All entries filed under “Nutrition”

Another reason to eat well

Posted by Dr. Larry Kaskel on Sunday Aug 07, 2011 7:03 am

David Liu Ph.D.

Saturday Aug 6, 2011 (foodconsumer.org) -- Weight loss induced by caloric restriction can boost sexual drive and performance of men with both obesity and type 2 diabetes mellitus, according to a new study in the Journal of Sexual Medicine.

The study shows that diabetic men with obesity who were given two diets specially designed for weight loss for eight weeks improved their "erectile function, sexual desire and urinary symptoms".

The two diets used in the study included a meal replacement-based low-cal diet with only 1,000 kcal per day and a low fat, high protein diet with carbohydrates and calories reduced by 600 kcal per day.

The study led by  Joan Khoo of Changi General Hospital in Singapore and colleagues, authors of the study, also found at eight weeks of dietary interventions, the meal replacement diet and low-calorie-high protein diet, that subjects reduced their weight and waist circumference by 10 and 5 percent, respectively.

The dietary intervention using either diet improved plasma glucose, low-density lipoprotein (LDL) or so called bad cholesterol, Sex hormone-binding globulin (SHBG), endothelial function, and International Index of Erectile Function (IIEF-5) among others in obese men with type 2 diabetes mellitus.

The findings of the study may be applicable to obese men without type 2 diabetes mellitus.  In fact, a study similar to the current one, but involving obese men without diabetes also found weight loss led to better sexual function at least in one third of obese men with erectile dysfunction.

The study led by Katherine Esposito MD of Policlinico Universitario in Naples, Italy and colleagues was actually a randomized controlled trial, meaning the study is more trustworthy.

The trial involved 110 men with obesity, meaning their bod mass index was over 30 kg/m2, with 55 men given special advice to reduce caloric intake and increase physical activity to achieve a weight loss by 10 percent and 55 men as controls only given general information on health food choices and physical exercise.

After two years, men in the intervention group experienced significant weight loss, that is, their BMI was down to 31.2 kg/m2 from 36.9 kg/m2 on average, while those in the control group decreased their BMI from 36.4 to 35.7 kg/m2 only.  

C-reactive protein was also improved in the study group.  High C-reactive protein was linked with inflammation, which is found more severe in men with obesity.

Men in the study group had better erection as the study showed that the average International Index of Erection Function increased from 13.9 to 17 while men in the control group maintained the same score. Seventeen men in the intervention group and three in the control group increased their IIEF score to 22 or higher.

The researchers further found the improvement of erection function measured by the IIEF-5 was independently associated with BMI, physical activity and c-reactive protein. This means there may be at least three mechanisms involved in the association between weight loss and erection function in men with obesity.

In any case, weight loss induced by caloric restriction regardless of what type of diet is used, helps improve sexual function or sex performance in men with obesity regardless of their type 2 diabetes mellitus status.

For men with or without obesity, certain foods do help their erection and maybe sexual performance as well.  Studies suggest oily fish like salmon, garlic, vitamin C and arginine supplements or eating lots of peanuts can boost the sexual drive and performance in men.

eat your eggs

Posted by Dr. Larry Kaskel on Monday Jul 25, 2011 8:29 am

This is from a great site "Health Realizations"

Over 16 percent of U.S. adults have high cholesterol, defined as 240 mg/dL and above, according to the U.S. Centers for Disease Control and Prevention (CDC). Even the average level for Americans, 200 mg/dL, is borderline high, they say.

This high cholesterol, public health agencies say, is putting people at an increased risk of heart disease, the leading cause of death in the United States. This stated “fact” scares millions of Americans into take statin cholesterol-lowering drugs to get their levels as low as possible … but what if this “fact” was actually not true?

Does Cholesterol Cause Heart Disease?

Cholesterol is actually an essential part of your body, used to produce cell membranes, steroid hormones, vitamin D and the bile acids your body needs to digest fat. Your brain needs cholesterol to function properly, as does your immune system, and if a cell becomes damaged, it needs cholesterol in order to be repaired.

In fact, making excess cholesterol is actually your body’s response to inflammation, which it does to help heal and repair your cells. So if you have high cholesterol you probably have high inflammation levels too (more on this later).

Many Americans are under the mistaken impression that all cholesterol is bad, but in reality cholesterol is good for your body and necessary for you to live. Unfortunately, the “lipid hypothesis” (aka the “diet-heart hypothesis”), the one that claims foods high in saturated fats drive up your cholesterol levels, which clog your arteries and lead to heart disease, is widely accepted and has helped to spread the misinformation about cholesterol throughout the public.

But the lipid hypothesis is actually seriously flawed.

In his book The Cholesterol Myths, Uffe Ravnskov, MD, PhD explained that Ancel Keys, who performed the study upon which the Lipid Hypothesis is based, used cherry-picked data to prove his point that countries with the highest intake of animal fat have the highest rates of heart disease.

Dr. Ravnskov revealed that the countries used in the study were handpicked, and those that did NOT show that eating a lot of animal fat lead to higher rates of heart disease were left out of the study, leading to entirely skewed, and faulty, data.

One recent study even found that there is no association between eating saturated fat (which is supposed to drive up cholesterol levels) and heart disease. The authors wrote:

“According to the classic ‘diet-heart’ hypothesis, high intake of SFAs [saturated fats] and cholesterol and low intake of PUFAs [polyunsaturated fats] increase serum cholesterol levels and risk of CHD [coronary heart disease].

However, few within-population studies have been able to demonstrate consistent associations with any specific dietary lipids, with the exception of trans fats and omega–3 fatty acids.

The available evidence from Cohort and randomized controlled trials is unsatisfactory and unreliable to make judgment about and substantiate the effects of dietary fat on risk of CHD … There is probably no direct relation between total fat intake and risk of CHD.”

Does This Mean You Can Eat Eggs Again?

If you’ve been shunning eggs because you fear they will raise your cholesterol, you needn’t avoid this healthy protein source any longer.

For starters, eating cholesterol is not what gives you high cholesterol. According to the Harvard Heart Letter, it’s a myth that all the cholesterol in eggs goes into your bloodstream and your arteries.

“For most people, only a small amount of the cholesterol in food passes into the blood,” the Heart Letter states. “The only large study to look at the impact of egg consumption on heart disease—not on cholesterol levels or other intermediaries—found no connection between the two.”

Eggs are also an excellent source of healthy nutrients, including choline, a B vitamin that may help reduce your risk of heart disease, cancer, dementia and more. Egg yolks also provide the most readily absorbed form of lutein, a yellow-hued carotenoid that may help fight everything from cancer and cataracts to macular degeneration and aging.

For more information, be sure to read The Truth About Eggs: How to Tell the Good From the Bad

What is Actually High When it Comes to Cholesterol?

Not only does evidence suggest that saturated fat does not cause heart disease by way of high cholesterol, but there is considerable questioning of what actually constitutes “high” cholesterol in the first place.

The American Heart Association states, “About half of American adults have levels that are too high (200 mg/dL or higher) and about 1 in 5 has a level in the high-risk zone (240 mg/dL or higher).”

But according to lipid biochemistry expert Mary Enig, PhD in the Weston A. Price Foundation quarterly magazine:

“Blood cholesterol levels between 200 and 240 mg/dl are normal. These levels have always been normal. In older women, serum cholesterol levels greatly above these numbers are also quite normal, and in fact they have been shown to be associated with longevity.

Since 1984, however, in the United States and other parts of the western world, these normal numbers have been treated as if they were an indication of a disease in progress or a potential for disease in the future.”

What this means is that many Americans may be taking statin cholesterol-lowering drugs unnecessarily, believing their cholesterol is dangerously high when it is not.

Statin Drugs: Is Modern Medicine’s Cure-All Harming Your Health?

Cholesterol-lowering drugs known as statins are among the most commonly prescribed drugs in the United States.

They work by interfering with an enzyme that your body needs to make cholesterol. Along with lowering cholesterol, the drugs -- which include Lipitor, Zocor, Mevacor, Pravachol, Crestor and others -- may also help your body reabsorb cholesterol that has accumulated on your artery walls, helping to prevent further blockage.

However, although cholesterol drugs do lower cholesterol, there is question over whether or not they actually lower your risk of heart disease.

For instance, as Business Week reported, James M. Wright, a physician and professor at the University of British Columbia, analyzed evidence from years of trials with statins and was surprised at what he found among data from patients with no heart disease who were taking the drugs:

He found no benefit in people over the age of 65, no matter how much their cholesterol declines, and no benefit in women of any age. He did see a small reduction in the number of heart attacks for middle-aged men taking statins in clinical trials.

But even for these men, there was no overall reduction in total deaths or illnesses requiring hospitalization—despite big reductions in "bad" cholesterol. "Most people are taking something with no chance of benefit and a risk of harm," says Wright.”

As Business Week continued, when you look at the fine print of data surrounding cholesterol drugs, the benefits often altogether disappear. Referring to one figure stated by drug maker Pfizer, which said 3 percent of patients taking a placebo had a heart attack compared to 2 percent of patients on the statin drug Lipitor:

“The numbers in that sentence mean that for every 100 people in the trial, which lasted 3 1/3 years, three people on placebos and two people on Lipitor had heart attacks.

The difference credited to the drug? One fewer heart attack per 100 people.

So to spare one person a heart attack, 100 people had to take Lipitor for more than three years. The other 99 got no measurable benefit.”

Suddenly the drugs don’t sound so miraculous, do they?

They also carry steep risks.

In one of the most revealing looks into the true side effects of statin drugs, a review published in the American Journal of Cardiovascular Drugs found nearly 900 studies of adverse effects linked to the drugs.

"Muscle problems are the best known of statin drugs' adverse side effects," Beatrice Golomb, MD, PhD, associate professor of medicine at the University of California, San Diego School of Medicine and co-author of the study, told EurekAlert. "But cognitive problems and peripheral neuropathy, or pain or numbness in the extremities like fingers and toes, are also widely reported."

Other side effects included increases in blood glucose levels, tendon problems and an increase in liver enzymes, leading to permanent liver damage. Because of this latter risk, people taking the drugs must have their liver function tested periodically.

Nausea, diarrhea, abdominal pain, constipation, headaches and skin rash are other known side effects.

Statin drugs are also known to block the production of important nutrients in your body, including CoQ10, which is beneficial to heart health and muscle function. If CoQ10 levels become depleted, which is common in those who take statin drugs, it can actually cause heart failure.

So What is the Best Way to Maintain Healthy Cholesterol Levels?

Remember the inflammation connection? Your body tends to make more cholesterol when it’s in a chronically inflamed state. What causes the underlying inflammation?

Inflammation is often due to poor diet and the consumption of processed foods or lack of live healthy raw foods. For instance, if you eat a lot of fast food, you probably have increased inflammation levels, as pro-inflammatory foods include sugar, soda, alcohol, bread, trans fats and red meat.

Inflammation is a problem because when your body is in a chronic state of inflammation, the inflammation can lodge in your muscles, joints and tissues. In fact, chronic inflammation is a leading cause of many diseases, both physical and neurological, including heart disease.

So, if you’re interested in keeping your heart healthy without taking drugs, reducing inflammation is an excellent first step, as this will typically naturally put your cholesterol levels into a healthy range. Some top tips to do this are:

• Eating a healthy diet with plenty of raw fruits and vegetables. Avoid processed foods and buy whole foods whenever possible. Fast food should be only a very occasional indulgence, or not on your diet plan at all, and raw foods should make up a regular part of your meals.

• Exercising regularly

• Not smoking

• Managing stress in your life

• Limiting alcohol

Start Low Carbing carefully via Dr Eades blog

Posted by Dr. Larry Kaskel on Monday Jun 27, 2011 9:14 am

In the last post we discussed ramping up the fat intake as the single best way to hurry the low-carb or keto adaptation along.  I didn’t mention it in the previous post, but another little secret is to keep an eye on the protein intake. Too much protein will prevent the shift into ketoses because the liver will convert some of the protein into glucose – this glucose will then be used first and slow down the ketogenic process.  Which, if course, prompts the question, how much protein is too much?  As long as you’re getting your protein from meat, especially fatty cuts of meat, you’re probably okay.  If you go for the extremely lean cuts of meat, say, skinless chicken breasts, or if you are supplementing your diet with low-fat protein shakes, you could have a little more trouble low-carb adapting.  If you’re going the shake route, I would recommend you add some coconut oil to the shakes for a couple of reasons.  First, you’ll hasten the keto-adaptation, and, second, the fat it coconut oil will help remove the fat from your liver (which I’ll discuss more later in this post).

A glass of Tinto de Verano pictured at left. A great way to hydrate. (See note at bottom of post.)

As I said, you need to really crank up the fat intake to push yourself over the adaptation divide as quickly as possible.  If you don’t like fatty cuts of meat, you can add a little medium-chain triglycerides (MCT) to your diet.  MCT are absorbed more like carbohydrates and are used quickly by the body.  They are almost never incorporated into the fat cells, so they burn quickly, and any extra that might be hanging around are converted to ketones.  So, MCT will drive the ketone production process.  And so will coconut oil if you prefer that.

You can find MCT oil at most health food or natural grocery stores.  It has never bothered me, but some people can get a little nauseated if they take too much of it, so if you decide to give it a try, start out slowly.  Or go with the coconut oil.

Aside from the occasional carb cravings, which we’ll deal with later, the most common symptoms experienced by those getting started on low-carb diets are fatigue, headaches, light-headedness or dizziness, and cramping.  I would say these four symptoms probably comprise 98 percent of the complaints we get from our patients we put on low-carb diets.  Not everyone experiences these symptoms – especially those who do what we tell them – but of those who do have symptoms, these are almost always the ones they have.  Let’s look at what to do to avoid them or treat them should you already be experiencing on or more.

Electrolytes

The most common cause of virtually all the symptoms listed above is an imbalance in electrolytes.  Following a low-carb diet results in a rapid lowering of insulin levels, which – though a good thing – can create problems in the early days.  We’ll address the electrolytes in the order of importance.

Sodium

When you are overweight and insulin resistant, you have a lot of insulin circulating in your blood most of the time.  This excess insulin does a number of bad things to you.  Gary Taubes wrote an entire book about how excess insulin makes you store fat in your fat cells.  But the story doesn’t end there.  Excess insulin also drives the kidneys to retain fluid, which is why many obese people retain a lot of extraneous fluid and experience pitting edema in their lower legs.

What is pitting edema?

If you push your finger into the tissue in the front (or just to the side of) your shin bone and your finger leaves an indentation – almost a finger print – that takes a while to fill back in, you have pitting edema.  Most overweight people experience this phenomenon late in the afternoon and/or at night after being on their feet all day.  The excess fluid pools around the lower legs and seeps into the soft tissues. In the morning, after the body has been horizontal through the night, the fluid redistributes, and the pitting edema goes away but then reoccurs as the day goes on.  Even people who aren’t all that overweight but who do have elevated insulin levels will have some degree of excess fluid accumulation even if they don’t experience pitting edema as evidence of it.

One of the first things that happens when people go on low-carb diets is a rapid improvement in insulin sensitivity.  Because the low-carb diet starts to quickly banish the insulin resistance, insulin levels fall quickly.  And as insulin falls, the stimulus to the kidneys to retain fluids goes away, and the kidneys begin to rapidly release fluid.  One of the common experiences at the start of low-carb dieting is the incessant running back and forth to the bathroom to urinate this excess fluid away.  Which is both good news and bad news.

The good news is that it’s great to get rid of the excess fluid but it comes at a cost, which is the bad news.  As the excess fluid goes, it takes with it sodium an extremely important electrolyte.  When sodium levels fall below a critical threshold (which can happen within a short time), symptoms often occur, the most common being fatigue, headache, cramps and postural hypotension.

Postural hypotension happens when you stand up too quickly and feel faint.  Or even pass out briefly.  It’s a sign of dehydration.  So if you’ve started your low-carb diet, made your multiple runs to the bathroom, and jump up off the couch to answer the phone and feel like your going to faint (or actually do pass out momentarily) and have to sit back down quickly, you’ve got postural hypotension.  It’s really easy to fix – you simply need to take more sodium and drink more water.  Salt your food more.  Increasing sodium is just another one of the many counter-intuitive things about low-carb dieting.  Just like eating more fat to lower your cholesterol.  You’ve got to start thinking differently.  The low-carb diet is one that absolutely requires more sodium.  A lot more sodium.

If you’ve got the brutal headaches that some people get when starting on a low-carb diet, add sodium.  And drink extra water.

Even if you don’t have pitting edema, postural hypotension or headaches, you still need more sodium if you are starting out on or following a low-carb diet. It’s critically important that you get extra sodium.  I can’t make this case too strongly.

An easy way to get extra sodium along with magnesium and potassium (a couple of other electrolytes we’ll discuss in a bit) is by consuming bone broth.  Unfortunately, you typically have to make the good stuff yourself because it’s difficult to find commercially.  You can get chicken broth and beef broth at most grocery stores, but it’s not nearly as good as the broth you can make yourself.  At the end of this post I‘ll give you a spectacular recipe that we have for a great bone broth we made at our now-defunct restaurant.  It is beyond good.  It requires a little time, but you can make a bunch and freeze it in small containers and keep it forever.

Short of making your own bone broth, you can use commercially available bouillon, which contains plenty of sodium and makes a nice hot drink.  Plop a cube in a cup of hot water and throw it back. Many patients have reported that drinking a cup of hot bouillon helps them get through carb cravings.  It’s easy and convenient, but can’t compare in taste to the real bone broth you make yourself.

In addition to broth, get some Celtic Sea Salt, Himalayan Salt or one of the other grayish, pinkish kind of grungy looking salts and replace your normal salt with these.  And don’t use them sparingly.  These salts have been harvested either from ancient sea beds or obtained by evaporation of sea water with high mineral content and contain about 70 percent of the sodium of regular salt (which has been refined, bleached and processed until it is pretty much pure sodium chloride, often with anti-caking agents added).  The other 30 percent of the volume is other minerals and micronutrients (including iodine) found in mineral-rich seas.  Consuming these salts is not just following a Paleolithic diet using modern food, but, depending upon the origin of the salt, it is consuming the same food your Paleolithic ancestors ate.  I much prefer these salts taste-wise to regular salt, and I salt the heck out of all my food with it.

Magnesium

The low-carb diet doesn’t really cause a massive depletion of magnesium like it does with the sodium and potassium (the next electrolyte on the list), but most people who are overweight, insulin resistant and/or hypertensive or diabetic are deficient in magnesium.  Even people with lipid problems are often magnesium deficient.  In fact, even people who don’t seem to have health problems can often be magnesium deficient because most people don’t get enough.   The last I read on the subject, about 70 percent of people don’t even get the minimum recommended daily intake of magnesium (which isn’t all that high).  So, in my opinion, it’s important to supplement this vital mineral.  Good magnesium levels help regulate potassium as well, so keeping your magnesium adequate helps with your potassium as well.

Nature has designed us so that approximately 300 plus of our enzymes require magnesium as a co-factor to make them work properly.  Which tells us that we evolved in a time when magnesium was readily available, otherwise the forces of natural selection wouldn’t have made such wide use of it.

Where did it come from?  I would bet most of it came from the water.  Most natural sources of water have a high magnesium content, so when you drink bottled water and softened and treated water, you get short changed.  Magnesium salts in water are one of the substances that tends to make deposits on your water pipes and makes it difficult to get a good lather with soap.  This problem is solved with water softeners, but the process gets rid of the magnesium.  In the old days when we all drank well water or stream water, we got a lot more magnesium.

Since magnesium is used in 300+ different chemical reactions in the body, a shortage of magnesium can cause problems.  One of the most common ones is an increase in cravings.  Often simply replenishing magnesium gets rid of many of the food cravings people have.

The best way to get magnesium is from supplements.  Get a good chelated magnesium supplement and take 300-400 mg per day.  We’ve found it best to take these supplements in the evening because magnesium is relaxing and taking it in the evening helps you sleep.  About the only problem people ever have with magnesium is loose stools, i.e., the milk of magnesium effect.  If that happens – and it is unwelcome – simply reduce your dosage until your stools normalize.

Purchasing magnesium supplements can be a little tricky because of the way they’re labeled.  First, a chelated magnesium supplement is one that ends with an ‘-ate,’ as in magnesium aspartate or magnesium citrate or magnesium citrimate.  The -‘ate’ ending tells you the magnesium is chelated, which means it’s attached to another molecule (the chelating agent..aspartate, citrate, or whatever) that helps with absorption.  Second, with magnesium supplements, the manufacturers sometimes list the dosage of both the magnesium and the chelating agent combined.  Since the chelating agents are a lot heavier than the magnesium, this labeling often ends up saying the dosage of each pill is, say, 1000 mg of magnesium aspartate.  This isn’t the amount of magnesium you’re going to end up getting because the magnesium is only about 15 percent of the weight of the total pill.

About the only way you can really tell how much actual magnesium your getting is to look on the label on the back and see how much of the RDI (Recommended Daily Intake) the dose is.  The RDI for magnesium is 400 mg per day so if you find the dose of the supplement you are considering contains 50 percent of the RDI, then you know each dose contains 200 mg of magnesium irrespective of what the dosage is on the front of the bottle.  As I say, I recommend 300 to 400 mg of magnesium per day.  The only downside of magnesium is loose stools.  Doesn’t happen to everyone, but does to a few.  For many people the magnesium seems to offset the constipation that some experience when starting a low-carb diet.  If you do experience loose stools, simply back off your dose of magnesium until things unloosen.

Magnesium is natures relaxant.  It makes many people sleepy, so we always recommend taking it at bedtime.

Potassium

Potassium is linked to sodium.  If you lose a lot of sodium through the diuretic effect of the low-carb diet, you’ll ultimately lose a lot of potassium as well.  Keeping your sodium intake up as mentioned above will help preserve your potassium as well.  And keeping your potassium levels up helps to ensure that you don’t lose a lot of lean muscle mass during your weight loss.  Plus, just as with sodium, adequate potassium prevents cramping and fatigue.

You can replace your potassium by taking potassium supplements.  In our clinical practice, we gave all patients starting the low-carb diet a prescription for potassium.  You can get the same dosage by taking four to five of the over-the-counter 99 mg potassium supplements you can purchase at any health food or natural grocery store.

There are a couple of prescription medicines that you’ve got to be aware of if you markedly increase your potassium intake, so if you’re on blood pressure medicines, ask your doctor if it’s okay for you to take potassium.

Before we move on to other supplements we can use to help with low-carb dieting, I want to address the subject of dehydration.

Hydration

A few years ago, I learned the lessons of adequate hydration the hard way, so take this as a cautionary tale and benefit from my painful experience.  I had always pooh-poohed the notion of drinking a lot of water in addition to coffee, tea and other non-caloric beverages because I always figured (and probably have even written in the pages of this blog somewhere) that coffee, tea, etc. are nothing but water with a little flavoring in them.  I mean, if you start out with a glass of water and put tea bag in it, the water doesn’t go away.  It’s still there; it just becomes tea-flavored water.  Well, turns out that’s not actually the case.

My daily ritual was as follows: Get up, stagger to the refrigerator and take a big gulp or two of sparkling water.  Then make my way to the espresso maker and crank out a cup of Americano.  Followed by four or five more Americanos over the course of the morning and early afternoon, interspersed with a gulp here and there of sparkling water.  A snort of Jameson in the early evening, maybe a glass of red wine with dinner and a decaf Americano after dinner.  If I watch a movie or read a book, I usually nurse another glass of Jameson.  I typically take my supplements at bedtime, so I throw back another half glass or so of sparkling water then.  Plenty of liquids, right?

Well, not exactly, as it turned out.

I began developing severe cramps in my hands and feet that I had a hell of a time massaging out.  That was just the beginning.  I started being awakened at night with brutal leg cramps, requiring my springing from the bed and walking them out.  My potassium is too low, thought I, so I started taking potassium.  No change in the cramping situation.  In fact, if anything, it got worse.  I was complaining to a friend who told me calcium had helped his cramps.  So I downed calcium at bedtime.  No improvement.

Another friend told me that tonic water had helped her with cramps, but I only half believed it, so didn’t really try.  Then MD and I had family visit us in Tahoe for skiing.  I upped my booze intake, kept the coffee intake about the same, and probably decreased my consumption of sparkling water (or water of any kind, for that matter).  The cramps increased dramatically.  And what was worse, they stopped limiting themselves to the night.  When MD and I were driving over to Napa one day, the cramps were so severe I could hardly drive.  I had to keep the seat back as far as I could get it so I could straighten my leg when one hit me.  Then my hands started cramping just holding them on the steering wheel.  I pulled off the freeway and made a beeline for a convenience store and grabbed a one liter bottle of diet tonic water and proceeded to chug the entire thing as I drove down the road.  Miraculously, my cramps subsided.  So, I figured tonic water (quinine) was the solution.

One night – after being out of tonic water for a few days and being failed by my bride in resupplying – I had another brutal night of cramps.  The next day I was scheduled for blood donation.  After going through the long list of questions that must be answered verbally (and fighting down the impulse to tell my interrogator that I had recently paid for sex while imprisoned in Africa – those who have given blood lately will know what I mean), I was sent to actually have the blood taken.  The phlebotomist couldn’t find my vein, which had never happened before because I usually have rope-like veins in my forearms.  She asked if I was dehydrated.  I told her I didn’t think so since I had had my normal four of five cups of coffee that morning along with my gulp of water.  She brought me a couple of 16 ounce bottles of water that I drank, and, bingo, there were my veins.  Big and robust as usual.

It finally occurred to me that my cramping problem might be due to dehydration and that the diet tonic that solved the problem did so not because of the quinine but because I was drinking all the water the quinine was dissolved in.  And it occurred to me that the cramping was worse in the middle of the night because a lot of water is lost through the breath at night. (See my second post on the Anthony Colpo Smackdown to read more about this.)  You can lose a couple of pounds during sleep simply by breathing water vapor away, which was, I’m sure, what was happening to me.  I was barely hydrated enough to prevent cramping while awake, but when I slept and my fluid level fell due to my breathing water away, I hit some critical threshold of fluid that kicked off the cramps.

I started rehydrating first thing in the morning and throughout the day.  Now I get up, drink anywhere from 16 to 32 ounces of remineralized water (more about which later) first thing.  Then I head to the espresso maker and start my daily Americano regimen.  But I consume at least 8 ounces of sparkling water after each cup of coffee.  And I drink water after each shot of Jameson and/or glass of wine (or any other alcoholic libation),* and I’m proud to report that I have been cramp free since upping the water.

My brush with cramping misery inspired me to hit the medical literature to read about hydration.  And I learned many wonderful things. For example, I learned coffee is a diuretic (which I already knew but had chosen to forget), but that some acclimation occurs over time.  Still, due to the diuretic effect, you don’t get the full fluid from a cup of coffee that you would from an equal amount of water.  Same with alcohol.  Once I started calculating how much fluid of that I drank throughout the day I was actually retaining, I was amazed that cramping was the worst that happened to me.

I learned that water has a lipolytic effect (fat burning).  I read this in a number of papers that had studied it, and the data clearly showed that those who took in a lot of water had increased lipolysis.  I didn’t deny the data, but I couldn’t figure out the mechanism (and apparently neither could any of the authors because none described it).  I thought on it a while and finally came up with what I think is a plausible scenario.

When you drink water, especially cold water, you require some increase in caloric burning to bring the water to body temperature, but that increase doesn’t amount to all that much (the authors did describe this phenomenon), but you also dilute your blood for a bit until the water equilibrates with the fluid in all the tissues, and effect that takes some time.  During this time, while the blood is more dilute, the concentration of the various substances carried in the blood decreases.  Which would mean that insulin levels would fall.  The typical blood volume is about 5 liters, so drinking a liter of water would increase the blood volume temporarily by about 20 percent, which would mean the concentration of insulin and other molecules in the blood would fall by about 20 percent.  A 20 percent drop in insulin levels would allow fat to escape the fat cells and would facilitate its transfer into the mitochondria for burning.  At least that’s my explanation for the lipolytic effect seen in numerous studies of subjects increasing water intake.

Those starting a low-carb diet are prone to dehydration because excess ketones are gotten rid of via the kidneys along with a lot of fluid.  So, when you start your diet, consciously increase your fluid intake.  Do like I do now and come up with some sort of regimen that ensures you consume plenty of water throughout the day.  You’ll feel better; you’ll avoid cramping; and you’ll actually burn a little more fat.  And don’t make the mistake I did and assume that drinking a lot of coffee, tea, booze or other diuretic fluid is a replacement for water intake.

Since I drink either bottled water or water that comes through our RO filter, both of which are depleted of minerals, I always remineralize my water by adding a pinch of Celtic Sea Salt or one of the other such salts to each bottle.  I add enough so that the water just barely hints of a salty taste.

Supplements

Every patient whom we started on a low-carb diet left our clinic with six supplements:  lipoic acid, CoQ10, Vitamin E, magnesium, a good multi-vitamin and a prescription for potassium. (Now I would add a substantial dose of vitamin D3 to the list, a dose based on vitamin d levels and sun exposure.) We’ve already dealt with the potassium and magnesium, so let’s consider the others.

First, the good multi.  I’m a believer in getting most of what’s needed vitamin- and mineral-wise from food.  And I’m also a believer that I’m an excellent driver.  Yet I always purchase car insurance.  I see a good multi-vitamin as the same thing – cheap insurance against any kind of deficiency.  I would rather have my patients urinating away fifty cents worth of vitamins a day than risk that they have a deficiency in one.  And I feel the same way about myself.  So, find a good multi-vitamin without iron and take it.  Based on the experiences of my own patients, I can almost guarantee you’ll feel better. Why without iron?  Because most people on low-carb diets get plenty of iron in a very absorbable form.  And too much iron isn’t a good thing, so don’t take it in your multi.

Alpha lipoic acid (ALA)

ALA is, next to magnesium, just about my favorite supplement.  It acts as both a fat-soluble and water-soluble anti-oxidant so it can pretty much weasel its way in anywhere in the body and stamp out inflammation.  It protects fatty membranes and even acts as a cellular nutrient.  It also helps the body deal with blood sugar, which helps the whole low-carb adaptation process along.  Many studies have shown an improvement in blood glucose levels and insulin sensitivity with ALA supplementation.  ALA can rejuvenate other anti-oxidants, and has so many virtues that entire books have been written about it.  My standard dose is 300 mg per day for patients starting low-carb diets.  There is a newer, more potent version of ALA available now called r-alpha lipoic acid.  The standard stuff is a combination of the r and l varieties, and since the r isomer is the active one, a supplement made entirely of the r variety is going to be more potent.  And more expensive.  If you use the r-ALA you can take 100 mg a day.

CoQ10

Another superstar supplement, especially for those who have been on or are on statins.  Statin drugs interfere with the body’s synthesis of this important nutrient, and those who have been or are taking statins are usually depleted to some degree.  If you’ve been taking a statin, I would take 300 mg per day of CoQ10.  If you haven’t, 100 mg per day should do.

Vitamin D3

I would also add at least 1000 IU per day of this nutrient.  You need to have your levels checked at some point to make sure you don’t overdo it, but at 1000 IU per day, this is unlikely.  If you do test and find you’re deficient, I would take 5,000-10,000 IU per day until 25 (OH) vit D serum levels are up to at least 50 ng/ml.  Along with all the other benefits vitamin D3 provides (which I have written about elsewhere on this blog), there is some evidence that it even boosts weight loss a bit.

5-hydroxytryptophan

The last supplement I’ll mention is one I’ve had much success with in treating people who tend to have carb cravings late in the day.  5-hydroxytryptophan (5-HTP) is the precursor to serotonin.  Most people who have carb cravings have them because their serotonin levels fall.  Taking 5-HTP will bring them back up.  It also helps with sleep.  Best time to take it seems to be about 4 or 5 PM for those who go to bed at the standard 10-12 PM.  You can move the dose around to find a time that helps the most with your carb cravings yet doesn’t make you sleepy other than when you want to be.  I usually recommend 50-100 mg.  It’s available at most health food stores and natural food grocers.

Fatty liver

The last bit of advice I’ll give is that you need to work to defat your liver as quickly as possible.  The good news is that you can do it quickly on a low-carb diet.  Studies have shown major improvement in just 10 days or so.   It’s important to defat your liver to help you lose weight more quickly because the liver breaks down insulin.  If your blood sugar goes up, the pancreas makes and secretes insulin to drive it down. It does so by driving the glucose into the cells.  At the same time, insulin drives fat into the fat cells and keeps it there.  As long as the insulin is in the circulation, it’s going to be preventing fat from leaving the fat cells.  The liver is the organ that breaks down and gets rid of the insulin.  And a healthy liver does it a lot better than a liver full of fat.

One of the liver’s most important jobs is detoxification of harmful substances.  We all (at least I) consume medications, food and drink that is toxic.  We (I) drink coffee, tea and alcoholic beverages.  The caffeine and alcohol are toxins.  They don’t really hurt us in the quantities that most of us ingest, but they are toxic nevertheless.  The liver detoxifies them.  Same with many drugs – both prescription and over-the-counter.  Tylenol puts a major detoxification burden on the liver.  When you drink coffee, tea, and/or alcohol and take OTC meds, you occupy much of your liver’s detoxification capacity.  Which means it can’t get rid of insulin as well and can’t regulate metabolism in general as well as it does when it isn’t busily detoxing toxins.

So, if you really want to hit it hard in the early phases of your low-carb diet and reach low-carb adaptation at warp speed, I would recommend avoiding – or at least limiting – coffee, tea, alcohol and OTC meds.

I am a huge lover of coffee and alcohol (coffee more so than alcohol despite my constant talk of Jameson) so I know this is a sacrifice.  One way to have it both ways is to switch from caffeinated coffee to decaf espresso.  Decaf coffee to me sucks taste-wise.  But decaf espresso ain’t so bad.  If you don’t want to go completely cold turkey, you can switch from coffee to espresso since espresso has double (or triple) the taste of coffee yet only about half the caffeine.  My favorite way to drink espresso is as Cafe Americano.  I love it so much that I even made a video of how to make it to send to people.  Take a look if you haven’t seen it yet.  It’s the best cup of coffee you’ll ever have. (I have one on the table next to me as I write these words on the patio in Cuenca, Spain.)

That’s about a wrap on my tips and tricks for kicking off a low-carb diet.  I’m sure many of you have tips and tricks of your own.  Please feel free to share them in the comments section.

The bone broth recipe at the very bottom of this post is from our defunct restaurant that I wrote about here.  We had this going on the stove all the time and used it as a base for about half the dishes we served.  It is absolutely spectacular.  I would eat is as a soup (we didn’t serve it that way) and take home bags of it and freeze it.  You can do the same.  I’ll provide the restaurant-sized version so you can either make a large amount in a big stock pot and freeze a bunch of it in individual packages.  Or you can cut it down to a smaller recipe.  If you do, just make sure to cut all the ingredient amounts proportionally.

ldl not the enemy

Posted by Dr. Larry Kaskel on Monday May 09, 2011 9:32 am

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Posted by Dr. Larry Kaskel on Sunday Apr 10, 2011 7:44 am

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Posted by Dr. Larry Kaskel on Friday Feb 18, 2011 11:47 am

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Posted by Dr. Larry Kaskel on Thursday Feb 10, 2011 11:28 am

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Posted by Dr. Larry Kaskel on Sunday Jan 16, 2011 8:53 am

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Posted by Dr. Larry Kaskel on Sunday Jan 09, 2011 9:28 am

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Posted by Dr. Larry Kaskel on Monday Dec 27, 2010 9:55 am

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	Karen Cutrona-Underwood E-RYT, Yoga Instructor/Owner, Blue Moon Yoga and Fitness, Inc. Read Posts | Bio
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