Dealing with Keto Breath and Other Odors

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Quick question: what side effect do you typically assign to eating asparagus? I bet you took less than a second to come up an answer: a different odor to your urine, sometimes quite pungent. Asparagus is a cruciferous vegetable with phytonutrients that produce the effect.

On Tuesday and Thursday, we looked at digestive problems with going keto; today we’ll look at odor issues.

Ketosis, the result of metabolizing fat into ketones for use as a fuel, also has a specific odor associated with it: your breath can smell like nail polish remover. The ketones may have complicated names such as acetoacetate, beta-hydroxybutyrate, and acetone, but they do one thing: they cause an odor in your mouth and as you breathe out. Our bodies always make those odors, but because we’re forcing the body to produce more ketones, the odor is more noticeable as ketone remnants exit the body via breath and urine.

In this case, there’s no real solution. If you want to use fat as a fuel almost exclusively, you learn to live with the smell. Just make sure to drink plenty of water, because water is important to get rid of these chemicals and protect the kidneys. Drinking water and brushing more frequently may help compensate for keto breath.

Health news has recently become full of eye-catching headlines about something termed “keto crotch.” While it can affect men, it seems to especially impact women by changing the odor of the vagina and vaginal discharges. It seems obvious that it’s the result of the diet, although there’s no research that I could find that has examined it. Gynecologists speculate that it’s the change in the vaginal pH that can contribute to increased odors. If that’s true, it would radically change the vaginal microbiome and that could change the odor. At this point, we don’t know.

One thing that may help is taking probiotics that contain Lactobacilli strains; some research has demonstrated benefits for bacterial vaginosis. Whether probiotics will help with the odor associated with the keto diet or not is unknown, but it’s possible. A prebiotic would also be needed to feed the probiotic because on a keto diet, there’s no fruit with its special sugar to feed the bacteria.

The Bottom Line

Going keto has side effects. Some people may not get any of them. Genetics, the microbiome, and other factors no doubt will have an impact on the extent of the side-effects. I’ve tried to cover the obvious ones this week but there are others, from depression to fatigue.

Which brings me to a question I’m often asked: what do I think about the ketogenic diet? I think it’s a good tool to use fat as a fuel for a limited time, and together with the right exercise program, it can be effective in helping people lose body fat; that’s why it’s part of the Fat-Burning Plan in the Optimal Performance Program.

I assess diets this way: what has to be added to make it healthy? Veganism requires most people get vitamin B12 from somewhere other than meat. The keto diet lacks vitamins, minerals, fiber, and probiotics typically found in vegetables. Both diets lack essential nutrients. If you decide to go keto, it’s important to add these supplements to your diet: a multivitamin-multimineral, probiotics, prebiotics, and fiber.

Because of the side effects, I just don’t think going keto is sustainable. Use it as a tool, as a means to an end for a specific goal. The goal is to stay healthy by learning to always do these three things: Eat better. Eat less. Move more.

What are you prepared to do today?

        Dr. Chet

Keto: Clearing the Air and Your Colon

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The next keto diet issues are still related to the digestive system: excessive gas and constipation. Let’s address the issue of gas first so that maybe the next time you bend over, you won’t have to worry about challenging the strength of your anal sphincter muscles.

The protein content of the revised keto diet may be lower than prior versions, but the body still has to break it down. If you don’t make enough digestive enzymes to breakdown the protein, it produces gas as it ferments in the microbiome. A lot of it. The simplest thing to do may be take a digestive enzyme that contains proteases to breakdown proteins before every meal. Taking a probiotic may also be a good idea, but we don’t know the specific strains of bacteria that will work on protein.

On the other hand, probiotics in general may help ease the constipation that can occur while on the ketogenic diet. The problem is this: the colon doesn’t have enough to do—waste products from foods are simply not there. Fats don’t have anything left after digestion; almost all protein sources don’t have much residue either. But your digestive system still has to repair and rebuild the digestive system on a regular basis. In addition to the probiotics, soluble fiber may again be the solution for the same reason as with diarrhea: it adds bulk to the stool.

I’ll wrap this up on Saturday with the topic that seems to still be making headlines: the odors associated with going keto.

What are you prepared to do today?

        Dr. Chet

The Downsides of Going Keto

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News stories about the side-effects of the still-popular ketogenic diet are showing up more frequently, so let’s review those this week and look at what you can do to address the issues while still attempting to stay in ketosis.

The first side effect is generally diarrhea. With the newer version of the ketogenic diets, the emphasis is on fats and oils, which make up the majority of calories, with protein second, and carbs last. Two things seem to contribute to diarrhea. The first is the use of fats containing high amounts of medium-chain triglycerides (MCT) such as extra-virgin coconut oil and other oil products made with added MCT. The reasons are unknown; it’s most likely related to changes in the microbiome due to the radical change in diet, but it may be that it’s a question of volume of MCT. Oils such as olive oil don’t seem to cause the problem. The solution to this problem may be experimenting with different oils to find the ones that work better for each individual.

The other reason the keto diet can cause diarrhea is a lack of fiber. The keto eating plan has no significant source of fiber in a diet without grains, beans and legumes, and vegetables; a couple cups of lettuce aren’t going to help very much. Soluble dietary fiber supplements may help, whether psyllium, inulin, or other fiber sources. Begin slowly by adding 5 grams a day mixed with water and slowly increase it to 15 or 20 grams spread out over the day. It can add bulk to the stool and stop what has been described as explosive diarrhea.

More on Thursday. Tomorrow is the Insider Conference call. There’s time for you to join before tomorrow’s call at 9 p.m. Eastern Time. What are you prepared to do today?

        Dr. Chet

Protein and Longevity: The Unproven Relationship

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I think the best way to assess whether the study I’ve been examining this week on protein and longevity is meaningful or not is to examine the interview with the primary author Christopher Proud, PhD. I’m going to give a series of his statements and whether the research addressed the question.

“Science has shown for some time that eating too much, in particular protein, reduces lifespan; and now we know why.”

This statement isn’t exactly true. While there does seem to be a relationship between calorie restriction and longevity in fruit flies and some species of mice, it hasn’t been proven in humans. There’s evidence in longitudinal studies on relationships between animal protein intake and some diseases, but it’s not accepted that high protein intake leads to an early grave. More likely, there are genetic and environmental factors to consider, but to suggest that eating less overall increases longevity for humans is not correct at this time.

“Eating high-fiber carbohydrate, such as those found in fruit, vegetables, and unprocessed grains and seeds, will produce the healthiest benefits. This is similar to the traditional Mediterranean diet which has well-established links to longevity. We already knew that lower food intake extends lifespan.”

Same as before—it’s an overstatement. There are some studies that show a decreased rate of diseases using the Mediterranean diet, but that doesn’t mean it will result in people living longer. It may mean they live better for the time they’re alive.

“Our team demonstrated that increased [protein] nutrient levels speed up protein synthesis within cells. The faster this process occurs, the more errors are made.”

Based on the way I understand the methods, they did impact protein synthesis by knocking out the eEF2K enzyme. As of this writing, I haven’t heard back from Dr. Proud, so I have yet to find how they overfed the cells, flies, or worms to effect that change.


The Bottom Line

I don’t think that the research done in this series of studies proves that high protein intake decreases longevity. As excited as the corresponding author was during the interview, it wasn’t as clear as he made it out to be. The research didn’t do anything to help set a target goal for human protein intake. How is it supposed to help without practical applications?

What is important is that we need to seek balance in our nutritional intake. It may be true that too much protein will impact the correct production of proteins, which would have long-term effects, and it’s hard to go wrong eating more fruits and vegetables. But longevity isn’t tied to a single nutrient or a single habit. We need to strike a balance. Eat less. Eat better. Move more.

What are you prepared to do today?

        Dr. Chet

References: Cell Biology 2019. https://doi.org/10.1016/j.cub.2019.01.029.

Is Protein Bad? The Research

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Let’s think about this logically. If we wanted to prove that a high-protein diet would decrease lifespan, we would have to feed some type of animal a diet high in protein until all the animals had died. It would be preferable to have animals that don’t live very long such as rodents. Then we compare the lifespans and causes of death with a control group. Simple and straightforward.

That’s not what the research group did. As I said in Tuesday’s Memo, they identified an enzyme called eukaryotic elongation factor 2 kinase (eEF2K) that slows the rate of protein synthesis. That enzyme is also found in C. elegans, a nematode, as well as in fruit flies and humans. They knocked out the eEf2K enzyme, therefore causing protein synthesis to happen faster. This is supposed to be what happens when too much protein is eaten. They noted more mistakes in protein synthesis as a result.

The methodology for this series of experiments is beyond my expertise. By a lot. Whether the research was on cancer cell lines, the nematodes, or the fruit flies, what I could not find in the Methods section is where they added protein or amino acids to the food for any culture or animal to mimic a high-protein diet. I wrote to the study’s lead author to see if my analysis was correct, but I haven’t gotten a response yet.

What does all this mean? I’ll wrap it up on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Cell Biology 2019. https://doi.org/10.1016/j.cub.2019.01.029/

Does Protein Decrease Lifespan?

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Just when we’ve accepted that carbohydrates are bad for us and everyone seems to be doing the paleo or ketogenic diets, a new study from an Australian research group created headlines by suggesting that high-protein diets are unhealthy because they decrease longevity.

For years we’ve been told that high-fat diets are bad. Then scientists suggested that it’s carbohydrates that are bad, which led to this keto-everything dietary phase we’re in right now. Now we’re being told that high-protein diets are bad for us as well? What the heck are we supposed to eat? Before we panic, let’s take a look at the research to see if it’s meaningful or not.

Researchers identified an enzyme called eukaryotic elongation factor 2 kinase (eEF2K) that slows the rate of protein synthesis. By so doing, it reduces the number of mistakes made in making or folding proteins. If a long-chain protein such as insulin has mistakes in the location of amino acids, the protein will not work as it should. When you consider the number of proteins the body has to make to function every second, too many mistakes could lead to disease and thus reduce our lifespan.

Is this real? Let’s take a look at how the research was conducted to figure out whether we have to be concerned or not.

What are you prepared to do today?

        Dr. Chet

Reference: Cell Biology 2019. https://doi.org/10.1016/j.cub.2019.01.029/

Fasting: A Metabolic Do-Over

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The changes that occur during fasting are remarkable. Blood sugar is maintained within normal ranges. Protein and other breakdown products can be used to make glucose. And there’s one more significant finding: levels of purines and pyrimidines increased during the fast. These are some of the substrates for making proteins and nucleic acids used for making DNA.

What does that mean? Fasting isn’t just a one-way event where things are only broken down; some are being rebuilt. Prior research on cancer patients have shown that a 48–96 hour fast helps use up immune system remnants and rebuilds the immune system. In those cases, they were reduced to 500–800 calories under hospital conditions. The fast helped them do better during chemotherapy.

Before we get carried away, a couple of things. The study I reviewed had only four subjects, they were normal weight, and they were all 29–30 years old. We don’t know how this type of fast would impact an overweight 55-year-old with type 2 diabetes. There may be differences in which metabolites result, and the rebuilding process may be different. Still, it’s encouraging.

I felt fine throughout my fast, but I had a head start, albeit a forced one. I can’t say that I notice any major differences except for the eight-pound difference in the scale. But how can you say that you feel your immune system is stronger or that your DNA is being replicated with fewer errors? You can’t.

This was not the type of fasting that manipulates the schedule so people can eat within a four-hour window and “fast” the rest of the day. I know people feel better and may lose weight, but there’s no evidence of any metabolic changes as significant as these. What is being attempted is to fit the fast into our lifestyle instead of letting it go organically for a day or two, and the benefits are important even if they’re not as dramatic as those in the study. Another name for this type of fast: a cleanse. What I think it proves is that you don’t need anything other than the will to do it for you to see some benefits. You don’t even have to abstain from food. You just have to do it.

If you want some guidance on doing a fast/cleanse, get out your copy of Real-Life Detox and get going. If you don’t have one, get your copy today. It’s time for a metabolic do-over! What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1038/s41598-018-36674-9

Gluconeogenesis: Making Sugar

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On Tuesday, I said that blood sugars remained stable in all subjects throughout the study. How can that be when they would most likely use all their stored sugar in 24 hours or so? Their bodies made glucose out of protein and scraps from the breakdown of other substances.

Many hormones and connective tissue are made out of protein and are typically repaired after damage. The liver can use some amino acids from the damaged proteins to make metabolites that can enter the citric-acid cycle. When those remnants become scarce, the Number One source is muscle. Skeletal muscle is our protein storage facility, and while it isn’t preferred to use protein in this way, the body is protective of your blood sugar level and will protect it no matter what; it will make sugar for energy using whatever is available.

Use of fat as a fuel also increases, primarily in the mitochondria. While it’s complicated biochemistry, mitochondria are then stimulated to become more active and produce more free radicals. The good news is that researchers also observed an increase in antioxidant activity. Glutathione levels remained constant but an analog of glutathione called ophthalmic acid increased, keeping the rise in free radicals in check.

There was one more significant set of metabolites that were released. I’ll cover that on Saturday. What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1038/s41598-018-36674-9

A Case for Fasting

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During the food poisoning episode last week, I didn’t eat for 30 hours. Of course, I had slept most of that time and eating was the last thing I wanted to do. Even though I could have started eating again, I decided to continue the fast to at least 60 hours. I continued to drink fluids—I’m not going to live without coffee—but no food or drinks with calories.

Why do this? I had just scanned a research paper written by a Japanese research group who had four volunteers fast for that long. They observed interesting changes in metabolism by measuring by-products of metabolism in blood. They took blood samples before the study and then at 10 hours, 34 hours, and 58 hours. In prior research, they had discovered 14 changes in metabolites, but this time there were 30 more changes that occurred during the 58-hour fast.

It’s difficult to establish a time-course of events as they didn’t collect blood every two or four hours, but we can compare baseline numbers with the results of the other times blood was collected and analyzed. Initially the body relies on stored sugar in the form of glycogen, but eventually sugar gets used up and the body has to rely on fat stores. Here’s observation Number One: blood sugar was consistently maintained varying only 10 mg/dl over the observed times. Surprised? I’ll tell you why that happened on Thursday.

What are you prepared to do today?

        Dr. Chet

Report Food Poisoning

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What should you do if you get food poisoning? Report it. The procedure may vary state to state, county to county, and even city to city, but here’s what we did.

The first thing: Paula called the restaurant where we ate and told the manager what happened, what we ate, and when. We can’t be sure their food was the culprit, but that’s the only time Paula and I ate the same things for the prior 24 hours. What we had to eat before then we shared with Riley, and he never had any digestive issues. It doesn’t have to be an accusatory conversation, but they should know—think of all the people that may have eaten at the same place. The manager was grateful for the information and said she’d check their stock of the food we ate.

Then I looked up the procedures for the county. They had an online form to fill out that asked about the symptoms, the timing in relation to meals, and what we’ve eaten over the past 72 hours. I filled it out on Sunday and they called Monday to check on some details. The forms were very detailed, and that’s probably why most food poisoning isn’t reported. By the time we feel better, which is just usually a couple of days, we think it won’t make any difference. But remember that no one can count the incidences if we don’t report it and let the health department do its job. Every time we see on the news that romaine lettuce or whatever has been recalled, that’s all the health departments working together to do their jobs—but they can’t help us if we don’t help them.

Paula and I have recovered from our bout with food poisoning. It was a very unpleasant 48 hours, but we made it; Paula adds that vomiting hard every 60 to 90 minutes is a great core workout. Most cases of food poisoning are not going to be fatal; only 450 deaths were reported per year out of the 1.2 million reported cases of salmonella poisoning. We don’t know how many could have been prevented with better info from the public.

We can never be sure our food supply and our home cooking techniques are perfect, but we can strive to make them better. So if you suspect you’ve gotten food poisoning, tell your doctor, your health department, and the store or restaurant as soon as possible. It’s the right thing to do, and it could save many other people from a miserable day or two. It might even save a life.

What are you prepared to do today?

        Dr. Chet