The Real Deal On Keto Body Odor

I’m continuing my crusade of keto mythbusting. Recently, there was keto crotch, then keto bloat, and today I’m returning to one of the O.G. myths—keto body odor. Yes, it seems detractors of the keto diet are hell-bent on making you think your body will become a stinky, bloated mess if you dare to drop your carbs below 50 grams per day…but is it true?

Here’s the spoiler: Yes, people in online keto diet forums occasionally complain about an unpleasant change in body odor when they first go keto. There is no scientific evidence that it actually happens, nor a clear, compelling explanation for why it would. Moreover, the anecdotal (and it’s all anecdotal) evidence suggests that if it does occur, it is rare and temporary. In other words, the whole idea of keto body odor seems to be exaggerated—shocking, I know.  

That said, significant dietary changes can result in other physiological changes that may manifest in a variety of ways. Since nobody wants to be the stinky kid, let’s take this opportunity to look at what might be plausible about keto body odor and what to do if you think you’ve been afflicted.  

What Causes Body Odor?

First, let’s clarify what’s meant by “body odor.” In the medical literature, the term is used in reference to aromas associated with breath, urine, feces, vaginal secretions, sweat (usually from the axilla, or armpits), and general bodily essence as it were. Because it’s such a broad term, the causes are also extremely varied. For the purposes of this post, I’m going to use the term “body odor” to mean aromas from sweat and general bodily funk, since that’s what’s usually meant by keto body odor.

Body odor arises when odorless compounds leave the body through glands in the skin and interact with microbes living on the skin’s surface. The microbes then release chemical compounds—what we actually detect as body odor. Typically, commercial deodorants target both pieces of the equation by using antiperspirants to minimize the excretion of the odor precursors and by creating an unfavorable environment for the microbes living on the skin. There is also a genetic component to how much individuals secrete compounds that cause body odor.

Although a huge industry is built around trying to help people mask their natural odors—and suggesting that body odor is always the result of poor hygiene—bodily scents are actually quite important. Just as other animals do, humans use olfactory cues for recognizing kin, making judgments about others’ personality traits and attractiveness, and even for detecting fertility. Although we rarely recognize it, the data suggests that smell probably factors into all our face-to-face social interactions.

Body odor can also result from illness. Before the use of sophisticated modern disease detection techniques, doctors were taught to use their sniffers as a diagnostic tool. Even today, smell can be an important clue that an individual is unwell. Often these odors emanate from the breath or urine, but certain infectious and metabolic diseases can be associated with distinctive body odors. In addition to perceptible body odor, the human olfactory system can detect infection and sense illness in others, presumably an important means of preventing the spread of communicable disease.

Diet and Body Odor

The whole notion that a keto diet can cause body odor rests on the assumption that how we smell is affected by what we eat. It turns out that there is scant evidence that that is actually the case.

When I’ve taken up the question of keto diet and body odor previously, I noted that there are really only two human studies that speak to this. One small study found that women judged men’s body odor more negatively when they ate a diet that contained red meat compared to when they abstained from red meat. However, the diets differed in other ways as well. In contrast, a different study found that women rated men’s body odor more positively when the men reported eating more fat, meat, and eggs, and more negatively when they ate more carbs. Hmm.  

Besides those two small studies, evidence that diet impacts body odor seems to come primarily from studies on guinea pig urine and meadow voles—not exactly the most compelling in my opinion.

Nevertheless, the common belief persists that certain foods will make you stinky: garlic, onions, cruciferous vegetables, and spicy foods especially. However, there is no evidence that this is actually the case beyond the obvious bad breath and, ahem, flatus that these foods can cause. In fact, the one study I found on the subject reported that garlic counterintuitively improved body odor.

So, Can Keto Make You Stinky?

As you can see, there’s minimal evidence at best linking body odor to diet, and none of it has to do with the keto diet itself. Nevertheless, the belief that keto causes body odor persists…thanks to the few complaints from some in the keto community (and, just maybe, those who have nothing to do with keto but want to cause a stir). While I don’t want to dismiss anecdotal evidence out of hand, I have noticed that once people go keto, their diet is immediately to blame for every weird smell, twitch, or symptom. It’s remarkable really.

In the interest of fairness, let’s look at the explanations that are typically offered for why keto might cause body odor:

Is It the Protein?

The first hypothesis is that keto dieters smell funky because they’re eating a lot more meat. As I already mentioned, there are only two small studies that speak to this, and the findings conflict. The idea at work: protein metabolism yields ammonia as a byproduct (true), which builds up because of eating “too much protein,” resulting in body odor.  

To which I object… First of all, it’s not necessarily true that going keto means eating more meat. My version of a keto diet certainly isn’t a steak-and-bacon fest—I still eat tons of veggies. If anything, my observation is that keto folks by and large remain fearful of eating “too much” protein lest it kick them out of ketosis. (The issue is not nearly so simple as that, as I’ve explained.) In any case, even if you’re eating a good deal of meat, a healthy liver should be able to convert the amount of ammonia generated into urea and send it off to the kidneys to be excreted as urine.

Maybe It’s the “Detoxing”?

Toxins such as environmental pollutants accumulate in adipose tissue, a.k.a. fat cells, and these toxins are then released into the bloodstream when people burn fat. Because the keto diet often results in increased burning of body fat, the theory goes that the body is “detoxing” all these pollutants, and that’s what causes body odor. Detoxing is a controversial subject, and while it is true that some of these toxins can be excreted through the skin, the actual amounts are fairly small (the majority get excreted via urine and feces). Plus, it’s not evident that the toxins that are excreted through the skin cause any particular odor. And wouldn’t any diet that actually does what it’s supposed to—i.e. burn fat—be subject to the same “stinky” detox effect? I think we can safely chuck this claim.

Are Ketones a Cause?

Maybe ketones themselves make you smelly? This one has the most potential validity, as it’s well documented that acetone—one of the three ketone bodies—gets excreted when you’re in ketosis. However, it’s the cause of the familiar keto breath, not body odor per se. I’ve seen no evidence linking acetone to actual body odor.

What To Do About It

Ok, I hear you saying, “Mark, I see that you’re skeptical, but I’m telling you… I stink!” What can you do about it?

Well, since there isn’t a clearcut cause, I can’t give a clearcut answer, but I’ll tell you what the general wisdom says:

First, you can support your body’s own detoxification pathways as I describe here. Your body should be able to do a fine job taking out the garbage—it’s designed to do so and is efficient at it—but hey, why not drink some coffee and throw some broccoli sprouts on your salad. This is a “can’t hurt, might help” situation.

Same thing goes for taking some nice epsom salt baths, another common recommendation. Whether there is any truth to their detoxifying nature, you’ll get a nice dose of transdermal magnesium with a hefty side of relaxation. Throw in some essential oils and olive oil and soak your cares away… hopefully taking some of the b.o. with it.

You can also experiment with eating less protein and more carbs, but I do see potential downsides to both. You definitely don’t want to eat too little protein, since it serves such a vital role in healthy functioning, and you don’t want to add back too many carbs if being in ketosis is your goal. That said, especially with regard to the protein you probably have room to play around, so feel free to experiment if you want. I’m not overly optimistic that this is the answer, but I’m always a fan of finding what works for you.  

Or, take a wait and see approach. Most keto side effects come and go as people become keto-adapted. If your problem is keto breath, not body odor per se, you can try chewing on some fresh herbs or taking chlorophyll supplements, but these will just mask the issue.

Lastly, if it is very noticeable and very bothersome, you can—and probably should—consult your doctor. If you are excreting significant ammonia, which usually happens via the breath, this is a sign of liver or kidney problems that need to be diagnosed asap.

The Bottom Line…

Because switching to a keto diet can initiate a profound metabolic shift, some people might experience side effects. And, sure, it’s conceivable that transient changes to body odor might be one of them. The lack of evidence that body odor is strongly affected by diet (as well as my own experience interacting with the thousands of people in my community who have tried keto) leads me to believe that this is a minor problem at most—and one that most people won’t experience at all. If it’s affecting you, feel free to try to solutions I described above. They might not resolve the problem immediately, but at least they’ll likely have other positive benefits.

Ok, what say you? Are your friends giving you a wide berth now that you’re in ketosis, or are you chalking this up to yet another thing the haters are blowing out of proportion?

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References:

Groyecka A, Pisanski K, Sorokowska A, et al. Attractiveness Is Multimodal: Beauty Is Also in the Nose and Ear of the Beholder. Front Psychol. 2017;8:778.

James AG, Austin CJ, Cox DS, Taylor D, Calvert R. Microbiological and biochemical origins of human axillary odour. FEMS Microbiol Ecol. 2013 Mar;83(3):527-40.

Natsch, A. What Makes Us Smell: The Biochemistry of Body Odour and the Design of New Deodorant Ingredients. CHIMIA Intl J Chem. 2015 Aug;69(7-8):414-420.

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5 Hemp Oil Benefits For Health and Wellness

Have you tried hemp oil?

After almost a century of being outlawed, hemp—a form of cannabis with extremely low levels of psychoactive THC—is now legal in the United States. This is big news for people interested in the therapeutic effects of cannabidiol (or CBD) because—while hemp doesn’t contain enough THC, the compound that provides the “high” of cannabis, or any other psychoactive compounds—it does contain cannabidiol (CBD).

For years, all anyone talked about when they talked about cannabis was the THC content. Breeders focused on driving THC levels as high as possible and ignored the other compounds. Even pharmaceutical companies interested in the medical applications of cannabis focused on the THC, producing synthetic THC-only drugs that performed poorly compared to the real thing. It turns out that all the other components of cannabis matter, too, and foremost among them is CBD.

CBD doesn’t get you high, but it does have big physiological impacts. These days, researchers are exploring CBD as a treatment for epilepsy, anxiety, and insomnia. They’ve uncovered potential anti-inflammatory, anxiolytic, and immunomodulatory properties. And now that it’s quasi legal, hundreds of CBD-rich hemp oil products are appearing on the market.

What are the purported benefits of using CBD-rich hemp oil, and what does the evidence say?

Although CBD research is growing, it’s still understudied and I expect I’ll have to update this post in the near future with more information. But for now, here’s a rundown of what the research says.

The Health Benefits of CBD In Hemp Oil

CBD For Anxiety Reduction

Anxiety can be crippling. I don’t have generalized social anxiety, but I, like anyone else, know what it feels like to be anxious about something. It happens to everyone. Now imagine feeling that all the time, particularly when it matters most—around other people. The average person doesn’t consider the import and impact of anxiety on a person’s well-being. If CBD can reduce anxiety, that might just be its most important feature. Does it?

Before a simulated public speaking event, people with generalized social anxiety disorder were either given 600 mg of CBD or a placebo. Those who received CBD reported less anxiety, reduced cognitive impairment, and more comfort while giving the speech. Seeing as how people without social anxiety disorder claim public speaking as their biggest fear, that CBD helped people with social anxiety disorder give a speech is a huge effect.

This appears to be legit. A placebo-controlled trial is nothing to sniff at.

CBD For Sleep

A 2017 review provides a nice summary of the effects of CBD on sleep:

In insomnia patients, 160 mg/day of CBD increased sleep time and reduced the number of arousals (not that kind) during the night.

Lower doses are linked to increased arousals and greater wakefulness.

High dose CBD improved sleep; adding THC reduced slow wave sleep.

In preliminary research with Parkinson’s patients, CBD reduced REM-related behavioral disorder—which is when you basically act out your dreams as they’re happening.

More recently, a large case series (big bunch of case studies done at once) was performed giving CBD to anxiety patients who had trouble sleeping. Almost 80% had improvements in anxiety and 66% had improvements in sleep (although the sleep improvements fluctuated over time).

Mental Health

While its psychoactive counterpart THC has been embroiled in controversial links with psychosis and schizophrenia for decades, CBD may be an effective counterbalancing force for mental health.

In patients with schizophrenia, six weeks of adjunct treatment with cannabidiol resulted in lower rates of psychotic symptoms and made clinicians more likely to rate them as “improved” and made researchers more likely to rate them as “improved” and not “severely unwell.” There were also improvements in cognitive performance and overall function. It seems the “adjunct” part of this study was key, as other studies using cannabidiol as the only treatment mostly failed to note improvements.

This was placebo controlled, so it makes a good case for CBD hemp oil as adjunct treatment (in addition to regular therapy) in people with schizophrenia.

Among 11 PTSD patients who took an average of 50 mg of CBD per day for 8 weeks, 10 (90%) experienced a 28% improvement in symptoms. No one dropped out or complained about side effects. CBD seemed to particularly benefit those patients who had issues with nightmares.

This is promising but preliminary. This was an 11-person case study, not a placebo-controlled trial.

Epilepsy

A recent review of four human trials lays out the evidence: More than a third of all epilepsy patients experienced 50% or greater seizure reductions with just 20 mg of CBD. The effect of CBD on seizure activity is so widely acknowledged and understood that the only FDA-approved CBD-based product is Epidiolex, a plant-based CBD extract used to treat seizures in patients with Dravet syndrome and Lennox-Gastaut syndrome.

CBD for epilepsy is legit. Side note: I wonder how CBD would combine with ketogenic dieting for epilepsy control.

Pain

By far the biggest draw for medical consumers of CBD is its supposed ability to nullify pain.

In one study, researchers induced arthritis in rats with intra-articular injections, then gave them CBD. Rats given CBD were able to put more weight on their joints and handle a heavier load before withdrawing. Local CBD reduced nerve damage.

That’s great for pet rats. What about people?

There actually isn’t a lot of strong data on pain management using CBD by itself. Far more robust is the evidence for using CBD with THC for pain. According to this group of researchers, the two compounds exert “constituent synergy” against neuropathic pain. One study found that low doses of each were more effective combined than high doses of either alone in neuropathic cancer-related pain. Another gave a THC/CBD oromucosal spray to otherwise treatment-resistant neuropathy patients, finding that the spray reduced pain, improved sleep, and lessened the severity of symptoms.

Anything Else?

Anecdotal evidence for pain relief and other benefits with CBD is vast. Chris Kresser, a practitioner and researcher I trust, swears by it. I have employees who use it quite frequently, reporting that it improves their sleep, hones their focus, reduces pain, speeds recovery, and reduces anxiety. These things are always hard to evaluate, but I can say that my people do great work, and I have zero reason to distrust them.

In later posts, I’ll probably revisit some of these other, more theoretical or anecdotal potential benefits to see if there’s any evidence in support.

Is It Safe?

A recent study gave up to 6000 mg of CBD to healthy subjects, finding it well tolerated and the side effects mild and limited to gastrointestinal distress, nausea, somnolence, headaches, and diarrhea. For comparison’s sake, keep in mind that a typical dose of CBD is 20 mg.

Mouse research indicate that extended high-dose CBD (15-30 mg/kg of bodyweight, or 1200-2400 mg per day for an 80 kg man) might impair fertility. Male mice who took high-dose CBD for 34 days straight experienced a 76% reduction in testosterone, reduced sperm production, and had dysfunctional weird-looking sperm. In the 30 mg/kg group, the number of Sertoli cells—testicular cells where sperm production takes place and sperm is incubated—actually dropped. Male mice taking CBD also were worse at mounting females and had fewer litters.

Those are really high doses. For epilepsy, a common dose is 600 mg/day, and that’s for a severe condition. Most other CBD therapies use much smaller doses in the range of 20-50 mg/day. Long term safety may still be an issue at these lower doses, but we don’t have any good evidence that this is the case.

There’s some evidence that the dosages of CBD required to achieve anti-inflammatory effects are also high enough to induce cytotoxicity in healthy cells, though that’s preliminary in vitro (petri dish) research and as of yet not applicable to real world applications. Time will tell, though, as the legal environment opens up and we accumulate more research.

Is Isolated CBD the Same As Whole Plant Extracts?

As we’ve learned over the past dozen years of reading about nutrition and human health, whole foods tend to be more effective than isolated components. Whole foods have several advantages:

  • They contain all the components related to the compound, especially the ones we haven’t discovered and isolated. Supplements only contain the isolated compounds we’ve been able to quantify.
  • They capture all the synergistic effects of the multiple components working together. Isolated supplements miss that synergy unless they specifically add it back in, and even then they’ll probably miss something.

It’s likely that whole plant hemp extracts high in CBD are superior to isolated synthetic CBD for the same reason. Is there any evidence of that?

A high-CBD cannabis whole plant extract reduces gut inflammation and damage in a mouse model of inflammatory bowel disease. Purified CBD does not.

Even at a 2:1 CBD:THC ratio, co-ingesting isolated CBD with isolated THC using a vaporizer fails to reduce the psychotic and memory-impairing effects of THC. In another study, however, smoking cannabis naturally rich in both CBD and THC completely prevented the memory impairment.

And as we saw in the pain section above, THC combined with CBD seems more effective against pain than either alone.

That’s not to say isolated (even synthetic in some cases—see note below) CBD isn’t helpful. We saw it improve joint pain and reduce nerve damage in arthritic rats. It’s just that full-spectrum hemp oil containing multiple naturally-occurring compounds is probably ideal for general health applications. Specific conditions requiring high doses may be another question entirely. Again, we’ll find out as more research comes out.

A word about synthetics: this is fodder for a follow-up, but it appears there may be additional concerns with synthetic CBD, and even supposedly “natural” CBD companies have in some cases allegedly added ingredients to their formulas without letting consumers know.

Is It Legal?

CBD-rich hemp oil lies in a legal grey area. The recently passed Farm Bill allows people to grow and make products from industrial hemp, as long as it contains less than 0.3% THC. That means CBD derived from industrial hemp is legal at a federal level. But because the Farm Bill has provisions that allow states to set their own rules, legality at a state level is more complicated.

States where hemp is still illegal—South Dakota, Idaho, and Nebraska—do not permit the sale or use of hemp-derived CBD oil.

In states that permit recreational cannabis—California, Vermont, Massachusetts, Maine, Oregon, Colorado, Washington, Nevada, Michigan, and Alaska—CBD derived from both hemp and psychoactive cannabis is legal.

In all other states, hemp-derived CBD is legal.

The FDA has yet to approve of CBD, so most of the big online retailers like Amazon and Walmart don’t allow CBD products to be advertised. However, Amazon sells a ton of “hemp extract” tinctures and oils with “hemp extract content” listed in milligram dosages—a workaround for listing the CBD content.

If you’re looking for CBD-rich hemp oil, watch out for culinary hemp oil, which comes in larger quantities and has no discernible CBD content. CBD-rich hemp oil will come in dropper bottles, not liters.

You can also buy directly from manufacturers online who proudly advertise their CBD content. I’ve heard good things about Ojai Energetics and Sabaidee, though I haven’t used either.

Many health food stores sell it. Surprisingly, I’ve seen it in every pet store I’ve entered in the last half year.

Word of Caution: Because it isn’t regulated by the FDA yet, there’s no telling exactly what you’re getting. Choose a product with verifiable lab tests. Many CBD hemp oil products have far less CBD than advertised. In addition to CBD content, the most reputable manufacturers also test for pesticides, heavy metals, mycotoxins, and bacteria and advertise their results.

CBD-rich hemp oil is a hot topic these days, and it’s only going to get hotter. I think the compound shows great promise in promoting health and wellness, and I’ll look forward to doing more research as it unfolds.

For now, what about you? Do you use CBD? Have you noticed any benefits? Any downsides? Share your questions and feedback down below.

Thanks for reading, everyone. Take care.

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References:

Bergamaschi MM, Queiroz RH, Chagas MH, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology. 2011;36(6):1219-26.

Lattanzi S, Brigo F, Trinka E, et al. Efficacy and Safety of Cannabidiol in Epilepsy: A Systematic Review and Meta-Analysis. Drugs. 2018;78(17):1791-1804.

Elms L, Shannon S, Hughes S, Lewis N. Cannabidiol in the Treatment of Post-Traumatic Stress Disorder: A Case Series. J Altern Complement Med. 2018;

Serpell M, Ratcliffe S, Hovorka J, et al. A double-blind, randomized, placebo-controlled, parallel group study of THC/CBD spray in peripheral neuropathic pain treatment. Eur J Pain. 2014;18(7):999-1012.

Silva RL, Silveira GT, Wanderlei CW, et al. DMH-CBD, a cannabidiol analog with reduced cytotoxicity, inhibits TNF production by targeting NF-kB activity dependent on A receptor. Toxicol Appl Pharmacol. 2019;368:63-71.

Carvalho RK, Souza MR, Santos ML, et al. Chronic cannabidiol exposure promotes functional impairment in sexual behavior and fertility of male mice. Reprod Toxicol. 2018;81:34-40.

Morgan CJA, Freeman TP, Hindocha C, Schafer G, Gardner C, Curran HV. Individual and combined effects of acute delta-9-tetrahydrocannabinol and cannabidiol on psychotomimetic symptoms and memory function. Transl Psychiatry. 2018;8(1):181.

Morgan CJ, Schafer G, Freeman TP, Curran HV. Impact of cannabidiol on the acute memory and psychotomimetic effects of smoked cannabis: naturalistic study: naturalistic study [corrected]. Br J Psychiatry. 2010;197(4):285-90.

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Keto Bloat: Separating Fact from Fiction

Move over, keto crotch. There’s a new fear-mongering anti-keto media blitz forming: keto bloat.

According to the “good scientists” of the Kellogg company food lab, an unprecedented number of young people are walking around with bloated guts and colons packed to the brim with impacted fecal matter, and it’s all because they’ve embraced ketogenic diets and “forsaken” fiber.

If this sounds like nonsense, that’s because it is.

Are millions of keto dieters suffering from bloating and constipation? I can find no evidence of this.

Is fiber necessary to prevent bloating and constipation? It’s complicated. I’ll explain later. But probably not.

Does the ketogenic diet necessarily exclude fiber? Not at all.

Are ketogenic diets as commonly practiced low in fiber? No.

What Is “Bloat” Anyway?

There are two things that people refer to as bloat: constipation and abdominal distension.

Constipation has different components. It’s being unable to make a satisfying bowel movement. It’s also feeling like you have to poop but are unable to. It’s being able to poop only a little bit. It’s struggling on the toilet bowl. Mostly, it’s being unhappy with your performance on the toilet.

Abdominal distension also can be different things. It might be trapped gas. It might be feeling “heavy” or “full.” It might mean your pants don’t fit after eating.

So, “bloating” can be any or all of these. You can pass hard small stools and feel like you’re bloated. You can poop just fine but have a lot of gas and feel like you’re bloated. You can spend hours on the toilet with not much to show for your effort and be bloated. So “Keto bloat” is difficult to pin down. That makes it easy to make claims and hard to disprove.

Let’s see how frequent bloating and constipation occurs in the ketogenic diet literature.

What Does Research Say About Constipation?

In a study of children with epilepsy placed on an olive oil-based ketogenic diet, about 25% of the subjects experienced constipation. So, was ketosis slowing them down? Not exactly. Those who experienced constipation were actually less likely to be in ketosis. Constipation went up as ketone readings went down, and epilepsy symptoms returned. Constipation improved as ketone readings went up and epilepsy symptoms subsided.

In adults with epilepsy on a ketogenic diet, constipation occurred in just 9% of patients. The authors note that this rate is lower than some other ketogenic studies and attribute the difference to “the heavy focus on importance of fiber from nutrient dense (fiber rich) vegetables, nuts, and seeds.” Note that they weren’t getting fiber from pills and powders. They were eating nutrient-dense foods that just so happened to contain fiber.

Another ten-year study compared the classical ketogenic diet, MCT oil-based ketogenic diet, and modified Atkins keto diet. They were all equally effective at reducing epilepsy symptoms in children, but the occurrence of constipation varied greatly. It was most common in the classic keto diet and medium chain triglyceride-based diet, both of which restrict protein. In the modified Atkins diet, which does not restrict protein, constipation was much rarer. Another study on the modified Atkins diet had similar results, with just 2 of 26 subjects reporting constipation.

Constipation does seem to be a common occurrence. However, the majority of keto diet studies are in epileptic populations following very strict clinical Keto diets. The extreme nature of these therapeutic ketogenic diets—extreme protein (7% of calories) and carbohydrate restriction—makes them an imperfect representation of how most people are eating Keto. And in studies of less-extreme, more realistic versions of the diet, such as modified Atkins (which allows more protein) or the version with “heavy focus” on vegetables, nuts, and seeds, constipation occurs at a much lower rate.

What Does Research Say About Bloating?

The only instance of something approximating bloating in the ketogenic diet literature occurred in studies using medium chain triglyceride-based diets. These are ones that use huge amounts of MCT oil to increase production of ketone bodies. It works great for curbing epilepsy symptoms, but it can also cause cramping, diarrhea, and abdominal pain. That’s not bloating per se. It’s literally the closest I could find.

Causes Of Bloating While Keto?

Okay, say you are dealing with constipation or bloating on a keto diet. What could be going on?

Not Enough Food

Constipation is often a consequence of low energy status. Everything that happens in the body requires energy, and if energy levels are low or energy availability is poor, basic functions will suffer. Bowel movements are no exception. The muscles and other tissues responsible for moving things along your digestive tract use energy. If you aren’t providing adequate amounts of energy, you’re depriving your tissues of the ATP they need to work best and sending your body a signal of scarcity which will only depress energy expenditure even more.

Low carb diets in general and keto diets in particular are very good at causing inadvertent calorie reduction. Great for fat loss, but some people take it overboard and go too far. I’m talking 800-1000 calories a day on top of CrossFit. That’s a recipe for disaster.

Water and Mineral Loss

When you go Keto for the first time, you shed tons of water. For every gram of glycogen you lose, you drop 3-4 grams of water. You also lose sodium and potassium with the water, and you need extra magnesium to regulate your sodium and potassium levels.

The water content of stool is what gives it that smooth texture we all desire. If you’re dehydrated, even mildly, you’ll have less water available for your bowel movements and be more likely to suffer from constipation.

Drink a big glass of salty water with lemon juice in the morning and sip on salty broth throughout the day. Zucchini is a great source of potassium, as is avocado.

Also, if you’re going to eat more fiber, you need to increase water intake for it to work.

Too Much or Too Little Fiber

The relationship between fiber and constipation is mixed. Some interventions do seem to help. Psyllium husk and flaxseed have both been shown to improve constipation. Galactooligosaccharides, a class of prebiotic fiber, improve idiopathic constipation. And inulin, another prebiotic fiber, improves bowel function and stool consistency in patients with constipation.

But there’s also evidence that more fiber can make the problem worse. In one 2012 study, patients with idiopathic constipation—constipation without apparent physiological or physical causes—had to remove fiber entirely to get pooping again. Those who kept eating a bit or a lot of it continued to have trouble evacuating. The more fiber they ate, the worse their constipation (and bloating) remained. Another review found mixed evidence; some people get less bloating and constipation with more fiber, others get less bloating and constipation with less fiber.

Personally, my toilet performance is stellar with or without a constant intake of voluminous levels of plant matter. Most days I eat a good amount—Big Ass Salads, broccoli, sautéed greens, berries—but on the days I don’t, I don’t notice any difference. I’m suspicious of the widespread calls for bowel-rending levels of fiber as the universal panacea for all things toilet, and I’m also suspicious of the people who claim fiber is unnecessary or even harmful.

Fiber helps some people and hampers others. There’s no one-size-fits-all with fiber, especially since there are many different types of fiber.

Too Many Sugar Substitutes

I get it. There are some interesting candies out there that cater to the Keto set and use various sugar alcohols—non-alcoholic, low-or-no calorie versions of sugar—artificial sweeteners, and fibers to recreate popular treats. It’s fun to eat an entire chocolate bar that tastes pretty close to the real thing and get just a few net carbs. But that’s a lot of fermentable substrate your gut bugs are more than happy to turn to gas.

If you want the opposite problem, you can always turn to Haribo sugar-free gummy bears.

FODMAP Intolerance

FODMAPs stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols—the carbohydrates in plants that our gut bacteria usually mop up. Most people have gut biomes that can handle FODMAPs; indeed, most people derive beneficial short chain fatty acids from their fermentation. But some people’s gut biomes produce too much fermentation when they encounter FODMAPs. Fermentation begets hydrogen gas, which gathers in the gut and causes great distress. Common complaints of the FODMAP intolerant are bloating, stomach pain, and visits to the toilet that are either unproductive or way too productive—all of which fall into the bloating category.

The myth is that Keto people are eating salami and cream cheese for every meal. The reality is that many people go Primal or Keto and find they’re eating way more vegetables than they ever have before. These are great developments, usually, but if you’re intolerant of FODMAP fibers, you may worsen the bloating.

What Can You Do?

Eat enough protein. Most people can get away with eating 15-25% of their calories from protein and still stay in ketosis. Most people can eat even more protein and still get most of the benefits of fat-adaptation. The keto studies which had the lowest rates of constipation were far more tolerant of higher protein intakes.

Eat FODMAPs unless you’re intolerant. Most people can eat FODMAPs. In most people, FODMAPs improve gut health and reduce constipation and bloating. But if your gut blows up after a few bites of broccoli or asparagus, consult the FODMAPs list and try a quick FODMAP elimination diet.

Make sure you’re truly constipated. Your stool volume and frequency of toilet visits will decline on a normal ketogenic diet because there’s less “waste.” Make sure you’re not misinterpreting that as constipation or bloating. If there’s less poop, there’s less poop. If there’s more poop but it’s just not coming, and you have to go but can’t, that’s when you have an issue.

Experiment with fiber. Fiber clearly has a relationship to bloating and constipation. You just have to figure out what that looks like in your diet.

  • If you’re bloated and constipated on a high-plant Keto Diet, eat fewer plants.
  • If you’re bloated and constipated on a low-plant Keto Diet, try eating more plants. If that doesn’t help, go zero-plant.
  • If you’re bloated and constipated on a zero-plant Keto Diet, try eating more plants. .

We all have to find our sweet spot.

So, to sum up, “keto bloat” is mostly a myth. There’s a glimmer of truth there, but it’s highly exaggerated. Constipation is common on the most restrictive clinical keto diets, while eating fiber from whole plant foods, being less restrictive with protein, and making sure you’re drinking enough water and eating enough calories and electrolytes seems to avoid the worst of it.

What’s been your experience with bloating and constipation? How have you handled it?

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References:

Ho KS, Tan CY, Mohd daud MA, Seow-choen F. Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms. World J Gastroenterol. 2012;18(33):4593-6.

Müller-lissner SA, Kamm MA, Scarpignato C, Wald A. Myths and misconceptions about chronic constipation. Am J Gastroenterol. 2005;100(1):232-42.

Guzel O, Uysal U, Arslan N. Efficacy and tolerability of olive oil-based ketogenic diet in children with drug-resistant epilepsy: A single center experience from Turkey. Eur J Paediatr Neurol. 2019;23(1):143-151.

Roehl K, Falco-walter J, Ouyang B, Balabanov A. Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life. Epilepsy Behav. 2019;

Liu YM. Medium-chain triglyceride (MCT) ketogenic therapy. Epilepsia. 2008;49 Suppl 8:33-6.

Arnaud MJ. Mild dehydration: a risk factor of constipation?. Eur J Clin Nutr. 2003;57 Suppl 2:S88-95.

Noureddin S, Mohsen J, Payman A. Effects of psyllium vs. placebo on constipation, weight, glycemia, and lipids: A randomized trial in patients with type 2 diabetes and chronic constipation. Complement Ther Med. 2018;40:1-7.

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Living a Life Like This Is Amazing

It’s Monday, everyone! And that means another Primal Blueprint Real Life Story from a Mark’s Daily Apple reader. If you have your own success story and would like to share it with me and the Mark’s Daily Apple community please contact me here. I’ll continue to publish these each Monday as long as they keep coming in. Thank you for reading!

My Primal story starts in 2014. I had a one-year-old baby. I was healthy. I was taking vitamins and supplements and I did exercise. I jogged and lifted weights. I only gained 10 pounds during my pregnancy because of my exercise routine.

The problem was my diet. But I didn’t know that. It all started with my skin and my teeth. I had eczema, red inflamed skin on my face, neck, knees, etc. and I always had cavities every time I went to the dentist. And I had THE best, the Absolute BEST Dental hygiene. I flossed after every meal. I water picked at night. I brushed my teeth 3 times a day. And without fail, every time I went to the dentist there would be a new cavity.

So. I am at the dentist. It’s 2014. He tells me that I have a cavity and he was going to fill it. I was very upset. I said “NO.” I told him not to fill the cavity. I told him I was going to heal it. The dentist is taken aback. He laughed at me.

I went home and Googled “How to heal a Cavity”. And it took me to this oil pulling sight. And it was a domino effect from there. I bought a book called Heal Cavities and Cure Tooth Decay, and I read that book cover to cover. And that book mentioned another book called The Paleo Manifesto, and it also talked about diet and how cavities start from the INSIDE out. So I immediately went out and bought The Paleo Manifesto and read that cover to cover. And that book took me to (you guessed it) The Primal Blueprint. I read that book cover to cover.

I already had a good exercise routine. But those books helped me to clean up my diet which led me to clean up my makeup routine, soap, shampoo, dental routine. It was a complete 180. I went totally green. Also the Primal Blueprint helped me to raise my exercise game and take it from good to Great.

And from there, I gained lean muscle mass. I STOPPED having and getting cavities. My skin cleared up and my eczema completely went away.

After I read Cure Tooth Decay and Heal Cavities, The Paleo Manifesto, and The Primal Blueprint, I STOPPED brushing my teeth so often and so hard. Everything in moderation. I started oil pulling in the morning. I started brushing and flossing my teeth ONLY at night before bed. And I started using mineralized tooth powder. From Primal Life Organics or Raw Dakota Tallow. And just by doing these 2 things, my tooth sensitivity went away immediately. And I started to notice that I could eat hot and cold foods again without any pain. I did this same routine for 6 months and now this is my normal routine. Since I started taking care of my teeth like this, I have NO sensitivity. My enamel that I spent my entire life eroding has come back. I have NOT had a cavity since 2014 and my gums are beautiful and healthy. I no longer dread going to the dentist.

My skin care changed a lot. After reading those books and going Primal/Paleo. I stopped immediately using conventional skin care. I started ONLY using castile soap from head to toe. I started using an acidic toner on my face to bring back the acid mantle that I spent my entire life eroding. I mix up equal parts (1 to 1 ratio) of raw, unfiltered apple cider vinegar with the mother and water. And I spray that on my face at night after I wash my face with the castile soap. And I use tallow as my face cream. From Raw Dakota Tallow or Vintage Traditions. And I do use conventional makeup. I have tried healthy, green makeup, but that is expensive and doesn’t do the same job as the regular conventional makeup. But since I started taking care of my skin this way ALL of the redness and eczema went away completely.

So in these pictures you can see me without makeup and the top picture is my clear, healthy skin now and the bottom is the red, inflamed skin from before. And you can see the lean muscle mass in the gray dress as opposed to the portly me on the Ducati before I went Paleo/Primal.

I do lift weights every other day and I do cardio every other day. My cardio is walking with alternating sprints. And I never miss a workout. But I never train super hard. I stand at work all day and I do a lot of slow movement throughout the day.

I do eat organic when I can. But that is not always possible. So I do eat conventional produce and meats. But I eat nose to tail. And I eat a lot of colorful veggies. I stopped eating sugar entirely. Cold turkey. I STOPPED eating all carbs and sugar. I did that for 6 months and then started slowly bringing back carbs, but healthy carbs like sprouted and fermented sourdough breads with European butter. I follow and maintain a Paleo/Mediterranean diet. My family is from Spain so I do eat a lot of ancestral food and I do drink wine. I was always a steak girl but now I eat lots of healthy vegetables with the steak. I eat lots of dark chocolate. But my treat is white chocolate.

Since I went Paleo/Primal (and I ONLY did this to heal a cavity) I am the healthiest I have ever been. I am 41 and I look like I am 26, and I feel like I am 26. This lifestyle, this way of life is really a lifesaver. Looking back now, I can see how the Standard American Diet and health care and personal care (dental and skin) are slowly poisoning the American people and were slowly eroding my health. This journey is NOT easy for some people. It was easy for me. In order to do this you have to be comfortable doing your own research and you have to be comfortable questioning what you have been taught, conditioned to think and you have to be comfortable questioning what you have been told.

I always took a multivitamin. But after reading these books and doing my research I started talking Fermented Cod Liver Oil, and High Vitamin Butter Oil. I take collagen. I take Iodine (Triodine) I take a really good multimineral (Concentrace minerals) I take a good multivitamin, I take Fermented Skate Liver Oil. But NOT all at once and NOT everyday. Every other day. I take a combination of these.

Do what works for you. I am NOT orthodox paleo/primal/Mediterranean. Living a life like this is amazing.

I would NOT recommend this but, it in my experience it can be done. After having appendicitis, and routine (best case scenario) appendectomy you can snow blow your driveway. I had appendicitis and the appendectomy on Tuesday. I went home from the hospital on Tuesday night at 9:30 p.m. I slept till noon on Wednesday and then I got up and started walking around. I had a good high fat, high protein lunch. And then I snow blowed my driveway (I live in Layton, Utah and we get a ton of snow where I live and it had snowed for 2 days straight). I did that because I figured that Grok did NOT have the luxury of being injured and then laying on the couch all day long and watching T.V. I figured that Grok would be up and walking around. At least foraging for food, for his tribe.

I am healthier than I have ever been in my life, and I have the energy to play with my 5-year-old and keep up with him.

I will Never, Ever go back to what I did and thought and believed before going Primal/Paleo. And it really is a domino effect. Once you start down this journey it will simply but take over every aspect of your life.

I want to thank MDA, The Primal Blueprint, Raw Dakota Tallow, The Paleo Manifesto and Cure Cavities and Heal Tooth Decay, as well as myself for my Amazing transformation. I was always skinny, but I am in PERFECT health because of this journey.

Elsha

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Keto Waffle Breakfast Sandwich (+ a Giveaway!)

Breakfast: it’s perhaps the menu with the most stumbling blocks for those living low-carb. Eggs are great, but—let’s face it—get old without some variety. At times we may find ourselves missing the traditional breakfast classics we might have enjoyed at one point—even when we know they don’t fit our current health goals.

But who said keto was about deprivation? Not us, for sure. With a huge array of keto-friendly classic recipes, we’re hellbent on showing the world just how great keto eating can be—with real food, full flavor and no compromises. So, back to breakfast now…. We dare you to bring this savory keto waffle breakfast sandwich to work—and see just how many people you convert.

Enjoy—and be sure to check out this week’s giveaway with our friends at Birch Benders (below)!

Servings: 2 sandwiches

Time In the Kitchen: 30 minutes

Ingredients:

  • 3/4 cup Birch Benders Keto Pancake and Waffle Mix
  • 1/2 water
  • 1 tbsp coconut oil
  • 2 eggs
  • 3 slices bacon
  • 2 sandwich slices of cheddar (or cheese of choice)

Instructions:

Mix Birch Benders Keto Pancake and Waffle Mix with water and coconut oil according to package instructions.

Grease mini waffle iron with Primal Kitchen® Avocado Spray Oil. Pour batter into waffle iron and cook according to iron instructions.

While mini waffles are cooking (or before), scramble 2 eggs in small skillet.

Cook 3 strips of bacon (in oven at 400 ºF/205 ºC).

When mini waffles are done, let cool slightly on plate or cooling rack.

When cooled, top two of the waffles with cheese slices, 1 1/2 bacon strips each, and divided scrambled egg. Top with the remaining two mini waffles to make 2 sandwiches.

For a little extra spice, add Primal Kitchen Chipotle Lime Mayo. Now dig in….

Now For the Giveaway…

Have we won you over yet to Birch Benders easy and incredible mixes? (They have a paleo version, too, btw.)

Just follow @marksdailyapple and @birchbenders on Instagram and comment on today’s MDA Instagram giveaway photo with your favorite keto recipe.

One lucky (random) winner will score a Primal Kitchen package worth $100: Vanilla Collagen Fuel, Classic Mayo, Chipotle Lime Mayo, Ranch Dressing, Green Goddess Dressing, and Caesar Dressing.

Good luck—and bon appetit!

Nutritional Information (per sandwich):

  • Calories: 415
  • Net Carbs: 6.6 grams
  • Fat: 32.6 grams
  • Protein: 22 grams

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Weekly Link Love—Edition 20

Research of the Week

Neolithic Brits hosted massive feasts that drew people and pigs from all over the island.

Researchers say they’ve found a cholesterol-lowering drug without the muscle-damaging side effects of statins.

Among people with kidney disease, higher oxalate excretion in the urine predicts kidney disease progression.

Our estimates imply that prescription opioids can account for 44 percent of the realized national decrease in men’s labor force participation between 2001 and 2015.”

High intensity interval training slows colon cancer cell growth.

After age 70, your fitness is the best predictor of lifespan.

Maternal infection during pregnancy increases the risk of neuropsychiatric disorders in the kids.

New Primal Blueprint Podcasts

Episode 319: Gretchen Rubin: Host Elle Russ chats with bestselling author, happiness expert, and good habit purveyor Gretchen Rubin.

Episode 320: Keto: Tippy Wyatt, Author of Asian Keto and Low Carb Cookbook: Host Brad Kearns chats with Tippy Wyatt in a wide ranging conversation about health, success, family, and balance.

Health Coach Radio Episode 3: Ali Watts: Hosts Erin Power and Laura Rupsis chat with Ali Watts about the differences between being a health coach and running a business.

Each week, select Mark’s Daily Apple blog posts are prepared as Primal Blueprint Podcasts. Need to catch up on reading, but don’t have the time? Prefer to listen to articles while on the go? Check out the new blog post podcasts below, and subscribe to the Primal Blueprint Podcast here so you never miss an episode.

Media, Schmedia

Parents blame a nearby cell tower for an increase in cancer diagnoses at their elementary school.

“Trip of Passion,” a new film exploring the use of MDMA therapy for PTSD.

Interesting Blog Posts

Why the strange collection of sounds called music is a uniquely human obsession.

How the miniaturization of tools might have made us human.

Social Notes

My pantry staples.

Everything Else

Doctor delivers the bad news to his dying patient via robot.

Medieval diseases returning to Southern California.

Chickens gang up to kill intruding fox.

Things I’m Up to and Interested In

Film project you should back: Defying All Odds, the story of Dr. Terry Wahls astonishing lifestyle-based recovery from multiple sclerosis. This is an important story that people should know about.

Article I found fascinating: How the Inuit Teach Their Kids to Control Their Anger

I hope they look further into this: Inactive ingredients aren’t so inactive.

I’m not there yet: At what age do you feel 65?

Question I’m Asking

With “keto bloat,” the media seems primed to launch another barrage of “terrible keto side effect” coverage. Do you think this is legit concern or malicious fear mongering?

Recipe Corner

Time Capsule

One year ago (Mar 10 – Mar 16)

Comment of the Week

“For sure, ground sloth is slow food.”

– Excellent, Walter.

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The post Weekly Link Love—Edition 20 appeared first on Mark's Daily Apple.

Dear Mark: Protein Efficiency in Seniors, Earned Carbs, Hardgainer with Limited Time

For this week’s edition of Dear Mark, I’m answering three questions from readers. First, is the reduced protein efficiency in older adults due to inactivity, or is it something inherent to the aging process, or both? Second, how does a person know if they’ve actually “earned” any carbs? Does everyone on a keto diet earn carbs by virtue of exercising, or is there more to it? And finally, how can a hardgainer with a packed schedule all week long and limited gym time maintain what little muscle mass he’s managed to gain?

Let’s find out:

Interesting observation on protein needs and training in Sunday with Sisson – general consensus is that older folks need more protein as they age but maybe that’s because they are less active and not simply a result of aging.

That’s probably part of it, but it’s not all of it.

In studies where they compare resistance training seniors who eat extra protein with resistance training seniors who don’t, only the seniors eating extra protein gain muscle mass.

Now, it may be that a lifetime of inactivity degrades your ability to utilize protein, and if these older adults had always lifted weights they would have retained their protein efficiency. But maybe not. As it stands, all else being equal, an older adult needs more protein to get the same effect, even if he or she is lifting weights.

Enjoyable read. As someone who lives a ketogenic lifestyle, and who is athletically active, I am not sure exactly how to go about consuming the carbs I’ve “earned.” I rarely run into problems with athletic energy, at least not below anaerobic threshold. Not sure that eating more carbs will improve my performance. And, if they would improve my performance, how does one go about calculating earned carb replacement without losing the fat burning benefits of ketosis?

It sounds like you’re in a good place.

When I say “eat the carbs you earn,” I’m talking to the people who do run into problems with athletic energy, poor performance, insomnia, and other symptoms of exercise-induced stress. Typically, the people who “earn their carbs” are doing stuff like CrossFit, high volume moderate-to-high intensity endurance work, martial arts training, and team sports.

I doubt extra carbs will improve your performance if most of your training takes place in the aerobic zone. But if you wanted to experiment, you could try a small sweet potato immediately after a workout where you passed the anaerobic threshold.

That’s the best way to determine if you’ve earned carbs. Eat 20-30 grams after a workout and see if you enjoy performance gains without gaining body fat. There’s no consumer-friendly way to directly calculate carb debt; self-experimentation is it.

I recently took a job that has me out of bed at 4am and not home until 6pm Monday Through Friday. Is there an efficient way I can maintain muscle mass only lifting weights Saturday and Sunday? I’m a hardgainer at 5’10” and only 140lbs. I’m afraid giving up my 5 day split will ruin what muscle I’ve been able to gain.

Any hardgainer has to eat, and eat, and eat. Increase your food intake. Just eat. Stick to healthy Primal fare, but pack in the food. Meat, milk, veggies, potatoes, rice, eggs, avocados, fruit. Throw some liver in, too (old bodybuilder staple). It doesn’t sound like fat gain is an issue for you, so I’d take advantage of that and just consume calories.

As for training, get some exercise snacks in during the week.

As soon as you wake up, do a quick superset of pushups. Do as many pushups as you can. Wait 30 seconds. Do as many pushups as you can. Wait 30 seconds. Do as many pushups as you can. There you go. That shouldn’t take more than 5 minutes in the morning. Can you squeeze that in?

Repeat this every morning with a different exercise. Pullups, bodyweight rows, kettlebell swings, handstand pushups, dips, bodyweight squats, goblet squats, reverse lunges, reverse weighted lunges. Just choose one thing to do every morning, cram as many reps as you can using the same format (max reps, 30 s rest, max reps, 30 s rest, max reps). Buy any equipment you can if you choose to use weights.

When you get home at night, do the same thing with a different exercise. Morning pushups, evening KB swings, etc. That way, you get about 10 minutes per weekday of intense strength training without impacting your sleep or schedule in any real meaningful way.

Make sure your sleep hygiene is rock solid. Dim those lights at night, turn on f.lux or night mode, wear the blue blocking goggles, get to bed (ideally) by 8:30, 9 to give you 7 to 7.5 hours of sleep. Sleep is essential for gaining lean mass (and staying healthy in general).

On the weekend, hit the weights hard on both days, hitting the entire body. Go high volume/reps. If size is your goal, dropping the weight a bit and focusing on range of motion and a high rep count (10-15 per set) is very effective.

Food, sleep, reps. Good luck!

Thanks for stopping in today, everybody. Additional thoughts for these folks—or questions of your own? Share them below.

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References:

Tieland M, Dirks ML, Van der zwaluw N, et al. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2012;13(8):713-9.

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