A non-zealot keto study!

These researchers were too interested in their sophisticated instruments for assessing body composition than to care about keto per se. Lol (Buechert et al., 2019)

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Small study (n=12), duration was 6 weeks.

Keto diet was good and well-adhered to. Urinary ketones positive on 97% of the days. The “rules” were also good, simple: no processed foods, be aware of hidden carbs in stuff like gum, lunch meat, etc. Fruits and vege were fine as long as they were within the carb limits and we know that they were, because positive urinary ketones. They were allowed nuts and dark chocolate, too.

It wasn’t supposed to be a weight loss study, but they all lost weight.

Weakness: no control group – only before/after comparisons.

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New low carb + IF study with weird results

Alternate day fasting combined with a low-carbohydrate diet for weight loss, weight maintenance, and metabolic risk reduction (Kalam, Varaday et al., 2019)

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Study design: 1 day of 600 kcal protein shakes then 1 day of protein shakes and normal ad lib food intake. “Alternate day fasting (ADF).”

There was some bias in the text/discussion (in favor of ADF; blamed low carb), but credit where it’s due – one of the more sensible lines in the paper: “It is also likely that only a selected group of individuals with obesity may find this diet tolerable and suitable for their lifestyles.”

Intermittent fastin concept – empty plate on blue background, copy space

With that, I agree. LC/ADF isn’t where I’d start, but it could work for some. However… it just didn’t seem to do so in this study very well.

Be aware of this -> “Fasting increases risk of binge eating and bulemic pathology: a 5-year prospective study” (Stice et al., 2008)

Tl;dr: the participants lost weight but didn’t improve any primary endpoints – triglycerides, fasting glucose, and insulin resistance didn’t change.

O_o

How do you lose 5 kg of fat and none of it from visceral adipose? ADF?

How do you lose weight with LCHP but not improve any metabolic markers? ADF?

-> a bit of the blame was shifted toward the LC component, although none of that stuff really happens in LC weight loss studies… suggests ADF...

ONE HINT FROM A MOUSE STUDY

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Red Light on the Brain and More

Final installment (probably) on RLT/PBM.

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Cognition

LLLT has shown promise in improving cognition [R].  

In a study testing broad neurocognitive functions, in comparison to placebo, participants who received LLLT showed more positive effects in reaction time, memory, and mood [R].

LLLT improved aging-related and vessel disease-related cognitive decline in an elderly population [R]. Laser treatment also improved memory, attention, and executive function in a population of patients with dementia [R].

Red light therapy has been studied in a wide variety of conditions including, stroke, Alzheimer’s disease, Parkinson’s disease, depression, and cognitive enhancement in healthy subjects [R].

Mental Health

LLLT has also shown promise in traumatic brain injury, with positive effects on sleep, mood, and anxiety [R].  

For example, one case study who underwent 20 treatment sessions over the course of two months experienced decreases in depression, anxiety, headache, and insomnia, while cognition and quality of life improved [R, R]. However, caution is warranted because these findings have yet to be replicated in a large-scale double-blind placebo-controlled randomized clinical trial.

LLLT is still in the experimental phase for emotional conditions, but some studies have shown a positive effect on major depressive disorder, simultaneous anxiety, and suicidal ideation [R].  

In a small study in patients with major depressive disorder and simultaneous anxiety LLLT showed improvements up to two weeks after treatment [R]. This was confirmed in another small clinical trial [R] and a larger one in patients who responded positively to behavioral therapy [R]. 

Anyone using this or interested in trying? Drop a note in the comments!

For more of the studies on PBM, head over to Patreon! Five bucks a month for access to this and all previous articles. It’s ad-free and you can cancel if it sucks 

These pork rinds are the bomb. Seriously! And if you like spicy

For personalized health consulting services: drlagakos@gmail.com.

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Red Light, Green Light, Photobiomodulation

Part 1 HERE

Now on to the [mostly] human studies –

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Low level laser therapy (LLLT), also known as photobiomodulation, is the use of low-energy red, near-infrared, and infrared light to treat a variety of health conditions like pain and inflammation but it can also be used to improve physical performance. 

Introduction

Essentially, a low-powered laser or light-emitting diode (LED) is used to shine a specific wavelength of light onto the skin of a patient to elicit certain physiological effects in the underlying tissue without causing any damage. Some examples of conditions often treated with LLLT include rheumatoid arthritis, chronic neck and back pain, periodontitis, and muscular injuries.  

The light source may be in the form of a laser or LED and the wavelength of light produced usually falls into the range of 660 nm (red) or 800-900 nm (near-IR/IR) [R, R]. 

Treatment sessions are usually short, lasting only seconds to minutes in duration, and are usually conducted every other day for weeks to months.

Surprisingly, unlike many other treatment modalities used to address similar conditions, there are virtually no reported side effects from LLLT.  

Effects of PBM/LLLT

Inflammation 

One study examined post-injury pain and recovery time in athletes who were treated with an average of four 20-minute sessions of infrared light therapy and compared them to historical values [R]. The average recovery time in athletes treated with LLLT was significantly shorter at 9.6 days when compared to the average anticipated recovery time of 19.2 days. 

A review on muscle repair in animal models concluded red light therapy has the capacity to reduce inflammation, positively impact growth factors, and increase angiogenesis [R]. One animal study showed that LLLT reduced inflammation in an injured muscle [R]. 

A well-known effect of chemotherapy is oral mucositis, which is inflammation that results in the  breaking down of the lining of the mouth. A systematic review concluded LLLT significantly reduced the incidence and severity of chemotherapy-induced oral mucositis [R].  

A study on chemotherapy patients showed a significant reduction in self-reported pain with LLLT [R].

 


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 are the bomb. Seriously! And if you like spicy… the former are a little heavier and don’t have a spicy option [yet]

For personalized health consulting services: drlagakos@gmail.com.

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red light therapy: don’t write it off yet –

I wrote an article about the human studies with red light therapy / photobiomodulation (PBM) a few years ago and didn’t publish it. I’ll update it and follow-up soon. In the meantime…

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Don’t write off the potential of PBM. We accept many biological influences of light – vitamin D synthesis, circadian rhythms, mood disorders, getting a tan and some endorphins, artificial light and blue blockers – and that’s just the stuff most pertinent to humans.

PBM: what’s it supposed to do?

help with wound healing & pain, inflammation & swelling, although it’s actively being studied in many other contexts – notably, to do with spine/nerves/brain stuff

Some people think it’s important to focus on wavelengths 600-700 nm (for superficial applications) and 780-900 nm (for deeper tissues) and not in between because in part, too much total PBM might reduce efficacy so cut out the ones with less biochemical activity so you can get more of the active wavelengths (Chung, Hamblin et al., 2012).

Disclaimer: there are a lot of inconsistencies in the PBM literature. Different doses, duration, surface area exposed, etc., etc., that make it hard to come to firm conclusions on any of it. That, plus, some of the units can get pretty pricy, especially since there’s no clear guarantee they’ll do anything for you. I feel ya.

One effect that seems pretty consistent is on improving skin health/appearance.

For the rest of this article and morehead over to Patreon! Five bucks a month for access to this and all previous articles. It’s ad-free and you can cancel if it sucks 

These pork rinds are the bomb 🙂

For personalized health consulting services: drlagakos@gmail.com.

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High protein diet: UNLEASH THE TABOO

At first, this article reads like a sarcastic blog post or something (Kalantar-Zadeh et al., 2019).

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[their words in italics; my commentary is not]

How often have you been told to eat more protein and less carbohydrates to stay healthy?

Uhmmm, never?

This is not an emerging food culture but rather a prevailing dogma in our society.

What society is that?!

Physicians, dietitians and other health care professionals tell us constantly about the advantages of a high-protein diet (HPD), such as losing weight rapidly, burning calories, diminishing appetite, preventing obesity, managing metabolic syndrome and treating diabetes. 

Which physicians!

This contemporary creed has gone so far that we feel continuously pressured to eat more protein and less carbohydrates, including even less fruits and vegetables. 

Am I taking crazy pills?

We feel compelled to eat only the meat patty of the sandwich and leave behind the bun when eating in front of others, otherwise we may lose credibility among friends and peers. 

Yes, crazy pills.

If somebody dares to recommend a ‘low-protein diet’ (LPD) or, even worse, to imply that ‘HPD may cause harm’, then it would be considered a serious aberration to health and a taboo.

This is some seriously emotionally charged stuff. TABOO! And as I read on, it became clear…….

For the rest of this article and morehead over to Patreon! Five bucks a month for access to this and all previous articles. It’s ad-free and you can cancel if it sucks 🙂

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For personalized health consulting services: drlagakos@gmail.com.

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Testing the carb-insulin model (CIM) in mice

or, the biggest mouse study that’s ever been done (Hu, Speakman, et al., 2019)

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Background rant: 20 years ago I thought I had a firm understanding of CIM. 10 years ago things got a little dicey here and there. Since then, the goalposts have been shifted so far and so frequently it’s a mess… we’ve come a long way from Atkins (for better or worse)

I disavow.

That said, regardless of where the goalposts were set, everyone should bookmark this study. They varied every macronutrient in nearly every possible way and took a variety of metabolic assessments (insulin sensitivity, body weight, food intake, etc.).

So whether or not their study tested the CIM to which you subscribe, there is still a ton of information here. My comments are mainly on CIM here lol

Speakman’s CIM is broken down into 5 somewhat overlapping parts.

  1. Increased dietary carbs increases fasting insulin which decreases fasting glucose

-In the context of any CIM, the postprandial state seems more relevant here; as in, ‘carbs increase insulin which reduces glucose and you get fat storage from the insulin and hangry from the hypo.’

These pork rinds are the bomb 🙂

2. Carbs and insulin induce de novo lipogenesis which makes you fat

-My only qualms here are: DNL is quantitatively more of a liver thing, and anyway, most of the fat that gets stored came straight from the diet, not DNL.

For the rest of this article and morehead over to Patreon! Five bucks a month for access to this and all previous articles. It’s ad-free and you can cancel if it sucks 

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Sunlight, reptile bulbs, and NO

Ultraviolet radiation suppresses obesity and symptoms of metabolic syndrome independently of vitamin D in mice fed a high-fat diet (Geldenhuys et al., 2014)

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Sunlight > vitamin D supps. It is known.

Brief review of vitamin D synthesis: TEAMWORK!

In brief: cholesterol -> 7-dehydrocholesterol in skin; sunlight (UV radiation) converts that into D3 which goes to liver on DBP and is made into 25(OH)-D3. That then goes to kidneys and is transformed into the active form, 1,25(OH)2-D3. What’s not shown in that graphic is when you have enough D, it’s instead converted into an inactive 24,25(OH)2-D3. This prevents toxicity from sunlight D.

Hypervitaminosis D (from supps) is rare but unpleasant.

Seasonally, in some extreme latitudes, fancy UV lamps &/or [speculatively] much cheaper reptile bulbs may supplement sunlight. And it’s not just vitamin D!

This study showed sunlight also increases nitric oxide in the skin, which has effects beyond the D… may also be supplemented with NO-inducing skin creams (also speculative), if applied to the right spots…

Big tie-in with our beloved brown adipose tissue.

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Cold Thermogenesis RELOADED

A lot of cool studies about brown adipose tissue (BAT) lately; here’s the rundown.

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More and more, with more sophisticated techniques, scientists are discovering we have more BAT than previously believed. And they all have theories on how it works and if it can be manipulated to make us healthier.

Activated BAT secretes a lot of stuff:

Exercise increases circulating 12,13-diHOME in humans (old, young, male, female, sedentary, active) (Stanford et al., 2018).

In mice, too, and surgical removal of BAT abolishes this effect. Dosing them with 12,13-diHOME increases fatty acid uptake and oxidation in skeletal muscle.

BOOM

Cold exposure induces the enzyme 12-LOX in BAT which synthesizes lipid mediators that improve glucose tolerance (Leiria et al., 2019).

Cold exposure in this #context is a few degrees above your shivering threshold. It’s NOT an ice bath — it’s shorts & a t-shirt in 50(ish) degrees F (10 C).

The good news: if you dislike exercise or find cold exposure unpleasant, there are other ways, eg, beta-3 adrenergic receptor agonism and some nutrients that can be obtained via diet.

For the rest of this article and morehead over to Patreon! Five bucks a month for access to this and all previous articles. It’s ad-free and you can cancel if it sucks 

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“Fats for thoughts”

An update on brain fatty acid metabolism (Romano et al., 2017)

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This was an interesting review, although it got off to a rocky start by stating: “glucose is the preferred energy substrate of the brain.”

My opinion is that “preferred energy substrate” is a weird concept in this context. When glucose declines and ketones increase, ketones will be used. Are they preferred now?

I’m not saying either are preferred. Just making note of this.

Given the title of the article, I was expecting a lot on DHA/fish oils but there was a good deal on ketones.

Yes, the brain definitely uses ketones; this is particularly important during starvation and it comes in handy during hypoglycemia.

it’s likely that you can avoid going into a coma during hypoglycemia if there are a lot of ketones around. Brain doesn’t use a lot of fatty acids, probably, to reduce the risk of hypoxia and/or oxidative stress (the former because FA oxidation is slow).

-> exercise is probably the number one “anti-aging” agent (good for everything but cognitive health in particular)

-> exercise & ketones -> +brain-derived neurotrophic factor (BDNF)

^^^I rather like BDNF and humbly suggest this may lean toward ketones being more “preferred”

Coconut oil may be helpful in this context.

For the rest of this article and morehead over to Patreon! Five bucks a month for access to this and all previous articles. It’s ad-free and you can cancel if it sucks 

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