking milage.

For many of my patients who spent long hours doing the tech commute in Silicon Valley, I tell them that regaining their mornings back can be a gift if they use it the right way. Instead of turning on their car engine to drive to work, they can now fire up their mitochondrial engine first thing in the morning and get some physical activity. This keeps their metabolism revved up so their body’s burning more fat throughout the day, especially if they can do this morning activity in a fasted state.

What About Resistance Training?

You might be asking why I didn’t call out weight training here in my ABCs? I guess I could have added a “D” for deadlifts which I am doing twice a week, but I really wanted to highlight the mechanics and physiology of COVID-19 which makes it prey on the aerobically challenged. If this were a pathogen that tore through skeletal muscle, I’d prioritize my lifts over longer cardio sessions. I love lifting weights and I’m not dissuading individuals from doing weight training, but maybe doing it a little differently than stacking progressively heavier plates on bars.

I’ve encouraged my patients who are no longer going to a gym to focus more on plyometrics and body weight training. A new fun goal I’ve set for myself is increasing my vertical leap so I can be more competitive in grabbing rebounds when I face my teen boys for one-on-one basketball. I also encourage you to set goals aligned with fun and pIay, rather than the more rigid goals of increasing your 1 rep max (1RM). I know I likely compromised my 1RM on weights, but I’ve added a spring to my walking step and running stride I didn’t have before, and that has improved my overall aerobic fitness and energy levels. My patients are also learning different exercises that they can now independently do at home or outdoors, so they are less tethered to an indoor gym or class schedule, and can now get a workout in anytime, anyplace.

A final thought I want to share with you that will hopefully help you view this new world we are living in with a brighter lens is the legacy you plan to leave after we are through this pandemic. Imagine if you had a journal you dusted off from your ancestors who lived through the 1918 pandemic. How inspiring would it be to read about how they endured that event, especially without internet and doorstep delivery of food and virtually any item we need with a few taps of our phone. We complain about the “fear of the unknown,” but we know so much more on a minute-to-minute basis about this virus and its impact than any of our pandemic predecessors who truly lived in the dark.

I’m actually keeping a pandemic journal and recommend you do the same. Do you want your future generations to know that you spent this period predominantly in fear, glued to your phone, hiding under the covers, and neglecting your health by baking every single day and avoiding exercise and all forms of social contact? Or would you rather share your fears and vulnerability openly, but then provide hope with all of the things you did to train for the COVID-19, by supporting your own physical and emotional health, and that of your family and surrounding community. Your actions now can provide courage and hope for future generations who will inevitably face their own pandemics and epidemics. Lift yourself and others out of this period, and be their inspiration. I wish all of you peace, safety and optimal health. Grok On!

For more information on health and access to my free COVID-19 survival guide and resources being used by Silicon Valley companies and readers worldwide, go to this page, https://www.culturalhealthsolutions.com/covid-19-resources/ and follow me for cutting edge science and daily tips on Instagram @roneshsinhamd.

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magnesiumMagnesium is an essential mineral that doesn’t get the attention it deserves. You’d be hard pressed to find any activity in the body that doesn’t use magnesium in some way. It has literally hundreds of functions.

Cellular energy production, protein synthesis, DNA and RNA synthesis, and cell signaling—which controls the secretion of certain hormones, among other things—all depend on magnesium. It plays an important role in ion channels that allow nerves to fire, potassium and sodium to cross cellular membranes, and muscles to contract. Production of ATP, the energy currency of the body, depends on magnesium. Your heart beats rhythmically thanks to magnesium.

Not surprisingly, then, magnesium deficiencies seem to factor into a wide range of health issues. Let me tell you about some of the biggies.

Health Issues Related to Magnesium

Before getting into the details, I want to draw your attention to a few challenges with the research literature. One, which I’ll return to later, is that magnesium levels in the body are tough to measure.

Second, lots of studies try to link dietary magnesium intake to specific health outcomes. Foods that contain magnesium, like leafy greens and fish, also contain a host of other vitamins and minerals, fiber, sometimes amino acids. This makes it hard to isolate the effects of any single nutrient.

The way magnesium intake is measured, usually with the Food Frequency Questionnaire (FFQ) or food diaries, is also fraught with error. I don’t put too much stock in studies that correlate dietary intake with any specific health outcome. Correlation doesn’t prove causation anyway, as you know. I’ll mention them here to give you a complete picture of what researchers are working with. Ideally, though, I like to see randomized controlled trials.

Magnesium and Inflammation

It’s increasingly clear that inflammation is at the heart of many, if not most, chronic disease states. Studies have shown that people who consume less than half the recommended daily allowance of magnesium have higher levels of C-reactive protein (CRP), a marker of inflammation.
1 Magnesium intake negatively correlated with CRP in two large observational studies, the Women’s Health Initiative Study 2 and the NHANES Study 3.

These observations are supported by experimental studies which, according to a 2018 meta-analysis. confirm that magnesium supplementation lowers CRP levels4

The Link Between Heart Health and Magnesium

There are many well-documented metabolic pathways through which magnesium can affect heart health. Magnesium may reduce heart disease risk by reducing arterial stiffness, improving endothelial function5, and/or lowering chronic inflammation. It also inhibits platelet aggregation, which is itself a risk factor for heart disease.6

Several large prospective studies have correlated higher magnesium intake or higher magnesium levels in the blood with reduced risk of cardiovascular disease and stroke.7 8 9 10 Magnesium deficiency is considered a risk factor for cardiac arrhythmia and hypertension (high blood pressure).

A recent review of the available evidence concluded that while it’s fair to say that magnesium intake is important for cardiovascular health overall, more randomized controlled trials are needed to understand the particulars better.11

It’s also too soon to conclude that supplementing would have any specific effects, although there is some promising evidence when it comes to hypertension. Two meta-analyses found overall positive, though inconsistent, benefits for lowering blood pressure.12 13 Magnesium supplementation can also be used alongside blood pressure meds to increase their effectiveness.14

Type 2 Diabetes and Insulin Sensitivity

Magnesium affects how cells take up glucose out of the bloodstream, glucose oxidation, and insulin sensitivity.15 Researchers estimate that 25 to 38 percent of type 2 diabetics are deficient in magnesium.16

Diabetes and magnesium deficiency is a vicious cycle. Prospective studies suggest that people with lower magnesium intake are at greater risk for insulin resistance17 and developing type 2 diabetes18. Once they have the disease, they lose more magnesium through urine, making them more susceptible to ongoing magnesium deficiency. This then exacerbates the problems of poor glucose management and insulin resistance, increasing the chances of diabetic complications.19

A 2016 review and meta-analysis showed that magnesium supplementation improves fasting glucose in folks with type 2 diabetes. Among folks who are at risk of developing the disease, supplementing leads to better glucose tolerance and insulin sensitivity. However, the authors also noted a high degree of variability in the data.20 A second meta-analysis found better insulin sensitivity and fasting glucose, particularly when supplementation lasted at least four months.The results of this analysis also indicate that the effects are greatest among people who start out with low magnesium.21

Magnesium and Bone health

Low magnesium is associated with low calcium, impaired parathyroid hormone secretion, low vitamin D, and inflammation. This adds up to a perfect storm when it comes to developing osteopenia and osteoporosis. On the other hand, chronically high magnesium levels may demineralize bones and put people at risk for fracture.22

In correlational studies, dietary intake is positively associated with bone mineral density in postmenopausal and premenopausal women 23, older men and women24, and older white, but not Black, folks 25. However, magnesium levels in the blood don’t consistently correlate with bone mineral density like you’d predict.

Several studies have shown that supplementing improves bone health in young men,26 postmenopausal women,27 and healthy girls.28

Magnesium and Migraines

A fair number of studies find that migraine sufferers have lower magnesium levels than people who don’t get migraines.29 Although migraines are still not well understood overall, scientists have proposed a variety way low magnesium contributes to migraines, including by affecting inflammation and vasodilation, among others.

Research also points to magnesium supplementation as an effective option for managing migraines. Children30 and adults31 with a history of migraines reported fewer and less severe episodes when supplementing with magnesium. One impressive study found that when people went to the emergency room with migraines, magnesium provided even more relief than drugs.32

The American Academy of Neurology and the American Headache Society agree that magnesium is probably effective for the treatment of migraines.33
The authors of a 2012 paper even went so far as to argue that all migraine sufferers should be taking magnesium.34

Magnesium Could Help with Depression and Anxiety

Magnesium has many complex actions in the brain, including affecting neurotransmitter and hormone release and neuronal firing. Although research provided promising evidence a century ago that magnesium can be used to treat depression, nobody took much notice.35 Even now there aren’t a ton of studies.

Depressive symptoms seem to correlate with dietary intake.36 Supplementation may alleviate symptoms of mild-to-moderate37 38 and major depression.39

In a 2017 review of 18 studies, about half reported that magnesium supplementation alleviated anxiety symptoms.40

But Wait, There’s More!

More research is needed, but magnesium may be a factor in:

  • Restless leg syndrome41
  • Fibromyalgia42
  • PMS43
  • ADHD44

What about Sleep?

Magnesium supplementation is often touted for sleep, but there’s actually not that much direct evidence that it helps. One small study involving 12 elderly participants concluded that magnesium supplementation enhanced sleep quality.45 In another study of 46 elderly insomnia patients, eight weeks of magnesium supplementation significantly improved sleep quality and quantity.46 That’s about it.

Still, many sleep aids contain magnesium because it is needed to convert 5-HTP to serotonin, which in turn converts to melatonin. It also blocks NMDA receptors in the brain and promotes GABA, both of which are important for sleep. (These same mechanisms may explain why magnesium helps with depression, by the way. Some scientists have also suggested magnesium’s action on NMDA receptors is why it alleviates migraines.)

Exercise Performance

Magnesium plays a key role in glucose metabolism and energy production. Since glucose is mobilized during exercise, it makes sense that magnesium would be important. Research in mice shows that giving them magnesium increases the amount of available glucose during exercise. It also delays the accumulation of lactate in the muscles, which may prevent fatigue.47

The evidence for using magnesium supplementation to improve human performance is mixed. For example, in one study, male professional volleyball players were able to jump higher, and they had decreased lactate production, after supplementing magnesium for four weeks.48 Triathletes likewise improved their swim, bike, and run times.49 However, another study found no benefit for marathoners.50

Even if it doesn’t yield a performance benefit, though, it’s clearly important that athletes make sure their electrolyte intake is sufficient. More on that next week.

Normal Levels and Magnesium Deficiencies

It’s difficult to test magnesium levels. The most common method is a blood test. Normal serum concentrations fall between 0.75 and 0.95 mmol/L.

However, less than 1 percent of total body magnesium is in the bloodstream, and serum level is tightly regulated by the kidneys, as well as bone and intestines. Blood tests are poor indicators of total body magnesium levels. Your doctor may use a combination of blood, saliva, and urine tests if they suspect a severe deficiency. No single method seems to work very well.

Clinical deficiencies in healthy adults are rare, but data from the large NHANES study suggests that perhaps only one-third of Americans hits the recommended daily intake.51 If true, many people may be walking around with sub-optimal magnesium levels. People who are at greater risk for deficiencies include those with gastrointestinal issues such as Chron’s or celiac disease that interfere with nutrient absorption, diabetes, kidney disease, or who take certain medications. The elderly and people with alcoholism often have low magnesium

Severe deficiencies can be indicated by low calcium and potassium levels, and by non-specific symptoms like muscle spasms and vomiting. Mild deficiencies usually have no noticeable symptoms.

Recommended Intake

The recommended daily intake for adults is 310 mg for females aged 19 to 30, and 320 mg thereafter. For males, it’s 400 mg up to age 30, then 420 mg. Pregnant women need an extra 40 mg per day.

Does Diet Matter?

Possibly. If you’re following a keto diet, you should supplement with sodium, potassium, and magnesium. You need up to an additional 300 to 500 mg of magnesium per day.

I’ve also previously considered whether folks following a carnivore diet may need less magnesium from their food, perhaps because they consume less glucose or fiber than omnivorous types. I think it’s too soon to tell, although I’m open to the possibility.

Foods High in Magnesium

Some of the best Primal-friendly sources of magnesium include:

  • Leafy greens: spinach, Swiss chard
  • Dark chocolate
  • Nuts: almonds, cashews
  • Seeds: pumpkin, hemp, watermelon
  • Fish: halibut, mackerel, salmon
  • Avocado

In addition to food sources, as much as 10 percent of our magnesium intake comes from drinking water.52

How to Choose a Magnesium Supplement

As with any nutrient, it’s best to get magnesium from food. The Food and Nutrition Board of the US Institute of Medicine designates 350 mg/day as the tolerable upper intake level (UL) for supplementing.

When choosing a magnesium supplement, look for a chelated form, the ones ending in -ate. They have the best bioavailability. Magnesium glycinate and malate are both good choices. Magnesium citrate is probably the most common since it is inexpensive and widely studied, but it can have undesirable laxative effects for some people. L-threonate is particularly noted for its cognitive benefits. Avoid magnesium oxide unless you specifically want diarrhea.

Certain pharmaceutical drugs can interact with magnesium. Talk to your doctor, especially if you take medications for osteoporosis or HIV, if you are on a diuretic, or if you are prescribed tetracycline or quinolone antibiotics.

Can You Get Too Much Magnesium?

While magnesium toxicity is possible, it’s very rare. Most forms of magnesium will cause gastrointestinal distress before that point. Stick to recommended doses, though.

Transdermal Magnesium: Epsom Salts Baths and Magnesium Oil

Both epsom salt baths (magnesium sulfate) and magnesium oil sprays (usually magnesium chloride) are touted as alternatives for boosting magnesium levels. However, there is almost no research verifying that it is effectively absorbed through the skin.53 Still, many people use them for recovery from exercise, relief from pain or cramping, and as sleep aids.

If it works for you, by all means keep doing it. However, if you’re looking for a guaranteed way to increase magnesium levels, it’s safer to go with a supplement.

Some Important Things to Keep in Mind

We covered a lot of ground today. Before I let you go, let me point out a couple of things.

First, as with most—probably all—vitamins and minerals, there’s a sweet spot with magnesium. Too little is clearly bad, but trying to cram in more than you need is not good either.

That said, some of the experiments referenced here used doses that are well above the 350 mg UL for supplementation. Don’t go mega-dosing on your own, of course. On the other hand, if you’re considering using magnesium to help with a specific health issue, consult your doctor to see how much you might need to see results.

Though it’s clear that magnesium is a big-time player in optimal health overall, more research is needed to understand the specific benefits. My guess is that most Primal folks eating a diverse diet are getting enough magnesium. If you’re curious, use a food tracking app like Cronometer to see how much you get over the course of several days to a week.

Stay tuned next week. I’m planning to talk more generally about electrolytes and when and why you’d want to supplement. Let me know if you have any questions along those lines.

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The box gym world needs a reset and there’s no better time than now.

By now, most people are aware of the backlash against Greg Glassman, CrossFit’s founder and CEO, because of tone-deaf, insensitive, and dismissive remarks he has made about George Floyd’s death and COVID-19.

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fat adaptedWhen describing someone that has successfully made the transition to a Primal or Keto way of eating I often refer to them as “fat-adapted” or as “fat-burning beasts”. But what exactly does it mean to be fat-adapted? How can you tell if you’re fat-adapted or still a sugar-burner?

As I’ve mentioned before, fat-adaptation is the normal, preferred metabolic state of the human animal. It’s nothing special. It’s just how we’re meant to fuel ourselves. That’s actually why we have all this fat on our bodies – turns out it’s a pretty reliable source of energy.

Here’s what you need to know about the benefits of becoming fat adapted, or keto adapted, and why it works with your biology.


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Are Being in Ketosis and Being Fat Adapted the Same Thing?

Fat-adaption does not necessarily mean you’re in ketosis all the time. Ketosis ketosis describes the use of fat-derived ketone bodies by tissues (like parts of the brain) that normally use glucose. That happens after you’ve depleted your glucose stores, and your body starts producing ketones for energy. When you’re in ketosis, you can usually detect ketones in your bloodstream.

Fat-adaption describes the ability to burn both fat (through beta-oxidation) and glucose (through glycolysis).

The Disadvantages of Primarily Burning Sugar for Energy

To understand what it means to be fat adapted, it’s useful examine what it means to depend on sugar for energy.

It Is More Difficult to Access Stored Fat for Energy When You’re Dependent on Sugar

What that means is, when your body is primarily looking for sugar for fuel, your skeletal muscle doesn’t as readily oxidize fat for energy.

What happens when a sugar-burner goes two, three, four hours without food, or skips a whole entire meal? They get ravenously hungry. A sugar-burner’s adipose (fat) tissue even releases a bunch of fatty acids 4-6 hours after eating and during fasting, because as far as your biology is concerned, your muscles should be able to oxidize them. After all, we evolved to rely on beta oxidation of fat for the bulk of our energy needs. Once your blood sugar is all used up (which happens really quickly), hunger sets in, and your hand reaches into the chip bag yet again.

A Sugar Burner Doesn’t Readily Access Dietary Fat for Energy

As a result, more dietary fat is stored than burned. Unfortunately for them, they’re likely to end up gaining lots of body fat. As we know, a low ratio of fat to carbohydrate oxidation is a strong predictor of future weight gain.1

Sugar Stores Deplete Quickly And Need to Be Replenished Often

A sugar-burner depends on a perpetually-fleeting source of energy. Glucose is nice to burn when you need it, but you can’t really store very much of it on your person (unless you count snacks in pockets). Even a 160 pound person who’s visibly lean at 12% body fat still has 19.2 pounds of animal fat on hand for oxidation, while our ability to store glucose as muscle and liver glycogen (stored glucose) are limited to about 500 grams (depending on the size of the liver and amount of muscle you’re sporting).2 If you’re unable to effectively beta oxidize fat (as sugar-burners often are), you’d better have some quick snack options on hand.

Sugar Burners Use Stored Glucose Quickly During Exercise

Depending on the nature of the physical activity, glycogen burning could be perfectly desirable and expected, but it’s precious, valuable stuff. If you’re able to power your efforts with fat for as long as possible, that gives you more glycogen – more rocket fuel for later, intenser efforts (like climbing a hill or grabbing that fourth quarter offensive rebound or running from a predator). Sugar-burners waste their glycogen on efforts that fat should be able to power.

The Benefits of Being Fat Adapted

There are some compelling advantages to being fat adapted or keto adapted, which may move you to make the switch if you haven’t already.

People Who are Fat Adapted Often See Improved Insulin Sensitivity

A ketogenic diet “tells” your body that no or very little glucose is available in the environment. The result? “Impaired” glucose tolerance 3 and “physiological” insulin resistance, which sound like negatives but are actually necessary to spare what little glucose exists for use in the brain. On the other hand, a well-constructed, lower-carb (but not full-blown ketogenic) Primal way of eating that leads to weight loss generally improves insulin sensitivity.4

Being Fat Adapted Means You Go Longer Between Meals

A fat-burning beast can effectively burn stored fat for energy throughout the day. If you are fat adapted, chances are, you can handle missing meals and are able to go hours without getting ravenous and cranky (or craving carbs).

You Can Better Utilize the Fat You Eat for Energy

A fat-burning beast is able to effectively oxidize dietary fat for energy. If you’re adapted, your post-prandial (after mealtime) fat oxidation will be increased, and less dietary fat will be stored in adipose tissue.

When You’re Keto Adapted, You Always Have a Fuel Source

A fat-burning beast has plenty of accessible energy available in the form of body fat, even if he or she is lean. If you’re adapted, the genes associated with lipid metabolism will be upregulated in your skeletal muscles.5 You will essentially reprogram your body.

You Can Burn Fat While Exercising

A fat-burning beast can rely more on fat for energy during exercise, sparing glycogen for when he or she really needs it. As I’ve discussed before, being able to mobilize and oxidize stored fat during exercise can reduce an athlete’s reliance on glycogen. This is the classic “train low, race high” phenomenon, and it can improve performance, save the glycogen for the truly intense segments of a session, and burn more body fat.6 If you can handle exercising without having to carb-load, you’re probably fat-adapted. If you can workout effectively in a fasted state, you’re definitely fat-adapted.

You Can Still Burn Glucose When Fat Adapted

It’s not that the fat-burning beast can’t burn glucose – because glucose is toxic in the blood, we’ll always preferentially burn it, store it, or otherwise “handle” it – it’s that we do not depend on it. I’d even suggest that true fat-adaptation will allow someone to eat a higher carb meal or day without derailing the train. Once the fat-burning machinery has been established and programmed, you should be able to effortlessly switch between fuel sources as needed.

A fat-burning beast will be able to burn glucose when necessary or available, whereas the opposite cannot be said for a sugar-burner. Ultimately, fat-adaption means metabolic flexibility. It means that a fat-burning beast will be able to handle some carbs along with some fat. When you’re fat adapted, you will be able to empty glycogen stores through intense exercise, refill those stores, burn whatever dietary fat isn’t stored, and then easily access and oxidize the fat that is stored when it’s needed.


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How Do You Know if You’re Fat Adapted or Keto Adapted?

There’s really no “fat-adaptation home test kit.” I suppose you could test your respiratory quotient, which is the ratio of carbon dioxide you produce to oxygen you consume. An RQ of 1+ indicates full glucose-burning; an RQ of 0.7 indicates full fat-burning. Somewhere around 0.8 would probably mean you’re fairly well fat-adapted, while something closer to 1 probably means you’re closer to a sugar-burner. The obese have higher RQs. Diabetics have higher RQs.7 Nighttime eaters have higher RQs (and lower lipid oxidation).8 What do these groups all have in common? Lower satiety, insistent hunger, impaired beta-oxidation of fat, increased carb cravings and intake – all hallmarks of the sugar-burner.

It’d be great if you could monitor the efficiency of your mitochondria, including the waste products produced by their ATP manufacturing, perhaps with a really, really powerful microscope, but you’d have to know what you were looking for.

No, there’s no test to take, no simple thing to measure, no one number to track, no lab to order from your doctor. To find out if you’re fat-adapted, the most effective way is to ask yourself a few basic questions:

  • Can you go three hours without eating? Is skipping a meal an exercise in futility and misery?
  • Do you enjoy steady, even energy throughout the day? Are midday naps pleasurable indulgences, rather than necessary staples?
  • Can you exercise without carb-loading?
  • Have the headaches and brain fuzziness passed?

Yes? Then you’re probably fat-adapted. Welcome to the human metabolism you were wired for!

That’s it for today, folks. Send along any questions or comments that you have. I’d love to hear from you guys.

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