Mastering Nutrition

Question: "Any recommendations for peripheral neuropathy? Testing vitamin B, lion's mane?" First of all, there is no such thing as vitamin B. I'm not trying to be a nitpick, but there's literally almost a dozen B vitamins, with different tests, that do different things. So, I think it's important to establish a habit of never saying vitamin B because, not to be a grammar nitpick, but I just think it's misleading to think about the concept of vitamin B.  There are quite a few B vitamin deficiencies that can cause peripheral neuropathy.  You can also cause peripheral neuropathy by taking vitamin B6 in too high doses, and that's one of the reasons why you have to separate them out because B6 is unique among the other B vitamins in that respect.  In Testing Nutritional Status: The Ultimate Cheat Sheet; I have an index of signs, and if we go into peripheral neuropathy, I have listed here deficiencies of thiamin, riboflavin, and vitamin E — toxicity of selenium and B6.  This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/  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: "If cholesterol, LDL-P, and oxidized LDL are high, the sterol panel is normal, and TGs are great, would you suspect clearance of the particles driven by LDL receptor in the liver is the issue, and what would you recommend to boost LDL-R?" Yes, it sounds like you should target LDL-R.  The big regulators of LDL-R function are thyroid hormone, and the amount of cholesterol in the liver cell, and anything that brings bile acids into the feces, and that's generally a high-fiber diet; psyllium husk would be a fiber you could add. Thyroid hormone is the other piece of that, and that you target with higher carbohydrate intake. Higher carbohydrate intake also acts on PCSK9 to boost LDL receptor activity.  This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/  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 are your recommendations on magnesium supplements and dosage?” My opinion is that most people shouldn't be supplementing with high doses of magnesium. I think if you're going to supplement with more than 400 milligrams a day, you should be testing your magnesium status, and you should be making decisions on that. I think there's way too many people throwing really high doses of magnesium into their system.  The topical stuff makes sense if you're absorbing poorly, but hey, maybe you're absorbing poorly because you don't need it, and so I think you really have to judge it against real metrics of results. So, in terms of types, I would not recommend magnesium oxide for anything. It's poorly absorbed, so maybe you could argue that magnesium oxide is going to help act as a laxative better, but that's not bowel function, that's pharmacologically modulating your bowel transit time. So, I don't think it makes sense to deliberately take a poorly absorbed magnesium to have that effect. The good sources of magnesium are: magnesium citrate is okay, glycinate is okay, malate is okay, across the board, I genuinely don't believe that the form is that important. It's just that oxides of minerals including magnesium are generally poorly absorbed. There isn’t much difference in the other forms. As always tailor it to the individual. I wouldn't give blanket recommendations there. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/  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: "Calcium score, is there a way to treat one's calcium score and get it to zero?" ⇒ No, you don't treat the calcium score. You take the calcium score as indicative of what's going on in atherosclerosis, and you treat that. The goal, I think, is calcium score equals zero. No, that's a bad goal because that's like saying my goal this year is to be a billionaire. Is that going to make me harder and get closer to it? I don't know. You set somewhere what the ideal is, but then you don't think about that, you think about — okay — what's the next step right now in front of me. What you focus on is the thing that's right in front of you. So, maybe you want to be a billionaire -- but your goal is, how do I increase my revenue this month? Not how do I be a billionaire this year. If you want a calcium score of zero, fine, but you don't think about that; you think about how do I lower my calcium score, because then when you lower your calcium score, you do more of that. When you do something that raises your calcium score, you do less of that. In atherosclerosis, calcium is super driven by the atherosclerotic progress. So, ideally it would be nice if you had ultrasound imaging of your carotid IMT. If you have advanced plaque formation, you probably will be able to see that on the IMT, like you can see how the plaque is developing and whether the actual atherosclerotic plaque is. K2 is relevant there, but a general deficiency of K2 is more likely to manifest as diffuse calcium deposits everywhere in the artery. So, it might be that your LDL is high, and then that's what you should be focusing on.  You really have to start from point A through B through C, and K2 is one of those things, but you need to look at all the factors that can be contributing to atherosclerosis. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/  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 do you think of alternative testing like hair mineral analysis or SpectraCell?" I'm against SpectraCell on the basis of, it's not validated. I gave more details in a podcast episode "What Makes a Good Marker of Nutritional Status?" and you can find that at chrismasterjohnphd.com/marker. Hair mineral analysis; I like hair mineral analysis when there is nothing better and more validated. For a lot of the trace minerals where we don't have good, validated markers of nutritional status, so I think hair mineral analysis is good. I also think hair mineral analysis is good if you don't have the money to do something comprehensive with all the best markers, and you want something that can clue you in when something might be off. So, the nice thing about it is, with less money, you cover all the minerals. The less nice thing about it is, it's not very well validated quantitatively.  Even where there's data, like for example — it is validated that your iron in your hair tends to be higher when your iron in your body is higher, and vice versa. But it's not validated to say, when hair is X amount, this is when you need more iron, and when hair is Y amount, this is when you need less. The way that the blood markers are — like transferrin saturation, ferritin, hemoglobin, all these more validated markers. We have tons of quantitative data saying — the normal range is this — the optimal range is this. You lose the precision when you go back to the hair mineral analysis. I wouldn't use it — the thing is, if you spend $200 on a hair mineral analysis, that's $200 that you can't put towards your Genova ION Panel, or you could have gotten four iron panels with that, right?  So, you have to be careful that if your financial resources are constrained, you might want to do the hair mineral analysis on that basis, but it might be a better financial decision long-term to hold onto that money and do free stuff. In Testing Nutrition Status: The Ultimate Cheat Sheet, what I say is, if you don't have the money for the comprehensive testing, you focus on the things that are free.  You do the dietary and lifestyle analysis.  You do the symptom analysis.  Then you go to the things that that indicates is most probable, and then you do the best validated test. Maybe this diet and symptom analysis all points you to iron, and you spend $60 on the iron panel, and that gives you more payoff than $200 on a hair mineral analysis.  So, it's not an obvious choice about when to get the suboptimal test. It's something you have to think about carefully. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/  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 do I address edema?  Edema is basically going to be caused by excess salt retention in the body. The reason is that with the exception of very extreme scenarios, your body is going to tightly regulate the sodium concentration of the water in your body, and sodium draws water.  Now, that's not to say that the cause is eating salt. And there are cases where eating salt might remove edema. But generally salt retention of total water volume is going to be a big factor. In hypothyroidism it becomes I believe at least partly about glycoproteins in those spaces that are holding onto water.  If it's thyroid-related, you're not really talking about nutritional support, you're talking about fixing your thyroid. Maybe that means nutritional support, but it might mean other things. But the nutrition is aimed at the thyroid, not the edema. Maybe manganese would help modulate those glycoproteins in hypothyroidism the same way that it does in regulating the stickiness of the arterial wall. I'm totally guessing on that. Edema in the menstrual cycle is caused by high aldosterone, which is probably caused by high progesterone. I know that everyone in alternative health thinks that progesterone is the good hormone, and estrogen is the bad hormone — but in PMS water retention, I believe progesterone is just accumulating so much that it's spilling into aldosterone. I genuinely don't know what to do about the high progesterone, but about the high aldosterone. Magnesium and B6 have been shown to help with that. I did an episode about that, so I would Google "Masterjohn what to do about menstrual weight gain" for more details on thata. Then I would play around with salt and potassium. So, generally less salt during that time and more potassium in the diet are potentially going to be helpful. I think the principles are going to be similar elsewhere. It doesn't have to be in the menstrual cycle. You are generally going to find that salt is increasing extracellular water, and potassium is increasing intracellular water, and that's often going to be a factor in edema that can't be tied to thyroid hormone. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/  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 do you determine if you're getting enough protein? I heard Dr. Stephen Phinney say, for those on a keto diet, if ketones are greater than 3 on a regular basis, then it's a sign you're not getting enough protein." First of all, why are you on a ketogenic diet?  If your purpose is to get the ketones, why wouldn't you want your ketones higher than 3? The ketogenic diet is, regardless of what people are doing it for, it's best tested in terms of epilepsy, and the classical ketogenic diet gets ketone levels up to 3 or 4 millimoles per liter… sometimes higher. Then the question is, you're not doing it for medical therapy, why are you doing it?  If you're doing it to lose weight, who cares what your ketones are?  There's a ton of people out there who are on a "ketogenic diet" who don't care what their ketones are because they're doing it for weight loss, for body composition, or to feel better. If those are what your goals are, your metrics should just be whether you're losing weight, whether you're getting better body composition, or whether you're feeling better. There's no data backing up the fact that you can measure your blood ketones and determine what any of those outcomes are going to be. That has nothing to do with why you need protein. Yes, too much protein is probably going to lower your ketones. Protein is anti-ketogenic. It's not as anti-ketogenic as carbs are, so I get the kernel of truth that Phinney is getting at. The higher your protein is, the lower your ketones are going to be, and maybe there's some general correlation to be seen across people that the people who tend to have ketones that high tend to not be eating enough protein, but that's a correlation that has nothing to do with the underlying reason of why you eat protein.  You eat protein because you need protein to optimize your neurotransmitters, you need protein to optimize your metabolism, and you need protein to optimize your body composition. The number one metric that we have on protein intakes and quantifying them is on body composition, and you want a half a gram, to a gram of protein for every pound of target body weight. So, if you're trying to gain muscle, use what you want to have at the end of gaining muscle. If you are overweight, use what your ideal weight would be. And the more you care about your body composition, the more you should aim for the top of that range instead of the bottom. It doesn't matter if you're keto or not. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/  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 supplements would you recommend for a ketogenic diet? Any concerns with carbs being that low?  If someone's on a keto diet and they have 80 grams total carbs, the first question I have is where are the carbs coming from?  That's really going to determine whether the person needs supplements. So, on a keto diet in general and protein, too? If you're eating a lot of fat instead of protein, then you're going to need supplements of the things found in protein foods. If your carbs are all coming from honey, then you're going to need things that are found in vegetables. ==>You just can't tailor nutrient needs based on carb total data alone.  The biggest things would be make sure you're getting a gram of protein per pound of body weight if your ketones and goals can handle that load of protein. That'll protect you from a lot of nutrient deficiencies right there. Try to cook your proteins in ways that recapture the juices. That will help conserve the electrolytes.  You also probably want salt and either a lot of low-net carb vegetables, or you're probably going to need more potassium in your diet. Those are the big things that I'd look at. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/  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: "Why would a male be low in calcium?" You either have something wrong with parathyroid hormone governing your calcium levels, in which case you would want to see a doctor about that, or you have a long-going deficiency of related nutrients.  Not enough calcium and not enough vitamin D should not cause low serum calcium — unless the deficiency has been going on for a very long time and is very bad. Then again, I don't know what measurement you're referring to. So, maybe the calcium was a tiny bit low, and you remeasure it, and it's not low anymore; it was a fluke.  But if you're talking about confirmed low serum calcium, then nutritionally, I would look at long-standing severe deficiencies of calcium and vitamin D. I'd follow it up with measurements of PTH and calcitriol to better assess the situation. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/  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: "I keep waking up in the middle of the night and stay awake for hours. Would low carb make it worse?" It definitely could.  Your brain will consume 120 grams of carbohydrate every day, just your brain. There's got to be another 30 grams or so that would be used no matter what obligately by red blood cells, certain cells in the testes, the kidney, and the lens of the eye. Then the rest of your body — if you're eating not a ketogenic diet, the rest of your body is not really trying to burn fat, so it's going to burn through carbohydrate. Your liver stores about 90 grams of carbohydrate to be able to stabilize your blood sugar between meals, and overnight is the biggest time where it has to do that because overnight is the longest period of time that you go without meals. If you add that up, you're looking at like 250 grams of carbohydrate a day — and remember we haven't gotten to high-intensity exercise yet. Now, if you go on a ketogenic diet, what happens?  Well, your brain glucose consumption goes down from 120 grams a day to like 30 or 35 grams a day. You cannot and will not ever, ever, ever, ever, ever go to zero. That's one thing. You still have another 20, 30 grams of carbohydrate that you're burning through by cells that cannot burn anything else. You still have a minimum probably 60 or 70 grams of carbs per day that you need — even when you're maximally keto-adapted. I'm not saying you need to eat those carbs. You'll make them through gluconeogenesis if you don't eat them. But the rest of the body where the needs were flexible, has mostly shifted to burning fat for fuel on a long-term ketogenic diet. So, the real big problem is if you're not low-carb enough to be keto, but you're way under 200, 250 grams of carbs a day. Like, probably 100 grams of carbs a day is like, if it works for you, great, but if you have symptoms of low blood sugar at night, you shouldn't be spending a lot of time guessing why, because you're in this gray area where you are not keto-adapted, your brain is still burning through 120 grams a day, your liver still stores 90 grams a day, and the rest of your body still probably is preferentially burning carbs for energy instead of storing them for the most part because the carbs are there. So, your body is not deliberately, intensively reorganizing to conserve the carbohydrate in that gray area. ==If you are eating 50 or 100 grams of carbs, and you are in this place, then you absolutely should connect the two and see if increasing your carbs helps. Low-carb is not the best solution to high fasting glucose. There's a lot of people on low-carb who have high fasting glucose. There's a ton of people who go low-carb and develop high fasting glucose. That’s because a low carb diet alters the hormonal environment in two main ways: 1.) Increases the morning glucagon response.  2.) Increases adrenal hormones.  Both of these are early and late-stage adaptations to low glucose supply.  This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/  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.