Mastering Nutrition

Question: If my tryptophan is low, and I'm on a low-carb diet, would you recommend 5-HTP supplements or tryptophan supplements or both? There are multiple reasons why tryptophan could be low. It could be that you are not eating enough protein, or it could be that you have a high utilization of the tryptophan. I would look in the test and see if the 5-hydroxyindoleacetate is elevated — because if it is, then that would suggest high serotonin production, and that might explain the low tryptophan. If that is the case, you may want to look into other explanations. In this particular case, we have talked about high estrogen levels and how they might be one of those things. In which case the root cause is the high estrogen levels and you need to address it at that level. Repleting the tryptophan maybe isn't necessarily the goal unless you have symptoms that are related to low tryptophan levels. If you're overproducing serotonin, if anything, you might have symptoms that are more related to high serotonin levels. You might not have any symptoms that are related to low melatonin levels, which is downstream from serotonin, in which case the main negative effect of depleting the tryptophan would probably be related to niacin because tryptophan is used to synthesize niacin — in which case the goal would probably be best served by supplementing niacin instead of tryptophan. Something to note: if you're trying to put on lean mass and it's not working, it could theoretically conceivably be possible that serotonin overproduction would be depleting the tryptophan to the point where you didn't have enough tryptophan to put on the lean mass you want. If the tryptophan is being diverted into serotonin, that's why it's low, again, judgeable by whether 5-hydroxyindoleacetic is elevated, then it makes no sense to put 5-HTP into the system because your problem isn't that you have low serotonin. If anything, it's that you have a high serotonin. The only other explanation I would say is if you have a low protein intake, you might need to increase your protein intake. But if that were the case, you would probably see other amino acids more across the board that were depleted and not just tryptophan. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/03/08/ask-anything-nutrition-feb-23-2019 If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: What to do if signs and symptoms of zinc deficiency persist despite taking 75 mg zinc gluconate per day. You should do plasma zinc. Also you know I kind of wonder whether you're taking that right. So if you're taking 75 milligrams of zinc like at one time then it's not surprising because you're absorbing like seven of those milligrams. The rest you are not. To maximize absorption take them on an empty stomach in 10-15 mg which is typically the smallest dose available. If you're doing that and the signs, the deficiency persist they're persisting when you're taking that, then it probably isn't zinc related. If they're persisting until you take that and it goes away, then either you aren't absorbing the zinc well, or you're not taking it right. Those are the two things. If you're not absorbing it well it could be a general malabsorption disorder, something causing loss of bile, or a polymorphism or genetic impairment in a zinc transporter, or low methylation which all can affect zinc transporters. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: Is a high value of arsenic a concern? Yes, arsenic is a toxin. You probably don't want a lot of it, if it's just a little high it might not cause terrible damage. I would look at methylation if I saw high arsenic, because methylation is needed to get rid of arsenic. Oh actually I should add that methylation supplements have been shown to help arsenic detoxification in areas of the world where arsenic was a serious concern. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question Are low polyunsaturated omega-6 values on the ION test a concern? Not the total, but if the arachidonic acid levels are low I would look at low arachidonic acid intake, or inflammation, or oxidative stress. It would concern me because arachidonic acid is important to a lot of physiological functions, but I don't care about the total omega-6. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: When high selenium does not come down in response dietary efforts and cessation of supplementation, what's going on? Either there's high levels of selenium in the soil where your food is grown, or you have low methylation because methylation is needed to get rid of excess selenium. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: Creatine, when is it recommend that if you don't have the MTHFR SNP that causes methylation problems? 1.)When you want to improve your physique. 2.)When you want to improve your athletic performance. 3.)When you have a rare creatine synthesis disorder. 4.)If you have depression, it might help. 5.) If you have any signs that something else is messing with your methylation even though your genetics don't explain it. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: When should tryptophan be taken on a keto diet? Night, day, both? Presumably you're doing this to try to increase tryptophan getting into the brain. The best thing to do is to take it two to three hours away from other protein. The second consideration is if you have an allotment of carbs that you concentrate at one time of day, then it would be best to take the tryptophan then. With the caveat being if you're eating protein with the carbs. In that case it would be best to take it away from the protein + carb meal. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: Do you think there are true non-responders to creatine, or do you think that those apparent non-responders have some defects in methylation that makes typical doses of creatine sufficient only for other needs. Alex Leaf would be a great person to ask about this and he's not here right now… [Alex appears] Alex, so Jen's question is are there true non-responders to creatine or do you just think that non-responders likely have some defect of methylation. It means the typical doses of creatine are only sufficient for their needs. Alex: I don't think that methylation is going to be relevant here. When you look at responders and non-responders, the difference seems to be in their ability to uptake creatine into muscle cells from the serum. So, it's very unlikely be related to methylation and it has to probably do with differences in creatine transporter abilities across cell membranes. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: How do I bring up low levels of arachidonic acid? Should I supplement with 250 milligrams? What brand is there from well-known company? If you want 250 milligrams of arachidonic acid, eat an egg. I don't know anything about arachidonic acid supplements yet, except that they exist because you can eat eggs and you'll get plenty. Do you want to try the supplement? Well you can, but I don't think it's necessary. You eat two eggs a day already, so eat four. The oxidative stress and inflammation will consume the arachidonic acid, so look at that too. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: How to interpret the pattern of high citrate, low cis-aconitate, low glutamate, and high glutamine. The aconitate and citric acid are markers on the citric acid cycle where we metabolize most of our energy. If citric acid is high and isocitric acid is low, (this must be the Great Plains Test which doesn't have isocitrate/cis-aconitate) that would indicate oxidative stress. In terms of the glutamate being low --- if your glutamate is low and your glutamine is on the high side, then you probably have ammonia generation from somewhere that you're mopping up with glutamate. That would be my guess, but that's another can of worms to open. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: What are the best ways to optimize glutathione status for someone who has a G6PD deficiency? Riboflavin was shown to be of benefit for normalizing oxidative stress in people who have glucose 6-phosphate dehydrogenase deficiency. So for people who don't know what this is G6PD is, glucose 6-phosphate dehydrogenase is an enzyme that you use to take energy from glucose specifically, you can't take it from anything else, and you use it to recycle glutathione which is a master antioxidant of the cell. You also need this to support the recycling of vitamin K and folate and you need this for synthesis of neurotransmitters among other things. But the big problem with G6PD deficiency is that you can have a lot of things go sideways when you can't use this pathway. Red blood cells become more vulnerable to hemolysis and that is a result of oxidative stress from poor glutathione recycling in the red blood cell. One of the adaptive responses to having G6PD deficiency is the glutathione reductase enzyme -- which is the enzyme that uses riboflavin and niacin to recycle glutathione with the energy taken from G6PD. That enzyme -- glutathione reductase -- it develops a voracious appetite for riboflavin that makes all the riboflavin that won't go anywhere else, get sucked up into that enzyme. So basically you become very dependent on riboflavin support of glutathione reductase because you have lost G6PD, the enzyme that's involved in passing the energy on to riboflavin in glutathione reductase. There's probably no harm to starting at 400 milligrams of riboflavin a day, but if you feel like you want to be more cautious about it, I'd start at 5 or 10 milligrams a day, test the effect on glutathione status. You know in this case I think you want to look at erythrocyte glutathione status, I don't usually recommend that test, but it might be a more relevant test specifically for this condition. What I would usually recommend for glutathione status would be plasma levels of glutathione. I also think LabCorp does whole blood glutathione. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: Are there diminishing returns in the amount of fish in a weekly diet? I know you mentioned eating fish about twice a week. I've been trying to eat salmon once a day. Is there an ideal ratio of fish to non-fish protein you should aim for? There's not a lot of data backing that up and the data we have is pretty poor quality. But I'm of the mind that the diminishing returns come after one or two servings of fatty fish per week. I think if you're talking about white fish it's different. But I am referring to salmon or mackerel — I think once a week or twice a week is good. As for white fish — it's not as different from meat as you might think, the real big difference in my view is there are some different, like there's selenium and iodine among other things. The big difference in salmon, mackerel, and other fatty fish, versus lean fish versus meat is the type of fat. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: How to deal with the fact that blood tests for nutritional status aren't adapted to children? There aren't childhood-based ranges that are data-driven. So what if the ranges need to be a little bit different in children? The approach in the Cheat Sheet is not to rely exclusively on ranges, it's also to look at the diet and lifestyle analysis and to look at signs and symptoms. So what you do is you piece together: does the diet and lifestyle analysis, the blood lab, and the signs and symptoms all say deficiency X, too much Y. Then that's very good information and what you do is you intervene on the basis of what seems probable and you monitor the outcome. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: I just saw an email from Matt Stone referring to the overly deified nutrient vitamin A. Also, a few Weston A. Price Foundation bloggers are starting to spread the word about being sick on a high vitamin A diet. Any thoughts about this and comments about Vitamin A being toxic? You shouldn't deify any nutrient, right? Any point of view that breaks down the world into good and bad molecules, is a doomed-to-failure point of view because molecules don't have virtues. Everything is about context. Too much vitamin A cannot be defined outside of context. Not just what your needs are, not just what your genetics are, not just what your turnover rate is, not just whether you are getting pregnant, but also the presence of other things in the diet. For example, vitamins D, E, and K, which will affect the vitamin A requirement because they all regulate each other's breakdown. Some people have too much Vitamin A. Some people take more vitamin A than they should. There's dozens of case reports of vitamin A toxicity, but there's no evidence that people at normal intakes who are not supplementing are getting inflammation from consuming dietary levels of vitamin A. The RDA is 3,000 IU. If you're correcting deficiency, 10,000 IU is highly reasonable over a short period of time. On the other hand, if you have someone who has a very long history of taking vitamin A supplements at 30,000, 40,000, 50,000 IU over 3 years, then, yeah, they might have all kinds of problems from that because they're taking too much. Toxicity is also way more likely if they're not taking vitamin D, vitamin E, or vitamin K. There's nothing remotely controversial about that; no reason to question it. There are probably a lot of people in Weston A. Price who think that more of a good thing is better, and I know for a fact that many people were taking two or three tablespoons of high-vitamin cod liver oil for many years. That was nuts then and it's nuts now; they're getting too many fat-soluble vitamins and too many polyunsaturated fatty acids from high levels of cod liver oil like that. But again, 3 to 10,000 IU, even long-term, there's no evidence of toxicity. Some people are going to be intolerant. I know anecdotes of people who take vitamin A at very low doses and it causes some hypersensitivity reaction. I don't know what causes it. So there will be stories of people who improve when they take the vitamin A out of their diets. It will happen, it makes sense. And on top of that there are epidemic proportions of people with fatty liver. What happens when fatty liver gets bad? The cells that store vitamin A in the liver dump their vitamin A into the bloodstream so they can transform into cells that lay scar tissue down in the liver. So people with fatty liver, which is about three-quarters of people who are obese, right, so about 70 million Americans, maybe more now, have fatty liver disease. Some proportion of them are laying down scar tissue in their livers and they are losing the ability to properly store and metabolize vitamin A. Could taking vitamin A out of the diet for them help? Probably, but it's a very tough place to be in because those people are going to have cellular vitamin A deficiency. So it's like, do you save the liver or do you save everything else? It makes sense to temporarily withdraw vitamin A, but really you need to just fix the obesity and fatty liver disease, then restore vitamin A that is needed. I have no problem saying that some people take too much vitamin A and that it can be toxic, but there are people going around right now saying that vitamin A is intrinsically toxic, and those people are absolutely nuts. That's flat-Earth level thinking that it's just intrinsically toxic and not a vitamin. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: Is it ok to mix carbs and fat? There are a lot of people on the internet that claim the Randle cycle is behind America being fat, since the standard American diet is mixed in fats and carbs. Yet, I feel great on a diet of about 30% protein, 30% fat, and 40% carbs, based on meat, potatoes, fruits, and vegetables. The randle cycle addresses why you would have elevated fatty acids or hyperglycemia and hyperinsulinemia due to competition. You're more likely to have circulating energy supplies in your blood due to poor tissue uptake when you're consuming carbs and fats together, and you're more likely to be more dependent on a higher insulin response. This doesn't mean that mixing them causes diabetes, it just means that there is more substrate competition and that, all else equal, if someone is on the edge of diabetes eating a mixed diet increases the probability that they're going to go over that edge because of the substrate competition contributing to hyperglycemia and the greater insulin requirement than someone who's on a low-carb or low-fat diet. If you have no evidence of metabolic dysfunction on a mixed diet, then there's no issue. Most Americans are fat because of caloric balance. Thinking that the glycemic or insulin response to eating plays a role in body fat gain is the same erroneous thinking that Taubes makes. There's an element of truth in Taube's carb-centric model, in that some people are going to eat more food in response to a high-carb diet if they have blood sugar problems. But that isn't the norm. To say that the Randle cycle is the cause of obesity is making the same mistake because it's focusing on the glycemic and insulin responses to eating instead of overall energy balance. What makes you fat is eating too much food. The only thing that you should change about the calories in calories out (CICO) hypothesis, on a practical level, is to say that it tells you very little about the behavioral modifications that someone needs to make to sustain the caloric deficit over time. So, why do people get fat? I largely endorse Stephan Guyenet's view: it's basically the proliferation of hyperpalatable food. A mixed diet leverages the principle of creating a hyperpalatable diet by mixing carbs and fat, but your diet doesn't sound hyperpalatable. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: Can you explain what parent essential oils are? I was given some articles that seemed to be saying that high-dose cold-water fish oils are damaging to cell membranes and mitochondrial function. "Parent essential oil" is a term invented by Brian Peskin, who looked at some data that said it's not clear that supplementing with fish oil is good for you because doing so can cause oxidative stress and cause damage to cells. That's true because the highly unsaturated oils found in fish oil, as well as in liver and egg yolks, are highly vulnerable to being damaged. This includes the physiologically essential omega-3 fatty acid, DHA, and omega-6 fatty acid, arachidonic acid. But that damage comes only when you eat too much. This is where I think Peskin is wrong, because he took that data and concluded that you don't want to eat any of these oils. Instead, you should eat oils like flaxseed that provide the "parent" fatty acids that your body turns into DHA and arachidonic acid. But the parent oils are prone to being damaged too, just to a lesser extent. On a gram to gram basis, they are safer, but you need to eat a ton of parent oils to get the physiological requirement for DHA and arachidonic acid. So, on a daily requirement basis, the parent essential oils are going to be way more damaging. I recommend simply taking a small amount of arachidonic acid and DHA, since then you fulfill your requirements regardless of genetics or the environment or whatever could impede the transformation of parent oils to these physiologically essential oils. High-dose fish oil is ridiculous, and risky, but that doesn't mean you shouldn't consume any. Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: What are your thoughts on monitoring HRV for optimizing performance? Measure your HRV every night and you stop exercising entirely to get a baseline. You completely stop working out, you don't go "oh no I'm going to lose my muscle mass," nothing's going to happen for a week or two. And this is the whole foundation of you having good data. This baseline ensures that you have good starting data that isn't influenced by anything. Now you start working out. You do one workout that's typical, you keep taking your HRV, you may see your HRV plummet. Then you say, how long does it take me to recover on my current diet and lifestyle? You repeat that, like you don't work out again until it's back up to the plateau level. Then you work out again and you see if you have a repeatable response where there's a certain amount of time on average that's fairly replicable that it takes you to recover your peak HRV after your typical workout. Then when you have that you get on that frequency. You can then start playing around with factors — like does it matter what type of workout I do? Is my recovery level consistently different when I lift weights at 5 reps per set versus 15 reps per set. Is my recovery time consistently different when I do cardio, or when I do cardio and weights on the same day, or when I play soccer. Then you can start to tailor your recovery time around the specific workouts. Maybe it takes you two days to recover from one workout and four days recovering from another. Lower body, upper body, if you have a lower body upper body split, does it take me five days to recover the lower body and does it take me three days to recover from upper body? At that point you can start tweaking diet and lifestyle. Do I recover faster if I eat more carbs? Do I recover faster if I eat food X? Do it recover faster if I take supplement X? Always testing one thing at a time and making sure it's replicable before you form a conclusion before you do the next test. Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: Why did the FDA have a vitamin A requirement during pregnancy at 8,000 IU, which is much higher than the IOM recommendations in the past? I have no idea. I do know that the concerns around vitamin A during pregnancy are that in the first weeks of pregnancy, 10,000 IU and higher has been associated with birth defects. That was one prospective study in 1995, which is higher quality than retrospective studies, but still contradicted all the retrospective studies that came to the opposite conclusion. So, there's no good consensus on the data, there's just moderately justifiable paranoia about the possibility that you could could cause birth defects. Also, there were like seven or eight letters to the editor about why that study had a bunch of problems with it, like the data just doesn't make sense. So the basis for restricting A in pregnancy is a theoretical concern that doesn't have a lot of data to support it. That said, I see no reason why someone needs 10,000 IU or more going into the first eight weeks of pregnancy. If you eat liver once or twice per week, you're not getting more than that. If you took a half a teaspoon of cod liver oil every day, you're not getting more than that. If you eat eggs and dairy every day, you're not getting more than that. So, I would not supplement with 10,000 IU and higher vitamin A going into pregnancy, not because I'm super paranoid and there is good data justifying the restriction, but because the theoretical concern outweighs the lack of theoretical benefit in most cases for most women. Now if that woman is trying to get pregnant, but her serum retinol is low and her eyes are dry and her night vision is bad and she has hyperkeratosis, then you bend the rules a little bit because you have an obvious justification to get her vitamin A levels up. It's just speculation versus speculation, so why not pave the middle ground of what you would reasonably get from food? This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: Does mixing carbohydrate with fat cause people to get fat because of the Randle cycle? There's a theory floating around on the internet that mixed diets are more fattening than low-carb or low-fat diets because of the metabolic competition between glucose and fatty acids. I don't believe this to be true because, in the context of isocaloric diets, mixed diets don't seem to be more fattening than low-carb or low-fat diets. Isocaloric diets are important for understanding physiological cause and effect, but they interfere with the real-life practical understanding of something. We want to use isocaloric science to study the academic question of, physiologically, are carbs and fat more fattening when combined than not combined. But, in real life, people eat more food on a mixed diet than they eat on a low-fat or low-carb diet. I think someone who says mixed diets are more fattening because of the Randle Cycle is totally misunderstanding this. They are more fattening because of the hyperpalatability factors that Stephan Guyenet has explained. Also, they probably are more likely to cause metabolic harm because of what Alex Leaf has explained about the Randle Cycle in his post, "Why you may reconsider buttering your potato" at Superhumanradio. He was arguing that you don't want to put butter on your potato because you have substrate competition between glucose and fatty acids, which makes it more difficult to clear the glucose from your blood and causes a compensatory higher insulin response. I'm not so insulin-centric that I believe that you necessarily always want to be minimizing your insulin response, and I definitely know that I have friends and colleagues who disagree with me on that, but I just don't view any disease, including type-2 diabetes, as a problem with hyperinsulinemia. The short of it is that the more you mix carbs and fat in your diet, the more likely you are to overeat. You don't necessarily overeat, but it's way more probable because it's hyperpalatable. The more you mix carbs and fat, the more you don't specialize in one or the other. What's the most efficient thing to do? If you eat a high-carb, low-fat diet your body specializes in burning carbs, you eat a high-fat, low-carb diet your body specializes in burning fat — and you're not going to do either of those as good if you're eating a mixed diet. Can you do them good enough? Often times, but if you have metabolic problems you might want to try a low-carb or a low-fat diet so you can specialize and be more efficient with your metabolism, because if you have metabolic problems whatever you're doing isn't working for you right now. Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: What to do if gamma-tocopherol levels are low-normal while taking 100 IU/d of alpha-tocopherol. My initial impression is that there is nothing wrong because I don't care that much about gamma tocopherol. My doctoral research specialized in gamma tocopherol and there is some evidence that gamma tocopherol does some things that alpha tocopherol doesn't do. It's likely that people who take high-dose alpha tocopherol supplements are suppressing their gamma tocopherol levels. But you don't have to be in the middle of the green for gamma tocopherol on the ION test. So if you are taking a 100 IU of alpha tocopherol at the time of test, then stop taking that and replace it with TocoSorb, or take a lower dose. I think a reasonable dose of vitamin E for the average person is 20 IU. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: What to do if taking biotin and yet beta-hydroxyisovalerate is elevated. Well in theory that's a marker of biotin deficiency, but you might have a defect in a biotin-dependent enzyme so you can try 5 milligrams, but if you still have high beta hydroxy isovaleric you need to start looking at a metabolic disorder, providing there are symptoms. You might have a 20% decrease in that enzyme activity. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: For someone who is taking 45 mg of vitamin B6 as P5P but has xanthurenate, kynurenate, and quinolinate high in the urine as markers of vitamin B6 deficiency, and who is a man with high estrogen, what should they do? If you have xanthurenate and kynurenate spilling into your urine, it means that quinolinate would be building up. Quinolinate is usually the last thing to rise in B6 deficiency. Quinolinate is an excitotoxin: it both can cause neurotoxicity like glutamate does and it can also make you hypersensitive to glutamate, effectively giving you a glutamate sensitivity. You clarified that quinolinate is in the fourth quintile. So you're kind of in the zone quinolinate might be a problem, particularly if you have trouble sleeping, or if you have trouble with anxiety, or you have anything that would be related to glutamate sensitivity, like headaches. If you have any of those symptoms, they could be from quinolinate buildup. In that case, I recommend increasing B6. I would titrate it up to 100 mg. I'd be very cautious going higher than that. Don't take any pyridoxine hydrochloride ever. Second course of action is look at iron and riboflavin levels. If there's any things wrong with those fix them, since they are needed to properly convert tryptophan alongside B6. Third course of action is to reduce protein intake, if necessary, or search for low tryptophan proteins and focus on those to meet your protein needs. You need at least a few hundred milligrams of tryptophan in your diet to be okay. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: For someone who is homozygous for the H63D allele of the iron- and hemochromatosis-related HFE gene, if ferritin is low but transferrin saturation is high, should they still donate blood? H63D is one of the genes that predisposes to hemochromatosis, a condition of iron overload. Most clinicians who work in this area do not consider the H63D allele to be a concern because it's less severe. With that said, most people who are progressive on the iron research front do believe it's a concern. There is literature showing that people can get clinical hemochromatosis from it and you don't have to get clinically hemochromatosis to be worried about iron overload. My opinion on this is going to be different than someone who is an expert clinician, but is not immersing themselves deeply in the physiological literature about how this works. I don't have the skills that they have in triaging and filtering who's ideal for what treatment and looking at large numbers of people that do one or another treatment and knowing intuitively what happens in those — but what I do have is I have immersed myself very deeply in the physiology. So the way that I look at this is as follows: iron saturation is an estimate of your transferrin saturation. It's a cheaper way to estimate it than to actually measure transferrin saturation, so it's much more common to get iron saturation. But let's assume that we're talking about actual transferrin saturation or that iron saturation is a good metric of it. That's your short-term iron storage. Ferritin is your long-term iron storage. The defect in the H63D allele, same for the C282Y allele of the HFE gene, the two moderate and severe hemochromatosis alleles. Allele is a variant of the gene. In normal physiology what happens is transferrin acts as a gauge of your iron status. The normal physiological levels are between 30 and 40 percent. Now being 41 percent doesn't mean you have a disease, we're not talking about diagnosis here, we're talking about understanding the physiology. Mechanistically this is designed so that as you go from 30 to 40 percent and especially as you go over 40 percent that communicates the signal to a hormonal system that says you have more iron than you need. So you ramp down iron absorption and you ramp up ferritin. Why do you ramp up ferritin? Because you have more than you need in your short-term storage, so that's when you put it into your long-term storage. Also, because ferritin is a protective response that prevents you from having free iron. Free iron is bad because it feeds pathogens and it makes infections worse. Free iron is bad because it causes oxidative stress and causes wear and damage on your tissues. And so to avoid free iron you ramp up ferritin while you take down your absorption from food at the same time. And now is that a problem at all? You could debate that, but if you're just talking, if you're not talking about diagnosis and you're talking about wellness, and you're talking about health management then… What I would want to do myself in that situation is I would first of all not let the ferritin go under 20, and if it's going near there I would be getting a CBC to make sure I'm not making myself anemic. And so I would not stop donating blood just because the ferritin is going down 60, 50, 40, I would consider it a gray area, it would be my preference to focus on the transferrin saturation and get it consistently under 40%. You get the pinprick to look at your serum iron levels, they're not going to let you donate blood if you're actually in the danger zone of anemia. So I would get the CBC to be proactive about it. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: Thoughts on lowering my resting heart rate. It's often in the high 80s or low 90s once I'm up for the day. I wish I knew the answer to that. I'd use it for my heart rate. I don't even measure my heart rate because my whole life it's been kind of high. I think breathing and meditation are probably the best things that you can do. I've typically had a white coat syndrome response to getting my blood pressure taken, and because as soon as I feel the pressure, I start to get anxiety and I'm like, "oh no it feels like it's high" and I get an adrenaline rush. A couple of years ago I got rejected from giving blood three times in a year because either my blood pressure, or my pulse was too high when they measured it, both because of the adrenaline surge. I was not able to donate blood until I started using Headspace, the meditation app, in particular the visualizations of the happiness portion. The first time I was able to donate blood was when I went in to get my blood pressure and pulse taken and I imagined that bright light in the middle of my chest I just did the visualization and "boom" my heart rate and my pulse, just went straight into normal zone because I was able to create an association between that visualization and the state that the meditation produced. So that would be the first thing that I'd try. If I find out that I have a medical condition with a physiological solution I'll let you know, because I have the same thing. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: How to manage the zinc-to-copper ratio and what to do if zinc and copper are both low-normal when supplementing with 15 mg of zinc and 1 mg of copper. I don't recommend looking at the zinc-to-copper ratio. Although there are studies correlating health endpoints with the zinc-to-copper ratio, I do not believe that it is a causal factor in disease. I believe the zinc-to-copper ratio is often associated with disease because inflammation raises plasma copper and lowers plasma zinc, based on taking zinc up in the cells and mobilizing stored copper out of the liver. You want zinc and copper at the right levels; the ratios are less important. You want both around the middle of the reference range; the bottom of the range is not adequate. If you are taking a supplement, then the simplest thing to do would be to take it twice per day instead of once per day and to make sure you are taking it on an empty stomach. Up to 50 mg of zinc will not cause nausea on an empty stomach in most people if you take it with a full glass of water. Some people do have digestive issues when supplementing on an empty stomach, and if you need to take it with food, do not supplement anywhere near phytate, which is the principal inhibitor of zinc absorption and is found in whole grains, nuts, seeds, and legumes. I recommend Jarrow's zinc balance, which has the exact ratio that you're talking about. It's a convenient way to have the copper in the zinc supplement already. But if you are low in copper, this isn't an adequate source for two reasons: (1) the amount of copper is too low, and (2) the form of copper isn't ideal (it has lower bioavailability because it's not the oxidation state that you get in food). For a copper supplement, I would want to use food first, and liver capsules if you want a supplement. For foods, check out the tiers of copper-rich foods that I recommend, which includes liver, cocoa powder, and certain mushrooms. Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: What nutrients are needed to break down old, damaged bone and build new, healthy bone? So you are breaking down bone all the time throughout every second of your life. We are always breaking down bone, we are always building up new bone, and if you had any kind of defect in the ability to break down old bone, then you would have problems manifesting elsewhere. Bone breakdown is necessary to maintain your serum calcium levels. You would probably be having severe hypocalcemic attacks if you were not breaking down your old bone — and you probably also would have exercise intolerance and/or poor exercise performance as a result of the undercarboxylated osteocalcin released from bone, which acts as a hormone to improve energy utilization during exercise. In fact the overwhelming problem in the general population is that people are breaking down too much bone and not building it back up enough. So if you just look at the course of someone's life over time when we are young we are building more bone than we're breaking down and that, somewhere around 25 years old depending on male and female — we reach peak bone mass and then we spend the entire rest of our lives declining in bone mass. To some degree when you're building bone you need everything. So eating a nutrient-dense diet across the board is important, but things that are extremely important that kind of stand out from building other tissues when you're building bone is collagen. Half your bone is protein — about 95 percent of the protein in your bone is collagen. The limiting factor for collagen synthesis is glycine. Collagen peptides provide glycine and they also are better at stimulating collagen synthesis than just powdered glycine. So collagen peptides, bone broth, edible bones from canned fish or from the ends of small chicken bones, would all probably be helpful. Then clearly calcium and phosphorus are the overwhelming minerals in bones. So you need enough calcium and enough phosphorus — between the two of those in the population most people do not get enough calcium and get too much phosphorus. People get phosphorus from processed foods and from soda, and in addition to the natural phosphorus in meat and other foods. If you are not eating junk food you probably don't get too much phosphorus, but you still probably get enough. If you're not eating junk food, and you're not eating dairy, and you're not eating bones, you probably do not get enough calcium and in particular many people in the natural health community have read a lot of anti-calcium supplementation stuff. I want to emphasize over and over again that it's better to get calcium from food than to get calcium from supplements, but it's better to get calcium from supplements and then not get calcium. Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: What are my thoughts on detoxing heavy metals? My thoughts are first you need to look at how bad the heavy metal is and if it is even at a level that a conventional practitioner would say you have toxicity; for example lead. If this is your situation then I don't feel comfortable advising anyone here, but if your levels are slightly high and you would like to reduce them, then my suggestion would be zinc supplementation on the basis that most heavy metals produce a metallothionein increase. Metallothionein is your endogenous chelatior. The ability of the heavy metal to provoke that protective response is completely dependent on zinc concentrations inside your cell even across the range of deficiency through normal status through more zinc than you need, and there's no evidence for a threshold or cutoff. So I think if your zinc status is fine and you boost your zinc status a little, without causing any zinc toxicity, or copper deficiency -- I think that's a very gentle and safe way to reduce your load of heavy metals. Unless what you're seeing is arsenic, in which case methylation would be my focus because methylation plays a specific role in addressing arsenic. For anyone who hasn't seen that I have a comprehensive methylation resource at chrismasterjohnphd.com/methylation. This Q&A can also be found as part of a much longer episode, here: https://chrismasterjohnphd.com/podcast/2019/02/24/ask-anything-nutrition-feb-17-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: What to do about elevated morning blood glucose in the mid 90s. I think usually your morning glucose is primarily impacted by your hormones and very rarely impacted by what you ate the night before, unless you are severely glucose intolerant. So the overwhelming probability is that if your blood glucose is elevated in the morning and mid-90s is not tremendously high; it is most likely cortisol. If there are other signs of slipping into pre-diabetes then I might come up with another explanation, but I don't think waking up in the morning and often having mid-90s glucose — with everything else being fine, is likely to be a sign other than cortisol levels. It's not necessarily a bad thing because you're supposed to have a cortisol spike in the morning. You may want to look at your cortisol levels over time. The DUTCH test can do that. It happens to look at a lot of other things that I think are useful so that might be my first go-to. First you want to know if that's actually the issue. If cortisol is out of range then you probably want to look at stress reduction as a first step, and there's some evidence for using phosphatidylserine to lower cortisol. If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: neither my mother nor myself respond to T3 supplementation (cytomel; up to 140 mcg/d). Body temp remains low and reverse T3 stays normal. Could you discuss the factors that might interfere with thermogenesis in response to T3, and offer considerations how to improve this? Having normal levels of reverse T3 tells you that the body isn't deliberately getting rid of the thyroid hormone. High reverse T3 would be a sign that your body just doesn't want the thyroid hormone around. That doesn't seem to be happening and so that makes me wonder if there could be a problem with taking up the thyroid into the cells. In which case I would expect thyroid hormone levels to be higher in the blood then you would otherwise expect them to be. Or if there's a problem with the thyroid actually carrying out its functions inside the cell to regulate gene expression. This could be a zinc deficiency issue, since zinc is necessary to allow the thyroid receptor to bind to the DNA. In fact, zinc is necessary for everything that has a nuclear receptor that alters gene expression by binding to a nuclear receptor. This includes receptors for vitamin A and vitamin D, receptors for the sex hormones, and for thyroid hormones; all require zinc to act. But, you seem to be saying that your issue is a specific thermogenic response, which makes me ask, are you seeing every other thing that you would expect from thyroid hormone and not thermogenesis? If that's the case, I have no idea. But, if you're not seeing any of the effects from thyroid hormone that you would expect, then I would say maybe some kind of resistance to getting into the cell if blood levels are elevated. If blood levels are normal, then maybe it's not acting on the nuclear receptor, which I'd think zinc deficiency. I don't know what else you could do with the exception of measuring the free fatty acids, which would be high if you had a zinc deficiency. They might not be if you're taking insulin and you're eating moderate to high carb. Get free fatty acids measured, which would often be called NEFA, for non-esterified fatty acids. You know you can't have everything. I would rather your pancreas just start making all the insulin it needs, but options are limited, right? so I don't know if you can fix the temperature issue. If you can with fixing it at the root problem great, but if you can't then absolutely I would I would manage your temperature with clothing. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: "What are your top three non-nutrient factors that prevent someone from entering beta-oxidation or ketogenesis? I mean like sleep disruption." Top three non-nutrient factors? Unless you are taking a drug that prevents lipolysis, then they aren't non-nutrient. The overwhelming things that govern those are carbohydrate and fat intake. You eat more fat, you have more beta-oxidation. You eat less fat, you have less beta-oxidation. You eat less carbohydrate beyond a threshold. ==I don't think sleep disruption is going to do that. Sleep disruption is going to increase your stress hormones — so with sleep disruption, your cortisol is going to spike, and it's going to increase your appetite for junk food — so you're probably more likely to eat things that are anti-ketogenic when you're sleep-deprived because you're eating more junk food, which has more carbs. You probably are not going to have lower beta-oxidation. You're probably going to have higher oxidation because you're going to eat more fat. But most people do not have impairments in beta-oxidation. If you have a riboflavin deficiency, you can have an impairment in beta-oxidation, but even in disease states, beta-oxidation is higher. If you have a fatty liver, beta-oxidation is increased because your liver is trying to get rid of fat. The overwhelming thing governing beta-oxidation is the relative balance of fat going into your tissues versus out. To the extent carbs displace the fat from being burned, carbohydrate is going to decrease beta-oxidation — but if you're eating carbohydrate, and you're eating more fat, versus less fat, you're going to have more beta-oxidation when you eat more fat. So, yes, sleep disruption will disrupt the appropriate way of handling those things, but I don't think it's going to block ketogenesis or beta-oxidation, except by messing up your appetite. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: "Any recommendations for peripheral neuropathy? Testing vitamin B, lion's mane?" First of all, there is no such thing as vitamin B. I'm not trying to be a nitpick, but there's literally almost a dozen B vitamins, with different tests, that do different things. So, I think it's important to establish a habit of never saying vitamin B because, not to be a grammar nitpick, but I just think it's misleading to think about the concept of vitamin B. There are quite a few B vitamin deficiencies that can cause peripheral neuropathy. You can also cause peripheral neuropathy by taking vitamin B6 in too high doses, and that's one of the reasons why you have to separate them out because B6 is unique among the other B vitamins in that respect. In Testing Nutritional Status: The Ultimate Cheat Sheet; I have an index of signs, and if we go into peripheral neuropathy, I have listed here deficiencies of thiamin, riboflavin, and vitamin E — toxicity of selenium and B6. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: "If cholesterol, LDL-P, and oxidized LDL are high, the sterol panel is normal, and TGs are great, would you suspect clearance of the particles driven by LDL receptor in the liver is the issue, and what would you recommend to boost LDL-R?" Yes, it sounds like you should target LDL-R. The big regulators of LDL-R function are thyroid hormone, and the amount of cholesterol in the liver cell, and anything that brings bile acids into the feces, and that's generally a high-fiber diet; psyllium husk would be a fiber you could add. Thyroid hormone is the other piece of that, and that you target with higher carbohydrate intake. Higher carbohydrate intake also acts on PCSK9 to boost LDL receptor activity. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: "What are your recommendations on magnesium supplements and dosage?" My opinion is that most people shouldn't be supplementing with high doses of magnesium. I think if you're going to supplement with more than 400 milligrams a day, you should be testing your magnesium status, and you should be making decisions on that. I think there's way too many people throwing really high doses of magnesium into their system. The topical stuff makes sense if you're absorbing poorly, but hey, maybe you're absorbing poorly because you don't need it, and so I think you really have to judge it against real metrics of results. So, in terms of types, I would not recommend magnesium oxide for anything. It's poorly absorbed, so maybe you could argue that magnesium oxide is going to help act as a laxative better, but that's not bowel function, that's pharmacologically modulating your bowel transit time. So, I don't think it makes sense to deliberately take a poorly absorbed magnesium to have that effect. The good sources of magnesium are: magnesium citrate is okay, glycinate is okay, malate is okay, across the board, I genuinely don't believe that the form is that important. It's just that oxides of minerals including magnesium are generally poorly absorbed. There isn't much difference in the other forms. As always tailor it to the individual. I wouldn't give blanket recommendations there. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: "Calcium score, is there a way to treat one's calcium score and get it to zero?" ⇒ No, you don't treat the calcium score. You take the calcium score as indicative of what's going on in atherosclerosis, and you treat that. The goal, I think, is calcium score equals zero. No, that's a bad goal because that's like saying my goal this year is to be a billionaire. Is that going to make me harder and get closer to it? I don't know. You set somewhere what the ideal is, but then you don't think about that, you think about — okay — what's the next step right now in front of me. What you focus on is the thing that's right in front of you. So, maybe you want to be a billionaire -- but your goal is, how do I increase my revenue this month? Not how do I be a billionaire this year. If you want a calcium score of zero, fine, but you don't think about that; you think about how do I lower my calcium score, because then when you lower your calcium score, you do more of that. When you do something that raises your calcium score, you do less of that. In atherosclerosis, calcium is super driven by the atherosclerotic progress. So, ideally it would be nice if you had ultrasound imaging of your carotid IMT. If you have advanced plaque formation, you probably will be able to see that on the IMT, like you can see how the plaque is developing and whether the actual atherosclerotic plaque is. K2 is relevant there, but a general deficiency of K2 is more likely to manifest as diffuse calcium deposits everywhere in the artery. So, it might be that your LDL is high, and then that's what you should be focusing on. You really have to start from point A through B through C, and K2 is one of those things, but you need to look at all the factors that can be contributing to atherosclerosis. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: "What do you think of alternative testing like hair mineral analysis or SpectraCell?" I'm against SpectraCell on the basis of, it's not validated. I gave more details in a podcast episode "What Makes a Good Marker of Nutritional Status?" and you can find that at chrismasterjohnphd.com/marker. Hair mineral analysis; I like hair mineral analysis when there is nothing better and more validated. For a lot of the trace minerals where we don't have good, validated markers of nutritional status, so I think hair mineral analysis is good. I also think hair mineral analysis is good if you don't have the money to do something comprehensive with all the best markers, and you want something that can clue you in when something might be off. So, the nice thing about it is, with less money, you cover all the minerals. The less nice thing about it is, it's not very well validated quantitatively. Even where there's data, like for example — it is validated that your iron in your hair tends to be higher when your iron in your body is higher, and vice versa. But it's not validated to say, when hair is X amount, this is when you need more iron, and when hair is Y amount, this is when you need less. The way that the blood markers are — like transferrin saturation, ferritin, hemoglobin, all these more validated markers. We have tons of quantitative data saying — the normal range is this — the optimal range is this. You lose the precision when you go back to the hair mineral analysis. I wouldn't use it — the thing is, if you spend $200 on a hair mineral analysis, that's $200 that you can't put towards your Genova ION Panel, or you could have gotten four iron panels with that, right? So, you have to be careful that if your financial resources are constrained, you might want to do the hair mineral analysis on that basis, but it might be a better financial decision long-term to hold onto that money and do free stuff. In Testing Nutrition Status: The Ultimate Cheat Sheet, what I say is, if you don't have the money for the comprehensive testing, you focus on the things that are free. You do the dietary and lifestyle analysis. You do the symptom analysis. Then you go to the things that that indicates is most probable, and then you do the best validated test. Maybe this diet and symptom analysis all points you to iron, and you spend $60 on the iron panel, and that gives you more payoff than $200 on a hair mineral analysis. So, it's not an obvious choice about when to get the suboptimal test. It's something you have to think about carefully. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: How do I address edema? Edema is basically going to be caused by excess salt retention in the body. The reason is that with the exception of very extreme scenarios, your body is going to tightly regulate the sodium concentration of the water in your body, and sodium draws water. Now, that's not to say that the cause is eating salt. And there are cases where eating salt might remove edema. But generally salt retention of total water volume is going to be a big factor. In hypothyroidism it becomes I believe at least partly about glycoproteins in those spaces that are holding onto water. If it's thyroid-related, you're not really talking about nutritional support, you're talking about fixing your thyroid. Maybe that means nutritional support, but it might mean other things. But the nutrition is aimed at the thyroid, not the edema. Maybe manganese would help modulate those glycoproteins in hypothyroidism the same way that it does in regulating the stickiness of the arterial wall. I'm totally guessing on that. Edema in the menstrual cycle is caused by high aldosterone, which is probably caused by high progesterone. I know that everyone in alternative health thinks that progesterone is the good hormone, and estrogen is the bad hormone — but in PMS water retention, I believe progesterone is just accumulating so much that it's spilling into aldosterone. I genuinely don't know what to do about the high progesterone, but about the high aldosterone. Magnesium and B6 have been shown to help with that. I did an episode about that, so I would Google "Masterjohn what to do about menstrual weight gain" for more details on thata. Then I would play around with salt and potassium. So, generally less salt during that time and more potassium in the diet are potentially going to be helpful. I think the principles are going to be similar elsewhere. It doesn't have to be in the menstrual cycle. You are generally going to find that salt is increasing extracellular water, and potassium is increasing intracellular water, and that's often going to be a factor in edema that can't be tied to thyroid hormone. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: "How do you determine if you're getting enough protein? I heard Dr. Stephen Phinney say, for those on a keto diet, if ketones are greater than 3 on a regular basis, then it's a sign you're not getting enough protein." First of all, why are you on a ketogenic diet? If your purpose is to get the ketones, why wouldn't you want your ketones higher than 3? The ketogenic diet is, regardless of what people are doing it for, it's best tested in terms of epilepsy, and the classical ketogenic diet gets ketone levels up to 3 or 4 millimoles per liter… sometimes higher. Then the question is, you're not doing it for medical therapy, why are you doing it? If you're doing it to lose weight, who cares what your ketones are? There's a ton of people out there who are on a "ketogenic diet" who don't care what their ketones are because they're doing it for weight loss, for body composition, or to feel better. If those are what your goals are, your metrics should just be whether you're losing weight, whether you're getting better body composition, or whether you're feeling better. There's no data backing up the fact that you can measure your blood ketones and determine what any of those outcomes are going to be. That has nothing to do with why you need protein. Yes, too much protein is probably going to lower your ketones. Protein is anti-ketogenic. It's not as anti-ketogenic as carbs are, so I get the kernel of truth that Phinney is getting at. The higher your protein is, the lower your ketones are going to be, and maybe there's some general correlation to be seen across people that the people who tend to have ketones that high tend to not be eating enough protein, but that's a correlation that has nothing to do with the underlying reason of why you eat protein. You eat protein because you need protein to optimize your neurotransmitters, you need protein to optimize your metabolism, and you need protein to optimize your body composition. The number one metric that we have on protein intakes and quantifying them is on body composition, and you want a half a gram, to a gram of protein for every pound of target body weight. So, if you're trying to gain muscle, use what you want to have at the end of gaining muscle. If you are overweight, use what your ideal weight would be. And the more you care about your body composition, the more you should aim for the top of that range instead of the bottom. It doesn't matter if you're keto or not. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: What supplements would you recommend for a ketogenic diet? Any concerns with carbs being that low? If someone's on a keto diet and they have 80 grams total carbs, the first question I have is where are the carbs coming from? That's really going to determine whether the person needs supplements. So, on a keto diet in general and protein, too? If you're eating a lot of fat instead of protein, then you're going to need supplements of the things found in protein foods. If your carbs are all coming from honey, then you're going to need things that are found in vegetables. ==>You just can't tailor nutrient needs based on carb total data alone. The biggest things would be make sure you're getting a gram of protein per pound of body weight if your ketones and goals can handle that load of protein. That'll protect you from a lot of nutrient deficiencies right there. Try to cook your proteins in ways that recapture the juices. That will help conserve the electrolytes. You also probably want salt and either a lot of low-net carb vegetables, or you're probably going to need more potassium in your diet. Those are the big things that I'd look at. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: "Why would a male be low in calcium?" You either have something wrong with parathyroid hormone governing your calcium levels, in which case you would want to see a doctor about that, or you have a long-going deficiency of related nutrients. Not enough calcium and not enough vitamin D should not cause low serum calcium — unless the deficiency has been going on for a very long time and is very bad. Then again, I don't know what measurement you're referring to. So, maybe the calcium was a tiny bit low, and you remeasure it, and it's not low anymore; it was a fluke. But if you're talking about confirmed low serum calcium, then nutritionally, I would look at long-standing severe deficiencies of calcium and vitamin D. I'd follow it up with measurements of PTH and calcitriol to better assess the situation. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: "I keep waking up in the middle of the night and stay awake for hours. Would low carb make it worse?" It definitely could. Your brain will consume 120 grams of carbohydrate every day, just your brain. There's got to be another 30 grams or so that would be used no matter what obligately by red blood cells, certain cells in the testes, the kidney, and the lens of the eye. Then the rest of your body — if you're eating not a ketogenic diet, the rest of your body is not really trying to burn fat, so it's going to burn through carbohydrate. Your liver stores about 90 grams of carbohydrate to be able to stabilize your blood sugar between meals, and overnight is the biggest time where it has to do that because overnight is the longest period of time that you go without meals. If you add that up, you're looking at like 250 grams of carbohydrate a day — and remember we haven't gotten to high-intensity exercise yet. Now, if you go on a ketogenic diet, what happens? Well, your brain glucose consumption goes down from 120 grams a day to like 30 or 35 grams a day. You cannot and will not ever, ever, ever, ever, ever go to zero. That's one thing. You still have another 20, 30 grams of carbohydrate that you're burning through by cells that cannot burn anything else. You still have a minimum probably 60 or 70 grams of carbs per day that you need — even when you're maximally keto-adapted. I'm not saying you need to eat those carbs. You'll make them through gluconeogenesis if you don't eat them. But the rest of the body where the needs were flexible, has mostly shifted to burning fat for fuel on a long-term ketogenic diet. So, the real big problem is if you're not low-carb enough to be keto, but you're way under 200, 250 grams of carbs a day. Like, probably 100 grams of carbs a day is like, if it works for you, great, but if you have symptoms of low blood sugar at night, you shouldn't be spending a lot of time guessing why, because you're in this gray area where you are not keto-adapted, your brain is still burning through 120 grams a day, your liver still stores 90 grams a day, and the rest of your body still probably is preferentially burning carbs for energy instead of storing them for the most part because the carbs are there. So, your body is not deliberately, intensively reorganizing to conserve the carbohydrate in that gray area. ==If you are eating 50 or 100 grams of carbs, and you are in this place, then you absolutely should connect the two and see if increasing your carbs helps. Low-carb is not the best solution to high fasting glucose. There's a lot of people on low-carb who have high fasting glucose. There's a ton of people who go low-carb and develop high fasting glucose. That's because a low carb diet alters the hormonal environment in two main ways: 1.) Increases the morning glucagon response. 2.) Increases adrenal hormones. Both of these are early and late-stage adaptations to low glucose supply. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: "Which brand and dosage of no-carb electrolytes would you take at night to optimize sleep, especially after sauna use?" I would drink a bottle of Gerolsteiner, and I would add to it 100 milligrams of any kind of magnesium: citrate, glycinate, malate, those three are fine. And I would add to it 400 milligrams of potassium citrate, or bicarbonate if it's an empty stomach. You say no-carb. Because of the potassium, I personally would take maybe like a teaspoon of honey with this. I would also take some salt. Let's say a half a teaspoon, to a teaspoon of salt with it. The caveat being if you're sodium sensitive you should be mindful not to overdo it. If you know you don't have a problem with salt and blood pressure, then I would recommend adding the sodium to the mix. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: "Vitamin K2, MK-4 and MK-7, might have caused prolonged heart palpitations. Upon stopping it, symptoms mostly resolved after a week or so. Does that mean that the body is better off without it? Might increasing calcium intake mitigate this?" I would say, the calcium is really interesting. I genuinely hadn't thought of that until you mentioned it. Even though I've heard other people ask this question, I haven't had time to look into it, but you raise a good point. So, it is conceivable, for example, that your bone density has been very low because you have not had the K2 you needed to get the minerals into the bone. So when you get the K2, you start loading the calcium into the bone, but maybe because your whole body is programmed to assume things were the way they were before you started taking the K2, then it doesn't adapt fast enough to normalize your blood calcium, which, by the way, how do you normalize your blood calcium? You take calcium out of the bone. MK-4 has been studied in high-milligram doses as an osteoporosis drug because it inhibits bone resorption. If you inhibit bone resorption, you will definitely interfere with your ability to maintain normal serum calcium levels because bone resorption is how you do that. So, either you're giving the nutrients needed to get the calcium into the bone and the body is just prioritizing that because it's been missing them for so long, and your serum calcium drops — or you're actually creating signaling stopping bone resorption, and so your blood calcium drops because of that. Either way; taking calcium might impact that, and I would love to have some anecdotal data on that because there's no studies on K2and heart palpitations. So, I would love it if we have some anecdotes of people saying whether the calcium helps, especially since so much of the K2 stuff is so skeptical of calcium. Kate Rheaume-Bleue's book Vitamin K2 and the Calcium Paradox, I think it's a great book. Basically, what that book is, is an enormous elaboration of my 2007 article on Activator X and Weston Price. If I had written that book, I would have done things a little bit differently. The whole idea of the calcium paradox that's in the title, I think it has merit. There is some data indicating that calcium supplements might worsen the risk of heart disease, but I think that the conclusions are way too anti-calcium, and I think there's too many people out there taking K2 who have it in their heads that calcium supplements are bad. Calcium supplements are bad compared to getting enough calcium from food. A huge portion of those people are not getting enough calcium from food, and getting calcium is more important than where it comes from. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome

Question, part 1: "Bovine colostrum from New Zealand cows. Yea or nay for those with dairy sensitivities? If nay, what would you recommend instead?" What is your goal? If you have a dairy sensitivity, your problem could be with casein, with the whey proteins, or with something more specific like certain antibodies. It's very complicated. You're less likely to tolerate colostrum if you have a known dairy sensitivity, but you can't really know without testing the colostrum. Question, part 2: "to settle a client's overactive immune system down." What, specifically, about the overactive immune system are we looking at? I would think maybe this is chronic inflammation that's not resolving, and then I'm thinking more about arachidonic acid and DHA. Question, part 3: "She can take a supplement one time and then the next time it throws her over. Same with food." Okay, that sounds to me like an oral tolerance issue. When you put something in your mouth, it goes to your gut, and then your immune system decides whether it's safe or whether it's not safe. Your immune system doesn't know anything when you're born; it is more or less a blank slate. You do have predispositions because you have genetics that impact categories of protein fragments that you have the potential to make a decision about, but you are never born having a tolerance or intolerance to something. You are born with very broad genetics that say, "I will make decisions about this category, I can't recognize this category, I will make decisions about this category." So, you eat food or take supplements, you put something in your mouth, you swallow it. In your gut, your immune system says, "This might be something important, I'm going to take it back to my home base and decide what to do about it." That home base is called the gut-associated lymphoid tissue, or GALT. Your immune system is deliberately taking things into that lymph tissue, purposefully taking fragments that are not completely digested for the purpose of making decisions about it. In the gut, how does it make that decision? Overwhelmingly, there are two pro-tolerance factors. They are prostaglandin E2, which is made from arachidonic acid, the omega-6 fatty acid that's found most abundantly in egg yolks and liver, and that is the direct target of anti-inflammatory drugs, acetaminophen (Tylenol), aspirin, high doses of EPA from fish oil, and probably a lot of herbal anti-inflammatories. They will lower prostaglandin E2, and prostaglandin E2 is critical for oral tolerance in the gut. So, any potential anti-inflammatory is a potential contributor to this. You need prostaglandin E2, made from COX-2 from arachidonic acid, made from everything that everyone believes is inflammatory. All the anti-inflammatory drugs, the Zone diet, almost everything written about inflammation says prostaglandin E2 is inflammatory. It is one of the two central causes of oral tolerance, of the immune system recognizing that something is safe. The other is retinoic acid made from vitamin A. So, to create a pro-tolerance environment, you want no COX inhibitors being taken, you want sufficient arachidonic acid in the diet, and you want sufficient vitamin A in the diet. Then what are the factors that tell the immune system, this is not safe, and that is tissue damage. So, the immune system is basically saying, "I will make a decision about this. To make this decision, I need data." So, what are the data that things are okay? Retinoic acid, prostaglandin E2. What are the data that say this is not okay? All the factors released during tissue damage because tissue damage is the number one sign that something is harmful. So, if the thing comes in and they're fine, then the next time they take it, they don't tolerate it. That sounds like they are programmed to decide that everything that comes in is a threat. And so they take it, and it gets into their system and it doesn't do anything, but meanwhile the immune system took a piece of that into gut-associated lymphoid tissue, and said, "We need to program to make an army against this threat," and so it's the second time that they took it that they have the reaction. And so that means, again, get the arachidonic acid, get rid of the anti-inflammatories, get the retinoic acid from the vitamin A, and thoroughly investigate any possible sources of tissue damage in the gut. I don't know if it's necessarily the gut. It could be tissue damage somewhere else that then the things circulate into the gut, but it's probably the gut because that's what's closest to the situation. So, those are the things that I would be looking at. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of

In part 2 of The Carnivore Debate, we cover the philosophy of the carnivore diet and the potential pitfalls of carnivore and keto. The research that Dr. Saladino and I discussed with each other before this debate is listed in the show notes -- there are five pages of references! Here's what we debated: What exactly is a carnivore diet? Is a 90% meat diet a carnivore diet, a carnivore diet you cheat on, a carnivore-ish diet, or just a meat-heavy omnivorous diet? And why definitions absolutely matter. Is the carnivore diet ancestral? What can we learn from present-day hunter-gatherers, the archeological record, and our evolutionary history as revealed by our genes? Who is the carnivore diet for? To what extent do carnivore and keto overlap? What are the benefits of keto and how broadly applicable are they? What are the potential harms of keto? In particular: acid-base balance thyroid, stress, and sex hormones oxidative stress and glycation sports performance We agree we need to cycle between the fed state and the fasting state. Can the keto diet, designed to mimic fasting-state physiology, provide adequate fed-state signals to keep our body feeling well nourished? Inuit CPT-1a deficiency redux: did a genetic impairment in the ability to make ketones sweep through the Arctic to protect the Inuit from acidosis, or to help them stay warm? Dr. Saladino completed residency in psychiatry at the University of Washington and is a certified functional medicine practitioner through the Institute for Functional Medicine. He attended medical school at the University of Arizona where he worked with Dr. Andrew Weil focusing on integrative medicine and nutritional biochemistry. Prior to this, Dr. Saladino worked as a physician assistant in Cardiology. It was during this time that he saw first hand the shortcomings of mainstream western medicine with its symptom focused, pharmaceutical based paradigm. He decided to return to medical school with the hope of better understanding the true roots of chronic disease and illness, and how to correct these. He now maintains a private practice in San Diego, California, sees clients from all over the world virtually, and has used the carnivore with hundreds of patients to reverse autoimmunity, chronic inflammation, and mental health issues. When he is not researching connections between nutritional biochemistry and chronic disease, he can be found in the ocean searching for the perfect wave, cultivating mindfulness, or spending time with friends and family. Find more of Dr. Paul Saladino on the Fundamental Health podcast and at https://carnivoremd.com Get my free 9-page guide to optimizing vitamins and minerals on the carnivore diet at https://chrismasterjohnphd.com/carnivore This episode is brought to you by Ancestral Supplements' "Living" Collagen. Our Native American ancestors believed that eating the organs from a healthy animal would support the health of the corresponding organ of the individual. Ancestral Supplements has a nose-to-tail product line of grass-fed liver, organs, "living" collagen, bone marrow and more... in the convenience of a capsule. For more information or to buy any of their products, go to https://chrismasterjohnphd.com/ancestral This episode is brought to you by Ample. Ample is a meal-in-a-bottle that takes a total of two minutes to prepare, consume, and clean up. It provides the right balance of nutrients needed for a single meal, all from a blend of natural ingredients. Ample is available in original, vegan, and keto versions, portioned as either 400 or 600 calories per meal. I'm an advisor to Ample, and I use it to save time when I'm working on major projects on a tight schedule. Head to https://amplemeal.com and enter the promo code "CHRIS15" at checkout for a 15% discount off your first order." In this episode, you will find all of the following and more: Masterjohn and Saladino Show Notes 00:42 Cliff Notes 05:18 Introductions 05:28 What is a carnivore diet? 18:15 Is the ancestral human diet carnivore or omnivore? 50:40 Who is a carnivore diet for? 01:08:03 To what extent do carnivore and keto overlap? 01:10:34 Who is a keto diet for? 01:18:50 Ketogenic diets are only a partial mimic of fasting physiology 01:23:46 Ketones effect on the NAD/NADH ratio 01:27:31 Ketogenesis has opposite effects in the liver as in the ketone-utilizing tissue. 01:29:31 Ketogenic diets and oxidative stress 01:40:18 Longevity: why you want to cycle between the fasting state and the fed state 01:45:04 Can the ketogenic diet provide a sufficiently robust fed-state signal? 01:53:11 The keto diet and thyroid, stress, and sex hormones 02:10:05 Keto and sports performance 02:18:05 Why do the Inuit have a genetic impairment in making ketones, to protect against acidosis, or to stay warm? 02:35:48 Wrapping up Access the show notes, transcript, and comments here: https://chrismasterjohnphd.substack.com/p/070-the-carnivore-debate-part-2 Chris Masterjohn, PhD, is the Founder and Scientif

Dr. Paul Saladino, Carnivore MD, and I sit down to talk about the carnivore diet. In part 1, we focus on whether you can get all the vitamins and minerals you need on a carnivore diet, and how to best design a carnivore diet to maximize the nutrition you get. We discuss what I consider high-risk nutrients: Vitamin C Folate And what I consider conditional-risk nutrients: Manganese​ Magnesium​ Vitamin K​ Potassium​ Molybdenum​ We also chat about some other things: Dioxins in animal foods: a reason for vegetarianism? The methionine-to-glycine ratio: balancing meat with bones and skin. Did paleo people get nutritional deficiencies? Bioindividuality: why we all have different needs and our needs evolve over time. Diversify to manage risk: does this mean eat plants, or just eat all the parts of an animal? Ketogenic diets and oxidative stress. Do carbohydrates give you more intracellular insulin signaling? Should carnivores eat dextrose powder for carbs? Are today's hunter-gatherers representative of those from 80,000 years ago? Did the Maasai really mostly eat meat and milk? My open-door helicopter ride in Hawaii. Dr. Saladino completed residency in psychiatry at the University of Washington and is a certified functional medicine practitioner through the Institute for Functional Medicine. He attended medical school at the University of Arizona where he worked with Dr. Andrew Weil focusing on integrative medicine and nutritional biochemistry. Prior to this, Dr. Saladino worked as a physician assistant in Cardiology. It was during this time that he saw first hand the shortcomings of mainstream western medicine with its symptom focused, pharmaceutical based paradigm. He decided to return to medical school with the hope of better understanding the true roots of chronic disease and illness, and how to correct these. He now maintains a private practice in San Diego, California, sees clients from all over the world virtually, and has used the carnivore with hundreds of patients to reverse autoimmunity, chronic inflammation, and mental health issues. When he is not researching connections between nutritional biochemistry and chronic disease, he can be found in the ocean searching for the perfect wave, cultivating mindfulness, or spending time with friends and family. Find more of Dr. Paul Saladino on the Fundamental Health podcast and at https://carnivoremd.com Get my free 9-page guide to optimizing vitamins and minerals on the carnivore diet at https://chrismasterjohnphd.com/carnivore This episode is brought to you by Ample. Ample is a meal-in-a-bottle that takes a total of two minutes to prepare, consume, and clean up. It provides the right balance of nutrients needed for a single meal, all from a blend of natural ingredients. Ample is available in original, vegan, and keto versions, portioned as either 400 or 600 calories per meal. I'm an advisor to Ample, and I use it to save time when I'm working on major projects on a tight schedule. Head to https://amplemeal.com and enter the promo code "CHRIS15" at checkout for a 15% discount off your first order." This episode is brought to you by Ancestral Supplements' "Living" Collagen. Our Native American ancestors believed that eating the organs from a healthy animal would support the health of the corresponding organ of the individual. Ancestral Supplements has a nose-to-tail product line of grass-fed liver, organs, "living" collagen, bone marrow and more... in the convenience of a capsule. For more information or to buy any of their products, go to https://chrismasterjohnphd.com/ancestral In this episode, you will find all of the following and more: Masterjohn and Saladino Show Notes 2:11 Introductions 6:36 Dioxins in food. 14:33 Methionine to Glycine ratio. 23:08 Nutritional deficiencies in paleolithic people. 27:09 Bio individuality/diversity 36:07 Deficiencies that arise from eating only muscle meat. 37:26 Vitamin C 44:22 Weston A. Price's documentation of whale stomach lining and moose adrenal as a source of vitamin C in Arctic diets. 56:03 Ketogenic diets, oxidative stress, and vitamin c. 58:36 Insulin 1:05:46 Antioxidant status. 1:22:44 Folate. 1:26:05 Riboflavin. 1:30:23 Manganese. 1:32:28 Dextrose powder. 1:37:31 Potassium/sodium. 1:52:37 Hunter gatherer diets now vs. 80 000 years ago. 2:03:05 The Maasai. 2:09:00 Vitamin K 2:19:00 The most radical thing I've done recently. Access the show notes, transcript, and comments here: https://chrismasterjohnphd.substack.com/p/069-the-carnivore-debate-part-1 Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: If your cholesterol is high, how do you avoid having a large burden of oxidized LDL? First, normalize your cholesterol. And no, I'm not saying that high cholesterol is the cause of heart disease. It's not, but oxidized LDL is, and the number one cause of both high cholesterol and oxidized LDL is not clearing LDL particles from the blood. So, I would never skip over the question of what I can do to get cholesterol in the normal range. I think the boundaries of the normal range are a little exaggerated. If you look at traditional cultures that eat a traditional diet, live a traditional lifestyle — they're not modernized, and they don't have heart disease — you do see cholesterol levels that go higher than ours. So, for a man, maybe going up to 220 mg/dL in total cholesterol is pretty normal. For a woman in her 40s and 50s, up to 250 maybe. I'm not looking to change those numbers if lifestyle and diet are ancestral. If everything else about the data make it look like that person's very healthy — especially if direct measures of plaque development like carotid IMT, intima-media thickness, and coronary calcium score are normal. I wouldn't be thinking about fixing the cholesterol at that point. But, for someone whose cholesterol is like 300 mg/dL, you don't even see that in Tokelau, where the saturated fat content and the traditional cholesterol levels are the highest ever recorded in an ancestral population. So, when they're that high, you have to fix it as your first line of defense. That means improving LDL receptor activity. The big things to look at are body composition, inflammation, fiber intake (higher fiber is generally better), and thyroid. Let's say you haven't brought the cholesterol down, what do you do to protect it? Well, that largely comes down to a few things. Imagine the lipoprotein leaves the liver, some as LDL, some as VLDL, both of which wind up being LDL at some point. It leaves the liver packaged with antioxidants. Those include vitamin E and coenzyme Q10, but it isn't limited to those two. They are just the most important in this situation. When LDL is circulating in the blood, it gets behind the arterial wall, and that's the main site of oxidation. So, the question is, how oxidizing of an environment is that? Also, it gets stuck behind the arterial wall, so the question is, how sticky of an environment it is? Because if it gets stuck in the oxidizing environment behind the arterial wall, then that's the very powerful regulator of whether it's going to oxidize. So, the stickiness. Probably the dietary approach that best regulates the stickiness is manganese. Manganese is found mostly in plant foods and vegetarians have the highest intakes. People with plant-rich diets that also eat animal foods are in the middle. And people who eat a lot of animal foods and no plants are at the bottom. So, eat a lot of plant foods is one thing. There are some animal experiments specifically with blueberries as a source of manganese showing in animals that it makes the arterial wall less sticky, so there's that. Then there's the oxidizing environment. A big part of that is systemic inflammation because if inflammation causes oxidative stress. You should have been looking at inflammation for high cholesterol in the first place. Assume you have that covered. And then antioxidants in general. You're looking at protein, selenium, zinc, copper, iron, manganese, vitamin C, vitamin E, glycine… you're looking at so many things in there, so you really got to figure out what the weakest link is in that person and focus on that weakest link. There may be many. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: "I'm curious about the role of the lymphatic system in fat metabolism, specifically in high-fat, low-carb diets. Is there a biochemical explanation for why improving lymphatic circulation would improve fat metabolism?" Well, I wouldn't call it biochemical, I'd call it physiological, but yes. Fat goes from your gut through your lymphatic system to your blood. If your lymphatic circulation is not good, neither is the delivery of your fat to any part of your body. It's as simple as that. If your lymphatic system is slow, so is your delivery of fat to every organ in your body. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Question: "Lp(a) and genetic component with relation to cholesterol and risk of cardiovascular disease." First, I'm going to be able to give better answers to questions if they're more specific. But to the question: Everyone seems to think that Lp(a) causes heart disease. I don't believe it. I don't believe it because the function of Lp(a) is to clean up oxidized LDL particles. It might have other roles, but that's one of the primary ones. So, we have two possible explanations for the correlation between Lp(a) and heart disease. Either Lp(a) causes heart disease and people with genetically elevated levels have a higher risk of heart disease, or it is correlated simply because people with more oxidized LDL particles (which does cause heart disease) have more Lp(a) to clean them up. I'll be recording with Peter Attia on this topic, so I'll brush up on Lp(a) data beforehand and may change my viewpoint, but this is my view right now. If anyone wants to send me data to look at to revise my view, I'll happily take a look. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

"Can magnesium hydroxide be absorbed via skin?" I don't know. I genuinely don't know. "I've been applying milk of magnesia as a deodorant alternative in spray form for a few years now, and it works well, but I'm concerned about I might be hypermagnesemic, as I'm having low pulse, low blood pressure, and frequent bowel movements." You might be hypermagnesemic. You should measure your magnesium status, for sure. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a. Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Concerns about long-term bicarbonate supplementation and other suggestions for raising pH Helen Donnell says, "Your post on urine pH and exercise tolerance was a game-changer for me, but anytime I miss a dose of bicarb, I'm right back to 5. Any long-term concerns with taking bicarb two to three times a day, any suggestions for other ways to get my system pH up?" Well, I will say in my case that I stopped taking the bicarbonate when I figured out that I had a zinc deficiency. So, for people who don't know the backstory here, Google "Masterjohn urine pH" and you'll probably get that blog post to come up. It's called "How Normalizing My Urine pH Helped Me Love Working Out Again". The backstory in brief is, when I was going through the mold and barium toxicity crisis of turn of 2016 into 2017. I got to the point where it would take several days to recover from one workout. I couldn't afford to be laid out like this I realized while looking at some lab tests — a Genova ION Panel — had some findings that suggested pH imbalance problems. The only thing abnormal in my ION Profile was that my glutamine-to-glutamate ratio. The glutamate was really high, and the glutamine was really low. First thought; sounds like a pH issue. I was talking with a friend of mine that led down the same rabbit hole, maybe the reason the workout is tanking me is because my system can't handle the lactic acid. So, I started measuring my urine pH, and my urine pH was very, very low. Less than 5. I just kept taking bicarbonate at ¼ teaspoon increments. It just wasn't going anywhere until at some point, all the sudden I shot up out of bed, and I was like I want to work. I felt amazing. I went and measured my urine pH, and it was 6. It was like it just went nowhere until I got enough bicarbonate in. Once that happened it crossed the threshold getting into 6, and all the sudden I felt amazing. That was the first big clue. Then I replicated things over time, and found that it was a consistent effect. What turned things around for me was when I realized that my zinc was low. That was because bicarbonate allowed me to work out consistently and gain more muscle mass. Gaining muscle made me get patches of dry skin. Well, what do patches of dry skin mean? It's the earliest sign of zinc deficiency. Resistance training increases muscle mass and that requires more zinc to sustain the new tissue. What does zinc have to do with pH balance? Well, zinc is a cofactor for carbonic anhydrase, which is one of the main enzymes in regulating pH. I started supplementing zinc and tested my plasma zinc. Even though I had been taking zinc for three days, my plasma zinc was at the level I associate with a deficiency — which is around 70. Once I started supplementing zinc, the pH problems went away. So, zinc is definitely something I would look into. If zinc isn't your issue, I would keep going down the rabbit hole and do a comprehensive analysis like I do with Testing Nutritional Status: The Ultimate Cheat Sheet. Harms of bicarbonate: alkalinizing the stomach is the main one. To avoid complications you want to take it as far away from food as possible. I do think that excessive chronic use and alkalizing the stomach could lead to a lower ability to kill pathogens in the stomach and lead to overgrowth of bacteria in the stomach or small intestine. I would feel more comfortable about using it as a bridge to get from point A to point B and fixing the underlying regulatory problems as the destination. This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/ If you would like to be part of the next live Ask Me Anything About Nutrition, sign up for the CMJ Masterpass, which includes access to these live Zoom sessions, premium features on all my content, and hundreds of dollars of exclusive discounts. You can sign up with a 10% lifetime discount here: https://chrismasterjohnphd.com/q&a Access the show notes, transcript, and comments here. Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.