Mastering Nutrition

Question: When on a ketogenic diet, it is a problem if ketones are going up to 5 to 6 millimoles per liter? One of the popular ketogenic advocates was saying that if the ketones are getting above 3, then it's from not eating enough protein. I don't really see it that way. I think that protein will suppress ketogenesis, and so will carbs. Five to 6 millimoles per liter is what you see in therapeutic ketogenic diets. In terms of how you could bring the ketones down, more carbs or more protein are going to bring them down. Between the two of those, probably protein would be the most important thing to increase as a means of protection against lean mass loss and as a means of keeping neurotransmitters and all the other things that you do with protein healthy. But you could raise the carbs a little bit too. Because remember that your carb demand even on a ketogenic diet is definitely not down to 20 grams of carbs. That's not even feeding your brain on the ketogenic diet. If you have room to increase carbs, then I think would be great to get the carbs up to at least 30 and then maybe use protein going up to supply the rest of that. Then also pay attention to micronutrients. Do a dietary analysis. If there are certain nutrients that this person is not really getting in that more vegetables would help those micronutrients, then increase the vegetables and the carbs along with them for that purpose. But just on macros alone, I would say go up at least 10 grams on the carbs and go up to, if you can get there, a gram of protein per pound of body weight on the protein, and that will bring the ketones down. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/09/06/ask-anything-nutrition-march-8-2019 If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here.

Question: Are there any solutions to getting nauseated from zinc supplements even at low doses and even when the zinc comes as oysters? With the zinc, my general recommendation is to take zinc on an empty stomach. The thing that is not controversial is that phytate is the principal inhibitor of zinc absorption. Phytate is found in whole grains, nuts, seeds, and legumes. I think there's a very broad agreement across the zinc research community that taking zinc not with a meal that contains whole grains, nuts, seeds, and legumes is going to lead to higher zinc absorption. Then there's some controversy. Does it matter whether the zinc is on an empty stomach compared to a phytate-free meal, which would be a meal that doesn't have any whole grains, nuts, seeds, and legumes? Because there's a gray area there, I say if you can, take it on an empty stomach. If you can't, take it with a phytate-free meal. Generally, it's the case that if someone takes 15 milligrams of zinc with a full glass of water, they are very unlikely to get nauseated from it. Whereas if almost anyone takes 50 milligrams of zinc with a full glass of water on an empty stomach, they're almost definitely going to get nauseated from it. I would get nauseated from it. Taking the low dose should allow you to take it on an empty stomach, but for some people, they do get nauseated even taking only 15 milligrams on an empty stomach. Well, you have two options. The ideal thing would be figure out the lowest amount of food that it takes to. If you eat the oyster at the end of a phytate-free meal, is it still making you sick? If so, I don't think that's the zinc. I think it's something else. And your digestive system might not be up to the task of eating oysters right now at this moment. But if at the end of a phytate-free meal if you can fit in one or two oysters and it doesn't make you nauseated at all, then I think that's great. Oysters are probably the ideal zinc supplement if you can get them in. A couple of oysters a day goes a long way to getting your zinc in. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/09/06/ask-anything-nutrition-march-8-2019 If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here.

Question: Could low LDL hurt female fertility? I haven't seen evidence of it, but that would not surprise me at all given that cholesterol is what you make sex hormones from. If you see levels that low, I don't know that it's intrinsically a problem. You kind of want to start looking at what are the reasonable things you could expect to happen from that that affect female fertility? Fat-soluble vitamins could be relevant. Sex hormones could be relevant. I'd start looking at those things. I doubt that the LDL being that low itself in and of itself is going to be the thing that compromises fertility. This is the thing. Is the LDL low because of really good clearance from the blood, or is it low because of really low production? If it's low because of really low production, then you definitely have problems with fat-soluble vitamin transport. Because if the liver is not making lipoproteins as much, the fat-soluble vitamins are staying trapped in the liver and they're not getting to other tissues that need them. While there's no evidence for it, it makes perfect sense that dietary cholesterol would help that because dietary cholesterol is very helpful in Smith-Lemli-Opitz syndrome, where the exact same defect is 1,000X to produce a devastating result. It makes total sense that in someone who is a carrier for SLOS, Smith-Lemli-Opitz syndrome, who has defective cholesterol synthesis in their gonadal tissues and therefore has defective sex hormone synthesis, it makes total sense of eating cholesterol would help those people. So, I would try it. Egg yolks. That's what most people are going to eat for cholesterol. But this all hinges on the question of the LDL is low, so what? Is it because it's being cleared rapidly or because it's not entering the blood due to lack of synthesis? Whether that person is going to have infertility as a result of it and whether that's going to be helped by dietary cholesterol, it's all going to get a hinge on that. But the good news is for both people, it's probably completely harmless to eat some eggs. Eating eggs might just be the thing that helps. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/03/30/ask-anything-nutrition-march-4-2019 If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here.

Question: Is it safe to take creatine when nursing?If you felt fatigued and you took the creatine and all of a sudden that started reversing, then you either felt fatigued because you had low creatine synthesis, or you felt fatigued because you had a methylation problem. Those aren't mutually exclusive. If you're not methylating well, the most sensitive thing that will happen is you'll synthesize less creatine. But I mean it could have gone beyond creatine. It could have been that you're synthesizing less creatine, and you're not regulating your dopamine properly and things like that. But certainly, you're addressing a methylation issue/a creatine deficiency issue. I don't know the exact cause and effect scenario that would lead to ovulation, but it makes sense that you ovulate. Think about the regulation of fertility, the whole thought process of the body's regulation of fertility. All of it comes down to energy. It comes down to the fact that when you get pregnant, you're investing -- I don't remember what the numbers are off the top of my head -- something like 50,000 kilocalories in the pregnancy. Then in lactation, you're investing another I think thousand kilocalories a day or something like that. The whole hypothalamic regulation of sex hormones and thyroid hormone is all regulated by leptin and insulin as signals of long-term and short-term energy status. Insulin and leptin are hormones. Endocrine hormones are between tissues. But what happens at the cellular level is I think it's very plausible that something that's happening at the cellular level and the recognition of what those hormones mean to communicate that energy is present, sufficient for fertility is going to be ATP dependent. If you're missing creatine, then you're going to have a drop in the power of the ATP signal and the recycling of the ATP. This is the basis for why creatine is used for muscular power, but it's also the basis for why creatine is used to use energy in producing stomach acid or to communicate or to transmit light and dark signals through your eye to your brain to make vision. All over the place, creatine is super important to the cellular utilization of energy. My guess is it's correcting a response inside the cell to the leptin and insulin. In terms of safety in breastfeeding, I don't think there's any evidence one way or another. It's probably safe because you could get this from meat, and there's no evidence of harm. But if you wanted to be hyper careful, I don't think you need to do this, but if you wanted to be like super, super careful, what I would do is divide the 5 grams over three or four meals evenly on the basis that there are very, very trace amounts of byproducts of high-dose creatine. Five grams will cause extraordinarily tiny amounts of toxins that appear in the urine. I mean, not toxins at the level that we're talking about, but I doubt it's a risk. But if you wanted to be hyper careful, divide the dose up evenly.  This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/03/30/ask-anything-nutrition-march-4-2019 If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here.

Question: Can you explain plant polyphenols and hormesis? In brief, our detoxification system didn't evolve to handle the toxins of modern society. Modern society invents a new chemical. Our body knows it's a toxin, but it doesn't know it because we were exposed to it for millions of years. It knows it because it has similarity to other toxins. That similarity may be weaker or stronger depending on the toxin. Our bodies do evolve to be bad at detoxifying. They evolve to be good at detoxifying. Our system is not designed to get sick when we encounter toxins. It's designed to get healthy when we encounter toxins. The way that works is throughout most of our evolutionary history, the toxins we were exposed to were the toxins in plants. Most of them are polyphenols. Most of them are the things that we ascribe health benefits to. A lot of those health benefits come from the fact that these are the toxins that our bodies are designed to work with. Xenobiotic defense -- xenobiotic is something foreign -- this defense system is this giant umbrella system that in a very general level assesses the likelihood of how much energy should we invest in keeping that system running based on how much toxins are we exposed to and uses that metric to invest the energy in that entire machinery. We're not investing in getting rid of a specific toxin. We're just taking the collective toxin and investing in the collective detoxification machinery, the collective antioxidant glycation-defense machinery. Because fruit and vegetable polyphenols were the major toxins, our system is designed to be very highly responsive to them, to use them as that metric. Now, in the modern society, what do we do? We invented new toxins. By the way, the fruit and vegetable polyphenols, what happens if you just take a bunch of them and you dump them on cells? You kill the cells. What happens when we eat them? Ninety-nine percent of them don't get absorbed. Why? Because the intestinal cells have a detoxification pathway that's just like the liver's. I think where you cross the line is, what you don't want to do is isolate those things into a pill and megadose them. That's why people, when they ask me about sulforaphane and milk thistle, my view of that is that that's what you do when you can't eat a high volume of unrefined plant foods with five to nine fruits and vegetables. But what you don't want to do is say, "Well, if the bottle says one capsule milk thistle a day is good for me, then ten capsules of milk thistle on top of ten servings of fruits and vegetables is good for me." Then you're in the zone of who knows what that's doing to you. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/03/30/ask-anything-nutrition-march-4-2019 If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here.

Question: What to do when serum magnesium is high but RBC magnesium is low? The magnesium in the blood and the hair is high. When you say blood, I'm assuming this is serum or plasma because the RBC magnesium is low. I'm hoping that's not whole blood magnesium in which case it would be hard to separate from the RBC magnesium. But I mean even for whole blood, if the RBC magnesium is low and the blood magnesium is high, then the magnesium that's in the blood that's high is in the serum or plasma, not in the RBCs obviously. Clearly this means that you're deficient in magnesium transport. You're not deficient in magnesium. So, the last thing that you should do is start blasting high-dose magnesium at that. Because not only is it not going to help, but you basically have two or three times the risk of harm from supplementing high-dose magnesium, because the harm of high-dose magnesium comes when your serum levels go to double the upper limit of the reference range. If your serum level is high, and your RBC is low, and you start blasting. B6, even if it's adequate, maybe try 10 milligrams. Work your way slowly up to 100 milligrams of P5P. See if that helps. If it doesn't, you probably have a more serious issue with magnesium transport. You might have a rare genetic defect in a magnesium transporter. Off the top of my head, I'm not sure how to manage that. There's probably things you can't do. It might come down to just maximizing all the different possible ways that you can get magnesium into your system and cells. That might mean that you want a modest hypermagnesemia. In other words, you want your serum magnesium to be a little over the top of the upper reference range in order to try to drive magnesium into the red blood cells. But you still need to measure it regularly so that you know that you're not anywhere near twice the top of the upper reference range. Then just do what you can to maximize the other factors. Insulin, salt, and B6 is what I think there. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/03/30/ask-anything-nutrition-march-4-2019 If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here.

Question: Is there a potential for adverse effects of 5-10 mg of folate for heterozygous MTHFR? Is there a potential? Yeah. The tolerable upper intake level for folate was set at 1 milligram on the basis that there are rare hypersensitivity syndromes that have caused reactions to 1 milligram or higher. On the basis that in numerous case reports, supplementation of more folate than that has been the factor that appears to precipitate the neurological degeneration in B12 deficient patients. It seems like if you're B12-deficient and you add a megadose of folate, there might be something causal about adding the folate precipitating the B12 deficiency. That makes sense. Folate and B12 participate together in methylation. The neurological degeneration specific to B12 deficiency is probably mostly due to the non-methylation functions of B12. That's why it doesn't happen in folate deficiency. If you add folate, you're going to probably redirect some of the B12 into the methylation pathway, rob it from the other pathway, which is metabolizing methylmalonic acid into the citric acid cycle. You do that and you provoke the specific neurological degeneration of B12 deficiency.The flipside of this is someone could say, well, there's no evidence that outside of these rare things that 50 milligrams of folate causes harm. That's true. There isn't a well-characterized harm from it. But I still think that it's stupid, it's stupid. Why would someone with a heterozygous MTHFR SNP need 10 milligrams of folic acid or methylfolate? That makes no sense biochemically at all. It makes no sense. First of all, are they compound heterozygous or are they just heterozygous for the SNP? I don't know if it's harmful, but it's irrational to take high-dose methylfolate for this purpose or high-dose folic acid is irrational. It's on the basis that it's not effective. It is five to ten times the Institute of Medicine's tolerable upper intake level. It's not that I know it will cause harm. It's just that it's way into the territory of what has the possibility of harm in some people. Why for no benefit would you take yourself deep into the territory of possible harm? This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/03/30/ask-anything-nutrition-march-4-2019 If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here.

Question: Is folate unstable in frozen liver or just in frozen veggies? The answer is folate is stable in frozen liver. It is not stable in frozen greens.  This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/03/30/ask-anything-nutrition-march-4-2019 If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here.

Question: How much vitamin C should I take with collagen? There's no evidence that you need to take vitamin C with collagen. There is a study by Keith Baar, who showed that 15 grams of gelatin, not collagen, but I suspect the collagen is exactly the same, 15 grams of gelatin but not 5 grams, the dose is important, with 50 milligrams of vitamin C taken before exercise improved collagen synthesis in the tendons. They included 50 milligrams of vitamin C because it's made for collagen synthesis, but they don't show that you needed the vitamin C. They just had the vitamin C in there. I don't know if it even matters in that context whether you need the vitamin C. I also have no reason to think that you need 50 milligrams instead of 10 or that 100 milligrams wouldn't work better because they didn't test the different doses. They tested the different doses of gelatin. I see no reason to think a high dose of collagen is any different in this respect. Let's assume that it's the same. What that means that I'm very confident that you need 15 grams instead of 5 grams when you take it before exercise to increase synthesis of collagen in tendons if that's what you care about. I have no confidence about how much vitamin C you need if you need any. But if you want to do what they did, then I do feel confident that 50 milligrams is enough to get some effect. I just don't know if it's enough to get maximal effect and I don't know if it's necessary at all or in that dose to get that effect. If it's for joint health and if it's taken before exercise, the timing is important because what you're trying to do is leverage the exercise to get more blood flow of the nutrients to the joints. That's why the timing matters. In that case, you take the vitamin C with the collagen, 50 milligrams is the dose we know works. We don't know if it's necessary, and we don't know if it's optimal. We just know that it works. If you're not taking it for joint health and you're not taking it specifically before exercise, you still need vitamin C. But the timing doesn't matter and pairing it to the collagen doesn't matter. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/03/30/ask-anything-nutrition-march-4-2019 If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here.

Question: Are liver capsules as good as eating liver? Liver pills are mainly for people who are not going to eat liver. That's the first thing. The second thing is, there are advantages to taking the dosing schedule of a little bit of liver every day.  Probably the ideal thing would be to have 10 to 20 grams of fresh liver every day. But the number of people who are going to do that are even smaller than the number of people who are going to eat the fresh liver. What the liver pills do is, number one, they give people who don't eat liver that frequently to get the nutrients that have absorption caps that are better off gotten in small doses at a time to get those every day. It gives people who are not going to eat liver at all a way to get liver in. I don't know. I mean, it's a tradeoff. Probably almost no one is going to eat 10 to 20 grams of liver every day. If you don't, are you better off taking the capsules or are you better off taking liver once a week? You're probably better off taking half and half, like take three capsules every day and still eat liver once a week. It's probably the best thing to do in that case. I don't recommend anyone who would otherwise eat liver stop eating liver and take the capsules, but I do recommend the people who won't eat liver take the capsules. I think it's a nice thing to do. If you eat liver but take the capsules anyway, then take that in a lower dose because you eat liver. Like I said, eat one serving of liver once a week or twice a month and take two, three, or four of the capsules instead of six; two, three or four capsules every day. I think that's a happy medium that can have best approximates the best thing which is the 10 to 20 grams of liver a day. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/03/30/ask-anything-nutrition-march-4-2019 If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here.