Insulin and Triglycerides

Every time I review someone’s blood test results, and then discuss with them what they mean and what they should do to improve their numbers, there’s something I almost always have to explain. And this was the relationship between fasting insulin and triglyceride levels.

Take a look at this plot:

trigs_vs_insulin_gb

Plot showing ten pairs of measurements of insulin and triglycerides, made from the same blood samples. They were collected between 2011 and 2017, and all are from my own blood tests.

It shows measurements of insulin concentration on the horizontal axis in mili units per millilitre (mIU/ml), and triglyceride levels on the vertical axis in milligrammes per decilitre (mg/dl). This is a correlation plot in which independent measurements of one variable are plotted against independent measurements of another in an attempt to see if there is a relationship between them.

Is there an order in the way the dots are organized? They are clearly not randomly distributed as a circular cloud of dots—it would mean that there is no relationship. Instead, we see what looks like a linear relationship in which lower values of insulin correspond to lower values of triglycerides, and higher values of insulin correspond to higher values of triglycerides. It’s not a straight line, but it’s definitely a clear linear relationship, and the value of the correlation coefficient, which quantifies how tight the relationship actually is, of just under 0.9 is pretty close to 1. In other words, it’s a pretty tight linear relationship.

Triglyceride is a fancy word for fat or lipid, because fat molecules are composed of three fatty acids held together by a glycerol structure. This is what triglyceride refers to. The amount of fat in the blood is affected by the amount of fat we eat, and the amount of body fat we have. Naturally, after a fatty meal, triglyceride levels will increase as the fat goes from the digestive system into the blood, they will reach a maximum, and then start to go down. The longer we wait before we eat again, the lower they will go. But there’s a few complications.

The first is that depending on the amount of insulin, one of whose jobs it is to transport nutrients into cells, whatever is circulating in the blood—and this includes glucose, of course, but also protein and fat—will in general be stored away faster if insulin is higher, and slower if insulin is lower. This means that if you eat fat together with sugar or starch, the whole lot will be packed away, and mostly as fat, minus the little bit of glucose your muscles and liver have room to store up as glycogen.

The second is that depending on the state of insulin sensitivity—the fundamental parameter that determines how well or poorly cells can use fat for fuel—triglycerides will in general be used up faster if we are more insulin sensitive and slower if we are more insulin resistant. This means that in the morning, twelve to fourteen hours after having had the exact same meal, the more insulin sensitive person will have lower triglyceride levels than the more insulin resistant.

And in fact, no matter if we have a measure of fasting insulin or not, and no matter how little we know about the person’s overall health, fasting triglyceride concentration is probably the best general marker of insulin sensitivity. Nevertheless, because their levels fluctuate quite a lot over the course of each day as a function of what we eat and drink, it is true for triglyceride levels as it is true for many other blood tests that are affected by the kind and amount of food and drink we’ve had over the last days, and most importantly by the amount of sweet or starchy carbohydrates.

Now, take a look at this second plot:

trigs_vs_insulin_final

Plot showing, in addition to the 10 points shown in the first plot (in red), another 20 pairs of measurements of insulin and triglycerides, also all from the same blood samples, but from seven other persons.

It shows the same 10 data points shown in the first plot from my own results, but with another 20 pairs of measurements taken from other people that I’ve coached and helped with the interpretation of their results. You can see that the relationship is better defined because of the additional points that now together cover a wider range of values on both axes.

However, you can also see that, the relationship is not as tight. In particular, there are a few points that are quite far off the main trend—mostly those at the top of the plot with high triglyceride and low insulin values. We see how these off-trend points affect the tightness of the relationship seen in the initial data set when we compare the values of the correlation coefficients. These off-trend points lead us to the third complication I wanted to bring up.

But first, please take a minute to consider the matter: What could lead to having low insulin and at the same time high triglycerides? What could be the cause of the difference between my numbers, which did contain some very low insulin levels, but all of which were paired with equally low triglyceride values, and this other person’s numbers? What causes insulin to go down? What happens when insulin is low? What could cause triglycerides to go up while insulin is low?

Insulin, no matter how high it is, will start to go down when we stop eating. The longer we fast, the lower it will go. Each person’s baseline will be a little different depending mainly on their metabolic health and their body fat stores. The more efficient the metabolism is at using fat for fuel—the more insulin sensitive, the lower insulin will go. But also the lower the body fat stores are, the lower insulin will go. On the flip side, the more insulin resistant and the fatter we are, the longer it will take for insulin to drop and the higher it will stay at baseline.

This is pretty shitty. I mean, as we develop insulin resistance, average insulin levels will become higher and higher. As a result we’ll store calories into our growing fat cells more and more easily, and will therefore become fatter and fatter, faster and faster. But fat cells also secrete insulin! So, the more fat cells there are, the higher the insulin levels will be, and the harder it will be to lower our basal insulin. To burn fat, we need to lower insulin levels. The fatter we are, the higher the insulin levels will tend to be. And the fatter we are, the harder it will be to lower insulin levels.

It’s a bit of a catch, but in the end, it’s not such a big deal because basically everyone who is overweight and who starts to fast and restrict carbohydrates melts their fat stores away very well. It works incrementally: insulin goes down a little, insulin resistance is reduced a little, fat-burning starts; insulin goes down a little lower, insulin resistance is further reduced, fat-burning increases; and on it goes, until we have lost all those extra kilos of fat that we were carrying on our body, be it 5, 15, 20, 35, 60 or even 100 kg of fat! It’s just a matter of time.

Now, after this little tangent on insulin and fat stores, we can come back to those anomalous points in the plot, the most conspicuous of which is the one just below 120 mg/dl of triglycerides but only 3 mUI/ml of insulin. Have you come up with an explanation? Here it mine:

That point is from one of my wife’s blood tests. It is unusual because it was done after 24 hours of fasting. My 24-hour fasting blood test done a number of weeks before, and my numbers were 41 for trigs at 2.3 for insulin. The difference between her and I was that I was already very lean, whereas she wasn’t. Therefore, as she fasted, her insulin levels dropped very low, and then the body started releasing its fat stores into the bloodstream in high gear. This is why her triglyceride levels were this high while her insulin was that low. It’s almost certainly the same for the other two points up there with trigs at 110 and 90 with insulin around 4 and 2.5 (the latter one of which is also my wife’s).

Since we did many of our blood tests around the same time, there are 9 data points from her on the plot. Several are in the centre of the main trend at insulin values between 6 and 7, but I’d like draw your attention to her lowest insulin value that was measured at 1.8, and at which time her trigs were at 57, and her lowest triglyceride level of 48, at which time her insulin was at 2.2. This shows that on average her values are a little further along the trend than mine are because of the small difference in body fat, but that she has good insulin sensitivity, and a well-functioning metabolism that can efficiently use fat for fuel.

The other off-trend point, but in the other direction on the right hand side, with insulin just above 10 and trigs around 65, is from my mother’s first blood test which I ordered and included insulin and trigs, before I got her off carbs. She was 82 at the time, eating a regular kind of diet, but not a very nutritious or varied diet with plenty of bread and cheese, because she had serious problems moving around and taking care of herself while still living alone. And so, it’s just the result of being older, having plenty of carbs, but not being highly insulin resistant nor highly overweight. Her baseline insulin levels were just generally higher because of her age and diet, but her trigs weren’t excessively high.

However, after just four days of intermittent fasting on a very low carb regime with most calories coming coconut oil spiked green juices and coconut milk smoothies, her insulin went from 10.3 to 4.7, and she lost 5 kilos, which, of course, were mostly from the release of water that the body was retaining to counter the effects of the chronic inflammation that immediately went down with the very-low carb regime and fasting.

Later, having sustained this strict green healing protocol for about 6 weeks, her numbers were at 2.9 for insulin and 56 for trigs. And by then she had lost another 5 kg, but this was now mostly fat. She had, at that point, recovered full insulin sensitivity, had lost most of her body fat stores, and overhauled her metabolism. She was 83 at that time, which shows that this sort of resetting of the metabolism can work at any age.

On this note, let’s conclude with these take-home messages:

First, the next time you get a blood test, request that insulin and triglycerides be measured, because it’s the only way to know what your fasting insulin actually is, and because it is very telling of your level of insulin resistance or sensitivity, overall metabolic health, as well as your average rate of ageing as we’ve seen in a previous post on insulin and the genetics of longevity.

Second, when you get the results back, you will be able to tell from your triglycerides concentration, in light of your insulin level, either how well the body is using fat for fuel—in the case you are already lean, or how fast you are burning your fat stores—in the case you still have excess body fat to burn through.

And third, resetting metabolic health can be done at any time and at any age, and is yet another thing that shows us how incredible our body is—the more we learn generally or individually, the more amazing it reveals itself to be.

Ten years of carbohydrate restriction: here’s why

It was almost exactly ten years ago, in March 2008, that I read Ron Rosedale’s Insulin and Its Metabolic Effects.  I now know that this is surely the one thing I’ve read that has had the most impact on my life. Rosedale’s presentation was a total revelation to me:  I had never read anything about insulin before, and his explanations of the biochemical and physiological functions and effects of insulin on the body all made perfect sense in and of themselves, but also appealed to my appreciation and reliance on complete explanations that are consistent with the facts we can observe about them.  I eliminated insulin-stimulating carbohydrates from my diet overnight.  That was that.

We were then still vegetarian at home.  Hence, the family breakfast, following Mercola’s example, became smoothies made of raw, local, pastured eggs with berries and stevia.  That lasted quite a while.  I always travelled with my hand blender and stevia, brought eggs if it was for short trip, or scouted out places to get good ones when the trip was longer.  Throughout a summer trip along the American west coast, I made our raw egg smoothies every day, in hotel rooms and campgrounds.

At one point, I discovered coconut oil and coconut milk.  The breakfast smoothies evolved to being made of eggs and coconut milk with berries, and eventually only coconut milk, berries and stevia.  This period lasted several years until we moved on to cold pressed green juice with coconut milk; it was two thirds juice and one third milk.  We also did this for several years until about two years ago when our son left for university, at which point we dropped having breakfast entirely to allow for a daily overnight fasting period of about 16 hours from after dinner to lunchtime.

 

Food intolerance testing in 2014 showed that all three of us were intolerant to eggs; we removed them from our diet.  My wife and I had the most and our son the least intolerances; this was not surprising given we were a lot older than him.  It also showed my wife and I were intolerant to most dairy products; we removed them from our diet.  We were also intolerant to grains: both highly intolerant to wheat, and then I, in addition, somewhat less so to barley, malt, and quinoa—we ate quinoa almost daily for years as our son was growing up.  He, although not intolerant to dairy or wheat, was intolerant to almonds, pistachios, and brazil nuts. (Here are my test results, if you’re interested.)

Imagine: vegetarian for 20 years, with a diet during these two decades from teenage hood to middle adult hood consisting primarily of wheat and grain products, beans, cheese and yogurt, eggs and nuts.  Of course, also plenty of sweet fruit, starchy vegetables, and salads, as with is true for most vegetarians.  But the bulk, both in volume and in calories, was from grain products, cheese, and eggs.  The shocker for me was that the food intolerance test painted the profile of a meat-eater:  if you remove grains, dairy, and eggs, what is left is animal flesh, vegetables and fruits.

If now, in addition, you remove fruit and starchy vegetables to avoid insulin-stimulating carbohydrates, all that is left is animal flesh and green vegetables.  That’s just how it is.  We also used to eat almonds—the richest in magnesium, and brazil nuts—the richest in selenium, almost daily.  But because our son was intolerant to both and I was intolerant to brazil nuts, we removed those from our diet as well.

IMG_2275

 

These were all food intolerances; they were not allergies.  But they were nonetheless intolerances, some stronger, some weaker.  If you are concerned about health in the sense of being in the best state of health you can, then obviously you must not eat foods to which you are intolerant.  Otherwise, your immune system is triggered each time the offending molecules in those foods enter the gut and bloodstream.  This gradually but inevitably makes the intolerance greater, your system weaker, and body sicker.

Over these ten years, I’ve read quite a few books, articles, blog posts, and detailed discussions about health-related matters.  I’ve also experimented quite a bit with my own diet, and learned a great deal from that.  The other thing I’ve done a lot of, is have conversations with people about diet, nutrition, diseases, and the metabolic effects of different foods and of insulin.

My position—which has only grown stronger with time—is that the first and most fundamental pillar of optimal health is having a metabolism that runs on fat.  And this means keeping insulin levels low by restricting sugars and starches.  Not necessarily always, but most of the time, as in almost always.

The first question that people ask when they find out is why: Why do you not eat bread? Bread has forever been essential to humans.  I simply couldn’t live without bread.  Or, why don’t you eat potatoes, or rice, or pasta?  They’re so good!  I simply couldn’t live without potatoes and pasta.  And, you don’t even eat fruit? But isn’t fruit full of vitamins and minerals?

The way I have answered has depended on a lot of things: the setting, the atmosphere, the company, the time available, but most importantly on the person.  Some people are actually interested to find out, and maybe even learn something.  Most, however, are not.  Consequently, I have made the answer shorter and shorter over the years.  Now, I even sometimes say: well, just because, and smile.

Maybe you have wondered, or even still wonder why.  Maybe although you’ve read so many times in my writings that I think everyone seeking to improve their health should restrict insulin-stimulating carbohydrates, you still wonder what the main reason is, what the most fundamental reason for which I don’t eat sugars and starches.  Here’s why:

 

It’s not primarily because carbs and insulin make us fat by promoting storage and preventing the release of energy from the ever larger reserves of fat in our body: I am lean and always have been.

It’s not primarily because carbs and insulin lead to insulin resistance, metabolic syndrome, and diabetes; inflammation, dyslipidemia, water retention, and high blood pressure; kidney dysfunction, pancreatic dysfunction, and liver dysfunction: my fasting glucose, insulin, and triglycerides have been around 85 mg, 3 mili units, and 40 mg per dl for years; my blood pressure is 110/70 mg Hg, glomerular filtration rate is high, and all pancreatic and liver markers are optimal.

It’s not primarily because carbs and insulin promote cancer growth since cancer cells fuel their activity and rapid reproduction by developing some 10 times the number of insulin receptors as normal cells to capture all the glucose they can, fermenting it without oxygen to produce a little energy and tons of lactic acid, further acidifying the anaerobic environment in which they thrive.  My insulin levels are always low, and my metabolism has been running on fat in a highly oxygenated alkaline environment for a decade.

It’s not primarily because carbs and insulin promote atherosclerosis, heart disease and stroke by triggering hundreds of inflammatory pathways that compound into chronic inflammation and damage to the blood vessels, which then leads to plaque formation and accumulation, restriction of blood flow, and eventually to heart attack and stroke: my sedimentation rate, interleukin-6, C-reactive protein, and Apolipoprotein-A are all very low.

It’s not primarily because carbs and insulin promote the deterioration of the brain, dementia, and Alzheimer’s, both through the damage to blood vessels around and in the brain itself, and insulin resistance of brain cells, which together lead to restricted blood flow, energy and nutrient deficiency, and accumulation of damaging reactive oxygen species and toxins in the cells, and, unsurprisingly, eventually to dysfunction that just grows in time: because my metabolism runs on fat, this means that my brain runs on ketones, and is therefore free of excessive insulin or glucose exposure.

It isn’t primarily for any of these reasons, which, I believe, are each sufficient to motivate avoiding sugars and starches in order to keep tissue exposure to glucose and insulin as low as possible.

 

My main reason is that, at the cellular level, in its action on the nucleus and on gene expression, insulin is the primary regulator of the rate of ageing.

Insulin is essential for life: without insulin, cells starve and die. It is essential for growth: without insulin cells don’t reproduce, and there can be no growth.  This is why at that most fundamental level, insulin regulate growth in immature individuals.  But in mature individuals, once we have stopped growing, insulin is the primary regulator of the rate of ageing, both in terms of its effect in suppressing the production of antioxidants and cleansing and repair mechanisms within the cell, but also in stimulating cellular reproduction. And the more reproduction cycles, the greater accumulation of DNA transcription defects, the faster the shortening of telomeres, and the faster the ageing.

This is a fundamental fact that appears to be true for all living organisms.  It is as true for yeasts and worms, as it is for mice and rats, as it is for dogs and humans.  And the rate of ageing is the rate of degeneration, of growing dysfunction, of more damage and less repair, of lower metabolic efficiency and less energy, of increased cell death and senescence.  I personally wish to be as healthy, energetic, strong, and sharp as possible for as long as possible.  This is why I avoid sugars and starches.  This is why I restrict insulin-stimulating carbohydrates.

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Want to lose weight? Here’s what you need to know in under 1000 words

One, you don’t want to lose weight: you want to lose fat. You don’t want to lose muscle or bone because they are very important functionally and metabolically. What you want to lose is fat. So weight loss needs to be reworded as fat loss.

Two, roughly speaking, the body is generally either storing surpluses or using reserves.

Three, the major fuels for the body are glucose and fatty acids.

Four, for the body to use fat reserves, insulin levels must be low. Fat cannot be efficiently utilized as long as insulin is high, because insulin promotes storage.

Five, the thyroid gland regulates metabolism and brain function. It requires adequate amounts of iodine without which it cannot work properly. To ensure healthy metabolic function, iodine supplementation is critical.

That’s what you need to know. If you want more details, I can expand a bit.

Insulin regulates fat storage

Every second that we are alive, trillions of biochemical reactions take place. The energy currency is adenosine triphosphate, ATP. Mitochondria produce ATP primarily using glucose or fatty acids. Fatty acids produces a lot more, but glucose is much easier to use. Both are used but one always dominates. In general, if there is glucose to be used, fatty acids are not much. For fat loss, we want to promote fat burning for ATP production to fuel cellular activity.

High glucose levels from carbohydrate intake trigger insulin secretion. This is necessary to bring the glucose into the cell, and to get rid of it from the bloodstream where it causes damage to the tissues by glycation. Within the cell, glucose can be either fermented without oxygen or oxidised with oxygen. Lower oxygen levels (and very high short term metabolic needs) promote fermentation. Higher oxygen levels (and lower metabolic ATP production rates) favour oxidation. More fermentation leads to greater accumulation of lactic acid, which further decreases oxygen levels. Red blood cells do not have mitochondria and therefore can only produce ATP by fermenting glucose.

Lower glucose leads to lower insulin. This triggers the release of fatty acids and glycogen into the bloodstream. If sustained, low glucose leads to the production in the liver of ketones primarily to fuel the brain whose cells can either use glucose, ketones, or medium chain fatty acids because longer molecules cannot pass the blood-brain barrier.

The higher the glucose, the higher the insulin, and the faster the uptake and storage of nutrients from the bloodstream into cells. The lower the glucose, the lower the insulin, and the faster the stored fat can be released and used.

insulinFatStorageFatRelease

Amount of glucose stored as fat and amount of fat released from fat cells as a function of insulin concentration. Plot taken from https://optimisingnutrition.com

The most metabolically active tissue is muscle. The more muscle we have, the more energy is used, and the faster both glucose and fat are burned to supply fuel to the cells. The more we use our muscles, and the more intensely we use them, the more they grow, and the more efficiently they burn both glucose and fat. Also, the stronger the muscles, the stronger and denser the bones will be. This is very important.

Therefore, as we burn more fat, we burn fat more efficiently. As we use our muscles more intensely, we burn more fat. And as we build more and stronger muscle, we burn even more fat even more efficiently, and make the bones stronger.

Different Carbohydrate Intolerance Levels

These mechanisms are universal in animals, but each animal is different, and each person is different. As far as fat loss is concerned, the individuality of people is related to their predispositions to insulin resistance and carbohydrate tolerance, (or actually, intolerance). Every person is differently intolerant to carbohydrates and differently predisposed to insulin resistance.

This is why in a group eating the same diet, there are people who are thin, people who are chubby, people who are fat, and everything in between. Basically, the greater the predisposition to insulin resistance (and the more sedentary), the lower the tolerance to carbohydrates will be, and the fatter you will tend to get. In contrast, the lower the predisposition to insulin resistance (and the more active), the higher the tolerance to carbohydrates, and the thinner you will tend to be.

This translates into different thresholds in the amount of carbohydrate we can eat without negative metabolic consequences, and consequently, the amount under which we must stay in order to burn fat instead of storing it. As a guideline, if you want to burn primarily fat for your body’s energy needs, this threshold would be around 20–25 grams per day if you are fat; around 30–50 gram per day if you are neither fat nor thin, and could be around 80–100 grams per day if you are very thin.

But no matter what your personal threshold happens to be, it will always be the case that the lower the intake of carbohydrates, the lower the glucose and insulin will be, and the more efficiently your body will burn fat as fuel.

Fat Loss Rate

The amount of fat that is burned is determined by the energy balance. The greater the total amount of energy we use, the greater the total energy needs. Total energy needs will mostly be met by energy from food intake and energy from fat reserves. If food energy intake is high, the need for stored energy will be low. If intake is lower, the need for energy from fat reserves will be higher.

Pushing this to the limit—maximal usage of fat stores—we would provide the protein necessary to maintain muscle and other active tissues and nothing more. In this situation, basically all energy needs would be supplied by stored fat reserves and glycogen when needed. This is greatly enhanced by resistance training.

The amount of protein needed is proportional to muscle mass and muscular activity. As a guideline, you can use 1–1.5 grams per kg of lean mass per day in the case of little physical activity, and 2–3 g/kg/d in the case of high muscular activity levels. Excessive protein is not great, but more is almost always better than less.

Fat burning and protein synthesis can be further optimised by intermittent fasting. Extending the time between feedings allows glucose and insulin to drop lower, which increases the rate of fat burning. And by eating fewer but larger amounts of protein in a meal is better because protein synthesis increases in proportion to the amount consumed.

Thyroid function regulates metabolism. Iodine is used in every cell, but in the thyroid, it is concentrated to more than 100 times the average of other tissues, because iodine is the main structural component of thyroid hormones. Iodine supplementation is critical because most soils are highly depleted. It is water soluble and very safe to supplement with.

Summary

  • High insulin from carbohydrate intake promotes fat storage.
  • Low insulin from restricting carbohydrates promotes fat loss.
  • Individual predispositions determine the threshold of carbohydrate tolerance.
  • Below this threshold fat is used as the main source of cellular fuel.
  • The rate of fat loss depends on balance between energy needs and energy intake.
  • Maximal fat loss rates are achieved by supplying just the protein needed to sustain lean tissues.
  • Iodine supplementation is critical to healthy thyroid, metabolic and brain function.

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You have cancer, and there’s lots you can do

Everybody knows that cancer rates are rising everywhere and every year. Everybody also knows that the words, “You have cancer. I am sorry.”, fall upon us like a death sentence. Everybody knows this, because we see it all around us, everywhere we look, and we hear about it every day, everywhere we turn.

If a doctor has, indeed, said these words to us, then we are probably scared, probably very scared. We know that basically everyone we have ever heard of who were diagnosed with cancer, died. Sometimes they died really quickly, like, within a few weeks. Sometimes they died within a few months. Sometimes it wasn’t so quick. Maybe it took a year of two, or three, or even five. They went through rounds of chemo. They were on sick leave at home for months on end. They sometimes appeared to recover at some point, maybe a bit, for a little while, but in the end, they died. And they died of cancer.

We also know that not even the most famous and richest people, like Steve Jobs, for example, can escape this kiss of death that the diagnosis of cancer delivers. Wealth and power are irrelevant when it comes to our prognosis as cancer patients: it is always bad. Of course, how bad it is depends on the kind of cancer, but why is it that so many different people, in so many different places, die of cancer every day?

I won’t venture into formulating an answer to this question, and I won’t dwell on cancer survival statistics. I don’t think it’s useful for us right now. I want to hurry and move to the good news. And the good news is that there many things you can do to help your body rid itself of cancer, which is usually the result of a long-standing disease process that has evolved over a lifetime, and has finally manifested itself in this way. This presentation of the question at hand is definitely not exhaustive, nor attempting to be. But this is what I consider to be some of the essential elements.

whitebloodcellsattackingcancercells

White blood cells (shown in blue) attacking cancer cells (shown in red).

 

Understanding cancer

To understand cancer, we have to understand the origin of cancer cells. Cells become cancerous due to a defect in energy production, a mitochondrial dysfunction, an inability to manufacture enough ATP (adenosine triphosphate) through oxidation of glucose or fatty acids to sustain the cell’s functions. This forces the cell to fall back on anaerobic (without oxygen) fermentation of glucose to supplement the deficient energy production from the dysfunctional or reduced number of mitochondria. Fermentation produces an increase in lactic acid in and around the cell. This decreases the availability of oxygen to the mitochondria, which further impedes their ability to produce ATP through oxidation of nutrients, and creates a negative feedback loop that pushes towards further mitochondrial stress and dysfunction, less oxidation, more fermentation, more acid, and less available oxygen.

Because energy production through fermentation is so very inefficient, the cell needs far more glucose, and naturally develops more insulin receptors in order to be ever more sensitive to, and able to capture circulating glucose more effectively. Cancer cells often have 10 times more insulin receptors than healthy cells. What should be clear is that it doesn’t matter where the cancer is, and it doesn’t matter how it evolved, whether it was due to a gradual evolution from an environment too high in glucose, lacking in oxygen, and saturated with acid, or whether it was due to exposure to a toxin or mitochondrial poison, of which there are many and increasingly more in our environment. In the final analysis, this is how cancer cells become how they are, and this is how they survive.

As to their multiplication and proliferation from a single or small group of microscopic cells to large macroscopic tumours in one spot or all over the place, this can be understood by considering that the cell that is devolving from its normal function to that of cell whose only function is to ferment glucose at the fastest possible rate, loses, little by little, the ability to do whatever it was doing before, by losing the ability to produce ATP that can be used by its different specialised parts and constituents to perform their specialised functions, the cell becomes less and less specialised, less and less differentiated and therefore more and more general and more and more primitive, to the point where the essential ability of the cell to destroy itself, when something in its workings has gone wrong, is lost. Having lost this safeguard, the primitive, the undifferentiated, but also necessarily abnormal and weakened cell, just ferments and multiplies, limited only by its ability to fuel itself and sustain this most basic activity of survival without other purpose but this survival in and of itself.

Removing cancer

Having recognised and understood this, the strategy by which we can help the body rid itself of the cancer cells, and regain its healthy physiological functions becomes clear. We have to 1) do all we can to cut off the source of fuel to the cancer cells, 2) clear out the accumulated acids and transform the acidic environment into one that is alkaline and oxygen-rich, 3) help restore the cells’ mechanism of apoptosis—their ability to self-destruct, and 4) do everything else we can to further weaken and destroy cancer cells by means that simultaneously strengthen healthy cells. It’s a simple strategy that is also simple to put into practice, as we will see in a moment.

1) Starve the cancer cells

The first point is to cut off the fuel to the cancer cells. The source of fuel is glucose, because cancer cells can only ferment and cannot oxidise, and the way the glucose is supplied to the cell is by the action of insulin that moves it across the cell membrane. Therefore, what has to be done to is minimise the availability of glucose, and, more important still, minimise the availability of insulin to shuttle the glucose into the cells. The lower the glucose, the less potential fuel there will be. The lower the insulin, the less glucose will actually be able to enter cells. There is no real lower limit. Without ingesting any carbohydrates, the body maintains and regulates blood sugar according to the stress levels and kinds of activities we engage in, independently of how low insulin levels are. And so, the focus should be to have the lowest possible insulin levels naturally.

The fastest way to lower blood sugar, but especially insulin, is to fast, to stop eating altogether, and just drink water and herbal tea, remembering to eat enough salt to match the water intake. The second best way of doing this is in form very similar, but turns out to be much easier to do, is also a kind of water fasting, but with the addition of fat from coconut oil and butter, melted in the herbal teas. Both of these forms of fasting will most effectively deprive the body of anything that can easily be made into glucose, and of anything that will stimulate the secretion of insulin, thereby will allow glucose to drop as low as possible, but more importantly, insulin to drop and stay at an absolute minimum, and therefore most effectively starving cancer cells, no matter where they are in the body and bodily fluids, in the tissues and organs. The first form of the classic water fast is harder, but many people do it without hesitation nor difficulty. The second form is much easier, and may even be more effective in inducing a deep state of ketosis given the additional intake of medium chain fatty acids.

We can easily imagine doing such a fat “fast” for days, or even weeks, depending on the severity of the situation, our resolve to suffocate and starve the cancer cells as quickly as possible, and, of course, the state and circumstances in which we find ourselves. In addition, we can do this as much as possible on any given day, independently of what else we eat. The more fat and the less carbohydrate we ingest, the lower the insulin and the more effective the anti-cancer healing protocol will be.

The third option is to eat and drink to keep insulin levels as low as possible. Here again, because fat is the macronutrient that stimulates the least secretion of insulin, truly minimal, it should be the main source of calories. Simple carbohydrates and starches are most insulinogenic, and protein is about half as insulinogenic as are carbs. Indigestible fibre does not stimulate insulin. Therefore, in the extreme, we would eat only fat, pure fat. The best ones being the most natural and least processed, most saturated and least unsaturated: coconut fat, butter, animal fat and, the best of the vegetable oils, cold pressed olive oil.

It’s important to understand the difference between having low blood sugar, and having low insulin levels. The first is like the amount of food in the kitchens of the restaurant, the second is like the waiter bringing it to the table. It is far, far more important in our efforts to stop the supply to cancer cells that we keep insulin levels as low as possible, than it is to try to keep glucose levels low. And to push the point further, it doesn’t really matter what the amount of glucose actually is, because as long as insulin is low, it will not be brought into the cell, into the cancer cells. The reason I emphasise this is because lack of sleep, emotional or psychological stress, intense physical exercise will all raise blood sugar levels temporarily, in some instances, to high levels. But as long as insulin is as low as it can be, the sugar will not be readily transported into the cells.

Naturally, we cannot have zero insulin, because we would die: our cells would literally starve to death, no matter how much we ate. Babies with a genetic defect that makes their pancreas not able to produce insulin always died of emancipation before the discovery and subsequent commercialisation of insulin as medicine. Similarly, if at any point in a child’s or adult person’s life, insulin stops being produced, incredible weakness and emancipation will follow, before it is tested and identified as the cause of their problem, hopefully in time before permanent damage ensues. Therefore, there is always some insulin in circulation, and therefore, sugar will eventually make its way into at least some cancer cells. This is why it is important to keep it as low as we possibly can naturally, and this is how we can appreciate the essential difference between the effects of high glucose and high insulin.

In a less extreme form than the fat-fast, we maintain low sugar and low insulin by getting and deriving most of our energy from fat. Eating cucumber or celery with almond butter or tahini, for example, or a green leafy salad with lots of olive oil, walnuts, and avocado, provides basically all calories from the fat, given that cucumber, celery and lettuce greens, are basically just water and indigestible fibre, while almond butter and tahini are 80\% fat by calories, and walnuts are 84\%. So is coconut milk, for example, at nearly 90\%, and dark 85\% chocolate, at 84\% fat based on calories. Focusing on feeding the body with these kinds of healthful, high-fat foods, will nourish, stimulate healing, and keep insulin and glucose levels as low as we can without either water fasting, or consuming only fat.

2) Alkalise to remove and excrete accumulated acids

The second point is just as important as the first, because it is the environment in which the cells live that actually has the most direct effect on their function. We have looked at the importance of achieving and maintaining an alkaline environment in the body in several other places. The essence is excellent hydration with alkaline water (pH>8) combined with the intake of proportional amounts of unrefined salt to promote the release of acids from the tissues, and its excretion through the urine by the kidneys. Without proper hydration, the cells will retain the acid with the little water they have to hold on to. Without proper amounts of salt, the kidneys will also retain the acid in order to maintain the concentration gradient that allows the nephron to function when it re-absorbs water.

Naturally, alkaline water will work infinitely more effectively. But the most important detail is the controlled balance between water and salt intake, and what we want is a lot of water and a lot of salt. We cannot take in large amounts of salt water without getting loose stools. So, it has to be smoothly distributed throughout the day, except in the morning, when we get up, because we are dehydrated, and need to drink about 1 litre of water over the course of one to two hours, before we start taking salt.

If you buy mineral or spring water, find the one that has the highest pH value. It should be greater than at least 8. If you have a water filter at home, then add alkalising drops to it before drinking it. I use Dr. Young’s PuripHy drops.

As acidity decreases, and the environment becomes more alkaline, oxygen will flow more freely, and become more available to mitochondria for oxidising fatty acids in producing energy. Remember that cancer cells do not use oxygen, and cannot use fatty acids to fuel themselves, whereas normal, healthy cells, not only can, but function much more efficiently on fat rather than glucose as their primary fuel. Adding chlorophyll and fresh juice of green vegetables to the alkaline water is an excellent way to further boost alkalisation, neutralisation, and elimination of accumulated metabolic acids. Unlike the first step, which is to lower insulin and glucose levels, and that can be done, to a great extent, literally overnight under fasting conditions, alkalising to eliminate accumulated acids is something that takes time. But in both cases, what matters most is consistency. Hour by hour, and day after day, the body will do what it needs to do as best is can, and improve in these functions with time.

Beyond this fundamental necessity to hydrate with alkaline water throughout the day, and day after day, the most therapeutic way to alkalise the tissues, and detoxify the body, is by taking medicinal baths in which we add two cups of sodium bicarbonate (baking soda), and two cups of magnesium chloride (nigari), or magnesium sulphate (epsom salts), if nigari is not available. This is easy, relaxing, extremely medicinal, and very effective in neutralising and eliminating acids and toxins from the body. In fighting cancer, you should be soaking in this kind of hot bath for 45-60 minutes three times per week. The benefits of this ultra simple trans-dermal therapy with sodium bicarbonate and magnesium are incredible. You can read a lot more about this from the baking soda, magnesium and iodine doctor, Dr Sircus.

3) Restore cellular self-destruct function

The third line of action is also essential, and it only requires you to take a few key supplements. The most important of these in the fight agains cancer is iodine, because of its fundamental role both in the structure and architecture of cells, but also in the regulation of apoptosis, the process by which a damaged cell will self-destruct when things have gone wrong somewhere. The importance of iodine cannot be overemphasised. And in healing cancer, or any serious disease condition, we will want to take high doses daily. Doses of at least 50 mg, but preferably 100 mg.

However, because of its very strong detoxification effects, as it pushes out all accumulated toxic halogens out of the cells to replace these by iodine in its proper place, we must work up to these high doses gradually, starting with 12.5 mg, and increasing the dosage as quickly as possible given the body’s response to it. Some people , maybe most, will experience headaches and possible nausea when starting on iodine. This is perfectly normal. The stronger the reaction, the more indicative of the body’s level of toxicity. Therefore, you should always view this as something good, in that toxins are being excreted out of your cells. It is important to support the detoxification process by taking chlorella and spirulina, probiotics and psyllium husks every day as well, while always drinking a lot of alkaline water with added chlorophyll for extra cleansing, if possible.

What I take and consider to be the best supplement is Iodoral by Optimox. Optimox recommends taking the iodine on an empty stomach for faster absorption, but it can also be taken with food for slower and possibly better assimilation. In addition, although iodine can easily be taken on an empty stomach, the co-factors, which include B vitamins, are much better taken with food to avoid potential nausea or queasiness. Moreover, taking it with food will slow down the absorption, and thereby decrease the negative sensations from the detoxification effects. The only thing is that iodine, given its stimulation of thyroid function, will energise the body. Therefore, it should be taken before midday. I take it either first thing in the morning or at lunch (or both).

You can read about the importance and functions of iodine in the following three books: Iodine, Why You Need It, Why You Can’t Live Without It by Dr. Brownstein; What Doctors Fail to Tell You About Iodine and Your Thyroid by Dr. Thompson; and The iodine crisis: what you don’t know about iodine can wreck your life by L. Farrow. There are also many web resources and highly informative forums about iodine and cancer. You can search for the words iodine and cancer to see for yourself.

Other fundamentally important micronutrients are vitamins B12 and D, both of which are needed for proper cellular function, and DNA transcription and replication, because of their roles in the nucleus of cells, activating and de-activating, switching on and off genes, to ensure everything in the cell works as it should. For best and fastest results—and that’s definitely what we need in our fighting cancer—B12 should be injected weekly in the amount of 1 mg, and in the form of methylcobalamin. (For optimal health in normal circumstances, it can be injected once a month in the amount of 5 mg.) Vitamin D should be taken with its sister vitamins, A and K2, for synergistic effects and biochemical balance in their functions. Each of these have complimentary roles, and should generally be taken together, unless there is a reason not to. You can read these two articles published by Chris Masterjohn from the Weston A. Price Foundation to learn why and how: On the trail of the elusive X-factor: a sixty two year old mystery finally solved, and Update on vitamins A and D.

It is by supporting proper cellular function, especially in the nucleus, with iodine, B12 and D, that cells will regain, little by little, the ability to recognise that they are damaged and need to self-destruct. There will always be millions or even billions of cells involved in the disease process we call cancer, but they will be distributed along a wide spectrum of dysfunction, from having very mildly impaired mitochondrial function from a light oxygen deficit cause by a little too much acid in the environment surrounding the cell, to full cancer cells that derive 100% of their energy needs from anaerobic fermentation without using any oxygen at all, and thriving in extremely acidic conditions.

Hence, many cells will die from being starved of glucose, because that’s the only fuel they can use; many cells will recover enough of their normal regulatory mechanisms to know its time to self-destruct; and many cells will actually regain their healthy function, repair their damaged parts, and replace their dysfunctional mitochondria with new ones. Nothing is ever black and white when it comes to cells and cellular function. Instead, everything is grey. But it is a million different shades of grey.

4) Do everything else that can help

The fact is that there are many, many more things you can do. Many therapies, many treatments, many supplements and herbal formulas, that have all proved highly effective against cancer. There are so many that many books have been written about them: About Raymond Rife, you can read The Cancer Cure That Worked by Barry Lynes; about Gaston Naessens, you can read The Persecution and Trial of Gaston Naessens: The True Story of the Efforts to Suppress an Alternative Treatment for Cancer, AIDS, and Other Immunologically Based Diseases by Christopher Bird; about Rene Caisse and the Essiac tonic, you can read Essiac: The Secrets of Rene Caisse’s Herbal Pharmacy; about Johanna Budwig, you can read Cancer – The Problem and the Solution; and the list goes on. There are websites devoted to these people and their approach to cancer, and this is just a few of them that I know about. One book that compiles a lot, maybe most, of the information on non-toxic treatments for cancer, is Ty Bollinger’s Cancer: Step Outside the Box.

Maybe you find it hard to believe that our governmental and medical authorities would have gone—and continue to this day—to go through such extreme measures in order to suppress treatments that work so effectively to help and heal people of their illnesses and of cancer, without negative side effects, and at very low costs. But this is a simple fact. And it is quite easy to understand if we consider that anyone, or any institution, that has commercial investments and interests in a particular endeavour, will go to great lengths to maintain and strengthen, as much as they can and for as long as they can, the conditions that make them successful. There’s nothing more to it than that. Let’s look at a few of those therapies and supplements which are easy to implement, and highly effective against cancer: hyperthermia, flax seed oil, enzymes, and turmeric.

Hyperthermia, or heat therapy, is a very well studied and effective therapy against cancer, both preventatively and curatively. The idea or principle is very simple: healthy cells can withstand high temperatures without damage. The reason why this is so, and why we know it for sure, is that the body produces fevers as a defence mechanism to destroy invading viruses and bacteria that, unlike our own cells, cannot withstand the heat. Similarly, cancer, and other compromised and damaged cells, are unable to cope with high heat. Hence, it was hypothesised, tested, verified and demonstrated that hyperthermia is really very effective at destroying cancer, while simultaneously cleansing and strengthening healthy cells and tissues. Infrared saunas are ideal in heating the tissues more deeply, but any sauna, steam room, or even bath that induces hyperthermia by raising the temperature in the body, will help kill cancer cells, cleanse, and restore health.

Enzyme therapy has also been used for many decades in the treatment of cancer patients extremely successfully. The late Nicolas Gonzalez who passed away last year, was its most recent champion, following in the footsteps of his mentor, Dr William Kelley. The treatment protocols are more complicated, and are always highly individualised, but the main element is the supplementation with large doses of enzymes, combined with the colon cleansing to eliminate the dead tumour tissues from the body. Large quantities of fresh vegetable juice are also often included in his recommendations. You can read about it here: http://www.dr-gonzalez.com/index.htm, but whether you decide to throw yourself completely into it or not, I strongly recommend taking proteolytic enzymes three times per day, always on an empty stomach at least 30 minutes before eating, and support cleansing by taking a colon cleanser before going to bed. This site, http://www.losethebackpain.com, has good quality enzymes and cleansing supplements that we’ve used, but you can also do your own research.

Flax seed oil, organic and cold pressed, combined with fresh organic quark or cottage cheese is, based on Johanna Budwig’s extensive, lifelong research, as well as practical clinical experience with patients, is another one of the most effective and simple cancer treatments. And although the biochemistry of it, and biochemical pathways through which the cancer is weakened and destroyed may be complicated, the implementation is very easy and simple, costs very little, and cannot in any way bring about harm, unless one is severely allergic to milk proteins (in which case the dairy can be replaced with another source of protein that will work as the carrier). Here is a good article that has links to other excellent articles about this: https://www.cancertutor.com/make_budwig/

Turmeric, an ancient, bright yellow, Indian spice, which is a powder made from drying the ginger-like root that is turmeric, is one of the most researched natural substances in modern times, and is surely one of the most powerful natural anti-cancer supplements. Since it has tons of wide-ranging health benefits, and carries no risks at all, it’s clear that everyone can benefit from it. You can read about it from Mercola here. You should take it three times per day, but with your meals, because the more fat there is in the gut, the better the absorption will be, as is true for most antioxidants, vitamins, and minerals.

I feel it is important to emphasise the point just made about the risk-free nature of supplementing with turmeric, because it is a crucial point that applies to everything we have discussed here, and everything we have discussed in all the natural healing protocols and nutritional approaches we have presented in the past. Food-based nutritional healing is, in general, risk-free, because it doesn’t involve ingestion of or exposure to toxic substances, and instead involves correcting deficiencies, boosting nutritional status, and optimising the biochemical and hormonal environment of the body in order to promote healing.

Of course, we can object by referring to examples of people dying from drinking too much water too quickly. But we are not talking about such extremes. Nonetheless, we could, for example, eat coconut oil or butter all day, and other than the possible nausea from taking in so much fat, you wouldn’t get anything more than loose stools. Moreover, the body’s own hormonal responses would naturally prevent overconsumption through a feeling of extreme satiety that would basically make it impossible to willingly eat more.

Another example is that of using baking soda or iodine. So simple, and yet so powerful, they stand as the perfect examples of the benign nature but extreme effectiveness of natural healing. We find written in the most recent edition of the Manual for the Medical Management of Radiological Casualties of the US Military Medical Operations, Armed Forces Radiobiology Research Institute, that sodium bicarbonate will “prevent deposition of uranium carbonate complexes in the renal tubules”, and that we should, “within 4 hours of exposure, administer potassium iodide (KI) to block uptake of radioactive iodine by the thyroid”, because they are the best known ways to protect the kidneys and thyroid from being destroyed by the radioactive elements that would—without the use of sodium bicarbonate and potassium iodide—migrate to these organs and destroy them.

But why wait for a chemical spill or a nuclear power station meltdown in order to rid the body of accumulated chemicals and toxins, and to replenish every cell with a plentiful supply of iodine to ensure that all cells and all glands function at their best, now and every day? We don’t have to wait. The same goes for turmeric, for enzymes, for B12, for A-D-K2, for hydration, for alkalisation, for minimal glucose and minimal insulin loads, for maximum nutrition and maximum health. Why don’t we start doing this preventatively right now?

Summary and Wrap up

Maybe you know all of this stuff already, or maybe you don’t and you are blown away and overwhelmed by the amount of information and range of topics we have covered. Maybe you are reading this because you are interested and curious to learn and be as well-informed as you can about health topics, or maybe you are desperately looking for relevant information that can help you or a loved one. No matter in which camp you find yourself, here is the summary and wrap up I can offer to bring all of what we have discussed down to a simple set of recommendations that anyone faced with a diagnosis of cancer, and fearful of, or skeptical about, or doubtful that the current standard of care in the cancer industry will help them, can understand and follow, knowing that none of these food choices, supplements, and therapies will bring them harm in any way, and that all will only do good, regardless how dire or hopeless their situation may appear to be.

  • Keep low insulin levels, as low as possible, by not having insulin-stimulating carbohydrates, and by keeping protein intake reasonably low. Focus on consuming natural, unprocessed fats as much as possible to supply the largest proportion of your daily calories. Consider a water or a tea-with-fat fast for a few days when it is suitable, or even as an intermittent fasting strategy on a daily basis. Consider also doing a green juice “fast” (only green vegetables) with added fat from blending in melted coconut oil or milk.
  • Drink alkaline water, always on an empty stomach, considering the day as divided between hydration periods, and feeding and digestion periods. The first hydration period is from the time you get up until you have your first meal. It is good to extend that period if you can to allow plenty of time for proper hydration after a long night of dehydration, with at least 1 to 1.5 litres over a period of at least 2 hours. Drink slowly to improve absorption and not pee everything out. Always allow 30 minutes without drinking before meals, and 2-3 hours after meals, depending on their size. The cycles of hydration and feeding during the day (for 3 meals) should be as follows: drink, wait, eat, wait, drink, wait, eat, wait, drink, wait, eat. For only two meals, which I recommend, then periods of drinking are extended and allow for even better hydration, cleaning of the blood, and better digestion.
  • Take iodine supplements with the co-factors and with food to maximise absorption and effectiveness. Start with 12.5 mg per day, and work your way up to 100 mg. Do this as quickly as your body allows you to. Take the iodine every weekday, and stop on weekends; five days on, two days off. (My wife and I take 50 mg per day.)
  • Take hot baths with sodium bicarbonate and magnesium chloride (or sulphate; 2 cups of each). Soak for 40 to 60 minutes. Do this three times per week. Always take your baths on an empty stomach, and drink at least one litre of alkaline water during the length of the bath. (Once per week is what I aim for as preventative medicine.)
  • Get B12 injections of methylcobalamin, 1 mg on a weekly basis. (My wife and I get a 5 mg injection once per month.)
  • Take proteolytic enzymes and Essiac tonic three times per day, always on an empty stomach, always at least 30 minutes before meals. (We take it once, first thing in the morning.)
  • Take turmeric and turmeric extract, as well as A-D-K2 with every meal or fatty snack, three times per day during recovery. (Once daily in normal circumstances.)
  • Take infrared or regular saunas, every day if possible, or even in the morning and at night if you have or decide to buy your own little sauna. I would definitely do this given how effective hyperthermia is at destroying cancer cells.
  • Eat Budwig cream.
  • Eat and drink greens.
  • Spend time outdoors, as much time as you can, moving, breathing fresh air, exposing your skin to the sunlight.
  • Keep low stress levels, as low as possible. Take tulsi, ashwagandha, and HTP-5 to keep stress hormone levels low, and mood high.
  • Take probiotics, chlorella and spirulina in the morning, and a colon cleansing supplement before bed.
  • Sleep well, long restful nights. Melatonin is very useful for this, and has many additional health benefits.

Cancer is very easy to prevent, but somewhat harder to dislodge once it has taken hold somewhere within the body. But no matter what type of cancer, how localised or generalised it is, or at what stage it finds itself, there is always hope. Hope of getting better and more comfortable, and hope for a complete recovery.

We have to remember that cancer cells are degenerate and weak. By making the environment as health-promoting to normally functioning cells, and simultaneously as hostile as possible to cancer cells, they will perish and be cleared out from the body as the waste that they are. The body heals itself, often miraculously quickly, when impediments are removed, and the elements needed for healing are provided. With all my heart, I hope this can help you and your loved ones.

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Keto-adaptation for optimal physical performance

A young man I know recently started to play rugby at a higher level, and thus more seriously than he ever has in the past. Being a smart guy, he wants to get his nutrition “on point”, as he writes, in order to perform at his best. He started reading about nutrition on the internet, and found it to be like “a snake oil convention”, which it most certainly is. So, he contacted me to get my opinion on the subject. I’ve been meaning to start writing about training and performance for a while, and balance out all my writings about disease and overcoming disease conditions, and so I thought this would be the perfect opportunity to start.

The first thing that needs to be said is that there are common aspects as well as differences in the way training and nutrition should be optimised for different disciplines and goals. In common to all disciplines, are that we always want to perform at our best, and recover as fast as possible. Those are the basic and most fundamental drivers.

Differences are much greater in number and far wider ranging in kind, but they can include core aspects like the duration of the event: speed and power versus endurance and stamina (think of the 100 meter dash versus the marathon, or the velodrome cyclist versus the Tour de France rider); the kind of effort required: sustained versus bursty (think of rowing versus tennis); the medium and nature of the forces against which we are working: water or air, with an intervening machine or without (think of swimming versus jumping towards the rim to slam dunk the basketball, skying versus bobsledding, wrestling or judo versus Formula 1 racing).

In every case, there are preferred and optimal skills and trained reactions, fitness and body composition, as well as morphology and muscular development. For now, let’s just look at the basics in the sense of what every athlete would want and would benefit from no matter what kind of activity they do: best performance and fastest recovery.

The most fundamental point is mitochondrial energy production

At the root of all activity of the body, and at all levels, is the generation of ATP by mitochondria. This is really the bottom line for everything, because this is what cells use to function and do what is required of them in every instant. Mitochondria, small organelles thought to have migrated into a cellular membrane early in the history of evolution of life on the planet, are present in every cell in different amounts, and are essential for life. They can oxidise or burn any macronutrient—glucose, amino acids, or fat—to produce ATP, but the bulk is derived either from glucose or fat. In the process, they produce byproducts of different kinds and in different amounts based on the nature of macronutrient used for fuel, and on the energy demands. Therefore, for optimal performance with a fixed number of mitochondria, we want:

  1. the maximum efficiency in ATP energy production, and
  2. the minimum amount of metabolically taxing byproducts.

These question of deriving the most amount of ATP in the most efficient way with the least amount of byproducts that ultimately impede physiological function, has been considered in On the origin of cancer cells (1 and 2)To summarise in very few words: fatty acids are the most efficient way to store energy, on a gram-per-gram basis they produce the most ATP when oxidised by the mitochondria in an oxygen-rich environment, and their oxidation result in the least amount of acidic and physiologically costly byproducts. Therefore, the inevitable and obvious conclusion, is that for optimal physical performance, we want maximum metabolic efficiency, and for maximum metabolic efficiency, we need to provide the conditions that allow our cells to use fatty acids as their primary source of fuel.

The key is efficient fat utilisation

Efficient fat utilisation is achieved in three stages, which are really just two, because the second and third blend into one another seamlessly. The first step is making sure cells can use fat as fuel. Because insulin signals cells to store energy, it prevents fat utilisation (lipolysis). Inhibiting lipolysis is one of insulin’s main functions. To allow cells to burn fat, insulin must be low. To lower insulin levels, we must either fast, or restrict carbohydrates (and to a lesser extent protein). In fasting conditions, most people will reach insulin levels low enough to start fat-burning after 12 to 16 hours. With severe carbohydrate and protein restriction, that means getting all or almost all of your calories from fat, the timescale is probably similar.This first step is therefore achieved within 24 to 48 hours.

The second step is basic adaptation to deriving cellular energy needs from fatty acids, those that we eat, and those that are stored within the body’s fat cells (adipocytes). This is achieved over the course of about 4 weeks by maintaining a very low carbohydrate, low to moderate protein, and high fat diet.

The third and last step is full keto-adaptation, achieved within two to four months of consistent carbohydrate restriction. The word keto in the term keto-adaptation refers to the fact that, from the breakdown of fats, the liver manufactures ketones, the one we measure as a marker is usually beta-hydroxybutyrate, used primarily to fuel brain cells that can only use glucose and ketones. This stands in contrast to most other cells that can use fatty acids directly. An exception to this—the only one, as far as I know—are red blood cells that can only use glucose.

A point that needs to be appreciated relates to the potency of insulin to stop fat-burning. As soon as glucose spikes, insulin will spike, and will stop fat-burning. This is particularly important if we are aiming to burn as much fat as possible or become as efficient fat-burners as possible. Consequently, the very worst thing we can do is to have sugar in the morning, just before or just after training. Even a small piece of fruit will do it. This will generally always stop fat burning in its tracks. And not just for a few minutes, but for hours, all the hours necessary for insulin levels to drop back down low enough to allow lipolysis to start again.

Maximally efficient fat utilisation is where an athlete wants to be, because this will ensure that they always use as much fat and as little glucose as possible, maximising endurance potential while minimising production and accumulation of lactic acid in the muscles. The most important benefits this brings are to be able to sustain long hours of exercise without “hitting a wall” from the exhaustion of glycogen stores, and having muscle fibres that can function smoothly unimpeded by the presence of large amounts of lactic acid, something which also significantly accelerates recovery, as very little time is needed to clear out the small amounts that remain in the muscle after the event or training session.

Fat stores are, for practical purposes, inexhaustible. Even in very lean athletes (below 10% body fat), there will be between 5 and 10 kg of fat reserves to draw on during that ironman, that ultra-marathon, or that mountain-bike-around-the-clock event. Each gram of these 5-10 kg provides 9 kcal of fuel. And so, that endurance event lasting 12 hours during which you burn 7500 kcal could be fuelled with just 830 g of body fat. Naturally, this would not happen, because glycogen from the liver and the muscles will always be used in greater or lesser amounts depending on the level of stress (physiological and psychological), and intensity of the exercise. Nonetheless, this is a good illustration of the massive reservoir of fuel we have at our disposal if we train the body to utilise fat efficiently.

montBlanc-ultraMarathon

The Mont Blanc ultra-marathon. All long distance runners should be keto-adapted.

To get to this point, the muscle cells need to be trained to use fat, first at very low intensity to make sure that they can fuel the activity using mostly fat, and then gradually increasing the level of intensity to force adaptation in continuing to burn fat as the primary fuel. Best way to achieved this, is by doing low intensity endurance work in a fasted state. And over time, gradually extending duration and increasing intensity.

Moreover, doing intense, muscularly demanding, resistance training in the fasted state, is beneficial in many additional ways, including the secretion of greater amounts of growth hormone and testosterone for better growth and repair of tissues, as well as more effective fat utilisation, and protein recycling, which involves the breakdown of damaged, scarred, and otherwise unused tissues in order to maintain, feed and rebuild the muscle tissues that are being used. The same mechanisms involved in protein recycling, act to preserve muscles that are active, while facilitating the breakdown of other tissues, and in particular fat stores, that are not.

There are many benefits to training in a fasted state, and doing both low intensity endurance, as well as high intensity resistance training. This is especially true over the long term, as the body becomes increasingly more efficient at fat utilisation, increasingly better at preserving active muscle mass, and increasingly more effective in repairing damaged tissues and cleaning out metabolic wastes. Such conditions are naturally highly favourable for building strong, healthy, lean muscle mass.

Fast recovery requires minimising inflammation

Whenever we do anything physical, some level of micro tears, fractures, and injuries to the muscle and bone tissues take place. The body’s repair mechanisms involve an inflammatory response. Without a healthy inflammatory response, we would not be able to recover from injuries, recover from training, or build bone or muscle mass. In fact, we would not be able to survive. What we want, is a fast and effective inflammatory response to heal, repair, or build whatever needs fixing as quickly as possible. What we do not want is a low-level of chronic inflammation that cripples the body from functioning at its best.

One of the greatest advantages of running on a fat-based metabolism with maximally efficient fat utilisation, is the fact that the muscle cells are fuelled by burning fatty acids without producing lactic acid. This is in stark contrast to a glucose-based metabolism, where most of the energy is derived from burning glucose, and this always produces lactic acid. As intensity increases, the amount of lactic acid produced will depend first on the intensity, and second on the level of keto-adaptation. The better the keto-adaptation, the more fat will be used to fuel the cells at higher levels of intensity. But, no matter what, the keto-adapted individual, and the athlete in particular, will always, and in all circumstances, produce less lactic acid than the one running a glucose-fuelled metabolism.

All acidic metabolic waste products need to be eliminated from the body. This is the role of the kidneys, whose function we have explored in The kidney: evolutionary marvel. For lactic acid that accumulates in the muscles, the first stage is to get it out of the muscle, and this usually takes quite a while. It can take from hours up to several days. The process of clearing it out can be accelerated using massage, stretching, and very low intensity exercise. Alkalising baths are a fantastic therapy for accelerating recovery, and lowering inflammation. Magnesium chloride and sodium bicarbonate baths are therefore an absolute must for the serious athlete. We have detailed the importance, roles and functions of magnesium in Why you should start taking magnesium today, and discussed inflammation and the importance of alkalisation in Treating arthritis (1 and 2). 

In the end, all metabolic acids lead to increased inflammation, and, when they accumulate in joints and tendons, inevitably to injury. Insulin-stimulating carbohydrates also cause inflammation. They trigger hundreds of inflammatory pathways. And so, by eliminating them from our diet, and allowing the metabolism to run on fat, we have done as much as we could ever do with our food to minimise inflammation in the body. This is what an athlete wants for the fastest possible recovery time, with best training performance, and the smallest risk of injury.

The final and most important element for fast recovery and low inflammation is optimal hydration. This is the most important because all of the body’s cleaning mechanisms, and especially the function of the kidneys, depend intimately on water and salt. Drink alkaline water on an empty stomach—at least 3.5 litres per day. Eat plenty of salt with all your food—at least a full teaspoon. The more you sweat, the more water, and the more salt you need. We looked in detail at how much of each is optimal in How much salt, how much water, and our amazing kidneys.

When do we eat?

If we train in a fasted state, the best is to train in the first part of the day, taking advantage of the fact that the fast has already lasted 12 hours or so. We can rather easily extend that further, and train around noon, following about 16 hours of fasting. Either way, we will want to eat between one to two hours after training, allowing a good amount of time to make sure the body is well hydrated, and stress levels have dropped. This will bring us to having our first meal of the day somewhere between 12:00 and 15:00. Different people have different schedules and preferences depending on the rhythm of their work and personal life. There are no hard rules, and things have to remain flexible, as irregularity is also an important part of training the body to be more adaptable. In fact, you should be somewhat irregular with your schedule for just this reason.

We can have only one meal per day, or we can have two, or we can have one big meal and some snacks, or, best of all, we can sometimes have one meal, sometimes two meals, sometimes have snacks, and sometimes not. The main point in training the body for optimal metabolic efficiency, is to be a significant amount of time, somewhere between 12 and 20 hours, without eating, and to train in a fasted state, in conditions of low blood sugar and low insulin levels. We discussed intermittent fasting in The crux of intermittent fasting, concluding that one of the most important points for successful and effective intermittent fasting is that the body be fuelled by fat and not by glucose. As you will have gathered by this point, our context here relies on the fact that the body is keto-adapted, and therefore, fuelled by fat.

What do we eat?

That was the original question my friend wanted answered, and it is, in a way, very simple to answer: we eat only the least contaminated, least processed, and least insulinogenic, the most natural, most nutrient dense, and most digestible.

Least contaminated means minimising our body’s exposure to toxic substances, heavy metals, hormone disruptors, pesticides, herbicides, chemical additives, anything that is toxic in one way or another. Least processed means minimising manufactured foods, of which we don’t need any. Least insulinogenic means minimising foods that stimulate the secretion of insulin from the pancreas, and this means minimising intake of simple sugars and starches, and not over-eating protein which is about half as insulinogenic as carbohydrates.

Most natural echoes least contaminated and least processed, but additionally implies a freshness, a wholesomeness, an absence of adulterations and manipulations. That’s what we want. Most nutrient dense means maximising mineral content, vitamin content, optimising amino and fatty acid profiles, and overall micronutrient content for a given amount of calories. Most digestible means minimising digestive stress, maximising enzyme content and nutrient absorption.

Digestion, the function and health of the digestive system, is essential. Everything from the food we eat is made available and usable—or not—by and through the digestive system. We have written about digestion on many occasions, but most specifically in Understanding digestion, Intensive natural healing, and Why we should drink water before meals.

But in practice, what do we eat? No junk of any kind. No polyunsaturated oils. No sweet things. No starches. Excellent animal foods and excellent plant-based foods: grass-fed, full-fat meats and organ meats like liver; nutrient dense and non-toxic fish like sardines, herring, anchovies, seafood and wild fish (avoid tuna, swordfish and any other large predatory fish, because they contain large amounts of mercury and other heavy metals); fatty nuts and seeds, especially coconut products, but also walnuts, macadamia, almonds, hazelnuts; dark leafy greens, both in salads (mixed baby greens, baby spinach, arugula, lamb’s lettuce, lettuces of all kinds) and steamed (chard, spinach, and anything similar); green vegetables like celery, cucumbers, broccoli, asparagus, and string beens; colourful vegetables like purple cabbage, red and yellow peppers. You can eat pretty much anything you can think of that is not processed, nutrient poor, or highly insulinogenic.

What should you have for breakfast? We already solved that problem! You do not eat breakfast anymore, remember?

What do you have for lunch after training? You’re in a rush or just lazy? Well, make yourself a coconut milk smoothy. You can put some protein powder (whey or plant-based, but never soy!), some superfood powders, some hemp or chia seeds. You prefer it sweet-tasting? Put some raspberries or blueberries, and stevia extract. You prefer it green and salty? Put some spinach and salt. In both cases, you can add avocado whenever you want. You can make it with cacao powder, with vanilla extract, or with almond extract. You can add raw or roasted almond or hazelnut butter, sunflower seed butter or tahini. Anything you want that is wholesome and healthful. You’ll need to experiment to find combinations you like. Start simple with few ingredients, and add things bit by bit to keep on top of the process and the blends of flavours.

If you’re not in a rush, or don’t want to have a smoothie? In this case you eat exactly as described above: healthy, nutrient dense animal and plant-based foods. This can be as simple as a can of sardines with a bag of organic baby greens. And for supper, the same as for lunch, really. The same simple and basic principles apply to everything you eat at all times, with these two additional points to keep in mind:

The first is that because we do not eat for a significant part of the day, and also because we eat either just one or two meals, it is crucial to get enough calories and fat, nutrition and protein. Otherwise, we will quickly find ourselves in calorie deficit, and this means that if we keep it up for a long time, we will first burn through our fat reserves, and then burn through our muscles. As athletes, we definitely do not want this. So, it is very important to get all the calories we need, especially if we train a hard or long hours on a daily basis.

The second is that for good, deep and comfortable, restful and restorative sleep, we shouldn’t go to bed on a full stomach, and most importantly, not on a stomach full of protein. Digestion is energy intensive. In the case of protein, it is also highly thermogenic, which means that it generates heat. Therefore, going to bed after a large protein meal will  lead to a restless, tossing, turning, hot and uncomfortable sleep. For a deep and restful sleep, we want the opposite: little digestive activity, a slow heartbeat, and a low body temperature. This means that large protein meals should be had several hours before bedtime, in the afternoon or early evening, allowing a good three to five hours for full digestion before going to bed. If you can’t avoid eating late at night, then eat light: a salad is perfect. For a snack instead of a light meal, have a couple of tablespoons of almond butter on cucumber slices or with celery sticks, for example. Because sleep is really the most important part of the body’s recovery process, it is imperative to optimise sleep.

Closing thoughts

With all of what we have discussed mind, is it really any surprise that more and more professional athletes are opting for this metabolic advantage? A number of years ago, the tennis champion Novak Djokovic divulged one of his secrets. What was it? It was exactly this. This year, the third time winner of the Tour de France, Chris Froome, also divulged one of his secrets. What was it? It was exactly this. Are you curious, say, about Froome’s standard first meal of the day? Four poached eggs, smoked Alaskan salmon, and steamed spinach. Surprising breakfast? Not in the least. Indeed, an excellent breakfast!

We are seeing more and more runners, swimmers, triathletes, but also power lifters and body builders making the switch. It is to their advantage, and when they themselves feel the difference it makes, they know it to be true, at which point there is no turning back. Obviously! Who in their right mind would give up such a metabolic advantage? I suspect that eventually, this will be the standard.

And it’s not surprising at athletes from various disciplines have made these changes to their diets and lifestyles. What is surprising is that so few have actually done this. The change is low, but there is a clear shift in this direction. This is attested by witnessing training specialists promoting these principles, training athletes in this way, and demonstrating the immense advantages that it brings to them in their performances. Vespa Power discussing fat utilisation on their website is a good example.

Is all this stuff new? Of course not! Medical doctors, nutrition researchers , diabetes and metabolic medicine specialists have been talking about this for many decades. Some pioneers include Atkins, Rosedale, Volek and Phinney. And the tradition has continued and expanded, especially in the last decade.

Is this the whole story? Of course not! It never is. But it covers the basics. I plan to explore different aspects of what we started discussing here. You can read more about all these things on blogs and websites. Here are three I have read: the athletic MD Peter Attia had a good blog with many informative articles (especially in the beginning) about physical performance at different stages of his own keto adaptation process. The professional ironman triathlete Ben Greenfield also has written about his experience going form fuelling his body with glucose to using fat instead. I point to these because they have articles specifically about the process of keto adaptation we describe above as foundational for optimal sports performance, and also because they were both meticulous in quantifying the physiological changes and writing about them.

Marty Kendall has a very good blog on optimising nutrition in the sense that we have discussed here, and have been writing about for five years, starting with our very first post, What to eat: four basic rules. But what Marty has done is to actually quantify the value of foods, using the USDA nutritional database, assigning to each food an insulin index derived from its insulinogenic potential, and a nutrient density score based on its macro and micro nutrient content. The associated Facebook group is a great resource for information on this and related topics.

Now that we’ve reached the end, I hope this was useful, and that I have managed to show that, whatever the reason or motivation, whatever the sport or skill set required, there is really no other option other than this when you are serious about optimal physical performance.

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First high-carb-low-fat day after 8 years on a low-carb-high-fat diet

A little taste of what’s to come from the results of my experiment with continuous glucose monitoring: this roller coaster ride is what most people experience every day. What was on the menu: melon, raspberries, watermelon, (nap), coconut water, tomato salad, fresh corn, a little ‘financier aux pistaches’, and finally, popcorn to finish off the day. Can you guess when I ate? Pretty obvious, isn’t it?

Screen Shot 2016-08-07 at 14.43.43

Hypoglycaemia as a metabolic impossibility

Last Thursday, the day before the operation, the dental surgeon told me: “Make sure you have a good breakfast. I don’t want you to get hypoglycaemic. It will last several hours.” I replied: “I never have breakfast, and it is impossible for me to become hypoglycaemic.” He was like: “What? What are you talking about? I don’t understand what you’re saying.” I just said: “Because I don’t eat carbohydrates, I cannot become hypoglycaemic.” I’m not sure he understood what I meant, but I suppose that given my response, he figured I knew what I was talking about.

I’m sure you’ve heard, at one point or another in your life, someone say: “I’m hypoglycaemic, I need to have something”, and then seen them pull out a can or bottle of juice, an apple or an orange, a granola or a chocolate bar? Maybe you’ve said it yourself! It sounds scientific; like we know what we’re talking about. Don’t you think? Maybe we’ve heard a doctor or a nurse say it. Maybe we’ve heard other people say it, here and there. And over time, saying this has become common parlance in North America, and surely in the UK as well. But what does it mean? What do we mean when we say that?

Do you know why I said what I did to the dentist? Do you understand why it is impossible for me, (and possibly you too), to become hypoglycaemic, even without eating for 12, 24, or 36 hours? Why is it that so many people suffer from hypoglycaemia on a daily basis, especially type II diabetics, and all the while, I’m writing that it is ‘a metabolic impossibility’? Am I wrong? Am I lying? Am I confused or trying to be confusing? And why is there so much hype about hypoglycaemia? Just Google it and you’ll see: 6.35 million hits! There’s even a Hypoglycaemic Health Association!

First of all, if you don’t already know what it means, hypo means low, and glycaemia means ‘sugar in the blood’. So, hypoglycaemia just means low blood sugar. But the thing is that what people usually mean when they say this, is that they are feeling tired, slow, flat, low-energy, light headed, maybe even dizzy, and interpret these symptoms to reflect a state of low blood sugar, which it usually does. But there’s a caveat: different people will feel the same symptoms at different blood sugar levels! Isn’t that a little weird? Doesn’t that make you wonder about what this means and implies? If there is such as thing as hypoglycaemia, why would it be different for different people? Meaning, why would a certain blood sugar level be fine for one person, and too low for another?

But what is low blood sugar? What is high blood sugar? What is normal blood sugar? Do you have any idea? And how much sugar is that, actually, circulating in the bloodstream? Any idea about that?

Let’s make it simple. Most people have between 5 and 6 litre of blood. Let’s take 5 litres as our baseline to make the numbers easier. Most people, on average, have around 100 mg/dl of glucose in their blood (even if they should have less!) Since there are 10 dl in 1 litre, and 100 mg =0.1 g, this makes 5*10*0.1 g = 5 g. Think on that for a second: in your entire body, there are 5 litres of blood, and in this volume of blood, there are 5 measly little grams of glucose. That’s a teaspoon!

For very low blood sugar levels, we can go down to about 50 mg/dl (half the normal average). This would amount to just 2.5 g in your whole body! And for critically (as in dangerously) high levels, we can go up to around 400 mg/dl (four times the average). In this case, that would amount to still just 20 g! Therefore, we can say that at any given time in our body there is on average 5 g of sugar, very rarely less than 2.5 g, and only extremely rarely, when we are severely diabetic, up to 20 g. So, all things considered, it’s not much, is it?

Now, why is it that most people feel hypoglycaemic at one point or another if they don’t eat for a while, sometimes in as little as a few hours? Why would different people feel these symptoms more or less intensely? And why would different people feel the same unpleasant or even debilitating symptoms of hypoglycaemia at different concentrations of blood glucose?

Well, if you feel symptoms of hypoglycaemia it means that 1) your blood glucose levels are significantly lower than your own usual average level, the level at which your system and cells have gotten used to functioning. This average level could be 200, 150, 120, 100 mg/dl or whatever. And the lower threshold before you start feeling weak, tired or even dizzy could be 40, 50, 60, or even 90 mg/dl. In fact, diabetics or soon-to-be-diabetics, could be walking around, going about their business with an average of 150, 200 or even 300 mg/dl without knowing it, until they get a blood test and someone notices. And they would definitely feel hypoglycaemic at levels that could be quite high. How come?

The key to understanding this conundrum in the apparent subjectivity of hypoglycaemia is the notion of glucose tolerance. But what is glucose tolerance if it is not insulin sensitivity? And what is insulin sensitivity if it is not the flip side of insulin resistance? I hope that by now, having been reading this blog for a while, you know everything about insulin resistance, how it develops and how it manifests itself in the biochemistry and metabolic functions of the body. (If you don’t, then just reread the posts you’ll find in the Diabetes and Carbs categories.)

This notion of tolerance explains it all very neatly: with chronic exposure to glucose, (as in high average levels of glucose in the blood for an extended time), insulin resistance increases, and thus, insulin sensitivity decreases. As insulin sensitivity decreases, more insulin is needed to clear the glucose from the bloodstream, and more glucose stays in circulation longer. The cells get used to this high level of insulin, and become less and less sensitive to it, allowing less and less glucose to get in. When the level of glucose drops below the threshold at which the cells can use it without much effort, muscle but especially brain cells, we feel hypoglycaemic. This is why hypoglycaemia is defined on a subjective and relative scale that depends on our own cells’ sensitivity to insulin, the hormone that shuttles the glucose in. We become hypoglycaemic when the body cannot use fat to fuel its cells, and ketones to fuel its brain. And the more insulin resistant, the more prone to hypoglycaemia.

Moreover, insulin sensitivity, or resistance, exists on a continuous spectrum in the population. It goes from extreme sensitivity to extreme resistance. On the side of high resistance, we have type II diabetics; and on the side of high sensitivity, we have those people like me, and maybe also like you, who restrict carbohydrates, getting most of their calories from fat, and whose cells are consequently fuelled primarily by fat and not by glucose. This makes them, it makes us, not only highly metabolically efficient, but also impervious to hypoglycaemia.

This is why I said what I did to my dentist over the phone the other day: for a body whose cells are highly insulin sensitive from being minimally exposed to glucose/insulin in the bloodstream, the levels of which are delicately and sensitively regulated by the liver (glucose) and pancreas (insulin) throughout the day based on food intake, activity and stress levels, the cells are primed to burn fat efficiently, and the liver is primed to produce all the fat-derived ketones to nourish the brain, which they do far better than glucose can. For a body that works like that, it is physiologically impossible to become hypoglycaemic.

By the same token, it is also physiologically impossible to ‘hit the wall’, just because the cells are fuelled by burning fat, not glucose, and there is always a large reservoir of fat in the body, in terms of calories, at least an order of magnitude larger than the reserves of glycogen in the liver and muscles combined, and this, no matter how thin you may be. For example, even at 8% body fat (like me), which is quite low, a person weighing 63 kg (like me), has 5 kg of fat to draw on, providing a reservoir of 45 000 kcal! This is why we see more and more high level long distance athletes and professionals (like this one), and even power lifters (like this one) switching to a very low carb high fat diet (often abbreviated VLCHF). They do this to get lean and to tap into the metabolic advantages of nutritional ketosis.

Two final points:

1) Insulin sensitivity depends sensitively on exposure to insulin, which depends sensitively on the presence of glucose, which depends sensitively on carbohydrate intake. And it is as simple as this: the less carbohydrate, the less glucose; the less glucose, the less insulin; the less insulin, the more insulin-sensitive. This is always true even if different people have different genetic predispositions to insulin resistance.

2) Nutritional ketosis depends on the ratio of calories derived from fat to those derived from carbs, as well as on a specific maximum amount of insulin-stimulating carbohydrates per day. This threshold depends on each person individually. For one person it can be as high as 100-120 g, whereas for another it could be at low as 15-20 g. In addition, if you deplete your glycogen stores from going for a really long bike ride, for example, you can eat as much as 200 or even 300 g of carbs, and still remain in ketosis, because all of it will go to replete glycogen in the muscles and liver. In most people and in most cases, however, a standard guideline is less than 50 g per day. But, remember, the lower the better.

So, are you clear on what the deal is with hypoglycaemia? And now, what’s it gonna be: carbs, hypoglycaemia, feeling tired and irritable, low in energy and mentally slow, light headed and dizzy; or fats and protein, nutritional ketosis, feeling good and strong, high in energy and mentally sharp, stable and alert.  That’s a no-brainer, right? What do you say?

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