Ep. 219 Breaking Down Calorie Restriction, Protein Intake and The Ketogenic Diet with Chris Irvin

I had the honor of reconnecting with Chris Irvin today! (He was with me once before, on Episode 175.)

Chris is a nutrition researcher, writer, and educator specializing in low-carb dieting for metabolic health and human performance. He is the author of Keto Answers, The Carnivore Diet for Beginners, and Mommy, Do I Have to Eat This? He is also the Chief Marketing Officer at BioCoach, a company dedicated to taking down prediabetes and diabetes.

Chris is an incredible resource on the value of keto and low-carb diets! His book, Keto Answers, is one of my favorite keto resources to recommend to clients! In this episode, Chris and I get into the differences between micro and macronutrients. We talk about the therapeutic uses of keto, low-carb, hormesis, and carnivore diets, the role of metabolic health, the value of protein, balancing longevity and sarcopenia, and the results of over-fasting, over-restricting, and creating too much stress on the body. We also dive into questions from listeners about the impact of low-carb and ketogenic diets on cholesterol panels and endurance, how to troubleshoot digestive distress, protein excess, and Chris’s favorite gadgets and supplements. 

I hope you enjoy listening to this podcast as much as I did recording it! Stay tuned for more!

“When it comes to low-carb diets, the weight-loss portion is a big piece of the puzzle, but it’s not the only piece.”

– Chris Irvin

IN THIS EPISODE YOU WILL LEARN:

• The therapeutic benefits of keto, carnivore, low-carb diets, and fasting.
• The value of protein.
• How much protein should you eat?
• The importance of having muscle.
• The benefits of eating grass-fed red meat.
• The problem with over-restricting, over-exercising, and over-fasting.
• Changing things up occasionally and using reverse dieting for optimum health.
• Adding more protein to your diet will make you feel better, and you won’t gain weight.
• How will a low-carb or keto diet impact your overall cholesterol?
• Chris explains how a low-carb or keto diet affects the performance of endurance athletes.
• Products you can use to optimize endurance performance.
• Chris explains why digestive distress could occur with keto and shares his recommendations for overcoming it. 
• The impact of a low-carb diet on thyroid function.

Connect with Cynthia Thurlow

Follow on Twitter, Instagram & LinkedIn

Check out Cynthia’s website

Connect with Chris Irvin

• On his website
• On Facebook, Instagram, and Twitter: https://twitter.com/TheKetologist 
• Thinking Health Newsletter 
• The Keto Answers Podcast

Transcript

Cynthia Thurlow: Welcome to Everyday Wellness Podcast. I’m your host nurse practitioner, Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent, is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

[music]

Cynthia Thurlow: Today, I’d the honor reconnecting with Chris Irvin. We recorded earlier last year on Episode 175. He’s a nutrition researcher, writer and educator, specializing in low-carb dieting for metabolic health and human performance. He’s the author of Keto Answers, one of my favorite keto resources to recommend to clients, and he’s also the chief marketing officer at BioCoach. Today, we dove into differences between micro and macronutrients, therapeutic uses of keto, low carb, hormesis, and carnivore diets, the role of metabolic health, the value of protein, balancing longevity and sarcopenia. What happens when you over fast, over restrict and create too much stress on the body? We dove deep into listeners’ questions including answering the role of low carb and ketogenic diets and then the impact on cholesterol panels, low-carb keto and endurance. How to troubleshoot with digestive distress? The role of protein excess, his favorite gadgets and supplements. I hope you will enjoy this podcast as much as I did recording it.

[music continues]

Cynthia Thurlow: Chris, it’s so nice to reconnect with you on the podcast.

Chris Irvin: Yeah. Thanks for having me on today, Cynthia. Well, I think the last time we spoke was like right before your book launch, that was the last time.

Cynthia Thurlow: Yeah, it’s hard to believe that book has been out for two and a half months. And the last six months have been so wonderfully chaotically busy that I’m excited to be going on vacation with my family in exactly two weeks from tomorrow.

Chris Irvin: Oh great.

Cynthia Thurlow: I’m going to just disconnect. [laughs] I’m forewarning my team, completely disconnecting. But I wanted to bring you back because you’re such an incredible resource, talking about the value of keto and low-carb diets. And I know last year, you had a carnivore cookbook that came out. I’d love to kind of start our conversation today talking about some of the therapeutic benefits, because I think a lot of people when they think about carnivore as an example, they’re like, “Oh, I know it’s anti-inflammatory and I know it can be beneficial.” And obviously, I did straight carnivore for nine months after being hospitalized because my body literally could not handle anything else. But really starting the conversation and talking kind of broadly about some of the therapeutic benefits of these diets, because it’s not just about weight loss, I think that’s unfortunate where people like focus their energies, but there’s so much beyond the obvious that really can be very, very therapeutic.

Chris Irvin: Totally, yeah. I guess to start we can go a little bit broader and just say like low-carb diets as a broad category and then we can get down into the specifics of like keto and carnivore, because each one of them does offer its own unique benefit, especially therapeutically. I think when it comes to low-carb diets, the weight loss portion, it is a big piece of the puzzle, but it’s not the only piece, but we do know that body weight and body fat, I guess I should say is a really big predictor of a metabolic disease, it’s a big predictor of a lot of different chronic diseases, so if you’re losing weight, you’re inherently going to be reducing your risk of a lot of chronic disease. But I think a lot of times that’s a little bit too reductionist of a view on things. There’re obviously different ways you can lose weight, some are much better than others. You can go super low calorie and essentially no nutrients and lose a ton of weight and also lose a ton of muscle and not be healthier or you can do it the right way, maintain muscle, burn body fat, have a really micronutrient rich diet, and be healthy with the weight loss. 

The weight loss, I really look at it as almost a side effect of a low-carb diet. When you’re following any sort of low-carb diet, you are restoring your metabolic health and that’s really where it comes in, as it relates to chronic disease and the therapeutic application of it. If you look at all of our most common chronic diseases, we’re looking at cardiovascular disease, diabetes, metabolic syndrome, cancer, and then even some of these neurodegenerative diseases, like Alzheimer’s and Parkinson’s and things like that, all of these diseases are, if not, directly caused by, they’re at least rooted in metabolic dysfunction or impaired metabolic health, which really breaks down if you really want to simplify, its blood sugar being out of whack, it’s chronically high insulin levels, triglycerides being all over the place and our cholesterol not being at the right ratio or with the right type. All the hallmarks that you think about when people say metabolic syndrome, which is a little bit too broad. All of those things are what’s roped into the metabolic health. 

When you look at any of these diseases, you see that something’s off. Usually, blood sugar and insulin I think are the two biggest ones. Especially if you look at diseases like type 2 diabetes, where it’s very common for people to– if they start off with prediabetes or type 2 diabetes, it’s very common for them to get secondary, third, fourth, fifth chronic diseases that will kind of add on to the type 2 diabetes. It’s really common for cardiovascular disease to come into play. It’s really no secret anymore that these areas are really important when it comes to our health and that’s where a low-carb diet shines is that, if you are not metabolically healthy, if you’re insulin resistant, your blood sugar levels are always high, you have chronically high insulin levels, then you don’t metabolize carbohydrates very well. And in fact, if you continue to consume them, you further exacerbate these problems, you continue this cycle of spiking blood sugar and raising insulin and all of the downstream effects of that. 

So simply put, when you follow any low-carb diet, you’re cutting out the main problem. And it is only one of the problems, we can get into some of the other things too, but you’re cutting out a major problem. And a lot of people like to argue that and say, “Okay, it’s not carbs that cause–” we’ll take diabetes, for instance, or just insulin resistance, more generally speaking, they’ll say carbs don’t cause insulin resistance, it’s X, Y, or Z. And all of that may be true, but I think rather than getting wrapped up into the chicken or the egg, it’s like, what actually works for these people and what doesn’t work. And we know that putting people on a carbohydrate-based diet, when they’re dealing with metabolic disorder, it’s setting them up for failure. They don’t see progress very quickly. If they do see progress, it usually means that they had to calories back really far, they’re consuming a really low-calorie, low-protein diet, which inherently is going to be lower in micronutrients, you’re just not getting as much opportunity to get those things in. It just doesn’t really make sense to go that route, low carb, it gets a catch of for a lot of these issues. At least at the start, I don’t think that anybody dealing with a chronic disease has to necessarily go low carb forever, but it’s a great way to kind of get things kicked off, get that blood sugar back in check, get those insulin levels back in check and then from there, you can adjust the diet and go different directions. Maybe you go even stricter into something like keto or carnivore or maybe you go like carb cycling, or you do a little bit– I’m big fan of Jessie Inchauspe, with her new book that just came out. Where she talks a lot about just different hacks that you can use to even while you’re consuming carbohydrates to reduce your blood sugar spike, those can all be great things. But if you’re kind of like that peak of insulin resistance, none of those things are going to be all that effective until you get that back in check with a low-carb diet. 

The thing that’s fascinating and most interesting and encouraging for people is that you can see dramatic improvements in a really short period of time with fasting, with keto, with carnivore, you can see improvements in your fasting blood sugar which is a huge marker that we use. Maybe not as important as we make it out to be, but it is a really big marker of metabolic health, you can see improvements in a couple of weeks in that area. Same thing with insulin, A1c is the number that we see improvements in a very short period of time. To me that’s exciting, because I know a lot of times people either think that, A, it’s going to be really quick and easy to solve this problem or it’s going to take forever. It’s not quick and easy, but it is a lot quicker than what some people let on. So that’s why I always like to take that approach. I think most times if you’re dealing with some sort of chronic issue, if you’re able to start with cutting out carbs, you’re going to be able to create space within your health and within your lifestyle to start making continuing improvements. I really like that to be the baseline for a lot of people who are trying to use nutrition as a remedy for chronic disease.

Cynthia Thurlow: Well, I think you bring up some really excellent points. I mean obviously, my whole background is in cardiology and I got to a point where I had prescription fatigue, because so many of the issues I saw in my patient’s, worsening diabetes, increasing vascular disease, etc. Yeah, maybe I could control symptoms, but we weren’t really fixing the problem. In a lot of ways, we’ve led patients to believe that every symptom necessitates a prescription medication. We’ve also not prioritized talking about nutrition with our patients. My mindset has always been it all starts with food and yet food can be such a therapeutic modality. Unfortunately, I think a lot of people fear when you say low carb, they’re talking really like under 30 grams of total carbs and I always say, “Listen, if the average Americans consuming 200 to 300 grams of carbs a day, average, getting you under 100 is going to be an effort, but it’s not something that’s not going to then not be sustainable.” 

When people start eating more nutrient dense whole foods, and by that I mean, whether you’re going lower carb as a starting point, you’re getting carbohydrates from non-starchy vegetables and low glycemic berries and maybe you are carb cycling and so maybe you have squash or sweet potato, you’re getting away from the processed carbs, the ones that get us into trouble, because even with as diligent as I am, when someone gives me gluten free bread at a restaurant, I have to work very hard not to eat it because one piece becomes two and you slather it with butter and all of a sudden, you’re derailing all the hard work that you do, which is not to suggest, we’re not encouraging people to find some degree of moderation.

Chris Irvin: Yeah.

Cynthia Thurlow: I think it’s also important to identify that each one of us may do something a little bit differently, but moving towards a lower carbohydrate diet. Especially with the degree of rampant metabolic inflexibility and poor metabolic health that we’re seeing and certainly. I presented at an event in Salt Lake in April and when I was looking at the statistics over how much weight people have gained during the pandemic, it was pretty significant. Most people gained anywhere from 15 to 20 pounds, but there was even a fairly good percentage of people that had gained more than 50, because it was a time when a lot of people felt powerless and there were many people that were finding solace in foods. 

Chris Irvin: Yeah.

Cynthia Thurlow: Certainly, a really important starting point for our conversation. You touched on protein, and I think this is probably for me, the macronutrient I talk about the most, probably secondary to carbs, but really emphasizing for people not to fear protein. Now, when you have people that come to you because your moniker as The Ketologist, and I think there’s this misnomer or misrepresentation that if you’re eating keto, you’re not eating enough protein and that really hasn’t been the case for me. What I typically see is people eating too much fat, because fat is delicious. Right? 

Chris Irvin: Right.

Cynthia Thurlow: Whether it’s avocado or nuts or cheese or whatever it is that people are indulging in. Let’s touch on the value of protein, why that’s so important and then maybe we can dovetail into talking about some of the research. We’re not all in agreement on this about longevity versus sarcopenia, that muscle loss with aging that I find really fascinating and how we can bridge the gaps conceptually on these topics.

Chris Irvin: Yeah. It’s a great question, because ever since I’ve been in the low carb space, this protein conversation just keeps coming up and there’s a lot of disagreement. Actually, just the other day I had a friend from back home text me and he just started a keto diet and he was saying, “Oh, I’m having a really hard time hitting my macros.” I knew when he said that, I knew what the problem was, I knew that he thought he needs to eat a lot less protein, because he’s a guy, he hunts, his fridge is stocked up with all kinds of deer and local beef and everything like that. So, I asked him, I said, “What’s going on with the macros? What are you having a hard time with?” He goes, “I’m just not getting enough fat, and I’m getting too much protein?” I was like, “Well, send me what your numbers are,” because I knew he was tracking. And he was like 30% to 35% protein, and like 60% to 65% fat. I’m like, “Dude, you’re perfect, don’t change a thing. You’re crushing it.” He’s also a guy who works out a lot, there’s just a demand for it. 

The fear of protein I think it is twofold. Generally speaking, I think there’s a fear of protein from– well, a bigger picture and we’ll get into this later is the longevity standpoint. But that’s not really why most people feared so we’ll talk about that separately. But I know there’s this general assumption that protein is bad for our kidneys. I remember when I was growing up going to my pediatrician and wanting to start drinking protein shakes and her saying, “Oh, you don’t want to have too much protein, it’ll be damaging to your kidneys.” I was never really one to take the standard advice on things, so it didn’t really stop me, but it’s this idea that it’s bad. And if you look at the research on, it’s very clear that even if you have damaged kidneys, you can still tolerate a good amount of protein. You do have to be a little bit more careful if you have like a kidney disease, or if you’re suffering from something in that area. But for somebody who’s healthy that’s this fear of protein for that sake, there’s no reason for it. 

Then the bigger reason why I think there’s a lot of fear of protein in this low carb, keto space, keto especially is this idea that if we have too much protein, that we’re going to be converting that protein into sugar. Gluconeogenesis is the famous sciency word that people like to throw around. It’s a real thing, it’s a process that does exist in our body, it’s a process that takes amino acids which are what’s found in protein, and it converts them to glucose. I think the idea because logically it makes sense that if we consume too much protein, that we will then have too much amino acids in our blood and that those amino acids will have to be shuttled to something and that it will get converted to glucose. I think a reason why people who tests their numbers, they’ll test in a way that almost agrees with this, because they’ll test right after they eat food and they’ll say, “Oh, that was a pretty protein heavy meal, I saw an increase in blood sugar, what’s going on there.” But if we look at the research, it’s also pretty clear and I love this phrase gets thrown around all the time, but it’s a really great way to look at is that it’s a demand driven process and not a supply driven process. 

So, just providing more amino acids from a supply perspective is not going to increase the rate in which we convert it to glucose. But if there’s a demand for it, it will. This is the reason why your blood sugar doesn’t go to zero if you don’t consume carbs, you can consume a zero-carb diet your blood sugar never goes to zero and there’s a reason for this. We need to have certain cells in our bodies like our red blood cells and even portions of our brain that are better on glucose, we need to have glucose available for those. We also need to have glucose available as a reserve for in case there’s the fight or flight like we need energy right now, our body is way at quicker metabolizing glucose or sugar versus like fat and ketones. So, we take it in and we can use it really quickly, say, this is a little bit more evolutionarily speaking, but if we need to run from something, run for our lives. But even in our lives today, if we’re really stressed about something, be having a glucose source to pull from, so we don’t go hypoglycemic and start getting the shakes in a stressful situation. 

It’s a good thing that we have this, but the research is very clear that even in the most metabolically damaged people, so you look at like diagnosed type 2 diabetics and their studies where they give them massive amounts of protein, like 50, 60, 70 grams of protein per feeding which is a lot. If you consider eight ounces of meat is somewhere between 40 and 50 grams, that’s a lot of protein. And even with them we only see maybe a modest increase in blood sugar, in a group that we would expect to see some blood sugar dysregulation. The feared really doesn’t match up. For anybody who is testing, they’re testing their blood sugar right after they’re eating, you’re going to get some sort of postprandial blood glucose response with most things that you consume. Even if you were to just have a ribeye steak that’s super fatty, just protein and fat, you’re going to see some response there. Unless you have a really small amount of fat, you’re going to see some sort of increase in blood sugar typically from consuming anything. 

I think a lot of times we kind of test in a way that makes us think that, hey, this actually is going on, we’re seeing this increase from it. So, putting those two things aside, those are the reason why we have this fear of protein. That’s why so many folks are eating 15-20% which is also kind of what’s recommended on a keto diet. If you so go on most of the major websites, we’re seeing protein at 15 to 20% and a lot of physicians will say, “Well, hey, that’s actually really high protein compared to the original version of keto, which was like a 10% protein.” But then what we have to think about is what’s the application of this, so the original application of keto was for pediatric epilepsy. They really need to be in a deep state of ketosis, there wasn’t as much of maybe a need for protein and they just knew that that worked right being at 10% protein was effective for that. But then this 20% to 25% recommendation didn’t really come from anything too much. There wasn’t like somebody sat down and did a big randomized control trial and said, “Hey, 20% to 25% is like where we should be for a keto diet when it comes to protein.” But for some reason this is taken on and if you go on online you see this everywhere. And really, I think it’s a problem because one, we’ll talk about the benefits of protein. Protein is so beneficial, but a generalized recommendation like 20% to 25% doesn’t take into consideration what somebody’s goals are for somebody who’s exercising and there was a great study published a couple of years ago on this where they had men and women resistance training, following a standard keto diet, I think it was 25% protein and they were resistance training a few times a week, and they lost muscle especially the men in the group they lost muscle and this is something we don’t want.

Like you mentioned sarcopenia, we’ll get into that a little bit later, but muscle is really important even for somebody who thinks you don’t want to gain muscle; you do want to gain muscle. Everybody needs to have muscle, it’s metabolically active tissue. We talked about metabolic health at the beginning of this that makes you metabolically healthy. Getting enough protein is essential for this. We don’t want to be losing protein and for somebody who maybe you’re living a sedentary lifestyle, you’re not eating, you’re not getting a lot of exercise, and you’re not putting a lot of physical strain on your body, maybe the 20% to 25% protein may work for you. That may be something that would align with what your goals are, but since most people should be exercising, and I think everybody can benefit from resistance training, then that just really isn’t going to cut it. Outside of the muscle loss, you’re also talking about poor recovery from the gym, so maybe you go into the gym one day and now you have a hard time getting back the next day because you’re so sore. But then even outside, we’re talking about performance but then there’s the just lifestyle component, I can’t tell you how many times I’ve talked to usually this one with women, because it’s kind of a double where it would be low protein and low calorie. They’ll say, “Oh, their mood is just really bad, and they’re having really bad anxiety, and they don’t know why” and You look at their protein intake, it’s like why were you consuming about 60 grams of protein a day, let’s bump that up a little bit and see what happens.”

So often, I see just that small change alleviating a lot of those issues. Then I think the other thing too, if you look at a little bit more practically, if you’re consuming a quality source of protein which in my eyes is red meat, I think fatty fish is good too and then there’s some white meat it has its pros and cons, but I think, the kind of the gold standard best is red meat from things like bison and beef and elk, any ruminant animal like that. This is also really nutrient dense, so when you prioritize that food not only are you getting protein, but you’re getting everything that comes with that protein, which is all of the micronutrients, the quality fat, cholesterol, saturated fat, things that we’re all so afraid of but that we need, and you’re getting them in a form that is more natural, it’s kind of in a form that like the ratios are beneficial to one another, and you’re getting it in a form that’s more bioavailable or more easy for you to digest as human, it’s kind of more aligned with our biochemistry.

There’s also that side of it too that if you’re eating low protein and it’s not just that that one macronutrient protein is low, it’s also likely that all of your micronutrients are going to be low and your quality fat intake is going to be low. This is where you see a low-carb diet, where they’re doing a lot of added fat, you’re putting a lot of oils and stuff like that on to your salads or anything like that. Some of those things are fine, but that’s not going to bring as much benefit as like a fatty ribeye that has all of these micronutrients in it. So, you’re much better off getting all of that from a whole food protein source versus adding it in, other ways.

Cynthia Thurlow: I think you bring up a lot of really good points. One thing that I really want to eliminate is the kind of phenotypic and this is just a woman north of 35 who is over restricting her calories, likely overexercising, probably over fasting. And I’m starting to see this type of woman so consistently, that I’m literally every guest, I just spoke with Robb Wolf last week, and we had a conversation about it too. Because it’s such a problem because these women are developing these really broken metabolisms. I’ve now taken on co-hosting duties of the IF Podcast with Melanie Avalon, which has been great because it’s a totally different format and a lot of the questions that are coming in it’s evident, these are women who don’t even realize they’re chronically undereating, they’re over fasting, they’re probably overexercising, I’m not sure what’s going on with their sleep. 

So, are you seeing the same phenotype with greater frequency, I think it’s people who are well intentioned, but they just don’t realize over time, you can’t be in a deficit all the time, like you actually, whether its carb cycling or I use the word refeeding. But it’s not like you eat everything in the world on that day. But maybe you’re having a wider feeding window, but I’m starting to see this happening more with women, because they’re a little more open. They’re not hungry for a second meal that’s what I hear or I’d like my OMAD and I don’t want to deviate from that. I always go back to the same thing, can you get your macros in, in your feeding window and I can’t think of any women that can have one meal and get 100 grams of protein.

Chris Irvin: Totally.

Cynthia Thurlow: They’re chronically kind of in this state of deprivation in a negative way, not in a positive way. Okay, I’ve reduced my caloric intake, I’ve adjusted my macros, I’m not overexercising, but when I’m starting to see these women that are living in this chronic state of deprivation.

Chris Irvin: Yeah, and I am seeing it a ton too. I think the reason why it happens too is I think for the longest time the talk was calories. It was all about calories, cut your calories low, eat less, move more, make sure you’re exercising a ton and I think a lot of women took this advice. But at their baseline they’re already exercising a ton, probably doing a lot of cardio, probably not doing a lot of resistance training and then they’re also eating low calorie and then what ends up happening is that it doesn’t work. Surprisingly, this calories in versus calories out soul approach isn’t really all that effective. And you see a lot of women who, “Hey, they’re not eating, they’re eating super low calorie, they’re exercising a ton, and they’re still not reaching their health goals, they’re still not reaching their weight loss goals.” So, then something like intermittent fasting comes along, and they say, okay, well, let me try intermittent fasting. They add intermittent fasting to the mix and now they’re eating even less calories. And to be honest, our bodies are super adaptive. We will adapt to, like– it’s not, if you eat really low calorie for a day, yeah, you might be really hungry, but if you eat really low calorie for months, you will adjust and your body really won’t have a lot of hunger, and you’ll end up being somebody that can do OMAD and it’s really easy for you to do and that may make it feel natural. 

Now, you’ve added fasting to the mix and then somebody tells you the fasted exercise is great. So now you’re doing those two things together and then somebody says that keto is also great, so maybe I should do that, and then OMAD’s even better than fasting so I’ll cut it back to even just one meal a day. It’s just a cycle that gets worse and worse. And to your point, yeah, you end up with this. You are super calorie restricted, which is a massive stressor on the body. If you look at the research on calorie restriction, we know there’s absolutely benefits of calorie restriction. There’s plenty of good to come from it, but chronically doing it is where the problem really arises and the micronutrients side, I think is the biggest reason why I like energy. Yeah, energy is a big component, but our bodies are pretty darn good at tapping into our own energy sources even if you were consuming a higher carbohydrate diet that was really low in calories. We would still expect you to be tapping into your body fat and producing some ketones a little bit just due to the calorie restriction. And we know even the leanest people out there have like 20 to 25,000 calories stored away in fat. So, from an energy perspective like we can get away with it, but like you said can you get your macros, can you get your micros in during this time, when you’re doing OMAD or fasting or just calorie restriction. 

I think what’s happening is, is not only are your calorie restricted, but your micronutrient restricted, because you just can’t possibly get enough in right and maybe you use supplements and things like that. But we know that one supplements maybe depending on the supplement aren’t as well absorbed as or well utilized in our bodies as they are consumed in the whole food form. I think that’s obviously an issue or they’re just completely useless in general, like some synthetic vitamins and things like that are just nowhere close to being what we would find them in the whole food form. I think that’s kind of the biggest issue with it. I think it’s important for us to– we don’t want throw the baby out with the bathwater, like calorie restriction can be beneficial. And if you want to calorie restrict for a couple of weeks, I think that’s fantastic. But what you need to do is you need to know that there is a period where now I need to go into a maintenance, not maintenance– I think a lot of people hear maintenance and they think “Oh, that means I’m not losing any more weight or I’m not going to be progressing towards my goal.”

Maintenance just means bringing up your calories out of being restricted. There’s a lot of studies, there was a really cool study years ago that showed after a keto diet coming into like a Mediterranean style diet where they increased calories a little bit, and they actually continued to lose weight even during that phase. Now, they did lose it at a slower rate, but they were still losing weight during that phase, so maintenance doesn’t mean that you’re stopping your progress. It just means that you’re coming out of that calorie restricted state. And then I think even eating in a surplus is beneficial for folks at certain time. Especially surplus means consuming quality food, like a surplus of doughnuts is not great, a surplus of steak and organs and eggs and things like that is fantastic. I think that’s another thing to take into consideration, but besides– So, you know you have the micronutrients, you have the lack of macronutrients, you are calorie restricted. But then, it’s the stress that gets put on the body too. So, all of these things are acute stressors. Even a low-carb diet can be an acute stress, ketosis can be an acute stressor and it’s a stressor in a way like we talked about hormesis. That’s another popular word that’s being thrown around now. Hormesis it’s kind of like the stress that you experience during exercise. If you’re lifting weights, it’s stressful but it’s a good stress because your body adapts. That same kind of thing is happening with calorie restriction, with low-carb dieting, with any of those diets, where your kind of restricting some aspect of your nutrition. 

This is a good thing because our body adapts, but we can’t do it all the time. Just like you can’t exercise all the time. If you were to just lift weights every single day, all day, you would get to a point where it wouldn’t be beneficial, it would actually be harmful to you. And this is what’s happening on the nutrition side too. I just recommend for like anybody out there who’s doing it, just know that you don’t have to go that far to see progress. I think that most women if they would, instead of even thinking about calories, if they were to just focus on quality protein intake, eating whole foods. The fasting thing, I’m a little bit torn on. I think fasting can be great from a lifestyle perspective. I love fasting for the mental boost. But I realized a couple years ago, when I was fasting and not tracking that, I was eating really low calorie for a long time and I didn’t know that. I had to kind of decide when it was appropriate for me to fast and when not too fast. Because my size, I can’t be eating 1500 calories a day for a year straight, that’s going to be harmful to my health at some point. I think if you were to just focus on those things intermittent fast, as far as it allows you to be able to still get an appropriate amount of calories and get an appropriate amount of micronutrients and hit your protein, everything like that, then that can be beneficial. But we don’t have to hit everything, we don’t have to do all of the things and put all the stress on our body, you’d be surprised what your body would feel like if you put it in a state of abundance. And you actually provided it with all of the fuel that it needs to perform optimally and then you may notice that, “Hey, I’m actually crushing it in the gym, a lot of these other symptoms that I thought were kind of a symptom of my body composition or other things were actually just related to my nutrition intake and all these things start fixing it themselves and you realize wow, I was able to do this without having to hate my life,” which I think is pretty important. [chuckles]

Cynthia Thurlow: No, I have to agree. The term hormesis which I talk about a lot, beneficial stress in the right amount at the right time. This is why I’ve started doing more conversations like this where each one of us are bio-individuals and even myself, I have a minimum threshold of 50 grams of protein when I eat a meal. I just had a very large chicken breast., I don’t eat a lot of chicken, but we grilled chicken over the weekend and I had that with a bunch of peppers and onions and I had some homemade Guac and that was my lunch. But it’s also the understanding that for me the threshold is always 100 grams of protein a day. However, I have to get that in but I also acknowledge I have at least one day a week where I will have a 12-hour feeding window and my kids think it’s bizarre. But I will sit with them and have breakfast and we may or may not eat lunch together, but we all eat dinner together on the weekends. It’s reminding my body I’m not starving so if you’re listening to this, and you’ve been doing fasting 24/7 for several years, you probably need to take your foot off the accelerator and you may need to do some degree of I hate using the word refeeding, because it gives this negative connotation. 

Chris Irvin: Yeah. 

Cynthia Thurlow: Even you talked about maintenance mode, but I think about reverse dieting and really it could be that you’re having 100 additional calories per day of protein. It’s really a small amount, but it’s slowly kind of monitoring. And for anyone that’s interested, I did a podcast with Amanda Nighbert, earlier this year talking about reverse dieting. But I think it’s important for us to know, we don’t want to be in ketosis 24/7, we don’t want to be rigidly dogmatic, because I think if people have success with one particular paradigm, whether it’s keto, low carb, carnivore, pescatarian, whatever it is, people assume that’s the only thing that they can do. And I encourage people to change things up, like whether it’s exercise or how you’re managing your stress or your eating schedule. You definitely don’t want to be doing the same thing or the fasting schedule all the time. You want variety in your life, it’s very important, our bodies are very smart and they need to have some variety, because that’s actually how you get stronger, you don’t get stronger by doing the same thing every single day.

Chris Irvin: Yeah. I think too to add to that is, when we think about nutrition, I think we always just think about what we cut out of our diets, it’s like don’t eat this, don’t do that, don’t eat during this time. But what we put into our bodies is equally important right. That’s where some of these more extreme OMAD and things like that can be difficult, because you’re not allowing yourself sufficient space to be able to provide yourself with enough of those nutrients. I think that’s kind of something that we need to think about and then on the refeeding side too, I think you brought up a good point there adding in the protein. Because I think this one component to calories, especially for people who have restricted calories for a long time. It’s a mental barrier to increase them, if you’ve been restricting them for a long time, and you’re tracking them and you know, “Hey, I typically only eat 1300 calories, and that’s all I’ve been doing. There can be a mental barrier for a lot of folks where it’s like, “Wow, even going to 1500 calories, that seems I’m going to gain weight, I’m going to get fat, I can’t do this.” If you’re kind of dealing with that start with protein specifically, because one the protein is, we need more of it anyway and if you’re calorie restricted, you’re probably not getting enough so that’s important. 

The other side of that too is that there were some studies done earlier, probably been about 10 years or so ago now where they did massive overfeeding of protein, where they were just crazy amounts like past what somebody’s like calorie limit would be where you would expect them to gain fat and they didn’t gain fat, which I think is super interesting. One of the things, we see about proteins is it’s really hard to gain weight on when you just add protein and even if you’re consuming more calories than what you’re used to. So, I think for a lot of people, if you’re kind of dealing with that mental barrier, you’re not sure, “Hey, if I increase this, I’m worried that I’m going to gain fat,” Start with the protein increase it there and then kind of see that, “Hey, I actually think you’ll notice that you feel better, but then also, you’ll just kind of see they’re like, hey, adding another 100, 200, 300 calories into my diet is not going to cause me to get fat.” Then now maybe you can kind of start to add in some other, maybe it’s more fat, maybe it is a little bit more carbohydrates too depending on what your goal is.

Cynthia Thurlow: I think it’s such an important point and it’s really a degree of experimentation. As much as I’m someone that doesn’t purport that people be a slave to the scale, if you are going through a refeeding, you probably want to be doing measurements kind of staying on track or staying attune to changes that you’re seeing in your body. Now, I got a lot of questions from people on Instagram when they knew that we were connecting. And one that I heard multiple times was there’s a fear of eating low carb or keto because they have “high cholesterol” and I wasn’t able to get them to delineate it. Did they have elevated triglycerides or HDL, but I suspect it’s the total overall cholesterol. And for anyone that’s listening working in cardiology, a lot of the medications that I was prescribing were very strong, specifically to addressing cholesterol and we don’t want our cholesterol to be too low. It’s actually a predictor of morbidity and mortality. I want you to think high level. When we’re talking about cholesterol, what gets cleaved from cholesterol, what is created from cholesterol, we’re talking sex hormone. So, all of the men that were on these really high max doses of statins that had a total cholesterol of 100 to get their LDLs really low release within this specific range, all ended up having issues with erectile dysfunction and just not feeling very motivated and they were sarcopenic and we’re wondering where all these things come from. So, what are your thoughts when someone expresses concerns about being on a ketogenic or a low-carb diet and noticing that their total cholesterol goes up.

Chris Irvin: Yeah. It’s a great question. I think this is one of those other most common fears against the diet. Because the whole reason why keto was crazy in the first place is that it was a high-fat diet and there’s this assumption that consuming dietary fat is going to increase your cholesterol. I think there’s a few important things to point out. You pointed out one of them, which is that most times people are referring to total cholesterol which is just not a full picture of what’s going on with your health. You know total cholesterol take into consideration HDL versus LDL, which I will not call good and bad cholesterol because that is not true. [Cynthia chuckles]. HDL is always called good, but too much HDL is bad. LDL is always called bad, but too little of LDL is a bad thing. I won’t refer to that, but there’re two different types of cholesterol that make up total cholesterol and when you’re just looking at that number you’re not getting a breakdown of that. But even if you are getting a breakdown of that there’re a couple other issues with that, sometimes what will happen is the doctor will only calculate HDL, and then they will calculate LDL just based off subtracting that from total cholesterol, which is not very accurate. So, that’s one issue with it and then the other one is that even if you are calculating LDL, you’re not looking at particle size. And this is something there’s way more–you’re more educated in this area.

You probably have tons of folks on this podcast that are much more educated in this area. But, particle size matters for LDL. LDL as a whole is not a reliable predictor of cardiovascular disease, but with that being said, this is something that we typically are looking at. This is a blood marker that’s always getting measured, this cholesterol, whatever a skew of those numbers you’re getting from your doctor, you’re always getting those things tested so it’s a legitimate concern. We see one of two things typically on keto, we’ll see some people will start keto and their total cholesterol will drop, which is usually kind of LDL dropping down, maybe it’s a slight increase in HDL or maybe HDL dropping to if it was already high, but we’ll see a dropdown, most people say, “Hey, that’s a good thing.” But then there is this other occurrence where we’ll see total cholesterol go up and this is where the fear comes in, says, “Hey, I saw my total cholesterol go up based on what the doctor is telling me, they’re going to put me on a statin or based on what the research says, this puts me at increased risks of cardiovascular disease.” 

I think there’s kind of two things here within that subcategory of people. One is that you get some folks where the total cholesterol is only going up because they’re seeing a modest increase in HDL to the good point. I know I said too much HDL is a bad thing, but seeing an increase in HDL can be a good thing and the right level. If you’re seeing an increase in total cholesterol because HDL is raising that’s not necessarily a bad thing. But then there are some times where we will see that it’s LDL that’s increasing and I know Dave Feldman has done some really great work out there looking at this the what does he call [crosstalk]?

Cynthia Thurlow: Lean Mass Hyper-responders. I’m one of them.

Chris Irvin: Yeah. Lean Mass Hyper– you are, yeah, yeah, that’s right. I think we talked about that last time on the podcast. So, what did you see? you saw LDL go through the roof when you started?

Cynthia Thurlow: Yeah. LDL went through the roof and I had to keep asking for a VAP, an advanced lipid analysis to look at particle size and for the benefits of listeners, if they’re familiar with this, you want light and fluffy, you don’t want these kinds of dense small particles. And because mine were light and fluffy my practitioner kind of let me be. But I do know for a lot of people, they may only have a traditional lipid panel drawn and I always say to people what that really speaks to is that we need more information. And obviously, if you have diabetes, you’ve got vascular disease, you’re at a different risk stratification than I am, just because I’m not in that risk stratification. I think there’s a lot of components that you have to take into account. But it doesn’t mean one lab test is for the rest of your life, it’s always with the context of getting more information, changing your diet and lifestyle choices. But obviously, I would love to get your input as well.

Chris Irvin: Yeah. No, totally and I think that’s typically what we’ll see too is that even in the folks where maybe their LDL is increasing if we look at the– if we’re fortunate enough to be able to look at the particle size, we will typically see that it’s skewing more in favor of the more lighter, less dense particles that aren’t going to be as big of a problem as it relates to cardiovascular disease. But you bring up a good point, I think this is kind of the biggest takeaway is that we can’t be based something as complex as our cardiovascular system on one single reading. I think anytime you see, I think it’s fine to use some of these markers like high LDL as a proxy to say, “Hey, we should continue looking at other things, but we should not use it as a proxy to say, here’s medication to get this number lowered, because that doesn’t make sense.” And we can get into statins too. I think statins when you look at the research there, they hilariously underperform, especially compared to what they’re marketed as, there’s some real mess of people messing with data to make it look a certain way, it’s just crazy.

We have to look at these other markers and I always tell people, the one, a lot of people talk about the triglyceride to HDL ratio, I think that’s really important. That’s a great predictor of insulin resistance and metabolic health as a whole, so that I think is more important. I think triglycerides as a whole is more important, I think if you’re sitting at really high triglyceride levels after you’ve gone through the keto adaptation phase. I think, if you’re a couple of weeks into keto, we’d probably expect those numbers to be higher, but if you’re a little bit more adapted, I think the goal is for those to kind of get into a lower range. If you’re not seeing that then that could be cause for concern. But then the other one that nobody tests for which I really like to see is C-reactive protein, which is a big marker of inflammation. Because to me that’s what really determines if this LDL is a problem or not. If we look at what LDL does in the body, LDL is actually we talked about the bad label that it gets. LDL is great, it’s really important for us, it goes through, it helps repair a lot of things in our blood vessels. It helps if we have some damage in our arterial walls, it’s able to kind of deliver the nutrients that are required to repair it. 

But what becomes the issue is that when inflammation is high, this is where LDL is more likely to be able to get embedded into our arteries, we’re more likely to have atherosclerosis, which I always limp through saying that word, it’s like the hardest work. [Cynthia laughs] But, you know, that’s where this starts becoming a problem. What we speculate and what we’re starting to see, thanks to folks like Dave Feldman, who are looking at this more is that even if LDL is really really high, if triglycerides are low, and CRP is low than which– if you’re eating an appropriate keto diet or an appropriate carnivore diet, a whole food one that’s you’re not consuming pro-inflammatory foods, then it’s not necessarily a problem. And that’s what should happen if you’re eating the right diet, you should see your CRP coming down, you should see your triglycerides coming down. So now this LDL isn’t necessarily a problem and looking at, I always the reference that I love, and I forget where it originally came from, it might have been diet doctor who originally said it, but it’s like to look at LDL as kind of the cause of cardiovascular disease would be like you coming home and your house is on fire and you blaming the firemen for the house being on fire.

Like if you have cardiovascular disease, you will have high LDL more than likely. That’s another reason why we see this correlation. If we look at research where people have been diagnosed cardiovascular disease and we measure their LDL. We will see typically high LDL which makes people think that, but if we understand what LDL does in the body, what we should look at this to say, “Hey, there’s a reason why LDL is elevated and the reason why it’s elevated is likely because of inflammation or high triglycerides or whatever.” And then now like that’s where we should be putting our focus on this fixing those two markers instead of looking at really what is kind of a symptom of this issue. 

Well, I always tell people like to go back to your– that’s a longwinded way to go back to your original question, which is somebody who’s doing keto, and they see their cholesterol go up, what should they do? I think that you should try to get a further blood analysis done, I think if you can get particle size for your LDL that’s really important or at least get a breakdown of HDL versus LDL. If you’re not getting that and then it’s really hard to get much out of it. But get that breakdown, get your triglycerides, get your triglyceride-HDL ratio, which you can usually always get because usually our most blood tests, cardio blood tests are going to be measuring your triglycerides and HDL, so you should be able to do that. And then the CRP that one I’ve seen some people say, doctor had no idea what it was when they brought it up, but I know if you go do your own blood work, you can usually ask for that measure to be made. And really, in my opinion, that’s kind of the biggest one is that CRP. If my CRP is low, and my triglycerides are in check, then I really don’t have any concerns about that cholesterol level.

Cynthia Thurlow: Well, a couple of things. I did a podcast with Dave at the tail end of 2020 and I had the opportunity to meet him in person in Salt Lake. He is probably one of the smartest people I’ve ever met. 

Chris Irvin: Really. Yeah.

Cynthia Thurlow: We had a whole conversation. He was trying to explain something to me and it was like 10 minutes into the conversation. I was like, Dave, you’ve completely blown past even my understanding on a cellular level of what’s going on. I was like, you just need to bring me back to reality. He’s absolutely brilliant. He’s changing the way clinicians are looking at cholesterol, LDL, etc. and he is doing research in this area as well. Dr. Bret Scher was a guest earlier this year and he is an integrative cardiologist, he has a lot of great content if you have a desire to learn more or want to kind of point your healthcare practitioner towards some additional resources. And I’m assuming you’re talking about a high-sensitivity CRP as it pertains to a CRP. This is a very specific marker and it is something covered by insurance. It’s not unusual, It’s not weird. You can absolutely positively ask your healthcare practitioner to order this for you. I don’t ever get pushback about that. I would say, in the context of asking for additional information, I think that’s completely reasonable. And you could also make the argument like maybe we want to look at a homocysteine, maybe we want to look at a sed rate like just to kind of get a sense for what inflammatory markers might be dysregulated. Now, a couple more questions, but things that I made sure the ones that were asked multiple times that we talked about. 

Chris Irvin: Yeah.

Cynthia Thurlow: There are keto endurance athletes who are concerned that, they’re going to negatively impact their power output their times by being in a glycogen depleted state. Although, based on like what little research I was looking at last night that seems to not be the case. And could you speak to your experience looking at the research for individuals that are doing endurance work, so not just someone that’s doing like a sprint, but maybe someone who’s doing triathlons or doing marathons? What has been your experiences in that area in particular?

Chris Irvin: Yeah. I think there’re two things. I mean, if we look at the research, before we get into the research, I’ll say, one of the issues, I think, is his not following the right ketogenic diet is kind of the first issue. So, if you’re an endurance athlete, your keto diet is going to need to look a little bit different from somebody who’s not an endurance athlete. So, going low protein, super low calorie, low nutrient that’s going to affect your power output, so let’s just assume that we’re talking about somebody who’s following kind of a keto diet that’s been optimized for them and their goals. If we look at the research, and Jeff Volek has always kind of been the best on this. Now, it’s been probably six years since that study came out, but he had a really awesome study, that he was looking at keto adapted athletes versus non-keto adapted athletes on carbohydrate intake and endurance performance. Adaptation part is really important because anybody out there who’s tried keto, if you start keto tomorrow, and you go try to run and you think that you’re going to put up the same number that you put up when you were a carb athlete, it’s not happening in that first day, usually feel like crap, it takes your body time to adjust. 

The keto adaptation period is important because it does allow your body to get accustomed to using these other fuel sources and everything like that. But the other thing that we see after keto adaptation is that you do have a glycogen that was kind of one of the most interesting things from this study is that not only do these athletes have glycogen without eating carbohydrates, but even post exercise they replenish glycogen to almost the same rate as the ones who are consuming carbohydrates. It’s this adaptation that your body’s gone through, because your body does want to have glycogen. We talked earlier in the podcast about having this glucose store for when it needs it. So, we do want that, It’s a good thing. The fear of the low power output is because of this fear of glycogen, I think that’s a misplaced fear, because we just don’t really see that being a problem. And really, if you look at it’s so funny, you asked this question, because I almost thought that we were past this point on the endurance side, because I’ve always looked at endurance and keto, it’s like, I thought we checked that one off the list, like everybody was in agreement that one’s awesome. Especially, when somebody like Zach Bitter, who’s a low-carb athlete, like broke the world record for ultra-marathon time. But it’s more of the other sports, where I think there’s maybe some more legitimate concern, but when it comes to endurance athletes, it’s very clear. If you are able to get keto adapted, you are able to allow your body to tap into a fuel source that is more abundant. That doesn’t require you to have to load up on sugary gels the whole time, which can cause GI distress, it’s a fuel source that produces an additional fuel source and ketones, which is great for your brain when you’re trying to perform.

There’re so many good things that come with it and there’s also this added benefit. And I think for a lot of endurance athletes, it’s something to consider is that you can take a dual fuel is what people say, the dual fuel approach to it. Where if you are adapted, you can use carbohydrates and what’s beautiful about being adapted is that you can have carbohydrates before an endurance event. Because carbohydrates no doubt can be an ergogenic aid that can boost sports performance, we know that. You don’t need them that’s important to know too. But let’s say that you’re an elite endurance athlete and you’re trying to be that top 1%, where just a small amount of time makes a big difference. You can use carbohydrate strategically but the beauty in being keto adapted is that when you burn through those carbohydrates, you’ll be able to transition back to burning fat very efficiently and this is why you’ll see carb athletes, carb-based athletes having to continually load up on sugars, once they’ve burned through whatever they’ve consumed, there’s a delay between them being able to really, like tap it like the insulin level go down, and they can tap into like burning body fat. And this delay is what causes the performance to dip. It’s what causes them to have to reach for another pack or in some cases it’s what causes them to bonk right or pass out from the activity. I think when it comes to keto for sports performance, endurance really is the best sport for it and I’ll also add to. I don’t know what your take is on it, but the HVMN product for endurance. They have a Ketone Ester product, Ketone-IQ that’s recently come out and half of the Tour de France teams are using that product. Obviously, the endurance athletes are using it and anecdotally, I’ll say to that yesterday I took it before I played basketball and I was running up and down the court and I had three or four possessions in a row where I had to sprint and it was max effort all out sprint, sprint, sprint four down and backs and then there was like a dead ball and I stopped. I kind of realized, I’m not even breathing heavy, I’m breathing like I am right now, this is insane. I’m in good shape, but I’m not knocked out shape, like what’s going on. There are some really cool sports products like that that are coming out I think that can be beneficial especially for those athletes that are in that upper echelon of you’re trying to be elite, you’re trying to be top notch performer, adding those in conjunction with now. I don’t think that it’s a replacement by any means. I think that it’s best in conjunction with a good low-carb diet. But yeah, I think there’re other things like that too that you can do to kind of further optimize your endurance performance?

Cynthia Thurlow: I think you brought up a lot of good points and really it comes down to metabolic flexibility. I’m glad that you brought up Ketone-IQ. Because I’ve talked about it a couple times on the podcast but for me obviously, I’m athletic, but I’m not an athlete. I use it when I’m going to do public speaking because I like to speak in a fasted state because I feel like I have all my neurons in my brain firing. I don’t have to struggle to find words, etc. Certainly, when I see you at KetoCon, I think I’m the first speaker on the first day, I will most definitely be taking it as [crosstalk] speaker for sure.

Chris Irvin: Yes. [laughs]

Cynthia Thurlow: Yes, nice segue into talking about digestive distress with keto. Especially, I heard this multiple times, people that are consuming protein and fat or just fat by itself, they feel they consume that and they have I’m assuming loose stools or diarrhea or just even an upset stomach? What are some of the things that you like to recommend to your clients?

Chris Irvin: Yeah. That’s a great question, couple of things just to get into a why that’s happening? I think there’s typically, I’d say maybe two reasons why you’re seeing some digestive distress. One is going to be an electrolyte deficiency; this may not be a cause of loose stool; this would be a cause if you’re having some GI distress. If we were deficient in electrolytes, which is very common on a low-carb diet, if you’re not replenishing them, then this can cause you to have some GI distress, and maybe make your bowel movements a little bit more infrequent. That would be the first thing is making sure that you’re like staying hydrated and replenishing electrolytes. Especially magnesium is going to be an important one there, sodium and potassium also going to play a bigger role. I think that’s usually the first thing I recommend, but if it’s a loose stool problem it’s interesting because we see this one with carnivore a lot too. A lot of people on carnivore will say that their bowel movements after they started have been a little bit different and there’s always two things that I like to look at. One if you’re comparing it to your bowel movements on a Standard American Diet that’s a lot different of diet. On a Standard American Diet, you’re probably going a lot more frequently, probably going several times throughout the day and there’s also going to be a lot more bulk in it because you’re consuming a lot of carbohydrates.

On a low-carb diet, we would expect there to be less bulk, but on a keto diet if it’s something where– it’s not necessarily a problem. I think that’s kind of the first thing to point out, some people will assume that it’s a problem, it’s not necessarily a problem. But if it’s something that you’re uncomfortable with, obviously on a keto diet you can alleviate it with adding some fiber and rice. If you want to add some like leafy green vegetables or something like that, that can be a good way to alleviate it. If you’re doing carnivore, obviously, you can’t turn to that so you don’t really have much of a choice there, but typically, I see with carnivore, we’re talking a week or two maybe of that being an issue. Then it kind of resolves itself, which I think for a lot of folks that are dealing with it on the low carb keto side of it, they’ll see the same thing, because outside of the fact that maybe you are electrolyte deficient, and outside of the fact that maybe you’re not getting enough fiber or you’re not getting as much bulk. I shouldn’t say enough fiber because I’m not like a huge fiber advocate, but if you’re just not getting enough things in your diet that provide bulk to your stool outside of those being the cause of it. It’s also that your body’s cleaning out a ton of stuff. You’re finally allowing your digestive system to take a break and clear everything out. When I talked to, it’s probably about a year ago, I did a podcast with Ben Azadi and he was talking about a study that I was shocked by. That was talking about how long food stays in your digestive system. So, if you’re somebody who is always– if you eat a meal every six hours or you wake up first thing in the morning and you eat and you’re always eating, you have this backlog of food. That you’re always processing, so you’re going to be going to the bathroom more and there’s going to be a lot more bulk. But let’s say that you’re not eating bulky foods anymore, and you’re doing intermittent fasting. Now your body has more time to clear out its digestive system and get back on track. Maybe this going to be one of those things, where there’s a lot of stuff garbage to clear out, if you’ve been eating the Standard American Diet for 30,40, 50 years, and there’s a lot of sludge for lack of a better term that’s kind of backed up in there that you’re going to be kind of clearing out. You’re also going to be seeing some shifts in your gut microbiome during this time. So, when you change what you eat, you’re also seeing a change in gut microbiome and this change can come with little side effects like having some loose stool or just impaired bowel movements. Those are my recommendations, sometimes you just have to stick through it, it’s really not as big of a deal, but staying hydrated and taking electrolytes is always going to be beneficial and then if you really don’t– if it’s something that’s really uncomfortable for you and you’re not enjoying it, adding a little bit of fiber here and there can be helpful.

Cynthia Thurlow: It’s interesting because I find more often than not when people go low carb or keto, they actually get constipated and it’s like you talked about the bile supportive foods and bitters. I think this is as unique as each of us are and if you’re eating a more nutrient dense diet, you may go through this period of acclimatization and I agree with you the electrolytes piece. I tell everyone if you are fasting and or also doing low carb or keto you have to replace the electrolytes. In fact, the irony is I had surgery about a month ago and of course my HRV data was a mess, I knew this was going to happen, of course. And so even though my sleep looked okay on my Oura and so I was actually saying to Robb, I just started using more sodium, I was having more electrolytes. I said, “It was amazing almost instantaneously my sleep scores got better, my HRV got better. I think the answer is to start with electrolytes. It means not just electrolytes, but also like salting your food.”

Chris Irvin: Yeah.

Cynthia Thurlow: [unintelligible [00:55:30] is usually the company. I would say, they’re a US-based company, they’re good people definitely always like to mention them. A couple more questions, I want to be respectful of your time. So, Hashimoto’s or thyroid issues and low carb there’s almost this thought process that you can’t consume a low-carb diet and have healthy thyroid function or if you end up developing Hashimoto’s, which is the most common form of hypothyroidism here in the United States especially for women, it’s like 80% to 85% of hypothyroid patients are actually Hashimoto’s, which is an autoimmune issue and I hear well, women have to eat a certain a certain amount of carbohydrates to be able to convert T4 to T3 and that hasn’t really been the case. Obviously, I have Hashimoto’s, which is in remission, but I just think if we’re looking at a population of people that are largely metabolically unhealthy, to suggest that a low carb or a ketogenic or carnivore diet is somehow harmful. To me it’s completely contrary to everything I’ve experienced as a clinician or as a human being.

Chris Irvin: Yeah. Totally and this is a really complex topic, because we do see some mixed results. Where we’ll look at some studies, and maybe some studies will show a decrease in thyroid hormone, some will show an increase, some will show it stays the same. Some of that’s just a difference in what the diet is that they’re actually following. But one thing I will say is that, I think we need to look at thyroid hormones similarly to how we look at like insulin. If we look at insulin as a hormone, we have in our mind that there’s a spate. We have these medical recommendations of this is the baseline number of insulin that you just kind of where are your healthy reference ranges, but then we know if you need a low-carb diet that reference range changes, you don’t need to have that as much insulin as what would maybe be in that reference range. I always wonder what other hormones that applies too. I do think there’s something to that with thyroid hormones where maybe, because you’re healthier in other ways you don’t need like for some of the studies that may show that there’s a decrease in it, that you don’t need as much thyroid hormone because your body’s doing things efficiently, maybe your cells are responding more efficiently to that hormone, because everything else is in check. I think there’s a component to that could be out there, but I haven’t seen any research on it. It’s just kind of one of those things logically I think, there could be something there. And there’s been some studies that look at or more reviews of the research I should say that, kind of show that ketones themselves can do a lot of the same actions that a thyroid hormone does as well. There’s also this thought of maybe when you’re in a state of ketosis with elevated ketones, that you may not need to have as high of thyroid hormones as you need. But really what I think’s going on in most of the cases where people are saying, “Hey, I noticed my thyroid hormones gone down, or I’m experiencing some problems with it, it’s because they’re following that version of the diet that you mentioned, probably 20 minutes ago now. It’s the women that are following intermittent fasting, OMAD, they’re on the treadmill all day, they’re super calorie restricted eating low protein, like that’s going to be a big cause of thyroid hormone being low, you’re in a super restricted state. 

Most of the time when I talk to women who are experiencing some sort of problem, or they have some sort of concern in that area, because it does actually happen. It’s not just a myth. Some women will follow a keto diet and they will see a decrease in their thyroid hormone. And if it’s not the first example I gave of, maybe there being a decreased need, then it’s usually if you ask them, “Hey, what’s going on with your diet,” you’ll find out, “Hey, they’re eating 1000 calories a day and they’re on like the treadmill for an hour and a half.” All of that to say that when somebody’s eating an appropriate keto, low carb carnivore diet with nutrient dense foods, they’re consuming an appropriate amount of protein, I think protein is actually really important when it comes to our thyroid hormones. If they’re doing all of those things, then we typically just don’t see a problem and that’s why somebody like yourself has seen so much success because you’re doing it the right way. If low carb was supposed to ruin somebody’s thyroid hormone, then what the heck would a carnivore diet do to it? There’s no way that you should have seen any sort of improvement when you were following a carnivore diet.

It’s one of those things and I get so frustrated with this one too, because you’re telling a lot of times and this is maybe I’m jumping the gun on this, but it seems a lot of women who are suffering from thyroid issues are dealing with a lot of other issues as well. They may be dealing with infertility, they may be dealing with insulin resistance and maybe borderline PCOS, different things like that. Now, you’re recommending against a dietary strategy that would be dramatically improving all of those different aspects. I get really bothered by this general consensus that women should be consuming a certain amount of carbohydrate or something like that. Now, I do know there’s some really great folks out there like Dr. Carrie Brown and Dr. Stephanie Estima, who are doing good research around carbohydrate consumption around your menstrual cycle and things like that which I’ll let them be the experts on that side of things. There’s definitely some validity to that, but just to generally say that a woman should have– they need X amount of carbohydrates to maintain this proper hormone function in their body. I haven’t found any research to back it up and anecdotally I haven’t seen anything that supports it.

Cynthia Thurlow: Well, I always tell people, that if your thyroid function is stable, you’re on medication or your labs are stable, you can absolutely adjust your macros. If you’re someone where your Hashimoto’s, your thyroid antibodies are high, haven’t been able to manage mitigate them. You’re still consuming gluten and we’ve talked about molecular mimicry on other podcasts, most recently with Dr. Amie Hornaman. But when we’re talking about unstable thyroid function that’s very different. I wouldn’t then add in the stressor of changing everything you’re doing about your diet, but if you’re doing well, I think it’s certainly reasonable. Now, two other questions, one that came in multiple times. Number one, what are your favorite gadgets for metabolic flexibility? I’m going to guess; I know some of them already. I’m very transparent that I love my continuous glucose monitor and glucometer because I think that builds awareness. I love my Oura ring because it helps me track data. But what are your favorite ones, you’re closely affiliated with BioCoach, and I think this is a really interesting way to be able to track additional blood glucose metrics. What are some of your favorite products that you utilize? or yep, right behind you? 

Chris Irvin: Yeah. As you say I got my BioCoach here. So yeah, I think measuring blood glucose is the most important marker for metabolic health. I really like to pay attention to it. The CGMs and everything that are out there are great. They’re just maybe not the most practical for a lot of folks, because they’re a lot more expensive. But I’ll say with BioCoach is to just to give a quick thing, like this device, there’s a lot of devices out there that will do the same thing as this. What’s really cool about what we’re doing at BioCoach is kind of the app that’s built into it. That this will report to– that provides a lot of insight and coaching and help with grocery shopping and all of that. That’s really why I like this. It’s not just necessarily a device, it’s also the app that kind of comes with it. I really like testing blood sugar, it really comes down to if you’re somebody who has a really good grasp on yourself and biochemistry and nutrition and all those things and you can afford a CGM. I think that you can get a ton of great information. I’ve used a CGM in the past, to just get as much info as I could, but then I know what to do with it. 

So that’s the difference if you don’t know what to do with that information, if those would just be data points that would be useless to you that something more like what we’re doing at BioCoach would be beneficial. I also have, and I’ve messed with it a little bit in the past, but I have one coming in is the Lumen device, I think is interesting as well and the reason why I think that device is interesting is, because one of the fundamental features of all these devices is that you’re giving feedback for people, you’re giving them a chance to see what’s going on in their bodies, which from a behavioral change standpoint that you mentioned, I think it’s really important. I really like Lumen’s ability to show you at a high level where your metabolisms at if you’re burning carbohydrates or burning fat, because I don’t think it’s practical to use a device like that, and then say, “Oh, I’m burning carbs, I need to go make a drastic change.” But it’s a good way to say, “Okay, given how I’m living my life, currently, this is what’s going on in my body and now if I live my life like this, this is how it’s going.” So, you can kind of figure out what’s working best for you so I like that.

Sleep trackers, I think are great too, Oura ring is something that I’ve always used in the past that I’ve been a big fan of. But there’s a new company that’s coming out called Circular that has a ring that I’ve been doing some testing with. They’re kind of just coming onto the market. I really like them because they have a little bit more insight on the exercise side of things. So not only sleep, but then they provide a little bit more on the exercise side, which I love. And same thing an app that will provide a lot of insight into the data, not just give you raw data points. I would say those are my big three that I’ll use on a reoccurring basis. I think there’s some other like with my Apple watch I do like to track my heart rate throughout the day, especially during exercise. I like to keep an eye on that HRV, especially post exercise as it relates to my recovery. I know you can do that with Oura and you can also do that with your Apple watch if you do a little back of the label or back of the envelope math. Yeah, those have been my favorites. I’m really just kind of getting into this tech space. When it comes to like the wearables, I’m fascinated by wearables. I think that the direction that they’re going, it’d be really interesting. I would love to see a continuous cortisol monitor. I would love to see glucose check that you could use the photo sensor to not have to be invasive at all. I think some of those really exciting things are coming in the future. I’m really just getting into it. Now, I’ve always been really traditional with folks, when people would ask me these questions, I’d be like, I don’t know, just eat steak you’ll be fine. {chuckles] But now I’m starting to see a lot more of the utility in these kinds of wearables and the feedback that they can provide. So yeah, I’m liking it.

Cynthia Thurlow: I think it’s always helpful. It’s a question I oftentimes like to ask, because I know for me, I’m very quantitative focused anyway and to me it doesn’t stress me out to have the information. Whereas I do have some clients who will say, “I don’t want to see my blood sugar spike because I’m playing tennis, I don’t want to see my blood sugar spike after having a dessert.” Whereas last night, and this is for full transparency, very rarely do I eat dessert, I like dark chocolate, but that has a pretty negligible impact on my blood sugar, but it was Memorial Day, and we had a big steak dinner and so I made gluten free brownies. And teenage boys, they ate most of it. I had a small piece, but I watched my blood sugar go from like 90 to 160 and it came back down very fast. That’s what you’re really looking for but I said to my husband, I was like, I so rarely see blood sugar spikes ever. Like I keep between I mean, maybe it’s like 20 points up and down throughout the day, It’s very nominal. It was very interesting to see that I said, “What’s most important to me in seeing that kind of outlier is how quickly did my body recover?” and it was very quick. I think it’s 160 and then it was back down– 10 to 15 minutes later, it was already coming down, which is what you want to see if you’re metabolically flexible. But I always say if we have aberrant data that goes outside our norm, don’t freak out about it, just say, “Okay, what did you do differently?” I know I’d dessert; I don’t generally do that. I also shouldn’t do that at the end of the day if I’m going to have a dessert it should be middle of the day, as we know we have more insulin sensitivity during the day. 

Chris Irvin: Yeah. 

Cynthia Thurlow: Last question. What are your favorite supplements? And the reason why I’m asking this, two people asked in the context of how to address insulin resistance. We could go down that rabbit hole, but we’re always going to talk about the lifestyle piece first. But are there specific supplements you like to use personally ones that are your favorites. I have favorites that I probably talk about a lot, but what are your favorites?

Chris Irvin: Yeah. I’d say my favorites right now, electrolyte supplement every day, especially I live in Florida and I sweat a ton. [Cynthia laughs] I play basketball, I hit the sauna like yeah, you can see me now, I’m sweating. So, I’m a big electrolyte guy to brands, I like to use Perfect Keto, which actually formulated that product. So big fan of that one, especially as that one’s been formulated to be a general electrolyte supplement. I start my day with that and then I love the LMNT electrolytes especially for after sauna and basketball because I sweat a ton there. The difference there is that LMNT has a lot higher sodium, so that ones I think especially good for after exercise or even before exercise. Those are daily supplements. We mentioned Ketone-IQ. This is one of the first supplements that I’ve ever tried that has made a noticeable difference on the way that I feel, especially cognitively, I take one shot of that and I can either sit here and have a podcast and just feel my brain is firing on all cylinders or I can go for a run and crush it. It’s a wide variety of benefits that it provides, I really liked that one. And then a couple other little ones, I do use a protein supplement after I work out because trying to get more protein in my diet. I’ll do like a beef protein, Equip is kind of my go to brand for that. I like to do collagen protein as well, especially before bed, so I’ll do a little bit of collagen, I like to use Perfect Keto for those. So those are kind of my general ones, but as it relates to insulin resistance. Generally speaking, if you’re following a low-carb diet, those can all be great supplements for you. But as it relates to insulin resistance, I think that berberine is supplement that gets me really fired up. We had a product that Perfect Keto that had it, but we had to get rid of it. Because, the whole government decided that anything targeting blood sugar was going to be really heavily regulated, and they didn’t like us having that product, so we ended up having to get rid of that one.

I really like blood sugar regulating supplements like that and berberine. Some of the research on it has shown that it can be just as effective as metformin, which is the commonly used medication for prediabetics and diabetics without a lot of the side effects that come with it. I really like that. You can get berberine as a standalone powder, it tastes like crap so you probably want to figure out a way to get it in a capsule form if you can or mix it in with some sort of flavoring. I think that’s a really sad. There’re a couple others too. I know that chromium can be really solid as well and some other supplements out there will combine these things. But really berberine as it relates to insulin resistance, I think is the best one that you can use. 

Cynthia Thurlow: Yeah, I even have it at my house and if I have a day where I have more discretionary carbs on a day that I haven’t lifted, I will actually take some berberine. I like Inositol.

Chris Irvin: Yeah.

Cynthia Thurlow: Because that can also be beneficial for sleep and then Chromium GTF, I feel like Chromium GTF isn’t particularly like in the continuum, berberine and Inositol I’ve had much better luck with patients and clients as opposed to chromium. I feel like we’re kind of pissing in the wind. I’m not sure that’s right. It’s really all that efficacious, it’s pretty benign. I agree with you that there are so many options for people. And when I think about how many of my patients were on oral diabetes medications, and yet we’ve got things like berberine that can be as efficacious. It’s really something if you are insulin resistant, talk to your healthcare perfect practitioner about whether or not this is appropriate for you to use and especially if you’re tracking metrics, if you’ve got a glucometer, you’ve got a CGM, and you can track your blood sugar, you may see an appreciable difference. It’s not something you want to take forever. I do believe that you need to take breaks but I think it can be helpful for a lot of people. And given the amount of people at least here in the United States and a lot of other westernized countries that are insulin resistant without even realizing it. Knowledge is power for sure.

Chris Irvin: Yeah, if I can add one more to that, too, I think, and this is one that I haven’t seen a lot of research on yet, but I want to would be ashwagandha for blood sugar. I’ve always liked ashwagandha as a general lowering of stress and actually in a higher dose it can boost the sports performance as well, like strength performance. But the ability for it to impact cortisol, I speculate would allow it to be really beneficial for blood sugar levels especially when taken chronically. So that’s not something that I’ve been able to measure yet and I haven’t found research on it. But generally speaking, it’s a great supplement for a lot of different reasons, so if insulin resistance is something you’re looking to combat that could be another great one to throw in there.

Cynthia Thurlow: Yeah, I love adaptogens. I mean, they’re plant-based compounds and they have so many benefits and ashwagandha is unique and that it can be stimulating and also calming. And understanding the physiology, the body and how these plant-based compounds can have a really positive net effect on kind of quieting the sympathetic nervous system is always a benefit. Well, obviously, Chris, I could talk to you forever. I’m sure we have a third podcast in our future. Let listeners know how to connect with you. Obviously, we’ll put links to all the things that you talked about. You’ve got your own podcast that I’ve been fortunate enough to be a part of, but let people know how to connect with you on social media.

Chris Irvin: Yeah. So, on social media, you can find me @theketologist, I’m on Instagram, Twitter, I think I’m out there in the TikTok sphere, but I’m not really on there. So, it’s just kind of floating account out there. Instagram is really the main account where I engage with and answer questions and what not. Then I have my newsletter, which is on Substack. It’s called Thinking Health. The link to that is in my Instagram bio, so you can pop over there. And then the podcast is the Keto Answers Podcast which you can find on the Apple Podcasting App. You can find it on Spotify, YouTube, any of those places.

Cynthia Thurlow: Awesome Chris. Always a pleasure to connect with you. Thank you again. 

Chris Irvin: Yeah, thanks for having me on. 

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