Mastering Nutrition

Question: "Which brand and dosage of no-carb electrolytes would you take at night to optimize sleep, especially after sauna use?" I would drink a bottle of Gerolsteiner, and I would add to it 100 milligrams of any kind of magnesium: citrate, glycinate, malate, those three are fine. And I would add to it 400 milligrams of potassium citrate, or bicarbonate if it's an empty stomach. You say no-carb. Because of the potassium, I personally would take maybe like a teaspoon of honey with this. I would also take some salt. Let's say a half a teaspoon, to a teaspoon of salt with it. The caveat being if you’re sodium sensitive you should be mindful not to overdo it. If you know you don't have a problem with salt and blood pressure, then I would recommend adding the sodium to the mix.  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: "Vitamin K2, MK-4 and MK-7, might have caused prolonged heart palpitations. Upon stopping it, symptoms mostly resolved after a week or so. Does that mean that the body is better off without it? Might increasing calcium intake mitigate this?"  I would say, the calcium is really interesting. I genuinely hadn't thought of that until you mentioned it. Even though I've heard other people ask this question, I haven't had time to look into it, but you raise a good point. So, it is conceivable, for example, that your bone density has been very low because you have not had the K2 you needed to get the minerals into the bone. So when you get the K2, you start loading the calcium into the bone, but maybe because your whole body is programmed to assume things were the way they were before you started taking the K2, then it doesn't adapt fast enough to normalize your blood calcium, which, by the way, how do you normalize your blood calcium? You take calcium out of the bone. MK-4 has been studied in high-milligram doses as an osteoporosis drug because it inhibits bone resorption. If you inhibit bone resorption, you will definitely interfere with your ability to maintain normal serum calcium levels because bone resorption is how you do that. So, either you're giving the nutrients needed to get the calcium into the bone and the body is just prioritizing that because it's been missing them for so long, and your serum calcium drops — or you're actually creating signaling stopping bone resorption, and so your blood calcium drops because of that. Either way; taking calcium might impact that, and I would love to have some anecdotal data on that because there's no studies on K2and heart palpitations. So, I would love it if we have some anecdotes of people saying whether the calcium helps, especially since so much of the K2 stuff is so skeptical of calcium.  Kate Rheaume-Bleue's book Vitamin K2 and the Calcium Paradox, I think it's a great book. Basically, what that book is, is an enormous elaboration of my 2007 article on Activator X and Weston Price.  If I had written that book, I would have done things a little bit differently. The whole idea of the calcium paradox that's in the title, I think it has merit. There is some data indicating that calcium supplements might worsen the risk of heart disease, but I think that the conclusions are way too anti-calcium, and I think there's too many people out there taking K2 who have it in their heads that calcium supplements are bad.  Calcium supplements are bad compared to getting enough calcium from food. A huge portion of those people are not getting enough calcium from food, and getting calcium is more important than where it comes from. 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, part 1: "Bovine colostrum from New Zealand cows. Yea or nay for those with dairy sensitivities? If nay, what would you recommend instead?" What is your goal? If you have a dairy sensitivity, your problem could be with casein, with the whey proteins, or with something more specific like certain antibodies. It's very complicated. You're less likely to tolerate colostrum if you have a known dairy sensitivity, but you can't really know without testing the colostrum. Question, part 2: "to settle a client's overactive immune system down." What, specifically, about the overactive immune system are we looking at? I would think maybe this is chronic inflammation that's not resolving, and then I'm thinking more about arachidonic acid and DHA. Question, part 3: "She can take a supplement one time and then the next time it throws her over. Same with food." Okay, that sounds to me like an oral tolerance issue. When you put something in your mouth, it goes to your gut, and then your immune system decides whether it's safe or whether it's not safe. Your immune system doesn't know anything when you're born; it is more or less a blank slate. You do have predispositions because you have genetics that impact categories of protein fragments that you have the potential to make a decision about, but you are never born having a tolerance or intolerance to something. You are born with very broad genetics that say, “I will make decisions about this category, I can't recognize this category, I will make decisions about this category.” So, you eat food or take supplements, you put something in your mouth, you swallow it. In your gut, your immune system says, “This might be something important, I'm going to take it back to my home base and decide what to do about it.” That home base is called the gut-associated lymphoid tissue, or GALT. Your immune system is deliberately taking things into that lymph tissue, purposefully taking fragments that are not completely digested for the purpose of making decisions about it. In the gut, how does it make that decision? Overwhelmingly, there are two pro-tolerance factors. They are prostaglandin E2, which is made from arachidonic acid, the omega-6 fatty acid that's found most abundantly in egg yolks and liver, and that is the direct target of anti-inflammatory drugs, acetaminophen (Tylenol), aspirin, high doses of EPA from fish oil, and probably a lot of herbal anti-inflammatories. They will lower prostaglandin E2, and prostaglandin E2 is critical for oral tolerance in the gut. So, any potential anti-inflammatory is a potential contributor to this. You need prostaglandin E2, made from COX-2 from arachidonic acid, made from everything that everyone believes is inflammatory. All the anti-inflammatory drugs, the Zone diet, almost everything written about inflammation says prostaglandin E2 is inflammatory. It is one of the two central causes of oral tolerance, of the immune system recognizing that something is safe. The other is retinoic acid made from vitamin A. So, to create a pro-tolerance environment, you want no COX inhibitors being taken, you want sufficient arachidonic acid in the diet, and you want sufficient vitamin A in the diet. Then what are the factors that tell the immune system, this is not safe, and that is tissue damage. So, the immune system is basically saying, "I will make a decision about this. To make this decision, I need data." So, what are the data that things are okay? Retinoic acid, prostaglandin E2. What are the data that say this is not okay? All the factors released during tissue damage because tissue damage is the number one sign that something is harmful. So, if the thing comes in and they're fine, then the next time they take it, they don't tolerate it. That sounds like they are programmed to decide that everything that comes in is a threat. And so they take it, and it gets into their system and it doesn't do anything, but meanwhile the immune system took a piece of that into gut-associated lymphoid tissue, and said, "We need to program to make an army against this threat," and so it's the second time that they took it that they have the reaction. And so that means, again, get the arachidonic acid, get rid of the anti-inflammatories, get the retinoic acid from the vitamin A, and thoroughly investigate any possible sources of tissue damage in the gut. I don't know if it's necessarily the gut. It could be tissue damage somewhere else that then the things circulate into the gut, but it's probably the gut because that's what's closest to the situation. So, those are the things that I would be looking 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.

In part 2 of The Carnivore Debate, we cover the philosophy of the carnivore diet and the potential pitfalls of carnivore and keto. The research that Dr. Saladino and I discussed with each other before this debate is listed in the show notes -- there are five pages of references! Here’s what we debated: What exactly is a carnivore diet? Is a 90% meat diet a carnivore diet, a carnivore diet you cheat on, a carnivore-ish diet, or just a meat-heavy omnivorous diet? And why definitions absolutely matter.  Is the carnivore diet ancestral? What can we learn from present-day hunter-gatherers, the archeological record, and our evolutionary history as revealed by our genes?  Who is the carnivore diet for?  To what extent do carnivore and keto overlap? What are the benefits of keto and how broadly applicable are they? What are the potential harms of keto? In particular: acid-base balance thyroid, stress, and sex hormones oxidative stress and glycation sports performance We agree we need to cycle between the fed state and the fasting state. Can the keto diet, designed to mimic fasting-state physiology, provide adequate fed-state signals to keep our body feeling well nourished? Inuit CPT-1a deficiency redux: did a genetic impairment in the ability to make ketones sweep through the Arctic to protect the Inuit from acidosis, or to help them stay warm? Dr. Saladino completed residency in psychiatry at the University of Washington and is a certified functional medicine practitioner through the Institute for Functional Medicine. He attended medical school at the University of Arizona where he worked with Dr. Andrew Weil focusing on integrative medicine and nutritional biochemistry. Prior to this, Dr. Saladino worked as a physician assistant in Cardiology. It was during this time that he saw first hand the shortcomings of mainstream western medicine with its symptom focused, pharmaceutical based paradigm. He decided to return to medical school with the hope of better understanding the true roots of chronic disease and illness, and how to correct these. He now maintains a private practice in San Diego, California, sees clients from all over the world virtually, and has used the carnivore with hundreds of patients to reverse autoimmunity, chronic inflammation, and mental health issues. When he is not researching connections between nutritional biochemistry and chronic disease, he can be found in the ocean searching for the perfect wave, cultivating mindfulness, or spending time with friends and family.  Find more of Dr. Paul Saladino on the Fundamental Health podcast and at https://carnivoremd.com Get my free 9-page guide to optimizing vitamins and minerals on the carnivore diet at https://chrismasterjohnphd.com/carnivore  This episode is brought to you by Ancestral Supplements' "Living" Collagen. Our Native American ancestors believed that eating the organs from a healthy animal would support the health of the corresponding organ of the individual. Ancestral Supplements has a nose-to-tail product line of grass-fed liver, organs, "living" collagen, bone marrow and more... in the convenience of a capsule. For more information or to buy any of their products, go to https://chrismasterjohnphd.com/ancestral  This episode is brought to you by Ample. Ample is a meal-in-a-bottle that takes a total of two minutes to prepare, consume, and clean up. It provides the right balance of nutrients needed for a single meal, all from a blend of natural ingredients. Ample is available in original, vegan, and keto versions, portioned as either 400 or 600 calories per meal. I'm an advisor to Ample, and I use it to save time when I'm working on major projects on a tight schedule. Head to https://amplemeal.com and enter the promo code “CHRIS15” at checkout for a 15% discount off your first order.” In this episode, you will find all of the following and more: Masterjohn and Saladino Show Notes 00:42 Cliff Notes 05:18 Introductions 05:28 What is a carnivore diet? 18:15 Is the ancestral human diet carnivore or omnivore? 50:40 Who is a carnivore diet for? 01:08:03 To what extent do carnivore and keto overlap? 01:10:34 Who is a keto diet for? 01:18:50 Ketogenic diets are only a partial mimic of fasting physiology 01:23:46 Ketones effect on the NAD/NADH ratio  01:27:31 Ketogenesis has opposite effects in the liver as in the ketone-utilizing tissue. 01:29:31 Ketogenic diets and oxidative stress 01:40:18 Longevity: why you want to cycle between the fasting state and the fed state 01:45:04 Can the ketogenic diet provide a sufficiently robust fed-state signal? 01:53:11 The keto diet and thyroid, stress, and sex hormones 02:10:05 Keto and sports performance 02:18:05 Why do the Inuit have a genetic impairment in making ketones, to protect against acidosis, or to stay warm? 02:35:48 Wrapping up Access the show notes, transcript, and comments here: https://chrismasterjohnphd.substack.com/p/070-the-carnivore-debate-part-2

Dr. Paul Saladino, Carnivore MD, and I sit down to talk about the carnivore diet. In part 1, we focus on whether you can get all the vitamins and minerals you need on a carnivore diet, and how to best design a carnivore diet to maximize the nutrition you get. We discuss what I consider high-risk nutrients: Vitamin C Folate And what I consider conditional-risk nutrients: Manganese​  Magnesium​ Vitamin K​  Potassium​  Molybdenum​  We also chat about some other things: Dioxins in animal foods: a reason for vegetarianism?  The methionine-to-glycine ratio: balancing meat with bones and skin. Did paleo people get nutritional deficiencies? Bioindividuality: why we all have different needs and our needs evolve over time. Diversify to manage risk: does this mean eat plants, or just eat all the parts of an animal? Ketogenic diets and oxidative stress. Do carbohydrates give you more intracellular insulin signaling? Should carnivores eat dextrose powder for carbs? Are today’s hunter-gatherers representative of those from 80,000 years ago? Did the Maasai really mostly eat meat and milk? My open-door helicopter ride in Hawaii. Dr. Saladino completed residency in psychiatry at the University of Washington and is a certified functional medicine practitioner through the Institute for Functional Medicine. He attended medical school at the University of Arizona where he worked with Dr. Andrew Weil focusing on integrative medicine and nutritional biochemistry. Prior to this, Dr. Saladino worked as a physician assistant in Cardiology. It was during this time that he saw first hand the shortcomings of mainstream western medicine with its symptom focused, pharmaceutical based paradigm. He decided to return to medical school with the hope of better understanding the true roots of chronic disease and illness, and how to correct these. He now maintains a private practice in San Diego, California, sees clients from all over the world virtually, and has used the carnivore with hundreds of patients to reverse autoimmunity, chronic inflammation, and mental health issues. When he is not researching connections between nutritional biochemistry and chronic disease, he can be found in the ocean searching for the perfect wave, cultivating mindfulness, or spending time with friends and family.  Find more of Dr. Paul Saladino on the Fundamental Health podcast and at https://carnivoremd.com Get my free 9-page guide to optimizing vitamins and minerals on the carnivore diet at https://chrismasterjohnphd.com/carnivore  This episode is brought to you by Ample. Ample is a meal-in-a-bottle that takes a total of two minutes to prepare, consume, and clean up. It provides the right balance of nutrients needed for a single meal, all from a blend of natural ingredients. Ample is available in original, vegan, and keto versions, portioned as either 400 or 600 calories per meal. I'm an advisor to Ample, and I use it to save time when I'm working on major projects on a tight schedule. Head to https://amplemeal.com and enter the promo code “CHRIS15” at checkout for a 15% discount off your first order.” This episode is brought to you by Ancestral Supplements' "Living" Collagen. Our Native American ancestors believed that eating the organs from a healthy animal would support the health of the corresponding organ of the individual. Ancestral Supplements has a nose-to-tail product line of grass-fed liver, organs, "living" collagen, bone marrow and more... in the convenience of a capsule. For more information or to buy any of their products, go to https://chrismasterjohnphd.com/ancestral In this episode, you will find all of the following and more: Masterjohn and Saladino Show Notes 2:11 Introductions 6:36 Dioxins in food.  14:33 Methionine to Glycine ratio. 23:08 Nutritional deficiencies in paleolithic people. 27:09 Bio individuality/diversity 36:07 Deficiencies that arise from eating only muscle meat. 37:26 Vitamin C 44:22 Weston A. Price’s documentation of whale stomach lining and moose adrenal as a source of vitamin C in Arctic diets. 56:03 Ketogenic diets, oxidative stress, and vitamin c.  58:36 Insulin 1:05:46 Antioxidant status. 1:22:44 Folate. 1:26:05 Riboflavin. 1:30:23 Manganese. 1:32:28 Dextrose powder. 1:37:31 Potassium/sodium. 1:52:37 Hunter gatherer diets now vs. 80 000 years ago. 2:03:05 The Maasai. 2:09:00 Vitamin K 2:19:00 The most radical thing I’ve done recently.  Access the show notes, transcript, and comments here: https://chrismasterjohnphd.substack.com/p/069-the-carnivore-debate-part-1

Question: If your cholesterol is high, how do you avoid having a large burden of oxidized LDL? First, normalize your cholesterol.  And no, I’m not saying that high cholesterol is the cause of heart disease. It's not, but oxidized LDL is, and the number one cause of both high cholesterol and oxidized LDL is not clearing LDL particles from the blood. So, I would never skip over the question of what I can do to get cholesterol in the normal range. I think the boundaries of the normal range are a little exaggerated.  If you look at traditional cultures that eat a traditional diet, live a traditional lifestyle — they're not modernized, and they don't have heart disease — you do see cholesterol levels that go higher than ours.  So, for a man, maybe going up to 220 mg/dL in total cholesterol is pretty normal. For a woman in her 40s and 50s, up to 250 maybe. I'm not looking to change those numbers if lifestyle and diet are ancestral. If everything else about the data make it look like that person's very healthy — especially if direct measures of plaque development like carotid IMT, intima-media thickness, and coronary calcium score are normal. I wouldn't be thinking about fixing the cholesterol at that point. But, for someone whose cholesterol is like 300 mg/dL, you don't even see that in Tokelau, where the saturated fat content and the traditional cholesterol levels are the highest ever recorded in an ancestral population. So, when they're that high, you have to fix it as your first line of defense. That means improving LDL receptor activity.  The big things to look at are body composition, inflammation, fiber intake (higher fiber is generally better), and thyroid. Let's say you haven't brought the cholesterol down, what do you do to protect it? Well, that largely comes down to a few things. Imagine the lipoprotein leaves the liver, some as LDL, some as VLDL, both of which wind up being LDL at some point. It leaves the liver packaged with antioxidants. Those include vitamin E and coenzyme Q10, but it isn’t limited to those two. They are just the most important in this situation. When LDL is circulating in the blood, it gets behind the arterial wall, and that's the main site of oxidation. So, the question is, how oxidizing of an environment is that? Also, it gets stuck behind the arterial wall, so the question is, how sticky of an environment it is?  Because if it gets stuck in the oxidizing environment behind the arterial wall, then that's the very powerful regulator of whether it's going to oxidize.  So, the stickiness. Probably the dietary approach that best regulates the stickiness is manganese. Manganese is found mostly in plant foods and vegetarians have the highest intakes. People with plant-rich diets that also eat animal foods are in the middle. And people who eat a lot of animal foods and no plants are at the bottom. So, eat a lot of plant foods is one thing. There are some animal experiments specifically with blueberries as a source of manganese showing in animals that it makes the arterial wall less sticky, so there's that. Then there’s the oxidizing environment. A big part of that is systemic inflammation because if inflammation causes oxidative stress. You should have been looking at inflammation for high cholesterol in the first place. Assume you have that covered. And then antioxidants in general.  You're looking at protein, selenium, zinc, copper, iron, manganese, vitamin C, vitamin E, glycine… you're looking at so many things in there, so you really got to figure out what the weakest link is in that person and focus on that weakest link. There may be many. 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'm curious about the role of the lymphatic system in fat metabolism, specifically in high-fat, low-carb diets. Is there a biochemical explanation for why improving lymphatic circulation would improve fat metabolism?" Well, I wouldn't call it biochemical, I'd call it physiological, but yes.  Fat goes from your gut through your lymphatic system to your blood. If your lymphatic circulation is not good, neither is the delivery of your fat to any part of your body. It's as simple as that.  If your lymphatic system is slow, so is your delivery of fat to every organ in your body. 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: "Lp(a) and genetic component with relation to cholesterol and risk of cardiovascular disease." First, I'm going to be able to give better answers to questions if they're more specific.  But to the question: Everyone seems to think that Lp(a) causes heart disease. I don't believe it. I don't believe it because the function of Lp(a) is to clean up oxidized LDL particles. It might have other roles, but that's one of the primary ones. So, we have two possible explanations for the correlation between Lp(a) and heart disease. Either Lp(a) causes heart disease and people with genetically elevated levels have a higher risk of heart disease, or it is correlated simply because people with more oxidized LDL particles (which does cause heart disease) have more Lp(a) to clean them up. I’ll be recording with Peter Attia on this topic, so I’ll brush up on Lp(a) data beforehand and may change my viewpoint, but this is my view right now. If anyone wants to send me data to look at to revise my view, I'll happily take a look. 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.

"Can magnesium hydroxide be absorbed via skin?" I don't know. I genuinely don't know. "I've been applying milk of magnesia as a deodorant alternative in spray form for a few years now, and it works well, but I'm concerned about I might be hypermagnesemic, as I'm having low pulse, low blood pressure, and frequent bowel movements." You might be hypermagnesemic. You should measure your magnesium status, for sure. 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.

Concerns about long-term bicarbonate supplementation and other suggestions for raising pH Helen Donnell says, "Your post on urine pH and exercise tolerance was a game-changer for me, but anytime I miss a dose of bicarb, I'm right back to 5. Any long-term concerns with taking bicarb two to three times a day, any suggestions for other ways to get my system pH up?" Well, I will say in my case that I stopped taking the bicarbonate when I figured out that I had a zinc deficiency. So, for people who don't know the backstory here, Google "Masterjohn urine pH" and you'll probably get that blog post to come up. It's called "How Normalizing My Urine pH Helped Me Love Working Out Again".  The backstory in brief is, when I was going through the mold and barium toxicity crisis of turn of 2016 into 2017. I got to the point where it would take several days to recover from one workout. I couldn’t afford to be laid out like this I realized while looking at some lab tests —  a Genova ION Panel — had some findings that suggested pH imbalance problems. The only thing abnormal in my ION Profile was that my glutamine-to-glutamate ratio. The glutamate was really high, and the glutamine was really low.  First thought; sounds like a pH issue. I was talking with a friend of mine that led down the same rabbit hole, maybe the reason the workout is tanking me is because my system can't handle the lactic acid. So, I started measuring my urine pH, and my urine pH was very, very low. Less than 5.  I just kept taking bicarbonate at ¼ teaspoon increments. It just wasn't going anywhere until at some point, all the sudden I shot up out of bed, and I was like I want to work. I felt amazing. I went and measured my urine pH, and it was 6.  It was like it just went nowhere until I got enough bicarbonate in. Once that happened it crossed the threshold getting into 6, and all the sudden I felt amazing. That was the first big clue. Then I replicated things over time, and found that it was a consistent effect. What turned things around for me was when I realized that my zinc was low. That was because bicarbonate allowed me to work out consistently and gain more muscle mass. Gaining muscle made me get patches of dry skin.  Well, what do patches of dry skin mean? It’s the earliest sign of zinc deficiency. Resistance training increases muscle mass and that requires more zinc to sustain the new tissue.  What does zinc have to do with pH balance? Well, zinc is a cofactor for carbonic anhydrase, which is one of the main enzymes in regulating pH.  I started supplementing zinc and tested my plasma zinc. Even though I had been taking zinc for three days, my plasma zinc was at the level I associate with a deficiency — which is around 70. Once I started supplementing zinc, the pH problems went away.  So, zinc is definitely something I would look into. If zinc isn’t your issue, I would keep going down the rabbit hole and do a comprehensive analysis like I do with Testing Nutritional Status: The Ultimate Cheat Sheet.  Harms of bicarbonate: alkalinizing the stomach is the main one. To avoid complications you want to take it as far away from food as possible. I do think that excessive chronic use and alkalizing the stomach could lead to a lower ability to kill pathogens in the stomach and lead to overgrowth of bacteria in the stomach or small intestine. I would feel more comfortable about using it as a bridge to get from point A to point B and fixing the underlying regulatory problems as the destination. 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.