Category Archives: Uncategorized

Diabetes Education to Lower Insulin, Sugars, and Hunger (the DELISH study)

Interesting lipid findings from the DELISH study (Mason et al., 2019).

[Patron link]

The nefarious “sdLDL” — whether you’re a believer or not in any cholesterol hypothesis relating to health, most agree that if LDL levels predict disease, it’s the small dense ones that do it best.

DELISH was a good study. Not a super-intensive double-blind randomized crossover study of keto vs. SAD, but rather a moderately ketogenic (> 0.3 mM bHB), “cut out the sugar & processed foods” intervention.

It worked.

The participants cut their carb intake in half but maintained baseline fibre intake suggesting indeed, they were cutting out processed carbs, not non-starchy ones, green leafys, berries, etc.

In the intro, it is mentioned that sometimes, LDL-C increases on a ketogenic diet. This has more to do with the specific foods than the macro’s or process of ketogenesis, and that was a general theme of this paper.

Indeed, this one had to do with red meat…. ooooohhh

If you’re interested to see how it played out, 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 

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

Affiliate links: Still looking for a pair of hot blue blockers? TrueDark is offering 10% off HERE and Spectra479 is offering 15% off HERE. Use discount code LAGAKOS for a deal on CarbonShades. If you have no idea what I’m talking about, read this then this.

calories proper

Share

The totality of evidence favors some manner of eTRF: 6 vs. 3 vs. 2 meals/d

Two studies. one compared 6 vs. 3 meals per day (Jakubowicz et al., 2019); the other 6 vs. 2 (Kahleova et al., 2014).

BOTH eTRF!!!!! Finally.

Tl;dr #1: with regard to body composition, 3 protein-containing meals/d seems to be the sweet spot. Muscle likes frequent feedings, but no additional benefit is seen beyond 3x/d.

[Patron link]

Tl;dr #2: If you’re gonna IF, the totality of evidence favors some manner of eTRF.

According to the data, the traditional 3 meal/d eTRF is great, less hunger, more satiating, etc. Or is you want to be like some anti-aging guru and skip dinner a few times/wk & go to bed hungry for that hormetic response or something, there are data supporting that too.

Let’s dive in it -> head over to Patreon! Join the community for up-to-date information about a variety of topics in the health & optimizing wellness space. Five bucks a month for access to this and all previous articles. It’s ad-free and you can cancel if it sucks 🙂

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

Affiliate links: Still looking for a pair of hot blue blockers? TrueDark is offering 10% off HERE and Spectra479 is offering 15% off HERE. Use discount code LAGAKOS for a deal on CarbonShades. If you have no idea what I’m talking about, read this then this.

calories proper

Share

The NAD+ Precursor Wars!

Many camps here! This is getting fun 🙂

Two different supplements: nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN). Both backed by good science & scientists (one camp is shilling a supplement while the other camp is selling books, which I don’t really care about) (the social media war is, however, hilarious).

[Patron link]

Both precursors appear equally effective in the rodent studies and I expect this to cross over when NMN finally has human studies.

BIG difference that nobody is really talking about is TISSUE SPECIFICITY.

1st problem: commentators were talking about NR/NMN as if it passed from your gullet directly to the liver. NR would be absorbed directly; NMN would be dephosphorylated to NR, absorbed, get re-phosphorylated back to NMN then converted to NAD+.

[insert Slc12a8 image here]

Since NMN and NR cost the same, this doesn’t really matter. Right?

Supp manufacturers just thought that since NMN was one step closer to NAD+, it might make a better precursor. But if it’s converted to NR prior to absorption, who cares?

And if the liver just releases niacinamide (NAM) to the rest of the body, WHO CARES?

THE PLOT THICKENS

This becomes relevant with all the different preparations on the market — intranasal, sublingual, regular oral (NR/NMN), NAD+ directly, and why can’t I just save a ton of money and use NAM instead! Relevant, yes. And interesting. I’ll summarize…

Have you tried any of these? Let us know in the comments 🙂

For a more nuanced look in to this, head over to Patreon! Join the community for up-to-date information about a variety of topics in the health & optimizing wellness space. Five bucks a month for access to this and all previous articles. It’s ad-free and you can cancel if it sucks  

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

Affiliate links: Still looking for a pair of hot blue blockers? TrueDark is offering 10% off HERE and Spectra479 is offering 15% off HERE. Use discount code LAGAKOS for a deal on CarbonShades. If you have no idea what I’m talking about, read this then this.

calories proper

Share

Nicotinamide Riboside (NR)

or nicotinamide mononucleotide (NMN)

[Patron link]

There is some banter about which is the better NAD+ precursor, but I don’t think it really matters. They are interconverted in vivo and cost about the same…

NR has been studied in both humans and rodents whereas NMN research is primarily rodents. I’m usually biased toward human studies, but again, I don’t think it matters in this #context.

Why NAD+ ?

Because OMG all of the animal studies! It’s like resveratrol all over again…

oh wait…

But seriously, old mice given either NAD+ precursor look like young mice by nearly every measure. NR and NMN have never been directly compared, but both produce equally positive effects in the various rodent models in which they’ve been tested.

And I’m fairly well-convinced NAD+ levels do decline with age…

Anyone gonna try NR or NMN? Let me know in the comments!

For the rest of this article and morehead over to Patreon! Join the community for up-to-date information about a variety of topics in the health & optimizing wellness space. Five bucks a month for access to this and all previous articles. It’s ad-free and you can cancel if it sucks  

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

Affiliate links: Still looking for a pair of hot blue blockers? TrueDark is offering 10% off HERE and Spectra479 is offering 15% off HERE. Use discount code LAGAKOS for a deal on CarbonShades. If you have no idea what I’m talking about, read this then this.

calories proper

Share

“Ketogenic diet and skeletal muscle hypertrophy: a frenemy relationship?”

You can say that again!

Hot off the presses (Paoli et al., 2019).

[Patron link]

Good paper. Nice background with information about muscle protein balance, anabolic & catabolic factors, and signaling pathways.

At one point the authors seem to have confused a study on starvation ketosis with nutritional ketosis, but in all fairness they also acknowledged the study showing beta-hydroxybutyrate can inhibit AKT which is important for skeletal muscle hypertrophy (Yamada et al., 2010).

Let’s dive right in to Table 1 which is a summary of human studies on keto & lean mass:

Starting with the study by Wood and colleagues (2010), who studied: a low fat diet, low fat + exercise, keto, and keto + exercise. Everyone lost weight. The low fat group lost significantly more lean mass than any other group. The authors interpreted this to mean keto “had a protective effect on muscle mass.”

LFD+ex, Keto, & Keto+ex all lost the same amount of lean mass although the keto groups were getting 50% more protein.

Another interpretation, one could say that 50% more protein and even resistance exercise weren’t enough to prevent keto-induced muscle loss. They lost just as much lean mass as LFD+ex and Keto.

Jabekk and colleagues compared resistance exercise + usual diet with resistance exercise on keto (Jabekk et al., 2010).

The authors concluded: “a general conservation of muscle mass.”

That’s OK, but the control group gained lean mass! Thus, an alternate interpretation could be that keto blunted muscle gains.

Not acknowledging the control groups, as in Table 1, is a not-so-subtle-way of shifting goal posts imo.

Similar issues in the study by Paoli and colleagues (Paoli et al., 2010)…

For the rest of this article and morehead over to Patreon! Join the community for up-to-date information about a variety of topics in the health & optimizing wellness space. Five bucks a month for access to this and all previous articles. It’s ad-free and you can cancel if it sucks  

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

Affiliate links: Still looking for a pair of hot blue blockers? TrueDark is offering 10% off HERE and Spectra479 is offering 15% off HERE. Use discount code LAGAKOS for a deal on CarbonShades. If you have no idea what I’m talking about, read this then this.

calories proper

text

outro2

Share

The impact of keto-adaptation on exercise performance and yada yada yada

New review out of Pittsburgh, Pennsylvania, gets some things right (Sherrier and Li, 2019).

[Patron link]

… takes some things out of context, too, like saying “beneficial effects of ketogenic diets on cancer,” as if that’s an established fact.

It’s not… but still, let’s focus on the positive

Some ground rules:

  1. ketogenic diet =/= fasting
  2. nutritional ketosis =/= exercise
  3. carbs =/= obesity
  4. the opposite of intermittent fasting isn’t diabetes

Another ground rule, or maybe a disclaimer: I’ve read and blogged about nearly every study on ketoadaptation & physical performance that’s out there. My 30000-foot view is: “it’s fine.”

Given adequate time to adapt (~3 weeks), keto doesn’t wreck physical performance. Some studies show a little positive, some a little negative; net sum = neutral.

Other energy systems kick in and performance is maintained. Any further gains from training are just that: gains from training (not gainz from moar ketoadaptation).

Keto isn’t muscle-sparing or anything like that, and you likely need more protein (not less) to maintain muscle, but this also isn’t really that big of a deal.

This article is pretty good, imo. Covers a lot of topics ranging from glycogen on keto to fat balance to exercise efficiency and more.

For my analysis of it and morehead over to Patreon! Join the community for up-to-date information about a variety of topics in the health & optimizing wellness space. Five bucks a month for access to this and all previous articles. It’s ad-free and you can cancel if it sucks  

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

Affiliate links: Still looking for a pair of hot blue blockers? TrueDark is offering 10% off HERE and Spectra479 is offering 15% off HERE. Use discount code LAGAKOS for a deal on CarbonShades. If you have no idea what I’m talking about, read this then this.

calories proper

Share

5/2, ADF, and eTRF: place your bets!

Three studies. Predicted effects on body composition & glucose tolerance?

Patron link

5/2 (Panizza et al., 2019): this is a form of intermittent fasting (IF). Two consecutive days you eat 70% less than usual; the other five days you eat at maintenance. It’s not ‘ad lib;’ there’s some calorie counting involved.

This study design was a little odd, but it’s cool that it came out around the same time as the other two (ADF & new eTRF) so we can cover a lot of ground in a short amount of time.

Is it fair to compare 5/2, higher protein, lower carb, Mediterranean diet to a lower protein, higher carb DASH diet? Predicted effects on body composition?

And I even say some nice things about fasting 🙂


For the rest of this article and morehead over to Patreon! Join the community for up-to-date information about a variety of topics in the health & optimizing wellness space. Five bucks a month for access to this and all previous articles. It’s ad-free and you can cancel if it sucks  

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

Affiliate links: Still looking for a pair of hot blue blockers? TrueDark is offering 10% off HERE and Spectra479 is offering 15% off HERE. Use discount code LAGAKOS for a deal on CarbonShades. If you have no idea what I’m talking about, read this then this.

calories proper



Share

Physiological insulin resistance: benevolent pseudo-diabetes

The mystery of the ketogenic diet: benevolent pseudo-diabetes (Blagosklonny, 2019)

[Patron link]

“studies in rodents have found that the ketogenic diet causes diabetes”

Narrator: No, they don’t. In fact, rodent keto studies are all over the board.

.

.

Sometimes glucose tolerance is up, sometimes it’s down, sometimes it depends on what you’re actually comparing it to — is the control group low fat or the notoriously misnamed high fat diet (it should just be called an obesogenic diet imo).

off topic — just found these and they’re awesome. Check out the digits.

OK, in some studies, keto mice are insulin resistant. Sometimes it correlates with body weight. See all the ‘somes’ here? You can’t make broad statements about rodent keto studies.

And you definitely can’t use them to support recommendations for human diabetes/obesity.

this probably isn’t even keto’s strongest suit anyway…

For the rest of this article and morehead over to Patreon! Join the community for up-to-date information about a variety of topics in the health & optimizing wellness space. Five bucks a month for access to this and all previous articles. It’s ad-free and you can cancel if it sucks  

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

Affiliate links: Still looking for a pair of hot blue blockers? TrueDark is offering 10% off HERE and Spectra479 is offering 15% off HERE. Use discount code LAGAKOS for a deal on CarbonShades. If you have no idea what I’m talking about, read this then this.

calories proper

Share

Tell me again, how skipping breakfast unlocks a secret anabolic potential of skeletal muscle

SMH

Time-restricted feeding plus resistance training in active females: a randomized trial (Tinsley et al., 2019)

[Patron link]

Hate to be a buzzkill because this was actually a well-designed and well-conducted study.

I’m not a huge fan of intermittent fasting (IR) because it’s usually shown to be no better than continuous energy restriction (CER) yet also require prolonged periods of severe energy restriction.

Also, if forced, I’d recommend starting with eTRF or an early dinner; the point being to extend the fasting window by starting it earlier in the day rather than ending it later — there might actually be some metabolic benefits of this over isocaloric CER.

And in this case especially, athletes, who benefit from increased protein-feeding frequency which is removed from IF by design (although the authors attempted to partially bypass this by adding some HMB to an IF group).

#context: this wasn’t eTRF. It was skipping breakfast. These weren’t older insulin resistant people. They were young females with resistant training experience.

So, tell me again, how fasting induces growth hormone secretion which promotes the anabolic potential of skeletal muscle?

Breakfast and a late lunch instead?


For the rest of this article and morehead over to Patreon! Join the community for up-to-date information about a variety of topics in the health & optimizing wellness space. Five bucks a month for access to this and all previous articles. It’s ad-free and you can cancel if it sucks  

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

Affiliate links: Still looking for a pair of hot blue blockers? TrueDark is offering 10% off HERE and Spectra479 is offering 15% off HERE. Use discount code LAGAKOS for a deal on CarbonShades. If you have no idea what I’m talking about, read this then this.

calories proper



Share

Short- and long-term regulation of appetite

The energy expenditure and food intake of individual men.

[Patron link]

So, this study has been making the rounds: Skipping Breakfast Before Exercise Creates a More Negative 24-hour Energy Balance: A Randomized Controlled Trial in Healthy Physically Active Young Men (Edinburgh et al., 2019)

I didn’t want to comment on it because critics could easily say I was just biased (many studies support breakfast from a variety of angles therefore so do I).

Does skipping breakfast allow your to maintain an energy deficit and lose excess body fat? If so, GO FOR IT. Skipping breakfast may not be optimal long-term wrt health & general well-being, but it’s better than carrying around excess body fat for decades.

I don’t buy intermittent fasting does much beyond that — with the exception of a few studies on eTRF (early Time-Restricted Feeding) which showed favorable effects on weight loss, insulin sensitivity, and fasting blood glucose. Not entirely sure why this happens with skipping dinner and not skipping breakfast but it is what it is. Probably has something to do with, ya know, circadian rhythms.

Regulation of energy balance –

1) I think the Edhold 1955 study on the short- vs. long-term regulation of appetite is great. Both what they did and their discussion.


For the rest of this article and morehead over to Patreon! Join the community for up-to-date information about a variety of topics in the health & optimizing wellness space. Five bucks a month for access to this and all previous articles. It’s ad-free and you can cancel if it sucks  

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

Affiliate links: Still looking for a pair of hot blue blockers? TrueDark is offering 10% off HERE and Spectra479 is offering 15% off HERE. Use discount code LAGAKOS for a deal on CarbonShades. If you have no idea what I’m talking about, read this then this.

calories proper



Share