Category Archives: Uncategorized

This study on intermittent fasting wasn’t bad!

Effects of Intermittent Versus Continuous Energy Intakes on Insulin Sensitivity and Metabolic Risk in Women with Overweight (Hutchison et al., 2019)

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8 weeks, 70% calorie restriction via continuous energy restriction vs. 70% calorie restriction via intermittent fasting (skipping dinner on 3 non-consecutive days per week) vs. no calorie restriction but still intermittent fasting vs. control. A+ setup so far.

  1. Skipping dinner: don’t freak out. Some people are totally OK with 24-hour fasts but freak out at the idea of skipping dinner. That’s weird (P<0.05).
  2. As with most weight loss studies, some people are going to report being hungry every once in a while. Hopefully not too much, or else it deteriorates adherence. This wasn’t a problem in this study, however, because all food was provided and it was only 8 weeks.

We’ll review the hunger data next (data from weeks 1 & 6), but for now, let’s break down the above figure.

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Rhythms of life: cognition & maintaining a healthy body composition across the lifespan

Circadian disruption, weight loss, and brain fog (Logan and McClung, 2019)

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“In psychiatry and behavioural medicine, novel circadian-based interventions are rare and often overlooked. Even in cases in which circadian disruption is not a primary cause of a disorder, stabilizing sleep-wake patterns using behavioural, environmental, or pharmacological tools might ease symptoms.”

Many studies suggest this is also true for weight management. You may think your subjective sleep quality is good, but have no idea how much circadian interventions can help shed a couple pounds. Reduced food cravings, improved nutrient partitioning & cognitive function, etc.

It’s important to start early, but becomes more important as we age.

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If you’re interested in setting up consultations with me, reach out: drlagakos@gmail.com.

Affiliate linksKetoLogic for keto-friendly shakes, creamers, snacks, etc. And get 15% off your ketone measuring supplies HERE.

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If you want the benefits of  ‘shrooms but don’t like eating them, Real Mushrooms makes great extracts. 10% off with coupon code LAGAKOS. I recommend Lion’s Mane for the brain and Reishi for everything else

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Don’t blame asparagus and mushrooms for what soda and potato chips did to you

“Carbohydrate quality and human health: a series of systematic reviews and meta-analyses” (Reynolds et al., 2019)

Essential notes:

-this article was about carb quality not quantity

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-fibre is complicated. You can say soluble & insoluble, but really there are many different types and all of them still aren’t even clearly one or the other.

-a low carb diet can also be a high fibre diet. In fact, I guess since my own diet has a lot of low carb (LC) plants, I was shocked that they considered 25-29 grams “high fibre.”

-again, a high fibre diet doesn’t have to be a high carb diet

-while I don’t doubt the effects of various fibres per se, other components of these foods may also contribute to their benefits (vitamins, minerals, other nutrients, etc.).

-fibre will not end the obesity epidemic otherwise Metamucil would’ve ended it years ago. The only fibre supp I’ve recommended is Bimuno, and that’s for GI problems not weight loss.

Is fibre *essential?*

Essential for what?

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Almonds, asparagus, broccoli, Brussels sprouts, cabbage, chives, endive, escarole, leek, mushrooms, onion, peppers, scallion, spinach, etc., etc., etc.

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Mistimed food intake and sleep can mess you up.

Mistimed food intake and sleep alters 24-hour time-of-day patterns of the human plasma proteome (Depner et al., 2018)

or

Why you need to be mindful of circadian rhythms Every. Single. Day.

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I once heard a joke – “I wish going to the gym was like going to high school. Once you get your diploma / get fit, you never need to go back” (or something like that). Unfortnately, circadian rhythms also fall into this category.

This study examined a pretty extreme model of circadian misalignment. Basically, they took a bunch of measurements during a normal day & night, then allowed the subjects a brief nap during the afternoon the next day, kept them up all night, then took more measurements during daytime sleep and evening wakefulness.

Looking at the bottom graph should tell you all you need to know about the importance of daily circadian entrainment. While some circadian clocks can maintain a normal rhythm for a little while after a period of circadian misalignment, look how quickly melatonin increased during the daytime in circadian misalignment. This didn’t really bode well for sleep as it declined by almost a full hour…

For the rest of this article and more, head over to Patreon! Five bucks a month for access to all articles. It’s ad-free and you can cancel at any time.

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The role of the ‘biome in insomnia, circadian disruption, and depression

Everything is connected! (Li et al., 2018)

Good sleep and mood are important for health and keeping active. Keeping active is important for sleep, mood, and health. Good health is important for sleep, mood, and physical activity.

“There is considerable evidence showing that the gut ‘biome not only affects the digestive, metabolic, and immune functions of the host but also regulates host sleep and mental states through the ‘biome-gut-brain axis… the ‘biome and inflammation may be linked to sleep loss, circadian misalignment, affective disorders, and metabolic disease.”

The only gut products I’ve ever really recommended are Bifido (eg, something like this or this) and GOS… and start with a very low dose.

Epidemiological studies have shown the infinite inter-connectedness of all of these conditions. Many people with sleep problems also have IBS. Many people with anxiety have sleep problems. Many people with IBS have mood disorders. Etc., etc., etc…

The authors of this recent review have suggested 3 main pathways in which this might occur.

  1. immunoregulatory pathway: mediated by cytokines, PGE2, etc.
  2. neuroendocrine pathway: enteroendocrine cells which secrete hormones that directly influence the HPA axis and the CNS.
  3. vagus nerve pathway wherein sensory neurons of the intestinal myenteric plexus respond to the ‘biome to affect gut physiology and signal to the brain (tenth cranial nerve and all that jazz)

Importantly, the CNS can also regulate the ‘biome via these pathways. Everything is connected! If something isn’t right with your health, these are probably the places to look.

The main 2 ‘biome inhabitants are Bacteroidetes and Firmicutes. Firmicutes (like Acidophilus) have been associated with obesity. Sometimes. Bifido is neither, it’s an Actinobacteria. Circadian misalignment and sleep deprivation have been shown to influence the relative abundances and ‘biome metabolites (eg, Davies et al., 2014). Jet lag increases Firmicutes which is reversed upon recovery. Whoa.

Bifido supps have been shown to improve emotional and cognitive indicators, the stress response, and anxiety in people with IBS (Plaza-Diaz et al., 2017)… and bifido is reduced in people with chronic fatigue syndrome.

Stress increases gut permeability, bacterial translocation, and bloating which is associated with sleep disorders because of course it is.

In mice, at least, these can be corrected by fixing their ‘biome…

Effects of the probiotic bifidobacterium infantis in the maternal separation model of depression (Desbonnet et al., 2010)

Not too surprising as 90% of your serotonin comes from chromaffin cells in your gut and bifido actually produces GABA. Bifido are reduced in patients with depression (correlation =/= causation, but this is highly consistent in a variety of contexts).

Sleep loss, circadian misalignment, affective disorders, metabolic disease, the ‘biome, and inflammation. They’re all connected! If something isn’t right, these are probably the places to look.

That’s all for now!

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If you want the benefits of  ‘shrooms but don’t like eating them, Real Mushrooms makes great extracts. 10% off with coupon code LAGAKOS. I recommend Lion’s Mane for the brain and Reishi for everything else

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Circadian clocks and insulin resistance

If nothing else, this article had great figures (Stenvers et al., 2018).

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Clock gene mutations, exposure to artificial light at night, disturbed sleep, shift work, social jet lag, etc., are factors that contribute to circadian disruption and insulin resistance.

Figure 1.

Figure 2. Clocks, clocks everywhere!

The human circadian timing system is not exactly 24 hours, therefore, it needs to be entrained every day. Environmental light is the most important zeitgeber for setting the central pacemaker, while that, food intake, physical activity, etc., contribute to setting peripheral pacemakers.

In humans, tissue-specific glucose tolerance, insulin sensitivity, and thus nutrient partitioning depend on the time of day. For example, glucose tolerance is higher in the morning than at night. And the effects of insulin on fat storage are greater at night than in the morning. Worded another way, adipose stores more fat with less insulin in the evening compared to morning.

Figure:

Some of the most basic findings to support the role of circadian rhythms in insulin sensitivity come from rodent studies: damage to the central clock (SCN) results in insulin resistance within weeks independent from food intake or physical activity. In humans, observational studies on shift workers have been supported by intervention studies on intentional circadian disruption which show, collectively, insulin resistance and various aspects of metabolic syndrome.

Figure: muscle clock

Entraining and capitalizing on the muscle clock has been largely under-rated until very recently. Entrain the muscle clock indirectly via SCN with light in the morning and more directly with food intake and some sort of physical activity. Capitalize on this by front-loading calories, optimize by combining all 3 (and maybe more in the future, as more is uncovered).

For the rest of this article and more, head over to Patreon! Five bucks a month for access to all articles. It’s ad-free and you can cancel at any time.

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If you want the benefits of  ‘shrooms but don’t like eating them, Real Mushrooms makes great extracts. 10% off with coupon code LAGAKOS. I recommend Lion’s Mane for the brain and Reishi for everything else

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Consequences of circadian disruption on neurologic health and the influence of nutrients & food factors

“Impaired sleep-wake cycle, the most robust output rhythms of the circadian system, is significantly affected by neurodegenerative disorders, may precede them by decades, and may also impact their progression” (Videnovic and Zee, 2015).

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^^^ that’s the ‘safe’ way of saying circadian disruptions likely cause neurodegenerative disorders. And if you have one or more of these disorders, addressing circadian rhythms should be first line therapy.

Sleep loss itself is a risk factor for cerebrovascular events, likely due to alterations in autonomonic nervous system or immune homeostasis, and sleep disorders are common in stroke victims.

The robust circadian variation in cortisol declines in aging adults, and the degree it is lost is associated with cognitive impairments and crappy sleep.

Parkinson’s Disease: circadian variation in symptoms — it’s almost always worse in the evening regardless of when dopaminergic medications are administered. Dopamine itself is a circadian hormone. All of these suggest circadian rhythms should be part of the treatment program. Indeed, 90% of patients report impaired sleep and reduced daytime alertness.

Alzheimer’s Disease: one of the big ones. Circadian dysregulation has a major impact on quality of life and represents a major reason for institutionalizing these patients. That’s expensive. Preclinical studies have suggested this is a function SCN atrophy (the master clock) and impaired pineal function (source of melatonin). Those two observations argue largely for the role of circadian dysregulation in the pathology of Alzheimer’s disease. No one is talking about light therapy and blue blockers for Alzheimer’s patients. No one.

Next up is the modulation of circadian clocks by nutrients and food factors, but for that, you’re gonna have to head over to Patreon! Five bucks a month for full access. It’s ad-free and you can cancel at any time.

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

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If you want the benefits of  ‘shrooms but don’t like eating them, Real Mushrooms makes great extracts. 10% off with coupon code LAGAKOS. I recommend Lion’s Mane for the brain and Reishi for everything else

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The three diet studies everyone is talking about (DiReCT, PURE, and Virta)

None of them have particularly great study designs, but that hasn’t prevented the buzz. Here is a summary of the strengths and weaknesses.

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Tl;dr:

DiReCT (Diabetes Remission Clinical Trial): randomized. N=306, 1-year. 3-5 months ultra-low calorie weight loss diet (~850 kcal/d) followed by 2-8 weeks of guided food reintroduction and then weight maintenance counseling.

PURE (Prospective Urban Rural Epidemiology): n=135335, 7.4 years follow-up. The dreaded Food Frequency Questionnaire, although they were comparing lowest with highest quintile… I think I can accurately recall if I’ve had more than 5 servings of something today or none in the past month. They’re not asking what I had to eat August 25th 2017 for lunch.

Virta: low carb, calorie restricted. N=262, 1 year long. They had a weight maintenance control group, which is good, but it’s not hard to beat a weight maintenance control group with any diet. A low fat comparison group would’ve been more informative.


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Regular circadian effects vs. effects of circadian misalignment.

Endogenous circadian system and circadian misalignment impact glucose tolerance via separate mechanisms in humans (Morris et al., 2015)

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“Glucose tolerance is lower in the evening and at night than in the morning.”

THE FIRST FRIGGIN’ LINE! Come on fam, please stop arguing against this fact. A basic tenet of circadian biology is our preparedness for food intake in the morning. “Skipping breakfast” is not hormetic. It’s CICO and not in a good way. Metabolism is gimped at night, so you end up having to eat less so you’re double-restricted (no breakfast and less food at night).

 

 

The point of this study was two-fold, in my estimation: 1) determine the normal circadian influences on glucose tolerance; and 2) influence of circadian misalignment.

 

When comparing the glycemic response to identical meals ingested after an identical period of fasting, either at 8 AM (subjective morning or “breakfast”) or 8 PM (subjective evening or “dinner”): postprandial glucose was 17% higher (ie, lower glucose tolerance) in the biological evening (8:00 PM) than morning (8:00 AM; ie, a circadian phase effect).

 

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20% off some delish stocks and broths from Kettle and Fire HERE

If you want the benefits of  ‘shrooms but don’t like eating them, Real Mushrooms makes great extracts. 10% off with coupon code LAGAKOS. I recommend Lion’s Mane for the brain and Reishi for everything else

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Intermittent vs. Continuous Energy Restriction: Study vs. Headlines

It started here: Effect of intermittent versus continuous energy restriction on weight loss, maintenance and cardiometabolic risk: A randomized 1-year trial (Sundfor et al., 2018)

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If intermittent fasting (IF) works for you, awesome. If not, don’t worry, you’re not missing out on much. The above study was a year long and showed no difference between IF and plain old just cutting out some junk food. IF group lost 8 kg, regular dieters lost 9 kg.

 

 

“Intermittent and continuous energy restriction resulted in similar weight loss after one year in men and women with obesity.”

In this study, the IF protocol they employed was most similar to 5:2 wherein you eat normally for five days a week and consume minimal food on two non-consecutive days.

“Feeling of hunger may limit long-term adherence to intermittent energy restriction.” [this seems somewhat unwarranted because, well, they made it a whole year which is pretty “long-term,” imo] [although they consistently reported higher feelings of hunger which may be unpleasant]

Backlash to the above tweet was savage lol and a lot of people cited a 2016 study with which I was familiar… that doesn’t really make their case…

HEADLINE vs. STUDY, people

disclaimer: if you’re hell bent on IF, I’m still a little biased toward #eTRF

For the rest of this article, head over to Patreon! Five bucks a month for full access and there are many other options. It’s ad-free and you can cancel if it sucks 🙂

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20% off some delish stocks and broths from Kettle and Fire HERE

If you want the benefits of  ‘shrooms but don’t like eating them, Real Mushrooms makes great extracts. 10% off with coupon code LAGAKOS. I recommend Lion’s Mane for the brain and Reishi for everything else

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LOOK AT THE DATA, PEOPLE.

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