February 14, 2018

Is There a Male Equivalent to PCOS? (a.k.a. The Detrimental Effects of Hyperinsulinemia on Men's Health)

Insulin has gotten a bad reputation in the low carb and keto communities. But insulin isn’t a bad thing. Too much insulin, too often, is a bad thing. If you ask people whose homes are threatened by wildfires whether lots of rain would be a good thing, you’ll probably get a very different answer than if you ask people whose homes have just been destroyed by hurricane floods. Water is not a problem; too much or too little water is a problem, and it’s the same with insulin.

So I’m not trying to demonize insulin. I wrote an 8-part blog series detailing the gnarly and nefarious effects of chronically elevated insulin (soon to be 9 or 10 parts -- new posts coming soon!), but the operative phrase there is chronically elevated. In and of itself, insulin isnt a problem. (Just ask a type 1 diabetic.) The bad stuff happens only when insulin is too high, too often. Now that that’s out of the way, on with the show!

We know for certain that PCOS (polycystic ovarian syndrome)—which is “is the most common endocrinopathy of reproductive aged women affecting 6-10% of the population,”—is driven primarily by chronic hyperinsulinemia. (Incidence may be as high as 18% among certain cohorts when different diagnostic criteria are used, putting the number of women affected worldwide at around 10 million.)

“Hyperinsulinemia associated with insulin resistance has been causally linked to all features of the syndrome, such as hyperandrogenism, reproductive disorders, acne, hirsutism and metabolic disturbances.” (De Leo et al., 2004)

In fact, the causal link (not just an association!) between hyperinsulinema and PCOS is so well-known (and so powerful) that metformin—best known as a diabetes drug—is among the frontline pharmaceutical interventions for PCOS. Keep this in mind as you read about the men’s issues here.

Facial hair, acne, oily skin, mood swings, weight gain, menstrual irregularities, and infertility are not the only signs and symptoms of PCOS. These signs & symptoms are driven by the underlying hormonal disturbances, which include: elevated insulin, increased adrenal androgen synthesis (more testosterone and/or DHEA), decreased sex hormone binding globulin (SHBG), increased luteinizing hormone (LH), and decreased follicle stimulating hormone (FSH). And while the stereotypical PCOS patient is overweight or obese, as many as 50% of women with PCOS are not overweight or obese. (Remember, chronic hyperinsulinemia leads to obesity in some people, but not all. There are millions of people walking around with a “normal” body weight, but sky-high insulin levels.)

Since men produce all of these hormones as well, could there be a male equivalent of PCOS?

You bet your bald spot there is!
Let’s take a look at three different areas where chronic hyperinsulinemia has adverse effects on men:

  • Early onset androgenetic alopecia (a.k.a. male-pattern baldness)
  • Erectile dysfunction
  • Benign prostatic hypertrophy (BPH) – enlargement of the prostate gland

January 31, 2018

Book Review: The Case Against Sugar

Gary Taubes wrote another book.

Gary Taubes! (*Fangirl squee!*)

Do I really need to say more?

I don’t, but since this is my blog, I will.

TL;DR: I loved this book and you will too. READ IT.

If you don’t read a lot of blogs and websites outside the low carb bubble, then allow me to tell you that there’s a large contingent of people who loathe Taubes. He takes a boatload of criticism, as does anyone who writes something that condemns or exonerates something other people love or hate (e.g., red meat and saturated fats, refined carbohydrates, and raw milk). But put me squarely in the camp that loves his work and is grateful for his meticulous research. (The endnotes and bibliography of Good Calories, Bad Calories are almost as large as my entire book.) I’m not saying he’s right about everything, nor that I agree with him on everything. I’m only saying I’m a big fan and have been for several years.

I had the pleasure of meeting Gary in spring 2017, first at a reading and book signing in Washington, DC, and then a few weeks later at a literary event in Charlottesville, VA. I actually drove him from Charlottesville back up to Dulles airport in my neck of the woods, so we had some time to chat and shoot the low carb breeze. Let me tell you, folks: I read GCBC during my deployment in Iraq, circa 2008. Having always been a sucker for salt & pepper hair, intellect, and a wry and somewhat dark sense of humor, I developed an immediate nerd crush on Gary. Never in my wildest imagination—and mine is pretty wild—did I think nine years later, I’d have him all to myself on the road for two hours.

Get your minds out of the gutter. Nothing happened except good conversation and Gary being an exceptionally good sport about the fact that my decade-old car has seen better days. (He assured me that his car is older and in even worse disrepair. We writers don’t exactly break the bank; not even ones like Gary, who garner big advances and have multiple bestsellers to their names.) Without revealing too much, I’ll say that it was really nice to talk with a writer of Gary’s caliber, and to find out that many of the emotional demons that plague me are not unique to me. Gary deals with his by throwing himself into work; I deal with mine by avoiding work. Neither strategy is all that healthy, long term. But I can look to Gary as someone with a lot of dark thoughts and inner turmoil who still manages to get shit done produce great work. It helps that he has a wife and two sons depending on him, so he sort of has to bring home the proverbial (and literal) bacon. 

As an aside, Gary has spent time in France, and he longs for it. As he talked about it, his desire to be there—and, maybe, to be the person he was when he was there—was palpable. He has also written and spoken a lot about his history as a smoker. I could totally see him as the quintessential ex-pat, sitting at a roadside cafĂ© in Paris, sipping coffee and reading poetry, complete with a black turtleneck and a cigarette.  

But enough about Gary. On to the book!

January 26, 2018

Introducing Ketoned Bodies

Confession: I had a hard time writing this post.

I’ve been uncertain of my place in the low carb world for a while now, trying to figure out where I fit in, or even if I fit in.  I’ve been looking at low carb and keto accounts on Instagram lately—something I’d completely avoided until just a few weeks ago.  In looking at the pictures people post, I find myself kind of stunned at the amount of packaged foods and special items marketed toward and targeted at keto eaters: exogenous ketones, powdered MCT oil for your coffee, special “keto collagen,” etc. 

To be clear, I’m not opposed to these kinds of things on principle.  I think they can make low carb and ketogenic diets more fun, more delicious, and easier to stick to, and considering I occasionally share things that might fall into this category, I’d be a hypocrite if I said they have no place in a ketogenic diet.

I guess my beef with those products is that some people’s Instagram accounts are so peppered with them that people who are new to this way of eating might think they have to use them, or that they’re doing something wrong if they get all their food at the local supermarket, rather than having a substantial portion of their diet consist of these esoteric and super-special keto products that can only be ordered online.

Remember: there are only three things—three things—needed to be successful on a ketogenic diet.

With this in mind, I think I’m zeroing in on what my place might be in this community, and I’m becoming more comfortable with it:  I’m the girl who reminds people how simple and UNcomplicated this way of eating is—when we let it be.  I’m the one who talks people down from the proverbial ledge of measuring blood ketones, urine ketones, breath ketones, blood glucose, heart rate variability, and drinking a 500-calorie cup of fatty coffee for breakfast because they’re afraid of the protein in sausages and eggs.  I’m the one keeping it down to earth, doing my best to make this way of eating clear, simple, and accessible to anyone who wants to give it a go, and I increasingly feel drowned out by an ever-widening sea of voices committed to doing the opposite: to adding layer after layer of unnecessary complexity, to the point where people feel like they need a dual PhD in calculus and biochemistry just to figure out what to put in their mouths.

That’s a great way to sell expensive products and gadgets, but if you ask me, it’s a terrible way to get people interested in this way of eating, and to help them get started.     

So, in keeping with my simplicity theme, I’ve written a couple of posts on low carb/ketogenic cooking, to help people see how quick and easy it is to put a meal together, whether you’re cooking for one or two, or to feed a large family.  If you keep your fridge, freezer, and pantry well stocked with low carb staples, you can whip up a delicious and suitable meal in minutes

If you’ve got a busy lifestyle and find yourself pressed for time more often than not, a good strategy for you might be to take a few hours once a week and prepare a large amount of food at once, so there’s plenty of good stuff cooked ahead of time, and it’s waiting in the fridge, ready when you are.  Or, if you’re like me, and you don’t have to worry about feeding picky kids, as long as you’ve got some canned tuna, salmon, or sardines in the pantry, and maybe some kind of vegetable in the fridge or freezer, dinner can be ready in 27 seconds.

HOWEVER, even though I am the queen of emphasizing how fast & easy it is to throw together a low carb meal in minutes, there are times when even I can’t stand the thought of choking down another bite of tuna, or I think I might turn into a cat if I have to pull back the lid on yet another can of sardines.  

On these rare occasions, it’s great to have an alternative.  A real alternative.  A hot meal, high in fat, moderate in protein, low in carbs, made with grass-fed and pastured meats, organic vegetables, and no junky vegetable oils.

This is a tall order, but the people at Ketoned Bodies are doing it!

January 10, 2018

Questions for You

Hey Everyone,

With a new year just having begun, I’ve been giving some thought to how I’d like to proceed in participating in the low carb nutrition and health community.

This might surprise you, but I consider myself a writer first and a nutritionist second. When people ask me what I do, I tend to say I’m a writer who mostly writes about nutrition and health, rather than a nutritionist who also happens to dabble in writing. I love writing. I’ve always loved it. (Even majored it in in college.) I am fortunate that I get to do it for a living: fortunate that someone out there thinks I’m good enough at it that they actually pay me to do it.

However, even though I do enjoy it, for me, writing is an arduous process. It’s not easy, and it never has been. However long you think it takes me to write a post, triple it, and that might come close to the ballpark amount of time it typically takes me to write. (Not including the time it takes to read relevant papers, if it’s one of my more science-heavy posts.) I can’t claim credit for this phrase, but it is absolutely 100% true for me: “I don’t like writing; I like having written.” Meaning, the process of writing—staring at a blank page, filling that page with incomplete, out-of-order, fragmented notes and thoughts, and slowly, painstakingly, turning it all into something coherent and readable—is a struggle and not fun. The fun part comes after that’s all done, and I get to hit “Publish” on my blog. (BTW: the two links in this paragraph are to a blog I had in a former lifetime, long before this nutrition gig.) 

December 27, 2017

New to Low Carb? Feeling Lost? "Paralysis by Analysis?" READ THIS.

Hey Everyone,

As promised, here’s the follow-up to my post on taking an Information Vacation from social media if you're feeling overwhelmed and panicky from confusing keto information coming at you from all sides. Since there will no doubt be loads of people new to this diet in the new year, I figured this was a good time to put this out there.

If you’re new to low carb, or maybe haven’t even started yet, this one’s for you.

If the reason you haven’t started yet is that, despite being an intelligent, grown adult, you can’t seem to make sense of the eight thousand pieces of conflicting information you’ve read about low carb and ketogenic diets, this one is definitely for you.

If you have already started, and still can’t make sense of the eight thousand pieces of conflicting information you’ve read about low carb and ketogenic diets, this is also for you.

You are not alone!

Here’s a quick list of words and phrases extracted from emails I receive from people looking for help with low carb or keto:

  • Confused
  • Overwhelmed
  • Conflicting info
  • Stalled
  • Frustrated
  • No idea what to do!
  • Totally lost!

If you’re brand new to all this, I have to be honest: I don’t envy you. As I mentioned in a recent podcast interview (probably my most fun and controversial one yet), getting started with a low carb diet was much easier 17 years ago, when I first gave it a try. Back then, the internet existed, of course, but the contingent of people talking about low carb was much smaller. There were only a handful of low carb chat rooms and forums, virtually no blogs, and if I recall correctly, neither podcasts nor YouTube even existed. So there was a lot less information available to newbie low carbers, but ironically, that was a good thing. Because now, while it’s wonderful that low carb and keto have become so popular, and there are more blogs, books, Facebook groups, podcasts, and YouTube channels than anyone can keep track of, unfortunately, for every good, reliable, accurate piece of information about these ways of eating, there are four pieces of nonsense and falsehoods that have to waded through first.

Like I said, I don’t envy the newbies.  

When I was brand new to this, around the year 2000, I had two main sources of information: the bulletin boards at LowCarbFriends.com (which I’m delighted to see still exist, as I haven’t logged in in about nine years), and Dr. Atkins’ New Diet Revolution. (Linking to the 1997 version because the one that got me started—the 1992 version, with the blue cover—is apparently no longer available.)

That’s right: the Atkins book.

December 12, 2017

Totally Overwhelmed by Conflicting Information on Low Carb or Keto? Take an Information Vacation!

Are you completely overwhelmed by information about low carb or ketogenic diets? Is your neck about to snap from the multiple times you’ve gotten whiplash from trying to follow an endless onslaught of contradictory advice on reduced carb ways of eating?

If your life revolves around weighing and measuring your food, tracking your heart rate, your sleep, your bowel movements, your workouts, the number of steps you take in a day, and more, and you’re afraid that if you let up for even one second, the entire edifice you’re propping up is going to come crashing down around you, this post is for you!

If diving down every low carb rabbit hole you find has become your main hobby, I totally understand. Perhaps, like me, you spent years doing what you thought were “all the right things” to get healthy or improve your physique. And, perhaps, like me, after years—decades, maybe—of that failing you, you discovered the world of carbohydrate reduction. And after learning nearly all the health and fitness tenets you once held dear were false, you now have a desire—no, an obsession—to learn as much as you can, as fast as you can, from as many different sources as you can. No one could blame you! You’ve got years of misinformation to correct, right? Nearly a lifetime of programming to de-program.


However, if your determination to understand the relevant biochemical pathways and mechanisms even better than the people who make their living measuring the amount of insulin secreted by a mouse pancreas, or measuring the ATP synthesized by cultured neuronal mitochondria from rats, has begun to interfere with your overall quality of life—and possibly even the results you’re getting from your low carb diet, because of all the darn stress—it’s time for you to…