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Inquiring Minds Want to Know: Older Bolder Links, Reads, and More 2 March 2019

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Keto (Nutritional Ketosis) and Weight Loss

Nifty narrative review of keto-adaption and exercise tolerance, fatigue recovery, and organ damage prevention.
Tracking the food you eat helps in weight loss.
Another traditional medicine look at a 12-week ketogenic diet trial.
Canadian FP docs query if a ketogenic diet is effective for weight loss. It is.
Your cells thrive with fewer calories? For the most part, yes.

Exercise and Fitness

Interval training and sprints are good for you and your weight loss.
Fat cells release TGF-beta 2 post exercise – and it improves glucose tolerance.
Physical activity patterns and mortality.

Other Topics That Caught My Eye

Orthobiologics for knee osteoarthritis. (Need free Medscape account)
Another look at gut bacteria and dementia.
Gut microbiota varies by ethnicity.
Is yerba santa useful in dementia?

Food, Glorious Food

Short TED vid on the history of cheese.
How Benton’s, a famous Southern bacon purveyor, makes their famous bacon. (No nitrites)
Coconut Curry Braised Chicken Legs
Thai Inspired Celery Salad Update

Cracks in the Conventional Wisdom Wall: Debunking the Obesity Paradox?

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Just a quick comment taking on the “fat but fit” mantra you’ll see almost everywhere today – here’s a quick read (Debunking the ‘obesity paradox’: Can fat be fit?), published on the 17th over on MDLinx, an internal medicine aggregator site.

Simply put, the obesity paradox, not to be confused (though it often is) with the fat paradox (working on a series related to the fat paradox to follow), stems from a group of research studies in which the august clinicians suggested that being obese (or overweight), particularly when looking at the elderly, wasn’t a bad thing, didn’t induce deleterious impacts, but in fact was protective (both for cardiovascular events and all-cause mortality).

The linked article above reports the key findings in recent three studies arguing otherwise (recently published in the European Heart Journal, The Lancet, and JAMA Cardiology), which clearly demonstrate that higher BMIs lead to greater incidence of cardiovascular problems in particular.

I don’t have time today to go into details here, though we’ll be revisiting this concept here on the blog over the next several weeks. The linked article above provides a very readable summary and links out to the three studies mentioned.

More to come.

My Personal Nutritional Ketosis Report Card 10 January: Through Week 36

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It’s been a few months since I shared my personal perspectives while engaging with a run of nutritional ketosis; my last update was here (15 August 2018), and here’s my post outlining why I wanted to give NK a run.

My Nutritional Ketosis Report Card at Week 36

Once again, for the most part, I’m pleased as punch overall after spending now slightly over eight months in nutritional ketosis, though for at least two weeks (one over the holidays), I’m sure I was drifting in and out of NK during the week.

My schedule is for the most part the same as I outlined in the 15 August post linked above, save for altering my walking routine due to a fairly impressive plantar fasciitis and calcaneal stress fracture (dammit).

A Closer Look at a Few Metrics

As noted in my last personal NK update, I have continued tracking a fairly close estimation of my macronutrients –

Up until starting my NK run, I’d lost 100 pounds without tracking a single calorie consumed over the 15 months window we’d been eating a fairly compliant LC/MP/HF diet around our camp, though of note been in a weight loss stall for several months (Dec-Feb).

I did however, principally at first as a learning tool, and later in part due to my medical training induced affinity for objective data, track a fairly specific diary of my daily carb intake (net carbs), which from the get go were always under 100 per day, and most often under 60 gm/day.

Again, largely as a matter of intellectual curiosity, when starting my NK run, I decided to track, as closely as possible, daily intake of carbs, protein, and fat, and to calculate my total caloric intake and deficit against my estimated BMR (adjusted for activity), as well as the percentages of carb / protein / fat contributions to my total calories.

Please note this point about tracking data: I still don’t recommend that most folks I work with track their intake as obsessively as I have been; it’s simply not necessary to make nutritional ketosis work for most. If you’re a data nut like me, go for it. Over the 36 weeks in NK thus far, the rolling averages of my intake and macronutrient accounting include –

Daily Carb Grams: 22.9 (91.4 calories)
Daily Protein Grams: 81.5 (326 calories)
Daily Fat Grams: 122.9 (1106.1 calories)

Average Total Calories per Day: 1525
Average Calorie Deficit per Day: –1565.7

Average Carbs as Percent of Total Calories per Day: 6.0%
Average Protein as Percent of Total Calories per Day: 21.4%
Average Fat as Percent of Total Calories per Day: 72.5%

Of note, without any conscious effort on my part, the trend of eating less protein and less calories overall continued most weeks, and several weeks I’ve dropped my carb grams to less than 20 g/day just to mix things up a bit, with no change in cognition, energy levels, exercise tolerance, hunger, or satiety.

Weight loss during my 36 week run now totals 59 pounds, fairly consistent with what I noted previously.

My Nutritional Ketosis Week 36 Bottom Line: Let’s Make It a Year

Overall I’ve been extraordinarily pleased with the results of my NK trial, especially in the context of my daily ability to engage with my life tasks, consistently and impressively improve my personal fitness, and chip away at the primary goals I originally outlined.

At this point, barring any unforeseen changes, I plan to ride the keto train to complete a full year in nutritional ketosis. Another report to follow in April.

My Keto Report Card 2 August 2018: Week 15

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Back on the Seventh of June I shared a quick post detailing my personal experience in a fairly diligent nutritional ketosis run; the week before I’d shared a short post explaining why I’d chosen to do the work (in retrospect, it’s been shockingly easy) to give keto a try.

Without rehashing all the why’s I laid out back then, I was interested in pushing through a weight loss stall first and foremost, though wanted to play a bit with seeing if being in NK would really improve mental clarity and my overall reserve of daily energy.

My Nutritional Keto Report Card at Week 15

For the most part, as summarized in the image to the right, overall I’m still pleased as can be with what life looks and feels like in nutritional ketosis.

My schedule hasn’t changed much; I’m still out of the sack between 530 and 6 (after 8 hours of sleep on average), still waking up without an alarm clock with the earliest light of the day. I typically still drink a cold-brewed coffee (still with a bit of cream and 10-11 grams of protein in the form of collagen powder), though due to the scorching heat during this Texas summer, almost every day I head out for a 2-3 mile walk while it’s cool.

Then it’s back to the desk for several hours of fairly intensive cognitive work, typically with very good energy and creative juices flowing, then I’m either doing a HIIT workout 3x/week, walking again or cycling again most days, with a sprint workout thrown in every 7-10 days as well.

Trying hard to eat WHEN (when hunger ensues naturally), typically lunch is somewhere between 1 and 2, with a family dinner then following (after the afternoon’s work) most often around 730 or 8.

We did make a run to Montana (to see a new grand-baby!) a few weeks ago, with a few days on the road challenging my keto compliance; interestingly my weight loss continued, though with a bit less satiety during travel and interestingly the week after.

A Closer Look at a Few Metrics

As noted 8 weeks ago, I have been tracking a fairly close estimation of my macronutrients –

Up until starting my NK run, I’d lost 100 lbs without tracking a single calorie consumed over the 15 months window we’d been eating a fairly compliant LC/MP/HF diet around our camp, though of note been in a weight loss stall for several months (Dec-Feb).

I did however, principally at first as a learning tool, and later in part due to my medical training induced affinity for objective data, track a fairly specific diary of my daily carb intake (net carbs), which from the get go were always under 100 per day, and most often under 60 gm/day.

Again, largely as a matter of intellectual curiosity, when starting my NK run, I decided to track, as closely as possible, daily intake of carbs, protein, and fat, and to calculate my total caloric intake and deficit against my estimated BMR (adjusted for activity), as well as the percentages of carb / protein / fat contributions to my total calories.

I still don’t recommend that most folks I work with track their intake as obsessively as I have been; it’s simply not necessary to make nutritional ketosis work for most. If you’re a data nut like me, go to it. Over the 15 weeks in NK thus far, the rolling averages of my intake and macronutrient accounting include –

Daily Carb Grams: 25.3 (101 calories)
Daily Protein Grams: 88.1 (352.3 calories)
Daily Fat Grams: 121.7 (1093.5 calories)

Average Total Calories per Day: 1552.5
Average Calorie Deficit per Day: –1537.3

Average Carbs as Percent of Total Calories per Day: 6.5%
Average Protein as Percent of Total Calories per Day: 22.6%
Average Fat as Percent of Total Calories per Day: 70.5%

Of note, without any conscious effort on my part, I’ve been gradually eating less per day overall over the 15 weeks (eating WHEN to satiety), with the percentage of carbs dropping over time, and fat increasing. Over the past 4 weeks, I’ve dropped carbs under 20 g/day just to make things interesting…

Weight loss during my 15 week run now totals 30.5 pounds, fairly consistent with what I noted during the first 7 weeks.

My Nutritional Ketosis Week Fifteen Bottom Line: Still Hot Damn!

All in all, I couldn’t be more pleased and feel better than I have since my late 20’s; at this point I’m guessing I might make this a 6-month run. We’ll see in a couple of months when I report again…

Foundation Series: Fitness Secret Weapon No. 1 – MOVE

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I had an interesting conversation over the weekend with a good friend from Montana.

He’s a very successful businessman with a loving family; though his principle business interest is commercial (multifamily) real estate, he and his two sons run an impressive grass-fed cattle operation in Montana on three fairly large land plots (they call them ranches up in that part of the world).

We’ve known one another for a lustrum or better now, and he’s been impressed enough with my body composition (and other) changes over the past eighteen months to himself jump on the Primal bandwagon. Working on his seventh decade of a very active life, he’s still out in the field six of seven days per week, though spends the bulk of his time behind a desk. He and his clan have additionally weathered a heart-wrenching tragedy this spring with the loss of a daughter-in-law.

After a rapid and for the most effortless weight loss for the first four months as a Primal guy, he’s been stalled now for the last two months and change. Even more frustrating to him was the fact that he felt his overall fitness level hadn’t changed radically since the New Year. So he called me Saturday afternoon, feeling just a bit defeated, and looking for some answers.

Time for a Bit of Long-Distance Detective Work

The first half hour of our conversation was spent with me mostly listening, prompting with a question here and there, but gradually a consistent story began to take shape, focused around two things.

One, and of lesser importance in the big picture, my friend had been consuming (too much) fruit (mostly South American in origin) on a near daily basis during the long Montana winter, which, pending where you happened to live in the state, persisted via a snowy, cold spring until late April or early May this year. This is another story for another day, but suffice it to say that fructose has been the undoing of many a concerted weight loss attempt.

Two, and perhaps most critically, my compadre hasn’t been moving enough. Yes, he’s busy, some days putting in 15 hours between desk, truck, and tractor, but we pretty quickly came to the same conclusion – he’s been far too sedentary coming out of winter and having dealt with the issues they faced as an extended-family unit this spring.

Back to the Basics with the Secret Weapon of Movement

One of the first things we did together was agree that movement – general, everyday, functional-task linked movement is a critical cornerstone for good health (and the Primal lifestyle). I reminded him that the movement we’re talking about here, the essential, get-off-your-butt and just move stuff, isn’t really what most would call targeted exercise or higher-level training (Sisson speaks to the distinction ably here), but really ought to be something we all think of as an essential, pretty much non-negotiable part of our day.

While for many a goal of 10,000 steps a day is ambitious, my friend noted that much of the tasking that he does “around the place” could be easily accomplished on foot instead of from the seat of a four-wheeler, truck, or tractor. Given the trials of the spring, and a generous spring runoff, he’d not be fly fishing much, though had two excursions involving hiking set up for this week (dang, that sounds like fun).

We chatted about ways to incorporate quick walks into his day, like a quick walk breathing in those glorious summer Montana mornings before settling in for the day’s work, a 10-minute stretch every two hours (or less) during the desk day, a 20-30 minute walk after dinner, and rewarding himself with at least one 2 hour or better hike each week to fish his favorite waters on the Big Hole River near his home.

We agreed that for him, a rational, baseline goal for moving in some form of low level aerobic activity (it works for most of us, too) would be in the 5-7 hours per week range, shooting for at least an hour per day or better (in a addition to his HIIT and resistance workouts he’s been fairly diligent with so far).

Bottom line, moving more is something we all can fairly easily incorporate into our day; it may take a bit of effort and reprograming and old habit or two, but the results build in quickly.

Question of the Week 23 July: Walk vs Jog

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A friend forwarded this question on from an acquaintance of hers, and I thought it worth running through some of the thinking on walking vs. jogging, particularly for someone over 40, above their ideal weight, and not as active as they perhaps think they are…

From Carol –

…My daughter is home from college and has been nagging me for weeks now to get out and run with her in the mornings. She’s of course 20, a life-long runner, and extremely fit, putting in 27-30 mile weeks on average. I’ve had a very stressful year (death of a parent after an ugly cancer battle) and put on another 30 pounds, making me about 55 pounds over what I feel is my best weight.

I’ve been a walker in years past (about 3 miles five days per week) but not in the past year, though I’m playing golf (out of a cart) once every 10 days or so so getting a fair bit of exercise there. Otherwise I guess I’m considered sedentary given my desk job. My daughter is convinced that walking is basically of no benefit for weight loss or general health and that I have to run at some every day to regain my form, and it’s beginning to stress our relationship. I’m ready to get started but she’s rattled my confidence in my old walking routine…

Kudos, and Let’s Agree That Simply Getting Moving is Good

Carol, kudos to you for making the decision to get back in the walking game, and kudos to your daughter for wanting to help you along the way (even though she’s overlooking some of the proven benefits of walking).

And I’d bet the farm that your daughter would agree that, without even delving too far into the science, that simply getting moving (more than you are now) will be a very helpful action for you to take – whether that be walking, jogging, or actually running. And sorry, though I’m not currently an active golfer, having played a number of rounds out of a cart in years past, I don’t think that’s providing much at all in terms of true exercise benefit, though the sun exposure (with appropriate high-exposure skin precautions) is probably boosting your vitamin D!

Walking is Great Exercise and Has a Number of Health Benefits

Please reassure your daughter that walking has a number of proven health benefits demonstrated across widely varying age bands, and in fact, particularly for those of us in our fifth decades and beyond, offers these benefits without the baggage of running-induced injuries that often increase with age.

In addition, as you’re “getting back in the exercise groove” after a tough year and with a (recently) sedentary lifestyle, walking allows you to ramp up your exercise volumes with relative ease, with a reasonable goal of walking five of seven days per week (or more); thirty minutes per outing is good, an hour is even better.

What Does some Representative Research Suggest About Walking vs Running?

In this study, equivalent energy expenditures by moderate walking and running invoked similar risk reductions for hypertension, diabetes mellitus, and hypercholesterolemia; perhaps lesser so for coronary heart disease.

This study of men 64-65 looked the effects on health of walking (more than 2 hours/day, 1-2 hours/day, and < 30 min/day); the more they walked, the greater benefit (decreased mortality) was noted.

This study showed that moderate walking (8.6 miles/week) was very effective at improving glucose tolerance and nearly as effective as a much more aggressive (diet, moderate exercise, weight loss) approach in those at risk for T2DM.

This editorial in the American Journal of Cardiology made some interesting observations about the efficacy of running vs. walking, though appropriately discussed the much higher injury rates associated with running.

There’s a hoard of research supporting the premise that injury rates are higher among runners of all skill level levels and mileage/volume; for example see this, this, and this. And finally, some studies, such as this one, suggest that more aggressive (strenuous) jogging provides no all-cause mortality benefit over sedentary controls. (A topic for another day.)

Bottom Line: Lace Up Those Walking Shoes

Bottom line, resuming your walking program is a great idea, and will benefit you in a multitude of ways. (I’ve resumed a vigorous walking program myself this spring and summer, and have come to treasure my early morning/sunrise adventures in the countryside; I’d forgotten with what gusto birds sing as the sun comes up.) Perhaps your daughter might accompany you some days, as a complement to her running program, and allow some genuine ‘social networking’ before she heads back to school.

Don’t forget that your body composition is 80% or more what you eat, with exercise contributing 10% (more or less) to the equation.

Older Bolder Foundations: Is Everything You’ve Been Taught About Macronutrient Partitioning Wrong? Probably. (Part 3)

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Let’s wind up this whirlwind tour of macronutrient partitioning with a look at the role fat plays in your food plan and a key closing thought. Scroll down below (or click) to read Part 1 and Part 2 if you missed them.

Getting to Your Best Macronutrient Partitioning: Fats

Fats, despite growing evidence to the contrary, continue to be broadly demonized by many in the traditional health and nutrition world (see current recommendations from the American Heart Association for example); not only that, we’re constantly implored to utilize the very fats that are in reality shockingly bad for us – namely the highly-oxidized, chemically-modified, PUFA-dominated franken-oils lining most supermarket shelves (again, see the AHA link above).

The good, healthy fats (butter and ghee, coconut oil and coconut products, animal fats, olives and olive oil, and avocados for example) provide a host of benefits and can be enjoyed, within the bounds of common sense, with two primary goals in their consumption: balancing out your daily caloric needs as your primary fuel source (after establishing your carb and protein requirements) and making your food taste good (yep, much of the flavor you savor in your food comes from fat).

[And yes, we’ll being taking a detailed look at what makes ‘good fats’ far better for you in detailed posts down the road. If you’re currently exploring the issue and want to dig deeper (no pun intended), pick up a copy of Dr. Cate Shanahan’s book Deep Nutrition for a dive into the science underlaying the fat recommendations here and across much of the wellness literature today.]

Balancing out daily caloric needs is the key take home point here and points to a critical principle that continues to fly in the face of conventional wisdom – that point being that the human machine (our metabolism) runs optimally on fat as its primary fuel source, not carbohydrates. There’s a plethora of literature espousing this Fat Paradigm (here’s a seminal article from Phinney, 2004), and we’ll be looking at the topic in much more detail a few weeks down the road.

Practically speaking, once you’ve reacquainted your metabolic machinery with the reality of burning fat as a preferred fuel source (which conceptually isn’t that difficult to do), fats become the variable in your food plan allowing you to accomplish all sorts of things. Things like rational, consistent weight loss or fueling high level functional life or athletic activities.

[As an example, I have a client who wants to loose roughly 40 pounds (at a very sustainable rate of 1.5 lb/wk), and we’ve dialed in her comfortable carb intake at about 60 g/day and protein in the neighborhood of 90 g/day. With her calculated BMR (based on LBM and adjusted for activity) 2150 cal/day, it’s a simple calculation to subtract her carb+protein intake derived calories from her BMR, along with the calorie deficit to produce the desired weight loss, to see that she needs about 800 cal/day from good fats, roughly 88 grams. An easy-peasy plan to derive and accomplish.]

For many breaking out of the carb-dependent paradigm can be a challenge, but once you’ve personally experienced the power of changing over to fat as your preferred fuel source, a whole new world of possibility opens up.

Getting to Your Best Macronutrient Partitioning: Seek and You Shall Find

In summary, your best macronutrient partitioning plan isn’t one that comes from the benevolent USDA, the American Heart Association (or just about any other traditional medical “association”), or from the fitness guru (and Instagram celebrity) online who promises a foolproof, customized meal plan for just three easy payments of $39.99.

Your optimal macronutrient partitioning plan…

…is at any point in time unique to you and you alone, though there are useful generalizations available to serve as jumping off points when reshaping your approach to food and nutrition,

…is going to be fluid (flexible), changing as your body composition and metabolic health improves,

…is going to be fluid (flexible), changing as your physical and metabolic demands change over time, perhaps even from day to day,

…is most likely going to built around the concept that the bulk of your daily calories will come from fat (good fats!), less from protein, and minimally from carbohydrates,

…will likely vary seasonally,

…will likely become so intuitive you don’t really even think about it from day to day,

…and will likely benefit from an annual or bi-annual “tune up” or “reset”, as in a period of nutritional ketosis for example.

Your challenge, should you decide to accept it, is to find that optimal macronutrient partitioning plan that fits your life today, and learn the skills to adjust it when life throws you a curve ball, or you just feel the need to push your limits out a little further.

Read. Study. Ask questions. Experiment with your own N=1 clinical trials. Need help along the way? We can help, as can a number of excellent health coaches only an email or call away.

Older Bolder Foundations: Is Everything You’ve Been Taught About Macronutrient Partitioning Wrong? Probably. (Part 2 of 3)

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If you missed yesterday’s post taking a well-earned jab at the conventional wisdom concerning macronutrients and macronutrient partitioning, scroll down (or click here) to read. Now, let’s get down to some practical nitty-gritty details…

Getting to Your Best Macronutrient Partitioning: First, the Caveats

When trying to dial in optimal macronutrient partitioning for any given individual (most likely you!), a couple of caveats are in order.

One, beware anyone (including the USDA) telling you that their formula / ratio / recommendations work for everyone, particularly if you have to pony up something (likely cash) up front to get the magic data. There’s a simple reason generic, one-size-fits-all partitioning recommendations aren’t worth much…

Two, your optimal macronutrient partitioning needs depend on a host of factors THAT ARE UNIQUE TO YOU; potentially including (a short list, just for example):

  • Your current objective(s): be it weight loss, athletic performance, cognitive improvement, general well being, longevity, etc.
  • Your current body composition: Are you overweight, underweight, lacking appropriate muscle mass?
  • Your overall metabolic health: Are you in full-blown metabolic syndrome with insulin resistance, on the edge, or “fairly healthy”?
  • Your overall level of activity: Are you a cubical-bound couch potato whose idea of a workout is the walk to and from the car in the parking lot, an occasional, casual walker, perhaps working a physically demanding job, or a gym rat?
  • Your overall general health: Do you have conditions that impact your body’s functions in a material way, such as joint problems (degenerative arthritis), heart disease or hypertension, poor sleep, or stress you can’t manage?
  • Your age: For example, protein requirements increase in the elderly, and the elderly’s protein requirements may be more impacted by higher activity levels.
  • Your current progress in your recovery journey: Your best macronutrient partitioning will change over time, pending where you are in your health and wellness journey, and as you purposefully get leaner, more fit, and thoughtful about how you fuel your mind and body.

Optimizing your macros takes paying attention to what your body’s telling you; it’s time to start listening…

Getting to Your Best Macronutrient Partitioning: Carbs

In all the study, reading, and learning I’ve done over the years, from where I sit no one has done a better job illustrating the role that carbs play in your macro intake than Mark Sisson of The Primal Blueprint and Mark’s Daily Apple. In particular his carbohydrate curve packs a boatload of information into one simple yet inspired graphic, reproduced below.

There’s volumes to talk about with regard to carbohydrate intake and we’ll be focusing on the subject extensively here on in months to come. At this point, as the vast majority of folks that I interact with have as a primary objective optimizing lean body mass (for most that means dropping fat and building/preserving muscle), we typically start by targeting 100 g (net) or less of carbs / day.

Getting to Your Best Macronutrient Partitioning: Protein

The current RDA for protein – 0.36 g/lb lean body mass (or 0.8 g protein/kg LBM) – is based on assumptions that don’t apply to many: a sedentary lifestyle, healthy / metabolically sound, with normal lean body mass and not trying to build muscle/increase LBM. For active individuals, for years have recommendations have quickly spun up into the 0.7 to 0.8 g/lb range (or higher).

Interestingly, many in the ancestral health and wellness world have been for some time challenging the RDA dogma above, and suggest that the minimal requirements may indeed be much lower, in the range of 0.5 g/lb LBM.

Intuitively you know that athletes need more, though as science drills down with more and more specific research, the shockingly high amounts of protein recommended (for example in body builders) appear to have quite potentially been simply too much. Suffice it to say that a large portion of the strength training community holds that 1-2 g protein/lb of LBM per day is reasonable.

For those seeking weight loss, and recognizing that goal number one is loss of fat and not lean body mass (muscle being the largest component of LBM), studies have shown that upping protein (basically doubling the RDA above) improves weight loss and better preserves LBM.

The elderly and those recovering from significant illness or injury need more protein (in the ranges of 0.5-0.6 g/lb LBM and 0.7-0.8 g/lb LBM respectively).

We’ll have much more to say about protein in weeks and months to come, but at this point we steer most to target roughly 0.5 to 0.6 g of quality proteins/lb of LBM per day, and adjust within 3-4 weeks based on your body’s response.

We’ll take a hard, detailed look at what constitutes optimal protein sources in a few weeks, and
tomorrow we’ll take a look at fat and some final thoughts on macronutrient partitioning.