Biohacking, Fasting and Ketogenesis
We’re not doctors, nurses or nutritionists. We’re just a regular family. We work in STEM fields, we like to know the "why" behind things and we have an interest in participating in our health and wellbeing. We use this page to accumulate resources and thoughts on the topic. It serves us, perhaps it will serve you as you study how to participate in your own health and wellbeing.
"The population will become split between the smart and the dumb. The smart ones will begin taking their health into their own hands because they’re already seeing that what we are doing now is not working. Our diet is not working because 70 percent of us are overweight and obese, we have 29 million diabetics and 75 million more prediabetics, and the rest of us don’t even know we’re prediabetic! People are realizing that what we are doing is not working and they are looking for other ways around this. That’s where do-it-yourself healthcare and self-monitoring will become the norm."
What is Biohacking?
Biohacking is being an active and rational participant in your health and wellbeing. Fasting, ketogenesis, nootropics, diet, exercise and behavior are just some of the tools that biohackers can use to measurably change the course of and optimize their health.
"Biohacking is using an engineering mindset and systems approach to manipulate the human body and its performance. The end goal of biohacking is to be an active participant in modulating and enhancing one’s own performance (both cognitive and physical) and longevity."
What can be Biohacked?
Another way to ask this question is
"what can we take measurements of,
then make changes to?"
- Blood chemistry
- Bacterial Biome
What can we measure?
Do it Yourself:
- Anthropometric measurements
- Blood Pressure, Heart Rate
Get from a Lab
- Blood Panel
- Bacterial Biome Analysis
- DeXA scans
Fasting *is* Biohacking
Fasting is not a diet. Fasting is biohacking. It is something you can do to effect change and then measure the results of yourself. Fasting should be accompanied by and followed with an intentional, purposeful diet and an intentional, purposeful lifestyle.
"My fasting increases my insulin sensitivity and decreases ambient cholesterol, glucose, and triglycerides. These are all markers that reduce my susceptibility to metabolic syndromes like diabetes. My fasting accelerates the growth of new neurons and elevates my natural human growth hormone production. This makes me a stronger, smarter version of myself."
"Fasting and starving live on opposite sides of the world. It is the difference between recreational running and running because a lion is chasing you."The Complete Guide to Fasting by Jason Fung and Jimmy Moore, page 39
Housecleaning for the Body
"It’s long been known that cells accumulate flotsam from the wear and tear of everyday living. Broken or misshapen proteins, shreds of cellular membranes, invasive viruses or bacteria, and worn-out, broken-down cellular components, like aged mitochondria, the tiny organelles within cells that produce energy, form a kind of trash heap inside the cell.
In most instances, cells diligently sweep away this debris. They even recycle it for fuel. Through a process with the expressive name of autophagy, or 'self-eating,' cells create specialized membranes that engulf junk in the cell’s cytoplasm and carry it to a part of the cell known as the lysosome, where the trash is broken apart and then burned by the cell for energy.
Without this efficient system, cells could become choked with trash and malfunction or die. In recent years, some scientists have begun to suspect that faulty autophagy mechanisms contribute to the development of a range of diseases, including diabetes, muscular dystrophy, Alzheimer’s and cancer. The slowing of autophagy as we reach middle age is also believed to play a role in aging."
"This is in essence a form of cellular cleansing. The body identifies old and substandard cellular equipment and marks it for destruction. It is the accumulation of all this junk that may be responsible for many of the effects of aging."
Your body's recycling program
“Think of it as our body’s innate recycling program,” says Colin Champ, M.D., a board-certified radiation oncologist, assistant professor at the University of Pittsburgh Medical Center, and author of Misguided Medicine. “Autophagy makes us more efficient machines to get rid of faulty parts, stop cancerous growths, and stop metabolic dysfunction like obesity and diabetes.”
"First of all, autophagy is a response to stress, so you’re actually going to want to put your body through stress in order to drum up a little extra auto-cannibalism."
"'Ketosis is like an autophagy hack,' Champ says. “You get a lot of the same metabolic changes and benefits of fasting without actually fasting."
75 milion Americans have metabolic syndrome
"The medical research community came to recognize that insulin resistance and a condition now known as “metabolic syndrome” is a major, if not the major, risk factor for heart disease and diabetes. Before we get either heart disease or diabetes, we first manifest metabolic syndrome. The CDC now estimates that some seventy-five million adult Americans have metabolic syndrome."
What is metabolic syndrome?
"Metabolic syndrome ... is a clustering of at least three of the five following medical conditions:
- abdominal (central) obesity
- elevated blood pressure
- elevated fasting plasma glucose
- high serum triglycerides
- low high density lipoprotein (HDL) levels"
"The complications that may result from metabolic syndrome are frequently serious and long-term (chronic). They include: hardening of the arteries (atherosclerosis), diabetes, heart attack, kidney disease, stroke, nonalcoholic fatty liver disease, peripheral artery disease, cardiovascular disease"
Fasting alone is not enough
"...the roots of metabolic syndrome lie in the Western diet, with its abundance of sugar, high fructose corn syrup, artificial flavors, artificial sweeteners, and overdependence on refined grains. Societies that have kept their traditional patterns of eating are not afflicted with these metabolic disorders. This book focuses on one particular facet of traditional eating patterns that is virtually forgotten in today’s society: intermittent fasting. However, this is only part of the solution. For optimal health, it is not enough to simply add fasting to your life. You must also focus on healthy eating patterns."
HDH Deficiency leads to higher fat
"HGH is a hormone made by the pituitary gland (the master gland). It plays a huge role in the normal development of children and adolescents as the name implies. However, it also plays a role in adults. HGH deficiency in adults typically leads to higher levels of body fat, lower lean body mass and decreased bone mass (osteopenia)."
Benefits of Fasting
- Nutritional Ketosis
This is when your body, depleted of glucose, shifts to burning fat for fuel.
- Reducing Insulin Resistance
If you spent your life fueling yourself with carbs/sugars (converting that to glucose for fuel) then you've probably grown resistant to the insulin your body produces to manage that glucose. Insulin resistance makes it harder for you to burn fat. Too much of this paves the road to becoming a Type 2 diabetic.
- Promoting Autophagy
Your body's natural mechanism to break down old and broken cell machinery and recycle them for energy.
- Increased Human Growth Hormone
Your body produces this naturally. Production increases during fasting to maintain muscle mass and lean tissues.
- An Effective Tool for Losing Weight
Depending on how you craft your fasting/diet/lifestyle regimen, you can lose weight. Once you are burning ketones instead of glycose, the weight you do lose is actual body fat. Weight loss isn't mandatory, however. Many fasters are already at their perfect weight and fast for short periods to support their training regimens with increased autophagy and HGH.
The Transition from Fed to Fasted
Summarized from The Complete Guide to Fasting by Jason Fung and Jimmy Moore, page 44 with additional information from Ace, of the Ace of Spades blog
You eat normally. Blood sugar rises. When there is too much glucose in the blood, the pancreas releases insulin. Insulin is a hormone that makes cells (like muscle cells) permeable to glucose. Excess glucose is then stored as glycogen in the liver or stored as fat.
- The Postabsorptive phase (6 to 24 hours into fasting)
Blood sugar and insulin levels fall. For energy, the liver breaks down glycogen, releasing glucose. Glycogen stores last about 24-36 hours. Your body might start producing grehlin, a hormone to encourage you to eat.
Glycogen stores have run out. The liver now manufactures new glucose from amino acids in a process called Gluconeogenesis
- Ketosis (3 days or so into fasting)
Your low insulin stimulates lipolysis, and your body starts breaking down fat (tryglycerides) for energy, making glycerol, fatty acids and then ketones. After 4 days of fasting, your brain is getting 75 percent of its energy from ketones.
- Protein Conservation (5 days or so into fasting)
High levels of HGH maintain muscle mass and lean tissues. Almost all the energy for basic metabolism is supplied by the fatty acids and ketones. Adrenaline levels rise to prevent decreases in metabolic rate.
Fed and Fasted
"The process of using and storing food energy that occurs when we eat goes in reverse when we fast. Insulin levels drop, signaling the body to start burning stored energy. Glycogen (the glucose that’s stored in the liver) is the most easily accessible energy source, and the liver stores enough to provide energy for twenty-four hours or so. After that, the body starts to break down stored body fat for energy.
So you see, the body really only exists in two states — the fed (high-insulin) state and the fasted (low-insulin) state. Either we are storing food energy or we are burning food energy. If eating and fasting are balanced, then there is no net weight gain.
Fasting, the greatest known boost to autophagy
"Nutrient deprivation is the key activator of autophagy. Remember that glucagon is kind of the opposite hormone to insulin. It’s like the game we played as kids – 'opposite day'. If insulin goes up, glucagon goes down. If insulin goes down, glucagon goes up. As we eat insulin goes up and glucagon goes down. When we don’t eat (fast) insulin goes down and glucagon goes up. This increase in glucagon stimulates the process of autophagy. In fact, fasting (raises glucagon) provides the greatest known boost to autophagy."
Not doing autophagy when you are digesting
"Digestion takes a lot of metabolic energy. After you eat, most of your metabolism is diverted to digestion. That's why you're sluggish or even sleepy after a big meal. (Digestion mostly stops if you're active, by the way, as that energy is diverted to moving around. Digestion would re-start once you start relaxing again)
Another process that takes a lot of metabolic energy is autophagy, which is the destroying of old, worn-down cells (which may have defects in their DNA and other operative machinery), eating them up and stripping them for spare parts like a burnt-out car, and making new cells (with correctly coded DNA) in their place.
When you digest, your body doesn't bother doing autophagy, as it's of lower priority. So going for long periods without any ingested food lets the body spend its metabolic energy on autophagy for a change."
Fasting. Loss of lean mass? No, likely an increase.
"Like cortisol, HGH increases glucose and thus is suppressed during feeding. Fasting is a great stimulus.
During fasting, there is the spike in the early morning, but there is regular secretion throughout the day as well. Hartman et al also showed a 5 fold increase in HGH in response to a 2 day fast.
This HGH is crucial in the maintenance of lean mass – both muscle and bone. One of the major concerns about fasting is the loss of lean mass. This does not occur. In fact, the opposite happens – there is likely an increase in lean mass."
Different Fasting Regimens
There are many ways you can incorporate fasting into your lifestyle. You don't have to stick with just one, and you can alternate as suits your goals best.
- The Monk Fast
Pioneered by WeFa.st, this is a 36 hour water fast.
- 16/8 "Leangains"
Pioneered by Martin Berkhan, this is a 16 hour fast followed by an 8 hour feed window. Mark feels that the 16 hour fasting schedule is "an ideal compromise between getting the best out of the fasting, without the negatives that may follow with a longer fast. This leaves eight hours as your eating window ... leaving room for proper pre and post workout nutrition.
- 20/4 "Warrior Diet"
Pioneered by Ori Hofmekler in 2001, this 20 hour fast is followed by a 4 hour window. Hofmekler's plan is based on "calorie restriction combined with exercise" that promotes autophagy.
- "Eat Stop Eat"
Pioneered by Brad Pilon, "Eat Stop Eat" is another regimen of Intermittant Fasting that has you taking a 24 hour fast, ideally, twice a week.
- 60 "The Himalayan Fast"
Promoted by WeFa.st, this is a 60 hour fast. It starts off with a minimal amount of food, 500 calories or less that are high-protein, low carb and high fat, and reduces to a zero calorie water fast if possible.
- Water Fasting
Maximum benefits for autophagy and HGH production. You can only drink water, black coffee or unsweetened tea. That's it.
- Bone Broth Fasting
Bone Broth contains numerous minerals, vitamins, collagen protein and sodium. It is quickly absorbed by the digestive tract, and many people believe that it has minimal impact on fasting.
- The 5:2 Diet
The 5:2 diet involves restricting your calorie consumption to 25% of your energy (calorie) needs, two days a week, and eating normally the rest of the time.
Is Fasting Dangerous?
Hey, we're not Doctors. We're just a regular family collecting information on the Internet.
Every risk I've seen attributed to fasting seems to be related to poor management: Dehydration, stress, poor sleep, depleted electrolytes, going right back to poor habits when the fast is over.
Of course, this doesn’t include some of the crazy things I’ve read out there that contradicts the actual science. "It will slow down your metabolism!", it doesn’t. "After 3 days, your body eats your organ linings!". Not even remotely true.
Seriously. If you are fat, your body is actually covered in food. Food you need to eat. The world record holder for a therapeutic fast was a fellow from Scotland who fasted for 382 days. He weighed in at 456 pounds, fasted to 180 pounds, and 5 years later weighed 196 pounds.
Recommended precautions for an extended fast
- Monitor blood pressure, heart rate, glucose frequently
- If you do not feel well at any point, you must stop fasting. You may feel hungry, but you should not feel sick.
- Drink water frequently throughout the day when you fast. Seriously. This is the cardinal rule.
- Daily Multivitamin
- To avoid refeeding syndrome, do not extend the fasting period beyond 14 days.
- When you break your fast, eat gentle things for a day to get the machinery going again, like eggs or guacamole
- Undertake 7 day fasts no more than once a month
- Undertake 14 day fasts no more than every 6 weeks
- Megan Ramos (works with Dr Jason Fung) recommends a teaspoon of salt per day, as well as magnesium supplements. She just puts Himilayan salt rocks on her tongue throughout the day, letting it get absorbed into her bloodstream there, instead of her digestive tract.
- If you have a medical condition, make sure you do this with medical supervision. Your Doctor may want blood tests throughout.
"Every few blood tests, I've been told I had elevated BUN/Creatinine levels (which usually indicates dehydration or kidney stress)."
"So I just know that I've frequently been dehydrated, and this is a chronic recurring problem for me."
Your skin is part of your immune system
Recent studies propose that our skin is part of our immune / lymphatic system. If your gut biome affects the operation of your gut, it stands to reason that your skin biome affects the operation of your skin.
"Recent studies have established that the interaction of T cells and skin-resident APCs are real events and have demonstrated that a subset of T cells that migrate to the skin can egress and return to skin-draining LNs, and even more, circulate in the blood and other tissues. These findings flesh out the concept of SALT with the consequence that, even under the homeostatic condition, skin is an active organ of immune system and immune reactions in the skin could influence systemic immunity."
Skin is the largest human organ
"The skin is the human body’s largest organ, colonized by a diverse milieu of microorganisms, most of which are harmless or even beneficial to their host."
"Symbiotic microorganisms occupy a wide range of skin niches and protect against invasion by more pathogenic or harmful organisms. These microorganisms may also have a role in educating the billions of T cells that are found in the skin, priming them to respond to similarly marked pathogenic cousins."
"The perception of the skin as an ecosystem — composed of living biological and physical components occupying diverse habitats — can advance our understanding of the delicate balance between host and microorganism."
You can't burn fat without ketosis
When your body runs out of stored glucose, it converts fat into glucose, fatty acids and then ketone bodies, a glucose substitute. If you are burning fat, you are producing ketones and are in a state of nutritional ketosis. This is different from diabetic ketoacidosis, which is a (very bad thing) complication of type 1 diabetes.
"I believe a low level of ketosis is actually the natural and most optimal state of metabolism for humans."
"When you don't have any food in your body to turn into energy, your body turns to burning the glucose it stores in the easily-burned form of glycogen. But you only have a limited amount of that -- 70 grams in your liver, and 200 grams scattered throughout all the muscles of your body.
When your body has also burned through all of that, it turns to the only stored energy it has left: Bodyfat. Note that the body doesn't particularly want to burn bodyfat -- we're built to accumulate fat whenever food is available (which, at least in the developed world, it almost always is) -- and only turns to burning bodyfat when food is scarce."
Ketones, produced by the liver
"Your body naturally goes into ketosis when you go for several days with low or restricted carbohydrate in your diet. The main ketones produced within the body are beta-hydroxybutyrate, acetoacetate and acetone. Ketones are produced by the liver from fat and provide an energy source that acts as a substitute for glucose for the cells of the body to produce ATP."
Ketosis, a natural state
"...yes, this is a completely normal metabolic state. In fact, according to pediatric physician Dr. Mary Newport, newborn babies who are exclusively breastfed will go into a state of ketosis within twelve hours of birth, and ketones provide about 25 percent of their energy needs. Actually, 10 percent of the fats in full-term human breast milk is composed of medium-chain triglycerides (MCTs), which the liver converts to ketones. This is one reason why virtually every infant formula sold on the market today contains MCT oil and coconut oil, which 'mimic the fats in breast milk.' Dr. Newport says this is a clear indication that 'from birth, and possibly before that, ketones play an important role.'"
Not filling it back up
"Jason and I started off only doing 24 and 36 hour fasts with our patients and within a year they’re down a hundred pounds and in 6 months they’re off of insulin, we had a tremendous amount of success."
"...just eat well, you go low carb, go keto on your eating days so you don’t fill back up your liver, you think of your liver as a cup, on your fasting day you empty it, on your eating day you don’t want to fill it back up"
Combating Health Conditions with Ketosis
"Many chronic symptoms and health conditions — such as fatigue, sleepiness, mood disorders, insomnia, gastroesophageal reflux disease, lipid disorders, high blood pressure, headaches (including migraines), gas, bloating, irritable bowel syndrome, joint inflammation, acne, and difficulty concentrating, to name a few — will improve on a ketogenic diet. Treating lifestyle conditions with lifestyle change such as this can make us a healthier and less drug-dependent country."
"Some fats are more apt to readily convert to ketones than others: short- and medium-chain fats, like those found in pastured butter, cultured ghee, coconut oil, and especially MCT oil (taken as a supplement), will readily convert to ketones. This can help improve the efficiency by which a person adapts to a healthy fat-based, ketone-fueled metabolism."
Keto Friendly Foods
If you can afford and acquire grass-fed/pastured products, it is very much worth it. Commercial critters are typically raised on processed feed full of omega-6 fatty acids, which are bad for you. They end up in the product, which ends up in you. Omega-6 fatty acids contribute to inflammation. Commercial critters are almost always pumped full of antibiotics and medicines, which also end up in the product, which ends up in you.
|Animal Fats / Fatty Meats
If you have not read Dr. Fung's 'Obesity Code', I highly recommend it. Here are a few excerpts and broad strokes.
"THERE ARE TWO prominent findings from all the dietary studies done over the years. First: all diets work. Second: all diets fail."
"The dreaded plateau, then weight regain, followed."
"Permanent weight loss is actually a two-step process. There is a short-term and a long-term (or time-dependent) problem."
"The hypothalamic region of the brain determines the body set weight"
"In the short term, we can use various diets to bring our actual body weight down. However, once it falls below the body set weight, the body activates mechanisms to regain that weight—and that’s the long-term problem."
"Insulin acts here to set body set weight higher. In the short term, we can use various diets to bring our actual body weight down. However, once it falls below the body set weight, the body activates mechanisms to regain that weight—and that’s the long-term problem."
"There is no one single cause of obesity. Do calories cause obesity? Yes, partially. Do carbohydrates cause obesity? Yes, partially. Does fiber protect us from obesity? Yes, partially. Does insulin resistance cause obesity? Yes, partially. Does sugar cause obesity? Yes, partially. All these factors converge on several hormonal pathways that lead to weight gain, and insulin is the most important of these. Low-carbohydrate diets reduce insulin. Low-calorie diets restrict all foods and therefore reduce insulin. Paleo and LCHF diets (low in refined and processed foods) reduce insulin. Cabbage-soup diets reduce insulin. Reduced-food-reward diets reduce insulin."
"Too often, our current model of obesity assumes that there is only one single true cause, and that all others are pretenders to the throne. Endless debates ensue. Too many calories cause obesity. No, too many carbohydrates. No, too much saturated fat. No, too much red meat. No, too much processed foods. No, too much high fat dairy. No, too much wheat. No, too much sugar. No, too much highly palatable foods. No, too much eating out. It goes on and on. They are all partially correct."
"...tailor the approach individually to address the cause of the high insulin levels. For example, if chronic sleep deprivation is the main problem causing weight gain, then decreasing refined grains is not likely to help. If excessive sugar intake is the problem, then mindfulness meditation is not going to be especially useful. Obesity is a hormonal disorder of fat regulation. Insulin is the major hormone that drives weight gain, so the rational therapy is to lower insulin levels."
"Long-term weight loss is really a two-step process. Two major factors maintain our insulin at a high level. The first is the foods that we eat—which are what we usually change when we go on a diet. But we fail to address the other factor: the long-term problem of insulin resistance. This problem is one of meal timing."
What is Insulin?
"...a peptide hormone produced by beta cells of the pancreatic islets, and it is considered to be the main anabolic hormone of the body. It regulates the metabolism of carbohydrates, fats and protein by promoting the absorption of, especially, glucose from the blood into fat, liver and skeletal muscle cells. In these tissues the absorbed glucose is converted into either glycogen via glycogenesis or fats (triglycerides) via lipogenesis, or, in the case of the liver, into both."
"Insulin also signals the fat cells to take up fat and hold on to it."
"All foods raise insulin to some degree. Refined carbohydrates tend to raise insulin the most and fatty foods the least, but insulin still goes up in both cases. Therefore, the most effective method of reducing insulin is to avoid all foods altogether ... Regularly lowering insulin levels leads to improved insulin sensitivity — your body becomes more responsive to insulin."
Insulin Resistance leads to high blood sugar
"Insulin resistance (IR) is a pathological condition in which cells fail to respond normally to the hormone insulin. The body produces insulin when glucose starts to be released into the bloodstream from the digestion of carbohydrates in the diet. Normally this insulin response triggers glucose being taken into body cells, to be used for energy, and inhibits the body from using fat for energy. The concentration of glucose in the blood decreases as a result, staying within the normal range even when a large amount of carbohydrates is consumed. When the body produces insulin under conditions of insulin resistance, the cells are resistant to the insulin and are unable to use it as effectively, leading to high blood sugar. Beta cells in the pancreas subsequently increase their production of insulin, further contributing to a high blood insulin level. This often remains undetected and can contribute to the development of type 2 diabetes or latent autoimmune diabetes of adults."
Exposure leads to resistance
"People who eat a lot and eat frequently -- especially if they eat a lot of high-carb foods or sugars -- really spike their insulin levels very high. The cells of the body grow tolerant to insulin, as an alcoholic grows tolerant to alcohol, and begin ignoring "normal" levels of insulin. Normal levels of insulin don't cause cells to accept glucose. The pancreas detects that blood sugar has not decreased due to its release of insulin, and releases more insulin.
This is the start of a syndrome called "insulin resistance." Cells are exposed to higher-than-normal levels of insulin and won't take in glucose; the pancreas responds by spiking insulin even higher."
Healthy glucose levels
"The general population, rather than worrying about cholesterol, should start paying attention to their postprandial [after eating] sugars. To me, the key to health is controlling your blood glucose levels following a meal to less than 140."
What is Basal Metabolic Rate?
"Basal metabolic rate (BMR) is the minimal rate of energy expenditure per unit time by endothermic animals at rest."
"Metabolism comprises the processes that the body needs to function. Basal metabolic rate is the amount of energy expressed in calories that a person needs to keep the body functioning at rest."
"The basal metabolic rate accounts for about 60 to 75% of the daily calorie expenditure by individuals."
"BMR generally decreases with age and with the decrease in lean body mass (as may happen with aging). Increasing muscle mass has the effect of increasing BMR."
"Basal metabolism is usually by far the largest component of total caloric expenditure."
"A decrease in food intake will typically lower the metabolic rate as the body tries to conserve energy."
Fasting increases metabolism
"Most people expect that a period of fasting will leave them feeling tired and drained of energy ... the body is still being fueled— it’s just getting energy from burning fat ... it’s also because adrenaline is used to release stored glycogen and to facilitate fat-burning ... studies show that after a four-day fast, resting energy expenditure increased by 12 percent. Rather than slowing the metabolism, fasting revs it up."The Complete Guide to Fasting by Jason Fung and Jimmy Moore, page 49
Calories in, Calories out? Not that simple.
"The first law of Thermodynamics is always true, but completely irrelevant to human health. Yes, if Calories In is more than Calories Out then you will gain fat. But if you eat more Calories, you will burn more calories. If you eat less calories, you will burn less. So there is no overall change in body fatness."
Dr Jason Fung, in The Evidence for Caloric Restriction
What are nootropics?
"Nootropics ...are drugs, supplements, or other substances that improve cognitive function, particularly executive functions, memory, creativity, or motivation, in healthy individuals."
"Nootropics are a broad classification of cognition-enhancing compounds that produce minimal side effects and are suitable for long-term use. These compounds include those occurring in nature or already produced by the human body (such as neurotransmitters), and their synthetic analogs. We already regularly consume some of these chemicals: B vitamins, caffeine, and L-theanine, in our daily diets."
Trillions of Microorganisms
"The human gut is home to trillions of microorganisms, which are collectively known as the microbiome. These microbes play a vital part in our gut health, supporting digestion and the synthesis of vitamins.
At this moment, two to six pounds of microbes are living in and on you. This ecosystem of trillions of microbes is also known as your microbiome, which contains bacteria and other microorganisms that are both beneficial and detrimental to your health."
"Certain microbiota perform tasks that are known to be useful to the human host; the role of most resident microorganisms is not well understood. Those that are expected to be present, and that under normal circumstances do not cause disease, are sometimes deemed normal flora or normal microbiota."
What lives in our gut helps to shape our health
"Most of us are aware that the bacteria in our gut play an important role in digestion. When the stomach and small intestine are unable to digest certain foods we eat, gut microbes jump in to offer a helping hand, ensuring we get the nutrients we need.
In addition, gut bacteria are known to aid the production of certain vitamins - such as vitamins B and K - and play a major role in immune function.
But increasingly, researchers are working to find out more about how gut bacteria - particularly the bacteria that is unique to us individually - influence our health and risk of disease.
Perhaps most studied is how gut microbiota affects an individual's risk of obesity and other metabolic conditions. In November 2014, for example, Medical News Today reported on a study claiming our genetic makeup shapes what type of bacteria reside in our gut, which may affect our weight."
Medical News Today, in The gut microbiome: How does it affect our health?
- Any fermented milk product
(yogurt, cheese, kefir…)
- Most fermented vegetables
(saurkraut, kimchi, pickles)
- Beet Kvass
(a fermented beet juice drink)
- Dark Chocolate
- Ginger Beer
- Microalgae like Spirulina, Chlorella
- Miso Paste
- Olives cured in brine
- Apple Cider Vinegar
- Burdock Root
- Chicory Root
- Dandelion Greens
- Jerusalem Artichoke
- Jicama Root
- Konjac Root
- Wheat Bran
- Yacon Root
What is Cholesterol?
"Cholesterol is essential for our bodies to function and without cholesterol you would die. In fact, "the majority of the cholesterol in our blood comes from our own bodies making it. I don't think a lot of people understand that concept. People mistakenly think they get most of their cholesterol from their food and that's not true. Cholesterol is used to make hormones like estrogen and testosterone, is transported into the adrenal gland to aid in hormone synthesis, repair nerves, and make bile for fat digestion, it's a structural component of our cells, it synthesizes vitamin D—it plays such a critical role in our body that we genuinely need it."
"it is an essential structural component of all animal cell membranes"
"...also serves as a precursor for the biosynthesis of steroid hormones, bile acid, and vitamin D"
"Since cholesterol is essential for all animal life, each cell is capable of synthesizing it"
"Most ingested cholesterol is esterified, and esterified cholesterol is poorly absorbed."
"Cholesterol is recycled in the body. The liver excretes it in a non-esterified form (via bile) into the digestive tract. Typically, about 50% of the excreted cholesterol is reabsorbed by the small intestine back into the bloodstream."
The Straight Dope
The series by Peter Attia is one of the most accessible and informative lectures on Cholesterol that I have found. Here are some excerpts.
"...standard cholesterol testing (including VAP) is largely irrelevant and you should have a lipoprotein analysis using NMR spectroscopy ...This topic bears an upsettingly parallel reality to that of nutrition 'science' in that virtually all health care providers have no understanding of it and seem to only reiterate conventional wisdom (e.g., 'LDL is bad,' 'HDL is good')"
"Cholesterol is "just" another fancy organic molecule in our body, but with an interesting distinction: we eat it, we make it, we store it, and we excrete it – all in different amounts."
"Cholesterol, a steroid alcohol, can be 'free' or 'unesterified' ('UC' as we say, which stands for unesterified cholesterol) which is its active form, or it can exist in its 'esterified' or storage form which we call a cholesterol ester ('CE')"
"Cholesterol exists in 2 forms – UC and CE – and the form determines if we can absorb it or not, or store it or not (among other things)."
"About 25% of our daily "intake" of cholesterol – roughly 300 to 500 mg — comes from what we eat (called exogenous cholesterol), and the remaining 75% of our "intake" of cholesterol — roughly 800 to 1,200 mg – is made by our body (called endogenous production). To put these amounts in context, consider that total body stores of cholesterol are about 30 to 40 gm (i.e., 30,000 to 40,000 mg) and most of this resides within our cell membranes. Every cell in the body can produce cholesterol and thus very few cells actually require a delivery of cholesterol. Cholesterol is required by all cell membranes and to produce steroid hormones and bile acids."
"Of this 'made' or 'synthesized' cholesterol, our liver synthesizes about 20% of it and the remaining 80% is synthesized by other cells in our bodies."
"Plasma cholesterol levels (which is what clinicians measure with standard cholesterol tests) often have little to do with cellular cholesterol, especially artery cholesterol, which is what we really care about. For example, when cholesterol intake is decreased, the body will synthesize more cholesterol and/or absorb (i.e., recycle) more cholesterol from our gut."
"Only free or unesterified cholesterol (UC) can be absorbed through gut enterocytes."
"Much (> 50%) of the cholesterol we ingest from food is esterified (CE), hence we don't actually absorb much, if any, exogenous cholesterol (i.e., cholesterol in food)."
"Most of the cholesterol we eat is not absorbed and is excreted by our gut (i.e., leaves our body in stool). The reason is it not only has to be de-esterified, but it competes for absorption with the vastly larger amounts of UC supplied by the biliary route."
"Re-absorption of the cholesterol we synthesize in our body is the dominant source of the cholesterol in our body. That is, most of the cholesterol in our body was made by our body."
"One of the unfortunate results of the eternal need to simplify everything is that we (i.e., the medical establishment) have done the public a disservice by failing to communicate that there is no such thing as 'bad' cholesterol or 'good' cholesterol. "All cholesterol is good! The only 'bad' outcome is when cholesterol ends up inside of the wall of an artery, most famously the inside of a coronary artery or a carotid artery, AND leads to an inflammatory cascade which results in the obstruction of that artery (make sure you check out the pictures in the links, above). When one measures cholesterol in the blood – we really do not know the final destination of those cholesterol molecules!"
"Eating cholesterol has very little impact on the cholesterol levels in your body. This is a fact, not my opinion. Anyone who tells you different is, at best, ignorant of this topic. At worst, they are a deliberate charlatan. Years ago the Canadian Guidelines removed the limitation of dietary cholesterol. The rest of the world, especially the United States, needs to catch up."
Bad Cholesterol, Argument & Rebuttal
Argument: "Heart disease is caused by too much "bad" cholesterol (LDL-C)"
Rebutal: "Atherosclerosis is caused by an inflammatory response to sterols in artery walls. Sterol delivery is lipoprotein-mediated, and therefore much better predicted by the number of lipoprotein particles (LDL-P) than by the cholesterol they carry (LDL-C)"
LDL-P is the best predictor of adverse cardiac events
"The same patterns are observed: 1) LDL-P is the best predictor of adverse cardiac events. 2) LDL-C is only a good predictor of adverse cardiac events when it is concordant with LDL-P; otherwise it is a poor predictor of risk. Amazingly the persons with the worst survival had low (below median) LDL-C but high LDL-P. The patients most likely to have high LDL-P with unremarkable or low LDL-C are those with either small LDL particles, or TG-rich / cholesterol poor LDL particles, or both (e.g., insulin resistant patients, metabolic syndrome patients, T2DM patients). This explains why small LDL particles, while no more atherogenic on a per particle basis than large particles, are a marker for something sinister."
"If you want to stop atherosclerosis, you must lower the LDL particle number."
"If you were only 'allowed' to know one metric to understand your risk of heart disease it would be the number of apoB particles (90-95% of which are LDLs) in your plasma ... If this number is high, you are at risk of atherosclerosis. Everything else is secondary."
"There's an increasing consensus that measuring particle concentrations of LDL—the whole particle, not just its cholesterol content—is a more meaningful and, in many cases, a more accurate means for assessing risk. And even more importantly, for defining goals of treatment. This whole area of particle testing has been categorized as 'emerging' technology, even though it's been emerging for three decades now."
Heart Disease is a Carbohydrate Problem
"If you look at the advanced lipid tests - LDL-P, ApoB, and the size and density of the LDL—then heart disease becomes a carbohydrate problem. As long as you're focusing on LDL cholesterol as the culprit, then you can blame saturated fat."
"Insulin resistance is important because it is the root cause of atherosclerosis. A random blood sugar level above 120, lots of small particles or Pattern B LDL cholesterol, remnant lipoproteins, elevated CRP levels, low GlycoMark, and A1c around 5.0–5.3 are the things that make me want to work up a patient more earnestly. You don't really need to do fancy advanced lipid testing; triglycerides, HDL, and non-HDL numbers are available on every standard lipid panel."
Triglycerides help you understand LDL
"Triglycerides are as tied to heart disease as LDL. There are two kinds of LDL: the large, buoyant variety that is not associated with heart disease, and the small, dense variety, which is definitely associated with heart disease. The best way to determine which LDL you predominantly have is by looking at your triglycerides level. High LDL and high triglycerides mean you have a preponderance of Small LDL-P, insulin resistance, and metabolic syndrome. That is what I am looking for when I run a cholesterol panel."
"I look for several things. I like to see a good, solid HDL number that is at least 10 points higher than what most labs consider 'normal' values. Triglycerides should be under 150; I don't believe as strictly that triglycerides must be below your HDL number as long as they are below 150. And finally, I check the fasting glucose and hemoglobin A1c."
Age, the single greatest risk factor
"Any guesses as to what the greatest single risk factor is for heart disease? ... It's age. Age trumps everything. In this sense, atherosclerosis is an “integral” disease (in the calculus sense of the word) — meaning it's a disease of compounding injuries, as I painstakingly went through above. Age = persistent exposure to LDL-P/apoB."
...how does 'good' cholesterol end up in places it doesn't belong and cause 'bad' problems?
"...atherosclerosis – the accumulation of sterols and inflammatory cells within an artery wall which may (or may not) narrow the lumen of the artery."
"To be clear, statistically speaking, this condition (atherosclerotic induced ischemia or infarction) is the most common one that will result in the loss of your life. For most of us, atherosclerosis (most commonly within coronary arteries, but also carotid or cerebral arteries) is the leading cause of death, even ahead of all forms of cancer combined. Hence, it's worth really understanding this problem."
"Cholesterol and triglycerides are not soluble in plasma (i.e., they can't dissolve in water) and are therefore said to be hydrophobic."
"To be carried anywhere in our body, say from your liver to your coronary artery, they need to be carried by a special protein-wrapped transport vessel called a lipoprotein."
"As these 'ships' called lipoproteins leave the liver they undergo a process of maturation where they shed much of their triglyceride "cargo" in the form of free fatty acid, and doing so makes them smaller and richer in cholesterol."
"Special proteins, apoproteins, play an important role in moving lipoproteins around the body and facilitating their interactions with other cells. The most important of these are the apoB class, residing on VLDL, IDL, and LDL particles, and the apoA-I class, residing for the most part on the HDL particles."
"Cholesterol transport in plasma occurs in both directions, from the liver and small intestine towards the periphery and back to the liver and small intestine (the 'gut')."
"The major function of the apoB-containing particles is to traffic energy (triglycerides) to muscles and phospholipids to all cells. Their cholesterol is trafficked back to the liver. The apoA-I containing particles traffic cholesterol to steroidogenic tissues, adipocytes (a storage organ for cholesterol ester) and ultimately back to the liver, gut, or steroidogenic tissue."
"All lipoproteins are part of the human lipid transportation system and work harmoniously together to efficiently traffic lipids. As you are probably starting to appreciate, the trafficking pattern is highly complex and the lipoproteins constantly exchange their core and surface lipids."
"The sine qua non of atherosclerosis is the presence of sterols in arterial wall macrophages. Sterols are delivered to the arterial wall by the penetration of the endothelium by an apoB-containing lipoprotein, which transport the sterols. In other words, unless an apoB-containing lipoprotein particle violates the border created by an endothelium cell and the layer it protects, the media layer, there is no way atherogenesis occurs.
"The progression from a completely normal artery to an atherosclerotic one which may or may not be "clogged" follows a very clear path: an apoB containing particle gets past the endothelial layer into the sub-endothelial space, the particle and its cholesterol content is retained and oxidized, immune cells arrive, an initially-beneficial inflammatory response occurs that ultimately becomes maladaptive leading to complex plaque."
"While inflammation plays a key role in this process, it's the penetration of the apoB particle, with its sterol passengers, of the endothelium and retention within the sub-endothelial space that drive the process."
"The most numerous apoB containing lipoprotein in this process is certainly the LDL particle, however Lp(a) (if present) and other apoB containing lipoproteins may play a role."
Cholesterol. Inflammation. What can we hack?
"We've long known that atherosclerosis is an inflammatory disease. In the absence of inflammation or injury to the endothelial cell, the cholesterol would never go through the arterial wall and it would never stay there."
"When we're talking about inflammation, I like to look at what's causing it. If the client's C-reactive protein levels are high, I want to look for the root cause of the inflammation and what's causing the damage. Things like smoking, excessive alcohol consumption, consuming trans fats and processed carbohydrates, having high blood sugar levels, chemical exposure, high blood pressure, and stress can all contribute to this. Everything on this list is very different than blaming inflammation on a high-fat diet, which is what many trusted professionals will point their finger at right away."
"Of the thousands and thousands of patients I have personally seen over the years with coronary disease, I can count the number of people who lacked a prevalence of small LDL particles on one hand. It is possible for it to happen, but it's highly unusual. The vast majority of people who have coronary disease or a risk of developing it have an excess of small LDL particles. There's only one thing that causes small LDL particles and that's carbohydrates, not dietary fat. We use a low-carb diet to eliminate the expression of small LDL, which also, by the way, reduces blood sugar levels and normalizes blood vitamin D levels."
Hacking Triglycerides / HDL
"There isn't a drug that lowers triglyceride levels well, which is why mainstream medical doctors don't pay much attention to them. But triglycerides respond very strongly to dietary changes. If you reduce your carbohydrate intake, you tend to have ideal triglyceride levels, in the 50 to 60 range. Additionally, the triglyceride-to-HDL ratio is a good indicator of how well your diet is dialed in. If the ratio is high, you might benefit from eating more saturated fats and fewer carbs."
Paul Jaminet, in Cholesterol Clarity, page 104 by Jimmy Moore, Eric Westman, MD.
"Elevated CRP can signal many different conditions, including cancer, cardiovascular disease, infection, and autoimmune conditions such as rheumatoid arthritis, lupus, and inflammatory bowel disease. The chronic inflammation behind an elevated CRP level may also be influenced by genetics, a sedentary lifestyle, too much stress, and exposure to environmental toxins such as secondhand tobacco smoke. Diet has a huge impact, particularly one that contains a lot of refined, processed and manufactured foods."
"There are now 34 large-scale prospective studies that have all come to the same conclusion: CRP is one of the most consistent risk stratifiers that we have. But it is important to think beyond CRP as a simple marker for high risk of disease. It also tells us something about the underlying biology."
"...patients with metabolic syndrome and high CRP have very high risk. Clearly, when the inflammatory mechanisms are engaged, metabolic syndrome patients do much worse"
"The patients with the very highest levels of hsCRP - 5 to 10, 10 to 20, or even greater than 20 mg/L—are, in fact, at the very highest risk."
"These data help to explain why those with periodontal disease, arthritis, and other systemic inflammatory disorders all have higher vascular risk. Perhaps inflammation from any cause has an adverse effect on the vascular endothelium."
"There are over 50 papers about the impact of exercise on inflammatory markers and event reduction ... Moreover, CRPs fell whether or not the patients actually lost weight. The exercise benefit was independent of weight loss."
Healthy flora and the things that feed them
"You don't necessarily need probiotics — a type of 'good' bacteria — to be healthy. However, these microorganisms may help with digestion and offer protection from harmful bacteria, just as the existing 'good' bacteria in your body already do.
Prebiotics are nondigestible carbohydrates that act as food for probiotics. When probiotics and prebiotics are combined, they form a synbiotic. Fermented dairy products, such as yogurt and kefir, are considered synbiotic because they contain live bacteria and the fuel they need to thrive."
First and foremost, probiotic foods are excellent for maintaining healthy gut flora. You already know how important your gut flora are for just about everything: if you want healthy digestion, clear skin, metabolic health, a generally good mood, easier weight loss, or pretty much anything else, pampering your gut flora should be at the top of your priorities list.
The 'good bugs' in probiotic foods are some of the very same bacteria that populate a healthy gut, so when you eat these foods, it’s an infusion of healthy flora right where they need to be."
Sleep is important to your health
"Sleeping < 7 hours per night is associated with increased risk for obesity, diabetes, high blood pressure, coronary heart disease, stroke, frequent mental distress, and all-cause mortality"
Good sleep helps lower cortisol levels
Cortisol raises insulin levels.
"...cortisol raises insulin levels and is a major pathway of weight gain. Therefore, reducing your cortisol levels is an integral part of your overall weight-loss effort. Reducing stress levels, practicing meditation and getting good sleep are all effective methods for achieving lower cortisol levels."
Keys to good sleep hygiene
"THERE ARE SEVERAL keys to good sleep hygiene, and none of these involve the use of medication. ( Medications disturb the normal sleep architecture, the pattern of REM and non-REM sleep.) Simple but effective ways to improve sleep include the following:
- Sleep in complete darkness.
- Sleep in loose fitting clothes.
- Keep regular sleeping hours.
- Try to get seven to nine hours of sleep each night.
- See the light first thing in the morning.
- Keep your bedroom slightly cool.
- Do not keep a TV in your bedroom.
A keto-friendly concoction
In its simplest form, it’s a keto friendly concoction of good coffee, MCT oil and grass-fed butter. It doesn’t really give you much of an insulin spike, the MCT oil is quickly converted into keytones and it has healthy fat. You probably want to avoid it during a fast if you can, but it’s a nice keto friendly boost otherwise.
Q: Will it break a fast?
A: It depends on why you're fasting. It won't take you out of nutritional ketosis, but it will interrupt autophagy because you have to digest it.
When does autophagy begin?
"There is no magic point at which autophagy 'begins' (let alone a special, fasting-specific form of autophagy): it's on all the time, and enhanced by fasting, at different time courses in different organs. A better question might be "when does autophagy peak after initiating fasting."
- LD's [Lipid Droplets] contain mostly unsaturated fats that were at some point consumed
- When LD's are not removed, they grow in number and size and result in disease.
- LD removal must be preceded by autophagy
- In the early stages of autophagy LD's grow in size, so it likely takes awhile before lipophagy kicks in
- It appears to be lipophagy, not LP lipolysis, that is enabled by autophagy
Carbs are taxing on the liver, not nutritional ketosis
"Q: I was talking to some co-workers and telling them about keto and one of them said that keto is not a long term diet because it is very taxing on the liver. I have read that people maintain ketogenic diets for years but that's all I know. So is it true? Is it not a good idea to remain in ketosis for a long time because it's very taxing for the liver?
A: Any weight lost diet is high fat diet, you literally consume your own animal body fat if you are losing it. Carbs are more taxing for liver. Fructose is the same hepatotoxin as alcohol, but even more dangerous for liver and pancreas, alcohol is made of carbs, but it's fermented carbs. Carbs induce de novo lipogenesis, fatty liver, faster than alcohol.
A: Digested carbs and and amino acids goes straight to portal vein, which means straight to the liver. Digested fatty acids goes to lymphatic system. Think about it. You can make any type of diet rather healthy or devastating. Not all fats are created equal."
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