Dr. Lagako's blog covers many of these topics in depth with citations to sientific research. I suggest reading some of his latest articles on the relationship between urine and blood ketone values in regards to circadian rythms and also his article on gelatin .
http://caloriesproper.com/
Interview:
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Here is a summary transcript of the interview:
0:00
In your book you describe several situations in which a calorie is
not a calorie. I found the discussion of HGH particularly
fascinating, yet you do not recommend it as a fat loss supplement.
Why not?
A
group of patients take HGH and regardless of the amount of calories
it favorably affected nutrient partitioning. More calories went into
building muscle and less into storing fat. The example was used to
demonstrate that nutrient partitioning is very important and mediated
by hormones. HGH has a lot of use in treating conditions but may not
be good for those that are already healthy and already engaging in
regular exercise. High intensity exercise is a known stimulus for
natural HGH. Adding HGH might not add extra benefit. There are not
many studies on athletes. Just stick with high intensity exercise
until more research is done on athletes.
2:02
It
appears that Nicotine has similar body re composition properties as
HGH although perhaps it works on different pathways. Any thoughts on
using nicotine patches as a fat loss aid?
Nicotine
would be a vitamin if it were not addictive. It does have a lot of
beneficial effects on cognition. It is a potent anti inflammatory
agent. It improves insulin sensitivity. The strongest aspect is its
ability to help attenuate appetite especially in those that are
overweight. It might not work as well in an athlete except in
improving cognition. It may help prevent post exercise soreness.
Tobacco products decrease insulin sensitivity but nicotine by itself
does not.
4:20
If you are already eating a ketogenic diet is there any reason to
further control blood glucose.
No
insulin sensitizing agents are useless to ketogenic dieters. If you
are not being exposed to dietary carbohydrates then you have little
need for a high level of insulin sensitivity. If you are adapted to a
ketogenic diet you insulin sensitivity may decline a bit but that
doesn't matter because you don't have insulin spikes without
carbohydrates. Berberine, cinnamon, and bitter melon might have
benefits reducing oxidative stress but they when it comes to the
ability of managing blood glucose levels it doesn't matter to low
carb keto dieters.
5:51
What is the mechanism of the insulin sensitivity agents?
There
are a couple different. Some work on the amylase enzymes to prevent
the digestion others act at the insulin receptor to dispose of the
carbohydrates faster. There is a wide spectrum of mechanisms.
6:20
You push a lot of protein in your book. There is a big concern about
too much protein kicking you out of ketosis. Is there a use for the
blood sugar controls to prevent this?
These
are two different issues. Consuming too much protein will not raise
blood blood glucose levels. When you eat protein above your minimum
requirements amino oxidation will occur in the liver in preference to
fatty acid oxidation, which is the main method of ketone production.
Also liver glycogen stores will increase decreasing the bodies need
to oxidize fatty acids.
8:00
There is discussion by doctors that if you don't have more than 15 or
20 grams of protein in a single serving the amino acids will get used
by the gut lining instead of going into the blood stream.
I
don't believe that is true. If you have a lower protein intake the
body will try to capitalize on it more efficiently by increasing
protein synthesis. The gut does use certain amino acids. Most
ingested glutamine will be metabolized in the intestine. Very little
of the branch chain will bypass the liver and the intestine and go
strait to the skeletal muscle. Other amino acids will be metabolized
by the liver.
9:55
If you have all of your protein in one sitting you might stimulate
excess amino acid oxidation so it might be better to have two meals
of protein instead of one meal. Do you want 10 meals of protein,
probably not.
10:20
What about large amounts of protein causing aging.
Protein
may stimulate cell turnover and cell growth. When it comes to protein
quality in the diet not sure how much high protein effects longevity.
Virtually no human studies on the issue.
12:10
You pose a hypothesis our lifespan might be determined by the total
calories consumed. Does eating amino acids instead of protein avoid
the calorie countdown.
Even
the BCAA that are shuttled directly to the skeletal muscle have
calories and energy.
13:50
What about cold thermometers revving up your metabolic engine and
aging you faster?
I'm
not an expert in this at all. You can increase your brown adipose
tissue by doing it. Some athletes do it but the data is very mixed.
Most studies use very different CT protocols and give very different
results. It could be helpful but should not be giving a blanket
endorsement.
15:10
Are you increasing the mitochondrial density by doing CT?
You
could be. The response of the mitochondria to the cold is increase
uncoupling which could cause some oxidative stress down the line. The
ketogenic diet will increase the number, function, and quality of
mitochondria. Especially after 3 months. You will no longer be tired,
you can do high intensity workouts and have increased endurance. The
primary mediator of that is the affect of the diet on the
mitochondria. From an athletic perspective the keto adapted state is
critically dependent on the mitochondrial response.
16:50
After keto adaptation it seems that the actual BHOB values don't
matter as much to how you feel and perform. Is that because you are
running directly off of free fatty acids.
You
should still be using ketones for some things. Your brain will still
be oxidizing ketones. The urine ketone strips are a little iffy. You
should register above 1 mM if you've adapted. The best measure of
adaptation is how you feel and perform.
18:40
Do you know of any other quantitative measurements?
The
blood meters are pretty good. Urinary a distant second.
19:00
Deep ketosis?
The
number one factor in the level of ketosis and how easy getting in is
patient history. The duration you've been on the diet. It is a direct
reflection of their mitochondrial performance.
20:20
Calorie math?
Probably
more than 4 lbs of muscle has been formed in 1 month where 15 lbs
were gained on a ketogenic diet. Water weight gained would be low
because you are ketogenic. Being an ketogenic athlete does amazing
things for nutrient partitioning.
21:40
What about salts after the transition period?
When
you switch to low carb it involves abandoning industrial processed
foods which have a lot of salts. Without the carbohydrates you don't
have much insulin which means you waste body salts a bit. This is
magnified in a ketogenic state.
23:02
Insulin is more fat promoting than muscle building.
If
you infuse just a small amount of insulin cells will completely stop
fatty acid utilization. This small amount of insulin is much smaller
than the amount required to build muscle or store salts.
23:50
What about gut function and thyroid function.
Gut
stuff isn't in the book. Gut biome thrives on carbohydrates which are
absent on a ketogenic diet. This doesn't bode well for gut health.
The patch for this is fermented foods like sauerkraut, pickles,
kefier. If you experience gut problems, bloating or constipation you
really should consider fermented foods.
26:44
I started on a resistant starch protocol from feedtheanimal blog.
Take potato starch with the fermented foods as prebiotic. Mix the PS
with MCT oil. If I don't have gut health issues no reason to do it?
If
you don't have gut health issues don't supplement. Only needed if
there is a concern.
28:07
Talking about thyroid. Carbohydrates are not necessary. If you have
symptoms of hypothyroid it is because of energy deficit. Keto diets
are notorious for spontaneous energy reduction. Adequate calories and
fat with weight maintenance should not be experiencing thyroid
issues.
30:20
The healing properties of ketones seems to be incredible. Ketone
salts are very interesting.
I
just did a blog post about that in a recent blog post. When you
infuse ketones into cells there is a huge increase in power output.
Ketones are a super fuel.
32:15
If you want to experiment with the ketogenic diet you have to go
longer than a month. The first week is difficult and athletic
performance will take a hit.
33:20
What about re-feeds?
Carb
re-feeds are unnecessary aside from emotional or psychological
support. If you are in an energy deficit for too long you might want
to ensure you get adequate calories.
34:47
I've avoided libido issues by eating a lot every 14 days or so.
Females
might experience amenorrhea and may not cycle which is a normal
response to energy deprivation. There are a few intervention studies
I've posted on my blog. Testosterone levels increase with saturated
fat.
37:20
Do you follow the lipid issues with low carb diets?
Trigs
go down with decreased carb intake.
39:10
I prefer zetia to statins for cholesterol lowering drugs. I think
high HDL is most improtant.
My
personal quest is to remove omega 6 from my diet.
40:00
The benefits of that alone are tremendous. These oils are usually
oxidized before consumption. Raw nuts probably are not so bad. Its
better to get rid of vegitable oils.
41:02
Have you heard the theory that omega 6 are pro inflation resolution?
The
major mediators are going to be the omega 3 from fish. There have
been cell and animal studies about omega 6 but I think it will be
omega 3s. I don't see a need for omega 6 in the diet.
43:22
Saturated fat is quite resistant to oxidative stress, so it is a good
way to reduce oxidative stress in the body.
43:40
May readers send you questions.
I'm
on twitter at caloriesproper you can email me at drlagakos at gmail
or you could go directly to the website and leave a comment.
