Mastering Nutrition

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What to do about elevated morning blood glucose in the mid 90s. | Masterjohn Q&A Files #27 Dec 16, 2019

Show notes

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.

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Access the show notes, transcript, and comments here.

Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

What to do, in the context of diabetes, if T3 supplementation does not increase heat production? | Masterjohn Q&A Files #26 Dec 13, 2019

Show notes

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/

Access the show notes, transcript, and comments here.

Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

What are your top three non-nutrient factors that prevent beta-oxidation or ketogenesis? | Masterjohn Q&A Files #25 Dec 12, 2019

Show notes

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/

Access the show notes, transcript, and comments here.

Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Recommendations for peripheral neuropathy | Masterjohn Q&A Files #24 Dec 11, 2019

Show notes

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/

Access the show notes, transcript, and comments here.

Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

How to improve LDL receptor activity. | Masterjohn Q&A Files #23 Dec 10, 2019

Show notes

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/

Access the show notes, transcript, and comments here.

Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

Recommendations on magnesium supplements and dosage | Masterjohn Q&A Files #22 Dec 09, 2019

Show notes

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/

Access the show notes, transcript, and comments here.

Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

How to lower your calcium score | Masterjohn Q&A Files #21 Dec 06, 2019

Show notes

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/

Access the show notes, transcript, and comments here.

Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

What do you think of alternative testing like hair mineral analysis or SpectraCell? | Masterjohn Q&A Files #20 Dec 05, 2019

Show notes

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/

Access the show notes, transcript, and comments here.

Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

How to address edema. | Masterjohn Q&A Files #19 Dec 04, 2019

Show notes

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/

Access the show notes, transcript, and comments here.

Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

How do you determine if you're getting enough protein? | Masterjohn Q&A Files #18 Dec 03, 2019

Show notes

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/

Access the show notes, transcript, and comments here.

Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.

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