Wellness Weekly 1/14/2021

Episode 57

We dive into the following topics in this episode:

➡️Wellness Journey – Self Care
➡️Article 1 – What happens if you immobilize one arm and exercise the other
➡️Article 2 – Ketosis as a treatment for COVID-19
➡️Rootine Supplement – MSM (methylsulfonylmethane)

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Lifestyle Medicine with Dr. Harris

5 Pillars of Great Health Wellness Program

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Episode Transcript

[00:00:00] Dr. Richard Harris: Join me, Dr. Richard Harris, as we strive to unlock the secrets of the human body. Strive for wellness. Strive for great health. Follow the show on iTunes, Spotify, Google, and Android.

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It’s more important to check at B12 and what the body’s using B12 to make. And that’s Rootine. It meets all of my quality standards, and that’s why I am a clinical advisor for the company because I believe in what we’re trying to do. So to learn more about Rootine, to see how you can benefit from Rootine, check out the link in the show notes, or head to our website, scroll down the bottom and click on the free assessment.

And now to this week’s episode. Hello and welcome to this episode of the Strive for Great Health Podcast. I’m your host, Dr. Richard Harris, and this is Wellness Weekly. So, of course, we’re going to start off with our wellness journey, and this wellness journey is about self-care. And we kind of talked about this last week when we talked about me walking through COVID. I have completely recovered.

Well, mostly completely recovered. I don’t have the chronic fatigue that I was having before. And finally, I noticed today that I smelled the garbage, and I don’t know if you’ve ever been happy to smell garbage before. I was super happy today that I could actually smell the garbage, and it’s the little things in life.

So finally, my sense of smell is coming back, but I. Always, always, always, always want to prioritize self-care. And it’s funny because all throughout my life, at different stages of my life, people would always tell me, Oh, once you do or get to X, Y, and Z, you’re not going to be able to do that anymore. So I remember in undergrad, once I got into pharmacy school, people were like, Oh, you’re not gonna be able to work out anymore in pharmacy school.

You’re gonna be too busy. I’m like, what? No, I need to work out. I need to be the best version of me; working out is how I don’t break people’s necks all the time. I am not a happy person if I don’t work out. So I prioritize getting in my workouts even more during that stressful time period. And then I remember as a pharmacist, people were like, Oh yeah, you’re not going to be able to work out.

You’re not going to have time. And then same thing I heard in medical school, same thing I heard in residency, same thing I heard being a doctor. It’s like somehow all of these things just magically would change my priorities, and I wouldn’t be able to make time for self-care. And it’s funny because now people are saying the same thing.

Oh yeah. You’re not gonna be able to do that when you have kids. And I’m like, okay. So you’re saying every single person on the planet who has kids doesn’t have time for self-care. Every single one of them. And it’s like, well, no, I’m like, yeah. I know plenty of parents who are amazing parents, wonderful parents, parents who I aspire to be like, who still [00:04:00] prioritize self-care, who exercise, who eat right.

Who realized that they are their best asset and to be the best mom or dad they can be, they have to be in the best possible shape that they can be in. And also, kids are like sponges. They pick up on everything. So if you really want your kids to be healthy, you have to prioritize self-care. You have to show them how to be healthy.

They’re not going to learn that anywhere else. They’re not going to learn it in school. They’re not going to learn it from anywhere else. In fact, so many people I talk to say, you know, I just ate this way because it was all I’ve known. I never exercised because I never knew; I never meditated because I’d never got exposed to it.

So if you want your kids to have these habits, these life-sustaining habits, so they’re not one of these 30-year-olds who’s on dialysis that I see all the time. You have to teach them, and you have to model the way. And so it’s even more important for me. It’s going to be more important for me to maintain my wellness regimen,  maintain my wellness plan when we have kids.

So I show them the way. I want them to have every single opportunity to succeed and be healthy and be wonderful, amazing, productive members of society. And I know a health and wellness structure, a health and wellness plan will allow them to be their best asset. And I’m going to have to model the way, and I want to be the best version of myself for my wife, for my parents, for my sister, for my kids.

And I know to do that. I have to be healthy. If I’m drowning, I can’t save you. I’ve got to put on my life vest first, and then I can save you. What do they say in airplanes, put on your oxygen before you put on someone else’. We have to help ourselves before we can help others. We have to be the best version of ourselves to be the best version of ourselves for other people.

And it’s not selfish to do that. It’s not; it’s actually the right thing to do to prioritize your own self-care and your health. So that then you can be the best version of yourself for others. You have more capacity for kindness for empathy when you prioritize your own self-care. And then, like we’ve talked about, when you have an illness, everything stops.

You want to be a great father, but guess what? If you have a heart attack right after that, you’re not going to be able to be a great father after that. Because there’s physical limitations. There’s things you physically can’t do anymore. If you’re on dialysis, guess what? You’re gone three days a week to dialysis.

That’s taking away time from your loved ones. So when there is an illness, everything stops until you get that illness under control. In most illnesses, chronic diseases in this country are preventable. And then most of them are reversible. We highly, highly underestimate how reversible diseases in this country, but we holistic practitioners see it reversed all the time.

But it revolves around self-care, revolves around a new identity. Like we talked about with Dr. Ruan, a new identity, and I’m actually adding that into my wellness courses about the power of how you see yourself and about visualization. And one of the things I think is so important about self-care is not, it’s not that you’re denying yourself of things.

Like people were like, Oh, I can never eat another donut again. And I’m like, that’s insane. I eat donuts. I just plan for that. So whenever I have a craving for something that’s off my wellness plan, it’s not really off my wellness plan. And why is it not really off my wellness plan? Because I budget in for cheat meals, not cheat days, not cheat weeks, but cheat meals.

So every four to seven days, I have a cheat meal, and whenever I get a craving for something that’s not on my wellness plan. I put it on my wellness plan by adding it to that cheat meal. [00:08:00] And when I do have a cheat meal, I make sure that I’ll have less calories that day. Maybe take a little bit extra vitamin because I know those cheat foods are very poor in nutrients.

And so I have a plan for it. And that’s what self-care is all about. It’s all about having a plan. It’s not about denying yourself something saying I’ll never drink again. I’ll never have donuts. I’ll never eat a piece of cheesecake. No, it’s about delaying that gratification and having a plan where that fits in.

So I don’t deny myself anything. Ever, I just budget for it, and it’s in my plan. So I don’t feel bad. I don’t feel guilty. I don’t feel wrong about it because it’s all part of the plan. So you have to have a realistic plan. And that’s what we talked about on the growth mindset episode is the S.M.A.R.T. goals.

Part of that is realistic. So I have a realistic plan, and I’m flexible on my plan. And that’s why I have a cheat meal every four to seven days. Cause it depends on how I’m feeling now. Some days I may go two weeks without cheating. Sometimes that may be a little bit less. It just all depends, but it’s still there.

It’s still budgeted. And then I’m flexible with my plan. All right. So let’s move on to the first article. The first article is entitled contralateral effects of eccentric resistance training on an immobilized arm. So basically, this study is looking at, Hey, if we immobilized one of your arms and we do resistance training, strength training on the other one.

What effect does that have on the immobilized arm? And so there’s two things you need to know eccentric versus concentric. So concentric is what we think of when we lift weights. It’s when you push up the bench or when you do a curl, that’s the concentric phase, the eccentric phase is, or the concentric phase is when the muscle contracts, when the muscle shortens, and the eccentric phase is when the muscle lengthens.

So it’s like when the, when you’re letting down the bar on bench press or after you’ve done your curl when you’re returning the weights down, that’s the that’s the eccentric phase, and they do slightly different things. So in the introduction, we know that immobilization can decrease strength and muscle mass.

So you get a 1.2% decrease in maximum voluntary contraction. And how we measure maximum voluntary contraction is we, we measure the force when you tell someone squeeze or push or do whatever as hard as you can. And you’ll also get a 0.2% decrease in muscle size per day. And this was measured in the elbow flexors.

So resistance training of the non-immobilized limb minimizes negative effects due to cross education or cross-training, meaning that the body sees one muscle doing something and working, and because of the brain muscle axis, you get some benefits in the immobilized arm. In fact, previous studies indicated that a combination of concentric-eccentric training at 50 to 70% of your one-rep max increased the MVC by 5.8%.

And the one-rep max strength by 13.9% and the trained arm. So in the arm that wasn’t  immobilized and prevented loss of MVC and one-rep max and the non-trained arm after three weeks of the immobilization. So what does this mean? It means that they exercise the arm that they could for three weeks, and that arm made gains.

And then actually, there was no difference in the immobilized arm between when it first immobilized and when they took it out of a mobilization. So that arm that wasn’t getting any training lost no string whatsoever. Now what is unclear and what the study looked at was if the concentric, the contracting phase of the workout or the eccentric, the lengthening phase of the workout is better for preventing loss in the, in the other arm and the [00:12:00] immobilized arm.

So previous studies have shown that eccentric training of knee extensor muscles had a two X greater increase in the MVC and the other arm or other muscle, another study compared a volume matched. They did the same amount of exercise, and it looked at the eccentric only. And concentric only training. And they found that the wrist muscles, the strength transfer to the non-trained arm was 19% higher in the eccentric training.

So meaning there was more strength to gain to the other arm that wasn’t trained in the eccentric training. And it’s theorized that eccentric only training has a greater increase in the brain muscle axis. So we call these the cortical spinal tracks. This is basically cortical spinal means cortex to spine.

And this is basically saying the tracks that increase movement from the brain to the spine. And that there’s a decrease in inhibition at the spinal core level in the non-trained arm. So the study aimed to look at the effect of eccentric only, and then concentric-ecentric training with matched volume on arm circumference, one-rep maximum, MVC strength, surface electromyography, which is basically looking at muscle activation, muscle fiber activation.

They also want to look at RFD, which is basically how much the rate of force development. So can you go, how quickly can you go zero to 100? Can you go zero to a hundred real fast? Or are you going zero to a hundred real slow? That’s what RFD basically means. And then they also looked at something that’s really cool.

They looked at something called elbow flexion joint position. So this is basically looking at how we orient ourselves in space. And so what you do with this is you have people say, okay, your arm’s at 30 degrees right now, 50 degrees right now, 60 degrees right now. And then you have them close their eyes and say, okay, you have to get back your arm to 30 degrees.

And then you measure the error. And so if your body’s able to sense where it is in time, in space very well, it has a low error. And in the medical term, we call this proprioception, basically, where are you in space? So this study recruited 18 men and 12 women. They excluded participants who had an injury or weight training experience in the last year.

So you’re getting some fresh participants. And so, each group increased intensity each week. However, the weight volume and total weight volume were similar in both groups. So the overall work was about the same. So you can’t say one group had a lot more training than the other group. And then, all participants were told to refrain from training outside the study.

There was no supplements, and they were told not to take anti-inflammatories and maintain their normal routine. So the immobilized arm was placed in a sling for about eight hours a day to be removed while sleeping, driving, shower, and bathing. In previous protocols have shown that this decreases strength by 20%, and it can decrease cross-sectional area, basically the size of the muscle by 11%.

And this was in the elbow flexor area. So they use a preacher curl bench and the exercise, and they use dumbbells for the exercise. In the eccentric phase, they would use four seconds of eccentric contraction. And then, the study author would take the dumbbell so that they didn’t get any concentric motion.

So they would go back to that position. And so they had them work out three days a week. And then they would do three times 10 reps or [00:16:00] the first week, and then four times 10 reps after that. And then, they increased intensity, and they based intensity off the one-rep max. And it was from 80 to 120% in the last week.

In the concentric-eccentric, they spent two seconds in each phase. They did four times 10 reps the first week and six times 10. After that, with less weight, 60, 70, 80, 90% of the one-rep max, they took two second resting time between reps and two minutes resting time between sets. Okay. So now we got we’re through all the technical stuff.

What did the study find? So they found that in, for arm circumference, the immobilized arm, of course, got smaller, but it’s in the control group. So they had three groups. I should have explained this earlier. They had a control group who did no exercise, an eccentric group, and a concentric-eccentric group. So the immobilized arm, the arm that was not doing any training.

Saw a loss of 2.1% circumference in the arm during the study period; it was about 2.1% in the concentric-eccentric. And then it was 5% in the control group. So the arm, that was immobilized lost less muscle mass in the exercise group. And then in the training arm, you saw a 2.9% increase in arm circumference in the eccentric, about a 0.5% increase in the eccentric-concentric, and a minus 0.2% loss in the control group.

And the one rep maximum, the immobilized arm actually had a 3.4% increase in the eccentric phase, a minus 0.1% in the concentric-eccentric, and the control loss 15, about 15% of their one-rep max. And then, in the training arm, there was a 15.2% increase in the eccentric, a 21% increase in the eccentric-concentric, and minus 1.2% decrease in the control arm.

So the maximum voluntary contraction in the immobilized arm, in the eccentric only it showed a 12.7% increase. And there was decreases in the eccentric-concentric. It was about nill. It was minus 0.1%, but it was minus 21.7% in the control groups, a lot of strength loss there. And then the trained arm, the greatest gain was in the eccentric group, 20.9%.

It was 13.7 and the eccentric-concentric. And then minus 4% almost in the control group. So for muscle activation, as measured by electrodes placed on the muscles to look at the muscle fiber activation in the immobilized arm, there was actually a 17.5% increase in muscle activation. That’s really interesting.

So you had more muscle activation in the immobilized arm because of what the other arm was. And then this actually increased by 5.9% in the eccentric-concentric phase. And then in the control group, it decreased by a whopping 35.2%. And the trained arm, you had an increase of 78% and the eccentric group, 15% in the eccentric-concentric and 0.2% in the control, by the way.

If you want all these numbers just head to our website. We, we do have episode transcripts on the website now, so you can go back, and there’s timestamps. So you can review all this information. If you want the cliff notes version, join our insider group, the insiders, get the cliff notes version. So RFD in the immobilized arm, RFD decreased in the control group but did not change in the other groups, and the trained arm, RFD increased more in the eccentric group.

So your rate of force development was higher in the eccentric group. And then, when you looked at the elbow, flexion where the arm is in space. The immobilized arm, the error increased by [00:20:00] 87% in the control group. So because that arm was inactivated, it lost the ability to determine where it is in space.

And this is really important for as we age, and this is why the elderly, if you don’t continue to exercise, have so many falls because they literally lose the ability to tell where their body is in space, and that’s why they fall. But this error rate did not change in the eccentric group, in the eccentric-concentric group, and the arm that was training the position area decreased by actually 35% in the eccentric group but did not change for the other two groups.

So this is a really interesting study and basically summing it up. What it found was eccentric only training produced greater increases in arm circumference, maximum voluntary contraction, muscle activity, and RFD for the trained arm. And then also improve the maximum voluntary contraction, muscle activity, and elbow flexor to a greater extent than concentric-eccentric in the immobilized arm.

The decrease in circumference in the immobilized arm was considered to be due to muscle atrophy from non-use. And the authors hypothesized that it’s possible that eccentric only may be more effective than concentric, only training in strength gains. And there are other studies that corroborate what the study has shown.

There’s other studies that show that eccentric training. You get an increase in muscle fiber activation. Again, this is thought to be due that this type of training requires more activation from the brain down to the spinal cord. So you get more recruitment of muscle fibers, and that the improvement in the RFD could be due to more recruitment of fast-twitch muscles, fast-twitch muscles are our explosive muscles, therefore strength.

They’re not the endurance muscles. Those are slow-twitch muscles. Study also found that exercise can increase proprioception, that ability to determine where we are in space. Again, this is why it’s so important that we continue to exercise, that we continue to move our bodies, especially as we age, to prevent falls, to prevent fractures because there’s high rates of death.

After hip fractures, it can be as high as 30%, and the authors theorize that the eccentric may activate other muscles around the targeted muscle to a greater amount. So you get more recruitment in other accessory muscles, and then it appears to activate the local circuits. So it activates the brain circuits more.

And then the local spine to muscle circuits more than the typical concentric-eccentric phase. So what’s the take-home here? I think the main take-home is two points. One. If you are in a situation where you have one limb immobilized, don’t just stop exercising, do what you can, especially training the other arm and it or other limb.

And it may be more beneficial to do more eccentric loading during that time period. The other takeaway here is if you are lifting, do not neglect the eccentric phase of the lift. Now a lot of people who do time under tension, and I spend, you know, 50% of my time doing time under tension workouts, know this. So that eccentric phase, that lengthening phase, that when you’re not actively pushing or pulling the weight matters, for muscle growth, for where you are in space, for neuromodulation of your muscles.

So remember that and use your workout times effectively. Okay. So article two, and this is another really technical article. I’m trying to do my best to get you the high-level point and the take-home points, and what you need. But at the same time, we’re a science podcast. Y’all, I know if you’re listening to this, you like science.

Or at least find it [00:24:00] interesting or maybe find me interesting or cute or whatever. I’m just glad; I’m just glad you’re listening. So this article looked at well, let’s start with the title. The title of the article is COVID-19 proposing a ketone-based metabolic therapy as a treatment to blunt the cytokine storm.

So unless you’ve been living under a rock for the last year and a half or so. You’ve been hearing about cytokine storm as a cause of the severe morbidity, which is disease impact, and mortality, which is death related to COVID. And this cytokine storm is basically the immune system gets overwhelmed, cannot do what it’s supposed to do, and just throws the kitchen sink at COVID causes massive activation and damages host tissue, which can lead to permanent issues or death.

So the authors of the study were looking at, Hey, we know ketosis has some really beneficial properties, so maybe ketosis could be used as metabolic therapy to help with COVID, let’s break down the rationale for that. And this is going to be technical. There’s going to be some science-y terms, but of course, I’m going to give you the 30,000-foot view as well.

So the 30,000-foot view is we know ketosis can increase cell efficiency and metabolic flexibility. Metabolic flexibility is can your cell burn sugar for fuel? Can it burn fat for fuel? How’s it do switching between the two and we know ketosis can be an immune modulation state. We talked about that in the keto podcast.

So ketosis can improve energy redox, basically the energy reactions, we’ll talk about that more in a minute, and metabolism, and can blunt inflammation and a lot of this, you’re going to hear again, I’m actually going to do a whole podcast on metabolism because there’s a lot that’s misunderstood.

It’s a very difficult subject. I might split it into two podcasts, but I want to go over this in detail so you can understand what is actually happening when we talk about metabolism. So there’s actually a clinical trial underway of the ketogenic nutrition plan and intubated SARS patients because we think there will be some benefit for doing that.

So the lung cells that COVID infects, these are alveolar epithelial cells. That’s a fancy term for lung cells. Have high energy demands, and they heavily rely on fatty acids for energy. And this effect is blunted by the infection, by the COVID virus. And as we talked about, cytokine storm results from improper immune activation.

So in the immunity balance podcast, we talked about the innate immune system and the adaptive immune system; innate immune system are kind of dumb. They just kind of are always there. And they look out for certain things. The adaptive immune system is a smart arm of the immune system. It comes in, and it has a very targeted approach.

So cytokine storm actually happens because you get improper activation, improper activation of macrophages, and neutrophils. You don’t get the adaptive immune system to activate. So you get less B-cell and T-cell activation. And so you get a bunch of pro-inflammatory cytokines that we’ve talked about.

Cytokines. These are messenger systems that our body uses to talk to immune cells. It’s how immune cells talk to each other. It’s how immune cells talk to other cells. So that system gets dysregulated, and you get this massive activation. And we’ll talk about this more in a minute, but ketones restore energy production during these states by normalizing a few things.

One is the ADP to ATP ratio. ATP is what our bodies actually use for energy. [00:28:00] So when you take in food, it all gets converted to ATP, and ATP is what makes things happen. You also get restoration of the NAD and NADH ratio. There’s a lot of talk about NAD right now, lot of talk, and it’s mainly revolving around longevity.

So NAD and NADH, this ratio is a, is a really great marker for your overall metabolic status. We’ll talk about this more in a minute. Another ratio is NADP to NADPH and then acetyl-CoA to CoA. So these four ratios are the principle ratios in controlling metabolism and energy balance, but they do more than that.

These are these molecules are also signaling molecules, and the ratio of them controls other processes in the body related to inflammation, immune cells, and even cortisol. So let’s dive in. I told you this is going to be science-y people; come on, enjoy the ride. So ketones have been shown to increase muscle power output and increase the CD4 to CD8 ratio by 25%.

And this is really important because an increased CD4 to CD8 ratio, and these are types of immune cells, is associated with increased immune function. And this ratio declines as we age. So this is one of the reasons why the elderly are more susceptible to infections and more susceptible to severe infections, and ketones help offset that.

And when I say ketones, it was looking; it was, this study was mainly looking at beta-hydroxybutyrate, BHB is the main ketone. So I’ll use the two terms interchangeably throughout this, but really what we’re talking about when we when I say ketones during the rest of this episode is, I mean, BHB or beta-hydroxybutyrate.

So viral infections caused an increase in inflammatory activation, which activates those reactive oxygen species. We talked about reactive oxygen, species, damage cells, damaged proteins, damaged DNA. You also get activation of RNS, reactive nitrogen species. And this is mainly nitric oxide. So we talked about nitric oxide on the nitric oxide podcast.

And nitric oxide does have a lot of beneficial properties, but our bodies use nitric oxide as well to kill off invaders. But so if this process is unregulated, this ROS and RNs generation is unregulated, you can damage host cells. In fact, one study showed that older COVID-19 patients had less SOD.

We’ve talked about superoxide dismutase. It’s what gets rid of hydrogen peroxide and those types of free radicals. So older COVID patients had less SOD than younger controls. So they, these people had less ability to neutralize reactive oxygen species. So increased ROS disrupts energy production.

It does so by increasing the ADP to ATP ratio. So if you have more ADP and its not getting converted over to ATP, you have less energy, because like we just talked about, ATP is what energy generation is all about. It’s all about making ATP from the foods we eat. ROS also decreases the NAD to NADH. NAD is essential for generating energy.

And we’ll talk about that pathway more in the metabolism podcast. But you want a higher NAD to NADH ratio. It’s associated with longevity; it’s associated with anti-inflammation. And typically, as we get older, this ratio declines. That’s why a lot of older people [00:32:00] have less energy, especially if they weren’t doing the things they need to.

So this also leads to a depletion of glutathione, which causes an increase in the NADP/NADPH ratio. And you don’t want that. All of this basically means that cells cannot perform their essential functions. They do not have the energy to perform their functions. And this leads to death and worsening inflammation.

So viral infections actually decrease part of the mitochondria called complex one. So you may have heard of the electron transport chain. This is how our mitochondria generate energy. So complex one is the first in that complex of generating energy. So viral infections decrease the genes that make the mitochondrial complex one.

So now you have less ability to generate energy and also increases ROS production. Another aspect of this system, and we talked about this before, is that pro-inflammatory TH-17 cells, and these are immune cells, TH-17, are a type of T-cells that have higher levels of an enzyme called PDK1. And what PDK1 does, is it inhibits part of our energy generation cycle.

And this causes a low energy state, which further promotes inflammation. So TH-1 and another type of T cell called T reg cells, regulatory cells have low PDK1 levels, and they primarily use fat for energy. While those TH-17 cells mainly use sugar for energy. So the TH-1 and T reg cells are actually anti-inflammatory cells.

And so we talked about this on the immune balance podcast. We talked about how the immune system needs to be in balance. Just like we have immune cells that get hype and want to go in there and burn everything down with the ROS and RNS that we talked about, there are immune cells that activate that say, Hey guys, calm down.

You’re destroying your own tissue. The invaders are gone. And there needs to be a balance between this system. But if the, if you are metabolically unhealthy, you do not have a balance in your immune system. This is, this is the key critical point. This is one of the take-home points that I talked about. If you are metabolically unhealthy, your immune system cannot function like it should.

So, T regs utilize fatty acids for energy. Th-17, the pro-inflammatory ones can not. And what’s interesting is that ketones bypass the blockage caused by PDK1. So they bypass the energy blockage and say, Hey, okay, there was a blockage over here. This cell can’t make energy, but aha, I got you. I’m going to slip into this pathway, and I’m going to allow you to make the energy you need to do your processes.

Ketones are also known to increase mitochondrial energy generation so you can generate more energy, more ATP. Ketone metabolism also helps fuel the complex one. So the virus decreased complex one ketone metabolism says, Hey, complex one. I got you. We’re going to put you back up. And this is through the generation of NADPH.

So ketone oxidation, meaning ketone metabolism increases the NAD to NADH ratio and decreases the NADP/NADPH ratio. That’s good. You want increased first one; you want decreased second one. Overall that indicates a much better metabolic state, and there’s some previous research that, that goes in line with this. Previous evidence shows basically a ketogenic-type feeding plan while people are on a ventilator reduced ventilator time by 40%.

[00:36:00] Another study in mice. And we talked about this study actually on one of our research Tuesdays and Thursdays; when we still did that, another study in mice showed that a ketogenic plan increased anti-inflammatory they’re called T Gamma Delta cells in the lungs. So it actually decreases inflammation in the lungs.

There is a caveat here. And that’s something that you hear people talk about that if you take exogenous ketones or drinkable ketones by themselves, they actually inhibit fat burning while they’re in your system. And that’s because they’re, they’re increasing your ketone levels. And so the body says, Hey, our ketone levels are good.

I don’t need to burn. Fat right now, but that doesn’t mean they can’t help you lose body fat because of some of the other cell signaling molecules and the anti-inflammatory actions and the regulation of hormones, and so forth. But the key takeaway here is that if you’re sick and you’re taking ketones, you’re going to need to increase your fat intake and decrease your sugar intake.

So you can’t just take ketones and pound a bunch of sugar and expect them to work. We’re going to talk about that in a minute. So early on infections, excess sugar stimulates pro-inflammatory mediators, and this is likely why diabetics get worse infections and worse outcomes. Ketones inhibit something we’ve talked about on the podcast before the NLRP3 inflammasome.

That’s a fancy name. Just remember inflammasome. And what does an inflammasome do? Makes inflammation. So ketones inhibit that, but that effect is blunted in the presence of high insulin or glucose levels. And this is why it really grinds my gears when some of these MLM people say, Oh, all you need to do is take ketones.

It doesn’t matter what you eat. No, it matters what you eat because high insulin levels, high sugar levels effectively get rid of the positive effects of the ketones. High insulin levels decrease your body’s own ability to make ketones. It inhibits the expression of ketogenic, genesis means making, so it inhibits expression of keto making genes.

Now, one of the things that this study touched on that I thought was interesting that I actually do. So I take exogenous ketones. We’ve talked about them now, when do I take them? I take them before my workouts, and I actually take them with sodium bicarbonate. And the reason for this is ketone bodies are acids, and so they can increase your blood pH.

Now, what previous research has shown is that taking them with sodium bicarbonate actually keeps the pH normal, increased the ketone levels, and increased power output in these athletes by 5%. In addition to the other power output increase that they saw now, fasting is also been shown to inactivate the inflammasome.

Fasting leads to increased NAD, fasting also activates the sirtuin pathways, and this decreases overall the reactive oxygen species generation. We talked about the sirtuin pathways on the longevity podcast. Go check that one out. I love SIRT1; I love AMP kinase. These are like my favorite genetic sequences.

Because they do all the good stuff that we really want when we say health and wellness. So ketone bodies also promote anti-inflammatory messengers. So there’s inflammatory cytokines, inflammatory messengers, and there’s anti-inflammatory cytokines. So ketone bodies help increase anti-inflammatory cytokines.

They decrease NF-KB; we’ve talked about NF-KB. NF-KB is the master inflammatory switch, is the master inflammatory genetic switch, which ketones also do epigenetic modification. And they do this through a process called histone deacetylase inhibition. So let’s just say our [00:40:00] genes are tightly wound up, in this process of histone deacetylase inhibition can cause the genes to be open to being read and then making proteins.

That’s, that’s an easy way to explain it. So just like methylation that we’ve talked about before, this is another way that you can change what genes are expressed at what time. So the ketone inhibition here that the histone deacetylase inhibition leads to increased AMP kinase activity, mTOR. mTor is a growth signal.

So when mTOR levels are high, it tells the body to grow. And so mTOR activations actually been associated with increased biological aging. So this increase in AMP kinase activity, decrease in mTOR stimulates autophagy. Now that’s really cool. We’ve talked about autophagy on the podcast before the body self-cleaning cycle, how the body can kill off cells.

And why would you want autophagy during an infection? Well, you want that because, especially for viruses, virus-infected cells need to die because virus-infected cells. What the virus is doing is hijacking our own machinery to make more virus, but you don’t want these cells to die in a haphazard way. You don’t want the stupid, the innate arm of the immune system to come in and just kill everything.

You want this to happen in a very regulated manner. And that’s why autophagy comes into place in this situation. Now. This epigenetic modification also helps facilitate the conversion of T-cells into the T regulatory cells that we talked about. The anti-inflammatory T cells. So ketones also activate something called GPR109A, and this inhibits NF-KB as well.

This molecule also works to increase thermogenesis, so it works to increase fat burning in fat cells. And if you don’t have this. And so they did the studies in what we call knockout mice, where a gene is missing. What happens is you decrease PPAR  alpha, which is the master regulator of ketogenesis, and increase PPAR gamma, which increases fat tissue generation or fat cell making, adipogenesis is what it’s called.

So basically, if you have this regulation in the system, you get less ketones, more body fat. Ketones also up-regulate a molecule called cathelicidins. We talked about this in the vitamin D podcast. So cathelicidins are anti-microbial proteins, cathelicidins also play a role in autophagy. And what ketones do is they increase one of these cathelicidins called LL-37.

And they also increase NADPH. We talked about that earlier, which protects LL-37. So this is why metabolic health is so important because, as you can see, these processes are very complex, but they’re all intertwined. And so you have one system that boosts another system that boosts another system that activates another pathway.

And then they, if everything is working perfectly, you get activation of the immune system, but not too much. It goes in there does its job. And then you get activation of another arm of the immune system that says, Hey guys, you’ve done a good job. Let’s all go party, and you’d need proper metabolic health to make this happen.

If you take anything away from that, I’m going to keep saying that you need proper metabolic health for this system to happen. And this is why COVID has impacted America to the extent that it has. Because if you look at obesity and the amount of people who are overweight and the amount of people who are dying, most people in this country have poor metabolic health.

So we talked about cortisol earlier. Ketones can actually help regulate the release of cortisol during an infection. So early in an [00:44:00] infection, you don’t want cortisol release. And the reason for that is cortisol dampens down the immune system, it suppresses it. If you suppress the immune system early in infection, that’s bad because now the virus or bacteria, whatever it is, is going to run them up.

However, you want late cortisol release to help stimulate the anti-inflammatory arm of the immune system and calm down the immune system. So early cortisol and infection, bad, late cortisol and infection, good. But this system can get dysregulated if you’re metabolically unhealthy. Why? Well, the NADP and NADPH that we talked about earlier, the enzymes that are responsible for activating and getting rid of cortisol, are dependent upon these things.

So by regulating the NAD and NADH ratio and the NADP/NADPH ratio, ketones actually help with the proper release of cortisol. So you get the, you don’t get the early release. You get the late release. Another thing that they do is they also work on the angiotensin pathway. This is something that you may have heard about with COVID because the this is a, a, something that’s happening in the lungs.

And so normally what happens is you get angiotensin one, it gets turned into angiotensin two. So, angiotensin one is actually pro-inflammatory. Now get this angiotensin two is actually anti-inflammatory. So what is the body doing? It’s activating the pro-inflammatory and anti-inflammatory system. So at first, it activates that anti the pro-inflammatory, the angiotensin one, and then the angiotensin two activates the anti-inflammatory.

This is that immune balance. We talked about, you need the pro system first and then the anti-inflammatory system later. So the pro-inflammatory doesn’t go out of control. But you need both. If you don’t have both, the system doesn’t work correctly. If there’s dysregulation in the system, it doesn’t work. So with age and COVID infection, angiotensin one predominates.

So what happens? You get dysregulated towards inflammation and actually ketones what they do is they work to decrease the angiotensin one, and then they help to decrease the angiotensin one receptor. So it helps lower that pro-inflammatory signal. So aging, COVID are saying, Hey, angiotensin one is going to predominate.

We’re not going to get that anti-inflammatory signal, but ketones work to decrease that. So it helps, again, balance. So ketones also help epigenetically regulate blood sugars. They actually increase the, the store, the sugar storage enzymes. You can see that ketones will, can help increase mitochondrial electron transport genes so you can generate more energy.

They increase anti-inflammatory gene expression. Another interesting thing is that they increase something called FOXO1. And what FOXO1 does, is it changes those dumb macrophages that we talked about earlier? They’re not really dumb. I just like to say that for theatrical purposes. So if you activate M2 macrophages. M2 macrophages are actually anti-inflammatory.

And get this, the FOXO1 activates M2 macrophages also activates GPR109A that we talked about earlier. Also, M2 macrophages depend on fatty acid metabolism, and M1 macrophages depend on glucose metabolism. So why is that important? Obesity, obesity shifts the macrophages to more M1.

This is one of the main reasons why obesity is a pro-inflammatory state and is no way, shape or form, or anything remotely close to being healthy. [00:48:00] You cannot be in a pro-inflammatory state and healthy. One of the main things that we do in holistic medicine is try to get rid of inflammation. One of the main things we do

Anyway. So these pathways, when you activate FOXO1, you also work to increase SOD, which decreases ROS and helps balance the NAD and NADP ratios. So this is, this is really important because not only do the NADP serve as a regulator of metabolism, but it’s also important for making sure that glutathione is available to help clear up some of the damage.

Also, if the NADP/NADPH ratio is too high, you don’t activate NRF-2, which is the master anti-inflammatory switch. NRF-2 increases anti-inflammatory genes, increases glutathione, increases SOD, increases catalase and NADPH. It also has a dual function. So in macrophages and neutrophils, it can increase the ROS and RNs production, but it also increases SOD and catalase.

So it’s saying here, I’m going to increase the production of these free radicals, so we can go and destroy cells, but I’m also going to increase the things that deal with those. So they don’t run amuck. Balance again, if you’re going to take anything away from my podcasts, anything away from what we do in holistic medicine, it is about balance.

And that was the whole purpose of this, is that if you do not have metabolic health, you do not have balance in no way, shape, or form do you have balance. And so, in my opinion, the most important thing that we can do as Americans is restore our metabolic balance to allow our bodies to do what they’re supposed to do.

So the supplement and we’re still in our Rootine series. So we’re going to end talking about a supplement MSM. MSM is pretty popular these days, and you’re starting to see a lot more people take it. We talked about MSM briefly on the podcast; I did about Re:play. So MSM stands for methylsulfonylmethane. So what does MSM do? It’s a source of sulfur in the body.

Sulfur is a mineral; it’s the six-month abundant mural in our body. And we use sulfur to generate cysteine, which, if you remember, cysteine is the rate-limiting amino acid, meaning it’s the, it’s the most important amino acid in generating glutathione. We also use it to make the amino acid methionine. MSM also may inhibit degenerative changes in joints, and it may do this by stabilizing cell membranes and scavenging free radicals.

So scavenging those, those ROS species, reactive oxygen species, free radicals. We can use the term interchangeably for the most part. So, this is why people take it a lot for joint pain. And so, your body uses MSM to create new connective tissue. It’s also been shown in some studies to reduce joint pains.

MSM also functions as a methyl donor for methylation. So it’s an epigenetic piece. So it helps us with our expression of our genes. There’s also some data that shows that MSM functions as an antioxidant. Petri dish studies or laboratory studies show it inhibits NF-KB and the inflammatory cytokines in NF-KB produces. There’s some data that shows it may help athletic performance.

Some data shows it doesn’t. Laboratory studies show that it inhibits many different types of cancer cells, which that’s always positive. And there’s some data that shows that MSM strengthens keratin. So you have improved skin health. So deficiencies are caused by poor [00:52:00] nutrition, especially if you’re eating a lot of processed foods.

MSM is easily destroyed by processing. And if you have a lot of oxidative stress, that’s also going to decrease your MSM. So what are the symptoms or diseases associated with deficiencies? Arthritis, osteoporosis, or bone problems, infections, increased oxidative stress, increased inflammation.

What are the food sources it’s found in green plants? Some algae, fruits, veggies, and milk. What genes do we look at? So you can look at the glutathione genes. We’ve talked about these before. GSTM2, GSTP1, GSTT. You can look at TNF. You can look at some of the genes associated with free radicals, which is GPX that’s for hydrogen peroxide, detoxification, and SOD.

You can also look at cytokine genes.  And then, you can look at two genes involved with collagen. So MMP3 is involved with collagen degradation and CLL1A1, that’s involved with collagen synthesis. And those last two genes you can also look at for vitamin C as well, which is something that we talked about already

Testing, you can look at methionine levels, you can look at glutathione levels. The dose, doses is up to 4.8 grams per day are GRASS, which means generally recognized as safe. The usual dose you’re going to see is between 500 milligrams, and three grams somewhere in that range is the usual dose. And it’s actually very well tolerated. If, if people do have side effects, are usually stomach-related.

Diarrhea, nausea, vomiting, that type of thing. And one of the questions we get asked a lot is, Oh, it has sulfur. So I have a sulfa allergy. I can’t take it. No, that’s a completely different thing. You don’t have a sulfur allergy. You have a sulfa, which is a group on antibiotics, you know, like Bactrim.

So if you have a sulfa allergy, it’s okay to take MSM. It’s not going to have an allergic reaction. All right. So this has probably been the most sciencey podcast that we’ve had, but you know, this is episode 57. So the training wheels are off, people. We’re going to talk about science. I’m going to try to make it in a way that you can understand that’s, that anybody can understand, but we’re going to talk about the specific science names.

And we’re going to talk about the research, and we’re going to talk about data because yes, we talk about mindset and emotion and all of that. But at the heart of why I started this was to get information out there about science, about what is in your best interest and our best interest as a society to keep us healthy.

So that’s it in a nutshell. All right. I think this has been a longer episode. I don’t even know how long I’ve been talking. So if you stuck with me to the end, thank you. Appreciate you guys. We’ve got a lot of content coming. You know, I’m not stopping this podcast anytime soon. I got ideas and episodes. I think I’m sitting on like eight or nine episodes right now, more interview requests coming.

So we’ve got a lot of content coming for you in 2021. I’m super excited about it. I want this to be the best year of your metabolic health. That’s what I want because there’s going to be another COVID-19. There’s going to be something deadlier. And if that happens, and we’re in the current metabolic state we are now, we are screwed.

So let’s make 2021 the year of metabolic health. And I’m here to help. I’m here to support. Y’all have a blessed day.

Thank you for listening to the Strive for Great Health Podcast with your host, Dr. Richard Harris. It’s our mission and goal at the podcast to impact as many lives as possible. To empower individuals, to take control of their health, and live a life full of joy and purpose.

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Thank you again, and God bless.

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