Question: What to do if taking biotin and yet beta-hydroxyisovalerate is elevated. Well in theory that's a marker of biotin deficiency, but you might have a defect in a biotin-dependent enzyme so you can try 5 milligrams, but if you still have high beta hydroxy isovaleric you need to start looking at a metabolic disorder, providing there are symptoms. You might have a 20% decrease in that enzyme activity. This Q&A can also be found as part of a much longer episode, here: https://chrismasterj...
Dec 26, 2019•8 min
Question: For someone who is taking 45 mg of vitamin B6 as P5P but has xanthurenate, kynurenate, and quinolinate high in the urine as markers of vitamin B6 deficiency, and who is a man with high estrogen, what should they do? If you have xanthurenate and kynurenate spilling into your urine, it means that quinolinate would be building up. Quinolinate is usually the last thing to rise in B6 deficiency. Quinolinate is an excitotoxin: it both can cause neurotoxicity like glutamate does and it can al...
Dec 24, 2019•8 min
Question: For someone who is homozygous for the H63D allele of the iron- and hemochromatosis-related HFE gene, if ferritin is low but transferrin saturation is high, should they still donate blood? H63D is one of the genes that predisposes to hemochromatosis, a condition of iron overload. Most clinicians who work in this area do not consider the H63D allele to be a concern because it's less severe. With that said, most people who are progressive on the iron research front do believe it's a conce...
Dec 23, 2019•8 min
Question: Thoughts on lowering my resting heart rate. It's often in the high 80s or low 90s once I'm up for the day. I wish I knew the answer to that. I'd use it for my heart rate. I don't even measure my heart rate because my whole life it's been kind of high. I think breathing and meditation are probably the best things that you can do. I've typically had a white coat syndrome response to getting my blood pressure taken, and because as soon as I feel the pressure, I start to get anxiety and I'...
Dec 20, 2019•3 min
Question: How to manage the zinc-to-copper ratio and what to do if zinc and copper are both low-normal when supplementing with 15 mg of zinc and 1 mg of copper. I don't recommend looking at the zinc-to-copper ratio. Although there are studies correlating health endpoints with the zinc-to-copper ratio, I do not believe that it is a causal factor in disease. I believe the zinc-to-copper ratio is often associated with disease because inflammation raises plasma copper and lowers plasma zinc, based o...
Dec 19, 2019•4 min
Question: What nutrients are needed to break down old, damaged bone and build new, healthy bone? So you are breaking down bone all the time throughout every second of your life. We are always breaking down bone, we are always building up new bone, and if you had any kind of defect in the ability to break down old bone, then you would have problems manifesting elsewhere. Bone breakdown is necessary to maintain your serum calcium levels. You would probably be having severe hypocalcemic attacks if ...
Dec 18, 2019•5 min
Question: What are my thoughts on detoxing heavy metals? My thoughts are first you need to look at how bad the heavy metal is and if it is even at a level that a conventional practitioner would say you have toxicity; for example lead. If this is your situation then I don't feel comfortable advising anyone here, but if your levels are slightly high and you would like to reduce them, then my suggestion would be zinc supplementation on the basis that most heavy metals produce a metallothionein incr...
Dec 17, 2019•2 min
Question: What to do about elevated morning blood glucose in the mid 90s. I think usually your morning glucose is primarily impacted by your hormones and very rarely impacted by what you ate the night before, unless you are severely glucose intolerant. So the overwhelming probability is that if your blood glucose is elevated in the morning and mid-90s is not tremendously high; it is most likely cortisol. If there are other signs of slipping into pre-diabetes then I might come up with another exp...
Dec 16, 2019•4 min
Question: neither my mother nor myself respond to T3 supplementation (cytomel; up to 140 mcg/d). Body temp remains low and reverse T3 stays normal. Could you discuss the factors that might interfere with thermogenesis in response to T3, and offer considerations how to improve this? Having normal levels of reverse T3 tells you that the body isn't deliberately getting rid of the thyroid hormone. High reverse T3 would be a sign that your body just doesn't want the thyroid hormone around. That doesn...
Dec 13, 2019•11 min
Question: "What are your top three non-nutrient factors that prevent someone from entering beta-oxidation or ketogenesis? I mean like sleep disruption." Top three non-nutrient factors? Unless you are taking a drug that prevents lipolysis, then they aren't non-nutrient. The overwhelming things that govern those are carbohydrate and fat intake. You eat more fat, you have more beta-oxidation. You eat less fat, you have less beta-oxidation. You eat less carbohydrate beyond a threshold. ==I don't thi...
Dec 12, 2019•3 min
Question: "Any recommendations for peripheral neuropathy? Testing vitamin B, lion's mane?" First of all, there is no such thing as vitamin B. I'm not trying to be a nitpick, but there's literally almost a dozen B vitamins, with different tests, that do different things. So, I think it's important to establish a habit of never saying vitamin B because, not to be a grammar nitpick, but I just think it's misleading to think about the concept of vitamin B. There are quite a few B vitamin deficiencie...
Dec 11, 2019•2 min
Question: "If cholesterol, LDL-P, and oxidized LDL are high, the sterol panel is normal, and TGs are great, would you suspect clearance of the particles driven by LDL receptor in the liver is the issue, and what would you recommend to boost LDL-R?" Yes, it sounds like you should target LDL-R. The big regulators of LDL-R function are thyroid hormone, and the amount of cholesterol in the liver cell, and anything that brings bile acids into the feces, and that's generally a high-fiber diet; psylliu...
Dec 10, 2019•2 min
Question: "What are your recommendations on magnesium supplements and dosage?" My opinion is that most people shouldn't be supplementing with high doses of magnesium. I think if you're going to supplement with more than 400 milligrams a day, you should be testing your magnesium status, and you should be making decisions on that. I think there's way too many people throwing really high doses of magnesium into their system. The topical stuff makes sense if you're absorbing poorly, but hey, maybe y...
Dec 09, 2019•2 min
Question: "Calcium score, is there a way to treat one's calcium score and get it to zero?" ⇒ No, you don't treat the calcium score. You take the calcium score as indicative of what's going on in atherosclerosis, and you treat that. The goal, I think, is calcium score equals zero. No, that's a bad goal because that's like saying my goal this year is to be a billionaire. Is that going to make me harder and get closer to it? I don't know. You set somewhere what the ideal is, but then you don't thin...
Dec 06, 2019•4 min
Question: "What do you think of alternative testing like hair mineral analysis or SpectraCell?" I'm against SpectraCell on the basis of, it's not validated. I gave more details in a podcast episode "What Makes a Good Marker of Nutritional Status?" and you can find that at chrismasterjohnphd.com/marker. Hair mineral analysis; I like hair mineral analysis when there is nothing better and more validated. For a lot of the trace minerals where we don't have good, validated markers of nutritional stat...
Dec 05, 2019•3 min
Question: How do I address edema? Edema is basically going to be caused by excess salt retention in the body. The reason is that with the exception of very extreme scenarios, your body is going to tightly regulate the sodium concentration of the water in your body, and sodium draws water. Now, that's not to say that the cause is eating salt. And there are cases where eating salt might remove edema. But generally salt retention of total water volume is going to be a big factor. In hypothyroidism ...
Dec 04, 2019•4 min
Question: "How do you determine if you're getting enough protein? I heard Dr. Stephen Phinney say, for those on a keto diet, if ketones are greater than 3 on a regular basis, then it's a sign you're not getting enough protein." First of all, why are you on a ketogenic diet? If your purpose is to get the ketones, why wouldn't you want your ketones higher than 3? The ketogenic diet is, regardless of what people are doing it for, it's best tested in terms of epilepsy, and the classical ketogenic di...
Dec 03, 2019•3 min
Question: What supplements would you recommend for a ketogenic diet? Any concerns with carbs being that low? If someone's on a keto diet and they have 80 grams total carbs, the first question I have is where are the carbs coming from? That's really going to determine whether the person needs supplements. So, on a keto diet in general and protein, too? If you're eating a lot of fat instead of protein, then you're going to need supplements of the things found in protein foods. If your carbs are al...
Dec 02, 2019•4 min
Question: "Why would a male be low in calcium?" You either have something wrong with parathyroid hormone governing your calcium levels, in which case you would want to see a doctor about that, or you have a long-going deficiency of related nutrients. Not enough calcium and not enough vitamin D should not cause low serum calcium — unless the deficiency has been going on for a very long time and is very bad. Then again, I don't know what measurement you're referring to. So, maybe the calcium was a...
Nov 29, 2019•2 min
Question: "I keep waking up in the middle of the night and stay awake for hours. Would low carb make it worse?" It definitely could. Your brain will consume 120 grams of carbohydrate every day, just your brain. There's got to be another 30 grams or so that would be used no matter what obligately by red blood cells, certain cells in the testes, the kidney, and the lens of the eye. Then the rest of your body — if you're eating not a ketogenic diet, the rest of your body is not really trying to bur...
Nov 28, 2019•8 min
Question: "Which brand and dosage of no-carb electrolytes would you take at night to optimize sleep, especially after sauna use?" I would drink a bottle of Gerolsteiner, and I would add to it 100 milligrams of any kind of magnesium: citrate, glycinate, malate, those three are fine. And I would add to it 400 milligrams of potassium citrate, or bicarbonate if it's an empty stomach. You say no-carb. Because of the potassium, I personally would take maybe like a teaspoon of honey with this. I would ...
Nov 27, 2019•1 min
Question: "Vitamin K2, MK-4 and MK-7, might have caused prolonged heart palpitations. Upon stopping it, symptoms mostly resolved after a week or so. Does that mean that the body is better off without it? Might increasing calcium intake mitigate this?" I would say, the calcium is really interesting. I genuinely hadn't thought of that until you mentioned it. Even though I've heard other people ask this question, I haven't had time to look into it, but you raise a good point. So, it is conceivable,...
Nov 26, 2019•4 min
Question, part 1: "Bovine colostrum from New Zealand cows. Yea or nay for those with dairy sensitivities? If nay, what would you recommend instead?" What is your goal? If you have a dairy sensitivity, your problem could be with casein, with the whey proteins, or with something more specific like certain antibodies. It's very complicated. You're less likely to tolerate colostrum if you have a known dairy sensitivity, but you can't really know without testing the colostrum. Question, part 2: "to s...
Nov 25, 2019•9 min
In part 2 of The Carnivore Debate, we cover the philosophy of the carnivore diet and the potential pitfalls of carnivore and keto. The research that Dr. Saladino and I discussed with each other before this debate is listed in the show notes -- there are five pages of references! Here's what we debated: What exactly is a carnivore diet? Is a 90% meat diet a carnivore diet, a carnivore diet you cheat on, a carnivore-ish diet, or just a meat-heavy omnivorous diet? And why definitions absolutely mat...
Nov 24, 2019•2 hr 42 min
Dr. Paul Saladino, Carnivore MD, and I sit down to talk about the carnivore diet. In part 1, we focus on whether you can get all the vitamins and minerals you need on a carnivore diet, and how to best design a carnivore diet to maximize the nutrition you get. We discuss what I consider high-risk nutrients: Vitamin C Folate And what I consider conditional-risk nutrients: Manganese Magnesium Vitamin K Potassium Molybdenum We also chat about some other things: Dioxins in animal foods: a reason...
Nov 23, 2019•2 hr 24 min
Question: If your cholesterol is high, how do you avoid having a large burden of oxidized LDL? First, normalize your cholesterol. And no, I'm not saying that high cholesterol is the cause of heart disease. It's not, but oxidized LDL is, and the number one cause of both high cholesterol and oxidized LDL is not clearing LDL particles from the blood. So, I would never skip over the question of what I can do to get cholesterol in the normal range. I think the boundaries of the normal range are a lit...
Nov 22, 2019•7 min
Question: "I'm curious about the role of the lymphatic system in fat metabolism, specifically in high-fat, low-carb diets. Is there a biochemical explanation for why improving lymphatic circulation would improve fat metabolism?" Well, I wouldn't call it biochemical, I'd call it physiological, but yes. Fat goes from your gut through your lymphatic system to your blood. If your lymphatic circulation is not good, neither is the delivery of your fat to any part of your body. It's as simple as that. ...
Nov 21, 2019•1 min
Question: "Lp(a) and genetic component with relation to cholesterol and risk of cardiovascular disease." First, I'm going to be able to give better answers to questions if they're more specific. But to the question: Everyone seems to think that Lp(a) causes heart disease. I don't believe it. I don't believe it because the function of Lp(a) is to clean up oxidized LDL particles. It might have other roles, but that's one of the primary ones. So, we have two possible explanations for the correlatio...
Nov 20, 2019•2 min
"Can magnesium hydroxide be absorbed via skin?" I don't know. I genuinely don't know. "I've been applying milk of magnesia as a deodorant alternative in spray form for a few years now, and it works well, but I'm concerned about I might be hypermagnesemic, as I'm having low pulse, low blood pressure, and frequent bowel movements." You might be hypermagnesemic. You should measure your magnesium status, for sure. This Q&A can also be found as part of a much longer episode, here: https://chrisma...
Nov 19, 2019•32 sec
Concerns about long-term bicarbonate supplementation and other suggestions for raising pH Helen Donnell says, "Your post on urine pH and exercise tolerance was a game-changer for me, but anytime I miss a dose of bicarb, I'm right back to 5. Any long-term concerns with taking bicarb two to three times a day, any suggestions for other ways to get my system pH up?" Well, I will say in my case that I stopped taking the bicarbonate when I figured out that I had a zinc deficiency. So, for people who d...
Nov 18, 2019•7 min
