Mood

Pillars of Performance: Optimizing Time, Correcting Underperformance, & Habit-Driven Training ft. Matt Dixon

Originally published on HVMN.org (https://hvmn.com/podcast/pillars-of-performance-ft-matt-dixon-episode-99) and authored by Zhill Olonan and Geoffrey Woo on January 8, 2019

Time. It’s our only limited & non-renewable resource.

If you’re an entrepreneur or engineer, it can be tough to set aside time for exercise when there’s always an email to respond to or a feature to write. If you’re an athlete, recovery can often fall by the wayside when your mind is fixed on seeing results.

We speak with Matt Dixon, founder of Purple Patch Fitness, a top endurance performance coaching company based in San Francisco. He is an expert in optimizing the lives of both time-starved athletes and knowledge workers. He was one of the first coaches to prioritize recovery and nutrition for elite athletes during a time when they were an afterthought.

In this episode, you'll discover:

  • The symptoms of underperformance

  • Which biohacks (for example, things like cryotherapy) are legit or overhyped

  • The difference in mindset between training and just working out

Watch Now: https://youtu.be/EVX7I2cVzl8

Transcription

Geoff

Hey Matt, thanks for coming in the office.

Matt D.

Thanks so much for having me. It will be great to be here.

Geoff

There's a lot of ways we can slice into this conversation, given your background as an athlete, as a coach, as someone who's been in the performance space for a long time. To set a context perhaps, why not have you tell your story of how you got into performance, how you got into athletics.

Matt D.

Sure, and it might take an hour. I'll do the very quick and dirty. I'm obviously not from the states. I grew up on the east side of London. In the early '90s, a very lucky recipient of a swimming scholarship over here, so I came across after finding the Olympic trials in '92, not making the team. Came across, and had the chance to swim in university here, obviously the best swimming country in the world. I went through four years, and if you know anything about swimming, it's not an easy sport. Particularly at the time I was doing it, it was all about big volume, big work. The program that I was in was very much that.

Geoff

What strokes were you swimming?

Matt D.

I was one of the lunatics, I was a breaststroker in 400m. I did one of the tougher events. I spent a lot of time in the distance lane accumulating way too many hours, 27 hours a week of swimming was sort of our average. Then we had to do the strength as well, and go to university. But I didn't make the team in '96, and retired from swimming at the ripe old age of 22 or so. But my education at the same time was in exercise physiology. From there, I got into coaching swimming, and was very lucky to coach at a very good age group program. We had a lot of sort of top swimmers. I went through my first journey, everybody sort of continued the regular swimming mindset in many ways. But decided that with my sort of restless curiosity that I seemed to have, I decided to move on and go and get my Master's in clinical physiology down at the University of South Carolina. It was when I was down there that I got into, I found this book "Triathlon, Three Disciplines." I'm a big guy, I weigh almost 200 pounds, so I also had a big engine. I run like a donkey dipped in cement, but I gave myself a shot at it, and I ended up doing very well.

Really from there, I sort of now had this backbone of elite swimming, coaching experience, and a background and a Master's of clinical physiology. I decided to go and try my hand at professional triathlon. I think the reason I give you that background is I'm a wonderful example of how to do a professional triathlon career very, very poorly. With the help of some terrible coaching, over sort of three or four years managed to train myself into the ground. I think it's indicative of what the sport was at the time. Success was just more, more, more, how many hours could you accumulate. Everything like recovery lip service, and recovery strength and nutrition was just lip service.

Geoff

Right.

Matt D.

For me, that was really the fundamentally best thing that could ever happen to me, when I look back now as a coach, because that forced me to reflect and was really the start of my coaching journey in triathlon and performance globally. I just thought, there just be a better way.

Geoff

I think that's been a recurring theme over the last, a lot of the conversations that we've had on the podcast and industry on the field. When do you think that tipping point came where there was that mind shift from, let's put in volume, you're a champion, tough it out, why are you being a softie? Towards, hey, you know, recovery is an active process. Let's be thoughtful about it, let's actually bake it into the routine. It seems that the conversation over the last maybe couple, two or three years have really accelerated. Or is that just a perception change, and it's really been a conversation over the last 10 years?

Matt D.

I'll say I think it started 10 years in a way. I remember when I first started Purple Patch, which we're 11 years in now. One of my first, what's always been important for us is education. I decided that I was really going to be polarizing not for polarizing's sake, but the traffic was going in one direction. As you say, the direction of just toughness. Out of my own experience, I thought, I've got to go about things in a different way. Because I fundamentally believe when I look back that there is a better way, a smarter more pragmatic approach, both at the world class level and at the amateur level. Right at that time, we started with a methodology where we didn't just look at endurance training. We sort of viewed the program as being what we call now for an education sake, the four pillars of performance. We talk about endurance, we talk about nutrition and everything that falls under that bucket. Strength and conditioning, which I think is critical for endurance athletes, and that topic of recovery. I decided to really start to write about recovery as that subject to that point. To answer your question very briefly, when I started talking about recovery, it was really polarizing. I somehow became known as this recovery coach. Some people, it really resonated with, and some people it was not exactly kind when they referred me to that.

I wasn't alone, I wasn't this maverick or pioneer of recovery. But I did see that right at the point 10, 15 years ago, that the sea was changing. It resonated, the message, because we had so many athletes, particularly busy time starved athletes, that were under-performing, both in terms of their effort they were putting into their sport, and their performance return that they would get from it, but also in life. They were walking around fit and fatigued. So it was almost like this message that was like, "Ah, that's what I want." I think that the sport started to evolve at that time across multiple levels. The acceptance that strength and conditioning is a key component, the understanding that nutrition and hydration is a part of the performance puzzle, not just an afterthought. And recovery not being a sign of weakness, but actually being a part of the program to facilitate what is still a tough sport or a tough set of sports. Endurance sports are challenging, but it's really the performance catalyst in many ways.

Geoff

Yeah. What did that initial insight come from? Was it a specific publication coming out of the research literature? Was it just your personal experience, and you coaching people and realizing, hey, if they take a couple days off here and there and do some active recovery, people are actually seeing better? So is this more of a practitioner lens that you've had these insights 10, 11 years ago? Or did it come from some seminal papers that you looked at, you read in the literature?

Matt D.

I did my Master's degree in clinical physiology in the late '90s. I don't even refer to myself as an exercise physiologist anymore, because that is such a young exploding science. I think it was at that time though it was a great backbone of knowledge, and I was reading plenty. I was reading lots of research, but I didn't get the answer or the catalyst of a methodology off of a research paper. I really got it out of an accumulation of my own experiences, and my own experiences being my own personal journey where I was world class in terms of work ethic. I was a performance level down. I was never going to be a world champion. But the one thing I could do was work really hard. I was unfortunate in some ways that my structural body, my muscular skeletal system was robust, so I could drive myself into the ground from a hormonal level, let's call it that. It was that experience, coupled with looking at the performance returns of other athletes that I swam with, other professional triathletes that I viewed and knew, and then my first exploration into coaching. I just looked at it and thought, this just doesn't make sense. So I think it was an accumulation of all of that. And I think one thing that can't be understated is, when you have sort of done it to yourself, but when everything is removed, so you lose all your sponsors, you lose the ability to exercise, I couldn't even, let alone training, I wasn't even exercising for a couple of years.

Geoff

So you really crashed.

Matt D.

It really crashed. When that happens, it forces you to look back and think, okay, let's actually take a real look at the landscape here. I realized I wasn't alone. It wasn't that everyone was in my situation, but I did see too many people in a fog of fatigue.

Geoff

Were there specific biomarkers that you looked at? Was testosterone down? Was cortisol up?

Matt D.

I think I had the testosterone of, I had my choice, either an 85 year old man or a four year old child. I went with the 85 year old man. I had very, very low testosterone, very limited cortisol response. You can imagine my iron levels were in the toilet. Everything across everything. Actually, I think that at the time as well, you're desperate to seek answers. I went to all kinds of doctors. This is past now, a professional triathlon is behind me. I went to all kind of doctors to try and get an answer. But ultimately, the answer was time, rest, healthy eating, and a very pragmatic lens on exercise. Even though I was an athlete that loved to train, I couldn't do that. I had to actually be smarter. But it wasn't something that could be rushed back by some magic supplement.

Geoff

It sounds like you were just stressed almost in a battlefield like condition.

Matt D.

Yeah.

Geoff

We talk to a lot of folks that serve in the military, and folks that have accumulated so much damage and time in the field have similar symptoms, like low T, high cortisol, maybe some sleep issues.

Matt D.

Yep.

Geoff

It's hard to reverse. It's not just like some acute damage, you break a bone, you can heal. It's just like an accumulation of a lot of stress. It sounds like you were very much working your body down and pushing it at such a limit.

Matt D.

And when it goes, it's very hard to define exactly. What is the symptom there? But I think up a level from that as well is the people, and so many of them at that time, that I felt the people that weren't in that stage, it's not that everyone was walking around in a coffin type thing. But it's the people that were just not getting the results relative to their hard work. Their only sort of route that they knew to try and seek more results was to do more work. And of course that becomes-

Geoff

So you're in a negative death spiral.

Matt D.

It's this negative death spiral. You saw so much. At that time in the sort of early years of Purple Patch and my coaching, I was very lucky to actually start to work with a few athletes that almost became my living laboratory. It was accidental, but it was very fortunate. I had a couple of my early professional athletes that happened to be working with real jobs at their time. So I was forced to try and get them to world class within the context of a very busy life, rather than a regular professional athlete that only focuses unapologetic world class performance.

Geoff

On 24/7 to train and rest.

Matt D.

Exactly. So how do we get these athletes to compete against those other athletes with all the time in the world? I had that challenge. Then I had one particular athlete who is very well known in the triathlon space, Chris Lieto, who was already world class. He had been on a journey, he had already won multiple IRONMANs and multiple Half IRONMAN races. His big quest was the Hawaii IRONMAN. This is going back to 2008, I think, when I started working with Chris. I looked at him, and looked at the landscape of him. While he was an infinitely better athlete than I was every going to be, I saw symptoms of under-performance relative to the work he was putting in. He was working out or training 30 hours a week. When I looked at him, there was no strength, recovery was an afterthought. I felt like he was under-fueled relative to the training.

Geoff

To his exertion, yeah.

Matt D.

All credit to Chris, he had been down this journey for many years. For his last two to three years, all he wanted to do was to perform great at the Hawaii IRONMAN, which is the world championship, and the toughest IRONMAN there is, Kona.

Geoff

The Kona, yeah.

Matt D.

He took a massive risk with me. I was pretty much a no name coach. I asked him to do a few things, which was the first to cut his total training volume by a third, to really take recovery seriously both in terms of sleep, which has become a trendy topic nowadays. But really maximizing sleep environment and the hours of sleep to try and improve the quality. He was eating around 1,500 calories a day more than he was in his previous years, and we started doing some strength and conditioning. He was moving into his late 30's, and I felt like there had to be a different way. That year was really a magical year, his first year, because Chris had always been upturned by muscular skeletal injury. That year, we managed to create the magic word in performance, consistency. He showed up to Hawaii that year, and he was already talking about next year. I could tell that he was as fit as he needed to be, and he had a big platform of base. But he was excited, and that really told me he was fresh. He missed winning by two minutes, but he got second at the Hawaii IRONMAN, a huge breakthrough performance. That was a wonderful opportunity for me and athletes like him to start testing and proving.

Geoff

Yeah, so it sounds like a lot of your intuition here is qualitative in assessing the athlete. I know within the last probably three, five years, it is much more quantitative biomarker trackers. This is a heart rate variability ring, so it's not just a piece of jewelry.

Matt D.

Yeah.

Geoff

Is that something that you look at now as these technologies are evolving, or is it a combination of you as a feel, the human side of engaging with your athletes seeing input output not matching? Or are you starting to use some of these quantitative tools?

Matt D.

It's the marriage of the two that creates the optimal scenario. One of the challenges for performance driven people globally is that there is a natural inclination to become what I call paralysis of analysis, getting driven by the information and the metrics. The truth is that the information that we receive, whether it's heart rate variability, sleep tracking, power meters on bicycles, biomarkers information, for me it is valuable information if it is actionable and it starts a conversation. But the human body, we're not building a bridge, we're building a human. It's highly variable, and ultimately has to withstand all sources of stress. We really try and sort of empower the athlete to be a thinker, and we use the information. We do use a lot of that information, we like to track sleep, we like to track mood, and obviously that's qualitative and quantitative. We capture data on all sessions that the athlete's doing, and we use that as information to help us paint the picture of which then it's a human decision that has to occur from that. A part of my job as a coach, or our team's job as a coach, is to help educate the athlete and then empower the athlete to ultimately become self-sustaining, to actually be able to make smart decisions. I think it's the same thing with the emerging trend that's happening now, that will happen in the coming future, is AI and machine learning, which is really interesting. If you take data science and you look at best decisions, but all of the companies that are going to come on the scene for that have to realize I believe that I don't think that will ever be a replacement for the human intuition and gut that has to become along as a part of the equation.

Geoff

Yeah, and I think that's been consistent with a lot of my conversations with coaches and athletes, in the sense that, I could I just get your thoughts here, sometimes coaches will analyze the information but not expose the raw data to the athlete. You don't want to confuse them with, you had a low heart rate variability rating today. I don't want to prime you that you're not going to have as good of a session today.

Matt D.

Yeah.

Geoff

Do you play with that, or are you pretty transparent, like, "Hey, here's the raw information. Let's not over-interpret the data here." How do you balance the priming the athlete for a really good day or bad day with like a placebo and nocebo effect, versus how do you actually be quantitative here?

Matt D.

I fall onto the latter more, sharing. But before then, I think there has to be a discussion and an educational process around how we are using the data. Even from a prescription standpoint, I'll come back to the question, but from a prescription, athletes tend to be very metric driven when it comes to what intensity should I ride my bike at, for example, or what should I run at. Even when there are prescription, we have a range of let's say power on the bike or pace on the run that we expect an athlete to be. But we prescribe it in terms of what this should feel like. What's the intention of the workout, what's the intention of the intervals within the workout, and what should that feel like? That could be in terms of perceived effort and the sensations that the athletes feel. Then on the other side of it is the marriage of, well these are the outputs that we expect, somewhere in this range. But that's a very different mindset than, "Here you go, Johnny, ride at this power." Because that's theoretically specificity, but that ignores what the body is providing us for that day. To answer your question, when it comes to some of the data that you might be looking at, it's data to help us make a decision or to frame where it is. So this is where we're at, let's see what the body can give us.

Matt D.

This is basically the decision making tree that the athlete can say, "I want to be open to a good performance, but if I was a little suppressed this morning and I get a good performance, then it really might be time for an extra day or two off that's a little bit lighter." Or, "Okay, this is the data, and my system's a little suppressed." Then they don't feel guilty if they give it a shot, go through a warmup, go through a pre main set, and it's just not there. There is reality. So I tend to prefer to share, but share within context. Ultimately, I'm dealing with highly motivated adults. I think that truth and education empowerment, and trusting that you can bring the athlete to look at things through your lens is long-term the more effective way to go about it.

Geoff

I think one assumes that, okay, if we're rational adults here trying to be the best possible version of ourselves, then more ground truth is better. It's interesting. In terms of you assessing how recovered someone is, or manipulating your protocol for them, do you take perceived exertion as the highest order a bit, or do you see some of these quantitative biomarkers, like HRV or amount of sleep. Or is that kind of a dumb question, like you still take both?

Matt D.

Both, but I think that the golden question is for the coach to ask the athlete, and for the athlete to ask themselves is, how am I feeling? One of the things that doesn't happen in busy lives is a pause. When you first wake up in the morning, you can't overstate the value of actually coming out of the weeds a little bit. Any time that you can have a conversation with yourself or a conversation with the athlete to say, come out and that you say, "Hang on, how am I feeling here? What am I looking to do," is really positive. Ultimately, that's the decision. Then what you have is the other supporting information to help make that decision. I'm not so sure, and there's the data, okay, that's clear. It's objective. But what I wouldn't do is say, "Oh, look at that HRV, for example, we shouldn't train today, period. I think that's just being shackled by the information.

Geoff

Yeah. I think when people think, okay, recovery, that seems intellectually appropriate, but what do I even do? When you tell your athletes to recover, is it like, hey, go sit down and watch Netflix? Is that, do some stretching? Is that, do some yoga? When you're actually recommending, prescribing recovery, what is the most optimal way to recover?

Matt D.

I'm a big fan of trying to boil complex to simple, so I make this as simple as I can when I talk about this. But I see recovery having really three main buckets. The first is sport specific. The second big area is lifestyle in many ways. And the third is what I call modalities. We'll just go through all three very quickly. Sport specific is planned recovery within the sport. For some people, for emotional reasons that means doing nothing from a training standpoint. Sometimes people just need that break, they need to release it from the calendar and not move their body. But typically, it tends to be, I'm more of a fan of active recovery. Very low stuff, maybe with a little bit of neurological stimulation, a little bit of very, very short fast stuff just to keep the dialogue between brain and muscle going.

Geoff

Just like slamming like a medicine ball or something?

Matt D.

Yeah, something very short, or a very quick pickup if they're running, and going up to a very fast speed type stuff. But nothing where they're looking to get fit or stronger or more powerful. Actually facilitate the bridge between hard work. And then of course within sport specific, you have things like how you're managing a season, how you're managing a block of work, where you have programmed multiple easy days in a row, or complete season breaks. But there's a whole category of that, and globally the need to know for the show is keep moving, but keep moving light, and nothing that's accumulating fatigue. The second area then is what I would call lifestyle. That is obviously around sleep, nutrition, fueling, which is a critical habit driven component in my mind of consuming calories after workouts, particularly for heavily training athletes. It's not just about restoring the calories that you've done in the workout. It's about sustaining energy, stunting cortisol, the stress response post-workout with protein.

Geoff

Yeah, rebuilding muscle protein.

Matt D.

And then rebuilding muscle protein.

Geoff

Rebuilding lycogene, yeah.

Matt D.

And obviously, preparing for upcoming sessions. A good platform of eating is obviously a part of recovery, as is post-workout fueling, as is daily hydration. In every training session you are doing, you are finishing suitably dehydrated, you'll never retain full hydration status. So what are you doing to facilitate recovery? Then the final big component is modalities. I might say that's everything that you have to pay for. Whether it's foam rollers, or body work, or stem machines, or compression socks, et cetera. They're all great, they're all nice, but they're just the little sprinkles on top of the cake. If you fundamentally don't get the program right, and you fundamentally don't have very simple but actionable supporting habits, the modalities are useless. That is way down on the priority list for me. Unfortunately, in performance driven people, the important stuff is less sexy. This stuff is more sexy, it's gadgets and you can pay for it. That becomes everyone's focus. Ultimately, if they have a smart and appropriate training program that integrates into their busy life, and it's supported with some very simple habits, they're going to be able to recover better and ultimately perform better. The other stuff, nice to have if you've got time and money.

Geoff

Just to be more pointed here, what do you think is in terms of modalities most overrated, most bullshitty, versus what you think is one of the best modalities?

Matt D.

I'm generally not a massive fan of cold water immersion.

Geoff

Cryotherapy story.

Matt D.

Cryotherapy stuff is mildly interesting, but not that interesting to me. I actually prefer heat. That's less of a physiologist's lens, and more of a coach's lens. I don't like interrupting the post-training adaptation process too much. I think we're at this point where there's this really interesting collision of research.

Geoff

Yes, so something that I've been looking into as well, I'd love to dive into this, the cold versus hot.

Matt D.

Cold versus hot. We're at this point where I think that any sensible coach would say, "I don't know right now." I think it's different tools for different jobs. If there's an isolated area where it tends to be that, yeah, an isolated area that's maybe a specific injury, then very cold treatment might be helpful. But for a heavily training athlete, consistently I see that when they come out of the cold immersion, whether it's ice bath or cryotherapy, it tends to make them feel less good when they go into their next heavy session. Versus heat, there's a great opportunity that if you're sitting in a steam room or you're sitting in a hot tub and you're able to do some mobility type stuff in there without looking too pornographic, it tends to make people feel good. It's relaxing, it's enjoyable. When they come out of it and they come back into their heavy training, joints are mobile or joints are loose. I'm working with heavily training sort of endurance athletes, but that tends to be the trend that I see. So I slide towards that.

Geoff

Interesting. I think from the physiology perspective, I think you touched upon a topic that I've been looking at, which is that for cold therapy, you halt, you insult the post-exercise adaptation.

Matt D.

Exactly.

Geoff

Where in a steam room or in heat, you actually sustain and accentuate that stress response. Some of the data coming out with hot saunas and steam rooms, you actually elevate growth hormone, you accelerate the heat shock protein recovery process.

Matt D.

Yep.

Geoff

Whereas, with the cold ice baths, you halt that insult, and then you halt the adaptation period, which might reduce inflammation. So you might not be as sore potentially, but you're not getting the benefits of being exercised.

Matt D.

But why are you training?

Geoff

Right, exactly. You want to get the effect of your exercise.

Matt D.

If the training is smart, and then you go, and the other thing that heat does as well for an endurance athlete is, by doing post-workout heat immersion, it actually helps with some of the physiological stimulation to perform in a hot environment. It also boosts your blood volume. So if you under-hydrate immediately following and put yourself in a little bit of a stressful situation from that standpoint, and then immerse yourself in heat, you're going to get heat adaptation, which is a nice positive. Then of course you hydrate over the rest of the day.

Geoff

Yeah. So I think that's spot on. I think that's a very nuanced argument. I think that's at the really cutting edge, and I think right now people are, "Oh, ice bath and then sauna." I think it's very confused.

Matt D.

Yeah, it is.

Geoff

I think people out there, the general lay, even coaches, I think they're just confused about that, if you talk to professional coaches. I'm glad that we're touching upon something I think at the cutting edge that will be more fully understood. But I think to be perhaps fair or steel man the cold argument, I think there's probably some application for, okay, you have an injury, you have another basketball game or a soccer match the next immediate day. Maybe you don't want to do the adaption training now. You want to just get your body in the place where you can go again tomorrow. Then I can see it's a compelling story. Does that seem fair?

Matt D.

A hundred percent. I was going to say, it's a sort of performance readiness tool. So I can imagine a MBA player on the road, and they've got to play, and come back tomorrow. We're not looking for adaptations there, or we, I have nothing to do with the MBA. But we're not looking for adaptations there. We're looking to be able to perform the next day on the court. That makes perfect sense. I'm not saying, hey, cryotherapy chamber, it's useless. It's not, it's really interesting stuff. But for people that are just looking to train and create optimal adaptations and carry it throughout the rest of the day with proper energy, it becomes more interesting with heat.

Geoff

Yeah, I think I'm on the same page there, where if I'm not trying to compete in a specific event, then I'm always using heat. I'm not really trying to blunt my adaptation.

Matt D.

Yeah.

Geoff

What are some good modalities? I guess we like heat, cold we're a little bit more skeptical, or we need to apply them in the right indication in the use case. Foam rolling, stretching-

Matt D.

Foam rolling and body work.

Geoff

What do you think of that? You think, what the fascia tissue, is that something that you think is beneficial, or is that just like a nice massage and it feels good? Maybe that's a benefit of itself.

Matt D.

I think so much of it comes down to the practitioner, and understanding. But time and again, the body work if done really, really well, is a great supplement. Going to a nice massage and having the legs flushed, it feels nice, so it might be good for the soul. But I don't think it's actually really being beneficial. The one thing I will say, our general approach for body work is to try and align the body work on a day of heavier training, because there's so much trauma happening. On the days that we are actually really looking for recovery, we like to leave the body alone. What happens with all sorts of body work is there is a little bit of trauma that occurs.

Geoff

People are really digging into the tissue, yeah.

Matt D.

Yeah, they're really digging in. So we don't want to do that on a day that we're looking for recovery. We want to have the body work done at the end of a hard training day. Then the next day, let the body regress to the mean. The body is wonderful at regressing to the mean, and that's what we want it to do. So let it have a time of healing. That really relates to injuries as well. Hot spots that people have, little niggles and pains, and they get foam rollers or trigger point. They just go hammer and tongs at it. They isolate the spot, which is typically the symptom not the cause. My IT band hurts, so I'm just going to absolutely hammer it. They end up doing so much trauma that the body can't respond.

Geoff

It just tightens up, yeah.

Matt D.

It just tightens up. They end up actually magnifying the injury. So I think that whole area is good, but it's really dependent on the practitioner. Some of the foam roller stuff is great. On stretching, I'm not a globally massive fan of static stretching. The old school classic hamstring stretch, or put your leg up on the table and just holding it in position. Stand and lean against the wall and lengthening the calf, and just leaving it there. We do a lot of work on what we call dynamic stretching, a lot of mobility work. Even post-workout, particular to me as sort of focusing generally more on endurance sports, most of the work that we're doing, we're not putting the athletes into massive acidosis. Even components like a cool down is in a time staff life. Warmup is critical, cool down less critical. We don't spend a long time cooling down. We don't do static stretching afterwards. We tend to do more range of motion and mobility exercises.

Geoff

Interesting. Yeah, I think that's something that I've personally just found much more interesting and it seemed a lot more effective. Doing more dynamic movement and stretches, rather than just trying to touch my toes.

Matt D.

Trying to touch your toes. It's funny, because I remember a couple of years ago watching the professional soccer players in the premiership, and they're all out on the field doing static stretching. But there's really interesting research around static stretching-

Geoff

Before games.

Matt D.

Before games leading to under-performance in sprinters. And there they all are, some of the best soccer players in the world, doing static stretching.

Geoff

You've got to tell their physiologist, hey-

Matt D.

Tell their physiologist, you've got to catch up. I think they are, but certainly for our athletes we don't do any static stretching before, unless there's some form of medical reason, so under the guidance of a specialist.

Geoff

How about more speculative modalities? Have you heard of infrared saunas? Is that on the edge of your knowledge? What else are some of the crazier modalities that you've seen?

Matt D.

We're building a center in San Francisco, and I think we're going to put an infrared sauna in there. I find it really interesting.

Geoff

Okay, you think it's reasonable, okay.

Matt D.

I think it's reasonable, but I haven't made the purchase yet.

Geoff

As you point out. Let's more on to nutrition. I think that's interesting coverage on the modality side. Obviously with our audience, a lot of interest around fasting, ketone diet, low carb diet. We had on a number of carnivores on the podcast recently, which were interesting conversations. We had on Mikhaila Peterson, who is the daughter of Jordan Peterson, who is a famous Canadian psychologist. We had some of the moderators and thought leaders in the carnivore space, I think a lot of interest in diet. I think it's always something that everyone cares about, because that's what we kind of make decisions on every single day. I would say that in the endurance space, there's perhaps an upswing in interest in low carb, but I think that needs to be thought of in a very careful way. Obviously, when we're doing IRONMAN triathlons, these are very intensive, so you want to be fueling properly.

Matt D.

Exactly.

Geoff

Just doing a fasted marathon is probably not the smartest thing to do if you want to actually win. What are your thoughts on diet and nutrition? Maybe you can unpack some of the considerations here.

Matt D.

The first thing that I would say is I'm not a massive fan of evangelism across any subject. As a coach, I try and surround myself with smart people, and I remain curious and explore. You guys, it became maybe a great case in point, where it's this really interesting exciting research that needs to be reviewed and looked at. But I don't think any of us can say, "Oh, we have the answer to nutrition globally." I tend to start at a place of habit driven. What are the key components. I don't think that you can have a discussion around nutrition without being in context of what the person or the athlete is trying to do.

Geoff

A hundred percent.

Matt D.

If you take a type 2 diabetic that is relatively inactive and has been living on a diet of processed food and sugar. That is a very different methodology that you might use of intervention to try and help them thrive and repeal their type 2 diabetes, than a fit healthy IRONMAN amateur triathlete that's trying to perform at their best level in IRONMAN. When we sort of mix the two and say, "This is the solution for all," I think there's going to be a collapse somewhere. From a performance driven population, I start with things that I think are, what are we looking to achieve? If we're looking to train consistently, achieve adaptations, and thrive in the other compartments of our life. So our work performance with cognitive function, et cetera, our health, and bring the best version out that we can for our family. For most performance driven people, that's what we're looking to achieve. For someone that's training or exercising in the morning, for me that means that we tend to front-load carbohydrates, and we tend to have carbohydrates following the workout when the gateways are there. But not carbohydrates alone, it has to be supported with plenty of protein and some fat. If they do that well, so I'm not a massive fan of fasting post-workout. I guess that's the message out of that.

But if they do that well, the last thing that someone that's sitting in the workplace wants to be doing is consuming a whole bunch of starchy carbohydrate and a whole bunch of sugar. That's going to start to create fatigue. Instead, we tend to anchor around lots of proteins, lots of vegetables, lots of fruits actually, and just a general well-rounded diet. To answer your question, maybe you just sort of probed me more into specific areas.

Geoff

Yeah, I think I just opened a giant can of worms here. I want to-

Matt D.

Yeah, exactly. I tend to be more habit driven than anything else. But if we think about our professional athletes that we work with, our very elite athletes, we have several of our athletes that are what we might call fat adaptive, if you want to think about that. None of them are fasting, eliminate carbohydrates from their life. They embrace fat utilization, they embrace proteins, they have to eat a lot to support their training. Actually racing, the predominant fuel source still needs to come from carbohydrates.

Geoff

Right, so I think that because we talk a lot about ketone esters, fasting, ketogenic diets, people think that we advocate that, or I advocate it, or I am on a ketogenic diet every single day of my life. I'm not. I think that you touch upon it nicely where you have to look at the indication to optimize your nutrition and your protocols around that. So again, I think you're absolutely on the dot. If you're a type 2 diabetic, you probably want to reduce as much carbohydrate intake as possible.

Matt D.

Yeah.

Geoff

But if you're trying to be at the highest level of performance, clearly there's a role for sugar for the anerobic push at the end of a race or during a race.

Matt D.

Yep.

Geoff

I wanted to touch upon what you mentioned, which is keto adaptation or fat adaptation. I think one interesting active debate in sports nutrition is, can one be as keto adapted as possible and have as peak performance as someone that's being filled with carbohydrate? I think some of the work out of Volek and Phinney are advocating, okay, keto adapt for six, nine months, and you don't need carbohydrate. I'm personally a little bit skeptical about that, given just some subjective in practice experience, and just looking at the broader literature of how useful a punch of sugar can be for performance. That sounds like a lot even for your keto adapted athletes, you still recommend carbohydrate during the races or before the races.

Matt D.

Let's think about the other side, I think, for the equation. When I hear stuff like that, the chances of that being function across and long-term, it would be like suddenly finding out that gravity exists. It's too revolutionary for me. Not to be too dismissive, I think it's really interesting. I think about it like this, and I'll talk in terms of triathlon globally or endurance training. If you're going out on a low intensity long endurance bike ride or run, you don't need to be packing your gills with Gatorade and sugar, and everything that was pushed and marketed and promoted to us for the last 25 years. That's a mistake. You can eat, in my mind and just my opinion, but you can eat real food that is not carbohydrate heavy, because you can train your body to actually become more fat adaptive, if you want to call it that. You shouldn't be overly dependent on high sugar in those environments. But if you're doing a very short, very high intensity interval workout, then on the flip side there is a case to be told that sugar is your friend in that environment. If you are doing an Olympic distance triathlon that is two hours of very high intensity, or running a marathon at the elite level-

Geoff

You're going aerobic-

Matt D.

You're going aerobic, and there may be, and it's really interesting, of is supplemental exogenous ketones, it's really interesting to me. But I don't know enough about it yet. So rather than just for me jumping on and saying, this is great, it's the next big thing. Let's stand back, explore, investigate, research, and hopefully lean on guys like you to-

Geoff

Have you experimented with ketones?

Matt D.

No, not at all.

Geoff

We've got to get you to experiment a little bit.

Matt D.

Yeah, will do. But the case comes back, it's pragmatism. I think it's where I started with evangelism, where there's this, in the same way as what do we learn from history when we were told that fat was bad? We saw what happened there. On the flip side-

Geoff

Right, you brought up-

Matt D.

Yeah, if it's this polarized, carbohydrate is bad, there has still been no diet that I'm aware of in history where a complete elimination of one of the three macro nutrients has ever been successful long-term. I still haven't seen one that's been successful.

Geoff

Yeah, well I think that's the N=1 that all the carnivores are testing out live right now.

Matt D.

Yes, exactly. Well, let them be the living experiment.

Geoff

We'll see, exactly.

Matt D.

We'll see, and it's investigating. I'm not being by any stretch dismissive of it. I think it's very interesting. But I also don't claim to be an expert. It's a part of my field, that I'm on to explore and understand and talk to specialists about to build than a pragmatic-

Geoff

Yeah, I just want to get your thoughts there. I think one thing that we've seen getting more and more traction is this notion of cyclical diets. We touched upon the notion of keto adaptation or fat adaptation, or fasted workouts. The notion there is that you want to stress the metabolism, so you up regulate enzymes and proteins that relate to when you're at later stages of the race where you are more fuel depleted. Then you also do training when you're fully fueled to give your body full adaptation across all types of fuels. Is that something that you guys play around with, or do you stay pretty consistent? That seems to be one of the things that you folks, on consistency we have a fairly stable diet, and we just put people on their habit and let them go.

Matt D.

There's a reason for that, where if we think about in terms of things that are mutually exclusive. If you only think about it at the enzyme level, you say, this happens in the lab, and this will happen, so this is what we should play with. I tend to come up a level and try and look at the whole landscape. For the vast majority of people that we're working with, if we remove the world class athletes that have all the time in the world to plan their meals, to sleep, to take naps, which is a huge part of recovery by the way. Everything that we would love in an optimal situation, there's more opportunity to play test and align. But most people are trying to integrate performance health fitness into a really big life. What's the knock on effect of someone if they fast, they get up, they go and train, they don't replenish calories afterwards, and they go into their work day.

Geoff

And they feel terrible.

Matt D.

They're going to feel terrible all day, so their cognitive function will lower, their decision making will lower, their ability to focus will drop. And ultimately, they're going to have massive motivational urges for foods that they don't want to eat.

Geoff

Right.

Matt D.

They have them in the afternoon, and they end up buckling because it's human nature. It's a part of their life, it isn't their life. So they end up eating pizza or ice cream, whatever it might be, and then they crash in the afternoon. It becomes incredibly stressful. When we are training within the context of a time starved life, we are placing a specific stress into a whole big reservoir of stress. The challenge of getting enough sleep, travel stress for work, your commitments at work and obviously with your family. It comes back again, it's really interesting, but the solution has to be habit driven and repeatable. Similar to the mindset of modalities, in order for anything to be effective, it has to be simple to execute and repeatable. They might go through phases or opportunities where you can look at the workout, look at the day and say, this is a time that maybe you're doing some careful reduction of calories or fasting. But it has to be done very strategically within context of the big picture. I think that's where people miss it, because in thinking that they're doing the right thing in one particular area, they fail to see the big picture.

Geoff

Right. I think it's an important caveat. I think one thing that is kind of my pet hypothesis here is that cyclical training blocks is fairly standard practice now in top level sports physiology training. Right?

Matt D.

Yeah.

Geoff

Like you'll ramp up a load, and then taper down before the event. I can imagine a world where, again, the caveat is that this is a professional with an infinite amount of time and resources to have custom diets. You have cyclical nutrition blocks that match your training volume that also peak for the competition. That could be an interesting interplay where the training volume is now sort of cyclical and customized, can you imagine that one of the other interventions, nutrition, is also cyclical and personalized for an outcome? It's funny you say it, because I was listening to that question. I think in some ways I'm a dummy. We kind of do that in a way, and I'll explain. You're dead right, and let me preface this first. It doesn't just have to be an athlete that needs to train. I think everyone needs to train, because exercise is random, training is structured and progressive. So even if you want to be the healthiest human being possible, I think most people that exercise want to improve.

Matt D.

The only way to do that is to have some structure and progression. From an athletic sense, that means that we're sending athletes through phases of training. The phase of training that we tend to be in right now is what we call post-season, which is the lowest physical stress. It's really a phase of preparation, so we're doing a lot of technical development and a lot of readiness of in the upcoming months being able to absorb and handle very heavy training loads. So at this time of the year, we really encourage athletes, this is a time of the year that there shouldn't be a workout where you are consuming high sugar, because the training load is not there. Versus if we go into right in the heart of race season and we're doing race simulations, we want the athlete to be adhering to the same timing amount and type of calories that they're going to be absorbing in the race specific training sessions. Not every training session, but in the ones that most mimic what they're going to do on race day. In many ways, it sort of is periodized, if you want to call it that. It is phase specific. So I said, hey, it has to be simple and actionable. We still do go to that level I would say.

Geoff

Yeah. I think the marketing side is interesting where, it makes sense again I think where you're speaking of like Gatorade, GU shots, it makes sense when you're in practice. But if you're a casual athlete who maybe goes to the gym for like 30 minutes on a treadmill or an elliptical machine, do you need to be downing a sugar bomb? Probably not.

Matt D.

The rule of thumb that we say to our athletes globally is, if your workout is 75 minutes or less, you just don't need any calories. Maybe if it's really high intensity, you might have something there just in case. You've got something wrong, and you're having a sugar crash or whatever. But for the most time, 75 minutes or less there's just no need. And you can drink to thirst for the most part, because you're not going to have any of that negative byproducts. But it is what you do afterwards that becomes really important. For a workout that's lasting multiple hours and is training and is interval driven, well then there's a case of like, okay, what's the strategy that I need to employ there to make sure you're maximizing performance, and you're not creating too much of a deficit that's going to have a lag into the rest of your day?

Geoff

Yeah. I think a lot of people focus on pre-fuels, but it sounds like especially on the recovery side, I agree with you. Fasting after a workout, unless there's some specific reason why you want to do that, is very stressful for your body.

Matt D.

Yeah.

Geoff

That 30 minute or hour period when your muscles are open to absorbing nutrition is a pretty critical time period.

Matt D.

Mm-hmm (affirmative).

Geoff

I don't think that's controversial. Anything interesting there, would you say a standard carbohydrate protein shake is kind of standard practice? Any specific nuances? I think you can get kind of nerdy with like, oh, do people care about vegan protein versus whey protein, versus should you just eat a steak? There's been emerging data around how ketone esters paired with carbohydrate and protein accelerates someone to glycogen and protein resynthesis enzymes. Anything interesting in playing around there for post-exercise nutrition?

Matt D.

A general rule of thumb, again, for the time starved busy person. It has to be simple, able to be executed, and easily absorbed. If you've got a very heavy training session, and then we tend to go carbohydrate, protein, easily absorbed. A protein source is a shake. But for the vast majority of people, you sort of point before the person going to the gym, the person doing strength, eat real food. It's a great opportunity. We have too much processed food in our life anyway, so if you get the opportunity to eat real food, it's great. We tend to lean more post-workout fueling of, that's a good time to actually have some of your carbohydrates that you're going to have in the rest of your day. Protein is always there, and a part of that is we know that protein is a natural suppressor of cortisol, which is obviously suitably elevated to help you perform. But you don't want to carry that into the rest of the day. We tend to be a little less on things like antioxidants, which tend to disrupt-

Geoff

Once again, blunt adaptations.

Matt D.

Blunt adaptation. So we tend to try and avoid people having lots of berries in their shakes, et cetera.

Geoff

Interesting.

Matt D.

But it doesn't mean antioxidants are bad. They're great in the rest of the day, they're full of vitamins and minerals, et cetera. It's the timing of them. Simple actionable stuff. I have never tested ketones as being a part of the process. All I've done so far is read Brianna's paper.

Geoff

Okay, yeah, we've got to get some actual data from you there.

Matt D.

Yeah.

Geoff

I think that resonates true with me personally. I like doing fasted workouts and fueling afterwards, which I think is a reasonable response in terms of draining out remaining lycogene, and then post-recovery you have full repletion of all those nutrients. That's more for longevity and metabolic stress reasons than for winning.

Matt D.

Yeah, winning anything. I'm not trying to win anything either. The other thing as well is I tend to, when I work out I work out in the morning. I just don't do well with food in my stomach. So you wake up naturally fasted. You go and exercise or you go and train. Then it's a great time to fuel the rest of your day and replenish. Even from a life structure, I think it's a really good thing in performance during. The only component, there is some research for female athletes and some of the negative hormonal byproducts of not taking in some calories, particularly protein, first thing in the morning.

Geoff

Interesting, yeah. There's definitely some variation in terms of how much body fat per gender that you want to maintain, absolutely.

Matt D.

Yeah, exactly.

Geoff

I know that a lot of our audience are high performance athletes, but people like myself, I'm not a professional athlete. I don't have any dreams or delusions of winning Kona. I consider myself more of a creative or intellectual worker. Do some of your training protocols, nutrition protocols, modalities apply to that world? How do we optimize our training, our routines to be move productive members of modern society?

Matt D.

I sort of have a Jekyll and Hyde life as a coach, and really our Purple Patch coaches have to live the same as well. On one side, I have my squad of pro athletes, and unapologetically, their quest is world class performance. But the majority of people that I work with outside of that people are very busy executives and CEOs that are looking to do just that. They understand the value of integrating fitness into their life, let's call it that. But how do they do that where it can have a net positive effect on their health and their cognitive ability, decision making performance, let's call it, in the workplace. Then also, still be able to return and be really present for their family. I think that's a utopian but achievable ideal. The lens that I take on that is, how do we draw the lessons from the methodology that we use for these elite athletes that are looking for fantastic performance, physiological fitness performance? How do we draw the lessons from that and translate and apply?

You don't just replicate, but translate and apply to someone that's just looking to thrive in life? Some of the key components if you imagine sort of, we always talk about in terms of an intersection of a Venn diagram, where in the busy working professional that's going to thrive, they have to have three main components. The first is their habits around what they're doing in the workplace. There's all sorts of really interesting emerging research of how to be most effective in the workplace. It used to be not so many years ago, probably aligned actually with the bubbling up of the interest in recovery, where effectiveness in the workplace was measured by the number of hours that you're actually doing, and toughness. And what we realized by working with so many executives and CEOs is toughness is not a differentiator. That's just a prerequisite.

Geoff

Everyone's tough.

Matt D.

Life is not easy, everyone's tough. But really being able to work in effective, both in terms of environment, understanding that you're working in sprints, taking breaks. Looking at things like hydration and realizing your pee breaks are performance enhancers. They're not distracting your effectiveness at the desk. Moving around, we obviously know things like standing desks and things like that. The key to actually consistently move around. Your Apple watch will tell you to get up every hour, for example. So there's a big bucket of what you do there. There's then I would say training. I mentioned this before. Just because you exercise, it doesn't mean you're healthier. Just because you get up every morning and go to the gym, it doesn't mean that that's actually creating positive adaptations or helping you thrive in the workplace. I think every human being needs to train. That doesn't mean they have to be trying to search and win Hawaii. It doesn't mean that they have to sign up for an event.

Matt D.

I think a goal of some nature makes it easier to adhere to. But their exercise that they're doing, the same as anything in life, will be more effective if it's structured and progressive. You draw from athletes not to become an athlete, but to actually get the most out of your sessions. If you are exercising four or five times a week, what are the sessions that are designed to move the performance needle and be more challenging? What are the sessions that are there to be more therapeutic emotionally and physiologically, and help support those key sessions? You don't need to be obsessive about it. You don't have to be evangelical about your fitness, but structure and progressive is key. I have never seen someone over the long term be highly effective in that area without having real structure behind it. One of the limiters of general group fitness, you get fitter and quick results over six weeks, and then what's the next thing, because everyone plateaus.

Geoff

You plateau, right.

Matt D.

Longevity and consistency can only happen if you have periods of progressively load, and then you have breaks to rejuvenate and step back. Not dormant, but breaks in the stress.

Geoff

So you're saying that, okay, you probably going to the gym 30 minutes or an hour a day is at least better than sitting on your butt.

Matt D.

It is.

Geoff

Right, that should be obvious. But you oftentimes see people plateau, so having some sort of progression and cycle or periodization around challenging yourself is maybe a little bit more incremental work but pays much more dividends, is your argument.

Matt D.

There's also loads of other benefits from it as well. One of the great components of training, if you want to call it that, it's almost in a therapeutic from a mental standpoint. Almost carries what meditation should do as well, and is a great performance inclusion. We didn't talk about it, but I think meditation is key. If you have structure around your workout those 30 minutes, it forces you to be present. If you are present or focused, then it removes you from the stresses or family or work or commitments. Outside of the dishwasher effect of your brain that's going to improve cognitive function, decision making, long and short-term memory and focus, it also removes a step away from you. That's key as well. So absolutely to be effective, you have to be structured. Every day should not be the same. Otherwise, the body won't adapt, because it gets used to the adaptations. But then the third bucket is rejuvenation, not recovery but rejuvenation.

Matt D.

That includes what we talked about with a backbone of healthy eating habits and fueling habits, positive sleep in terms of quality and quantity. But I think also another venue for the high performing individual to remove themselves from the rigors of work. That might be building model airplanes. It might be meditation. But there has to be an escape. When you get the connection of those three components, where you have great habits around fueling and recovery and rejuvenation, tied in with appropriate and integrated training. It can't just be dumped on top of life, it has to be integrated into life. And positive work habits, something happens every single time, they accelerate. Yeah, they improve in sport, but they also become better at decision making, better leaders, more effective, and they start to join the dots. The final thing I will say about it, which I think is most interesting is when I've worked with so many CEOs, it's the same tools and mindset that they would apply to setting up their business strategies. All of the lessons that they have as a business leader, they already know them. But most of them do a very poor job of connecting the dots to themselves.

Geoff

To themselves, yes.

Matt D.

We have a saying, "Coach our pros like CEOs, and our CEOs like pros." Once they join the dots, they realize, how can I have been such a dip shit? It's all basic and habit driven, it's not overly complex. They start to join the dots between the parallels of that. If you look at the traits of a high performance CEO, for example, and you look at the personality traits of everything that makes a professional athlete, they're exactly the same.

Geoff

The same, yeah.

Matt D.

They're exactly the same. They continually cross pollinate, and just look at each other.

Geoff

It's interesting, you're essentially an executive coach or a life coach with a vehicle of training, which is interesting. I think there's a couple nuggets in there, especially around the structure of training, making sure that you're actually meditative or present when you're training. That just reminds me when I am at the gym, I see so many people in between their sets on their phone, checking social media or Twitter, or any of that stuff. I've been guilty of that myself.

Matt D.

They're missing a chance.

Geoff

Do you think that that distraction has really popped up in the last couple of years that you didn't see 10 years ago? Do you just feel that people are just a lot less present now? You have to just retrain people's mind more aggressively today versus 10 years ago?

Matt D.

I think we've fallen into a trap of feeling that we always have to be connected to be effective. The truth is the antithesis of that. I think you have to be really programmed to be effective. A great example of that is email. We always feel like we have to respond to email straight away, and hand up I'm also guilty of that. Versus, we know that the most effective way to use an information transfer tool, which is email, is to do it in blocks of focus.

Geoff

Block it off, yep.

Matt D.

And then turn it off, so that you can be present on task. The same applies with exercise as well. Can you imagine if I said to you, "All right, we're all going to go and meditate, and we're going to go and sit in a room, but we're all going to be on social media." You'd say, "That's insane." The same applies, because exercise or training is not meditation, but you are spending some of your valuable time.

Matt D.

For many people, time is our most precious commodity, you are deciding to spend this time on something that you know is really valuable for you. But you want to get the biggest results, and the best way to get results is to execute as intended. The only way to do that is to be present. It's why I banned cell phones from our indoor cycling classes. I need people to be present. Then when they come back-

Geoff

Do people listen to music?

Matt D.

Music is a tool in training, as another one that's really interesting. Similar to our nutrition discussion, it depends on the training session. I think music is a great motivator. We know that it can lift mood, it can lift performance if we're happy and we're enjoying-

Geoff

But it can be distracting.

Matt D.

It can't be a distraction.

Geoff

I've almost took it off, just so I get distracted. I don't like the song lyrics, then you just get thrown off.

Matt D.

Exactly. For me personally, I'm not a fan of, "Hey I'm a coach, listen to me because it's what I do." But there are certain sessions where if they require focus, where they're really interval driven, then the best thing might be some music to help maximize performance. But you're not listening to a podcast there, for example. Versus, if I go for a trail run and I'm getting some byproducts, physiological benefits by being out there for an hour or whatever it might be, but I'm not really training per se. The purpose of that session is for me to move my body, have fun, and be a release, go listen to a podcast. It's a great way, because that's feeding my soul as well with something that's interesting.

Geoff

Yeah, very balanced, very wise. You've dropped a lot of interesting nuggets out there. How do people find you or learn more about Purple Patch, learn more about you and all the things that you offer?

Matt D.

Our website is purplepatchfitness.com, but I think the easiest way is probably the Purple Patch Podcast actually. We do a weekly podcast, and it's not about triathlon training, it's about the subject of performance globally, and it's only education. One of the things that's right since the inception of Purple Patch is the passion for education. I think that's a great venue to listen, and I love to hear thoughts. We answer questions every week. I love it when people engage and participate. So either head to the website or listen to the podcast. We appreciate if you share with your friends and family if you find it valuable.

Geoff

Yeah, if you enjoyed this conversation, head on over. Matt's got some wisdom to share here. Thanks so much for dropping by the H.V.M.N. Podcast.

Matt D.

Really great fun. Thanks so much, really appreciate being here.

Geoff

Thank you. Cheers.


Gut Checking Your Heart Health

Originally published on HVMN.org (https://hvmn.com/blog/nutrition/gut-checking-your-heart-health) and authored by Nate Martins on Feburary 27 2019

Heart health is a hotly debated topic—and rightfully so. Heart disease is the leading cause of death in the United States.

The medical community remains committed to studying heart health, attempting to provide the public with analysis and solutions to some of their most pressing concerns. How much does family history play a part in heart health? How much exercise should I get? Can I really eat all those “healthy” fats?

There isn’t a single answer. And over time, even the gold standard proposed answer can change.

Remember when eating fat was the enemy? Counterintuitive as it may seem, we now know that eating more fat might lead to weight loss,1 which can reduce risk for a number of heart-related illnesses. This is just a singular example of how we learn, how studies change, and how advice medical professionals may give based on those learnings will also, undoubtedly, change too.

Point is, the medical community has spent centuries studying heart health. Even still, if you’re looking for an answer to the question “What makes a healthy heart?” you’ll get a library’s worth of different answers.

Let’s look at some of the most common concerns about heart health, and use scientific studies to analyze their merit.

A Portrait of Heart Disease

Heart disease is a shapeshifter manifesting itself in various forms. It’s a catch-all phrase for numerous conditions.

Over 600,000 people every year die of heart disease in the US, with coronary heart disease the most common (killing 370,000 yearly).2

In men and women, about 40% of these deaths are related to what’s called “ischemic heart disease.”3 This occurs when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. Conditions caused by atherosclerosis (hardening and narrowing of the arteries) include coronary heart and artery diseases, leading to heart attacks and potentially sudden death.

About 35% of heart-related deaths in men and women are caused by brain-related cerebrovascular disease.3 These conditions are also caused by atherosclerosis, but instead the blockage of blood vessels flowing to the brain. This can lead to a stroke, in which the brain is deprived of oxygen and parts of the brain can become permanently damaged (or even results in a permanent disability / death).

Collectively, in men and women, inflammatory, rheumatic and hypertensive heart diseases account for less than 10% of heart-related deaths.3

Inflammatory heart disease can be caused by various infections, viruses, bacteria or other toxic material. Essentially, this is an infection of the heart, and sometimes, its origin isn’t found. Rheumatic heart disease relates to damage to heart valves, often a complication of rheumatic fever which is usually a condition suffered most commonly in children under 15. Hypertensive heart diseases are associated with high blood pressure, in which the heart works under increased pressure, leading to problems in the arteries and muscle.

The remaining ~15% of heart disease-related deaths are caused by various conditions like congenital heart disease, cardiac arrhythmias and heart failure.3

Dietary Fat

For years, fat was villainized. Low-fat-this and low-fat-that became popular dietary staples in fear a diet high in fat would be the culprit of an unhealthy heart. But now we better understand only certain types of fat can be dangerous, and a diet of healthy fats can foster a healthy heart. Increased fat consumption is not always associated with cardiovascular disease.4

There are several different kinds of dietary fats.

Saturated fats are solid at room temperature, like in butter and coconut oil. Historically, it was recommended to limit dietary intake of saturated fats because it was thought to be associated with heart disease. But emerging research illustrates increased consumption of saturated fat can have beneficial effects on blood biomarkers, like increasing healthy HDL cholesterol levels.5

Unsaturated fats are liquid at room temp, like in vegetable-based fats such as olive oil. They’re typically thought of as the healthy fats, and increased consumption of mono and polyunsaturated fats have been linked to improved blood biomarkers like lower blood triglycerides.6 When people talk about “good fats,” they’re likely referring to monounsaturated and polyunsaturated fats. These have fewer hydrogen atoms than saturated fats, and can be found in vegetables, nuts, seeds and fish.

What you want to watch out for are trans-fats. These are produced artificially when hydrogen is added to unsaturated fatty acids in order to solidify them and increase shelf life. Associations with poor health outcomes forced the FDA to remove their GRAS (generally regarded as safe) status in 2015.7

How does fat help or hurt your heart? It has to do with lowering LDL (bad) cholesterol, which can line arteries and cause atherosclerosis, a blood vessel disease that can lead to heart attacks and strokes.

One review showed that reducing saturated fats, and replacing them with polyunsaturated fats, reduces coronary heart disease events.8 But another study showed inconclusive results when analyzing the effects of saturated fat consumption on vascular function, diabetes and stroke.9

While it seems fat isn’t the devil it was once cast, it’s still important to monitor dietary fat and focus on consuming unsaturated fats.

Exercise

Just like biceps or quads, the heart is a muscle. With regular exercise, it can become stronger, better able to pump blood throughout the body.

Before getting into all the positives about exercise for the heart, there are a few considerations.

Heart problems rarely occur due to physical activity; however, cardiac arrests and heart attacks are possible, but these usually occur in those who already have some type of heart condition, especially those with congenital heart problems (meaning, they’ve had these problems since birth).

Rarely, heart problems occur as a result of physical activity. Examples of these problems include arrhythmias, sudden cardiac arrest, and heart attack. These events generally happen to people who already have heart conditions. Fitness level can also play a role.

However, the benefits of exercise for the heart seems to far outweigh the risks.

Overall physical activity, including running, weight training, and walking are associated with reduced risk of coronary heart disease (CHD).10 The opposite of a healthy, active lifestyle is a sedentary one (one many people live!). A sedentary lifestyle increases risks for death from CHD, according to a meta-analysis.11 But there’s a “Goldilocks effect” when it comes to exercise—too little exercise is bad, and too much exercise can also be bad.

While it’s inconclusive the best type of exercise to promote heart health, there isn’t anything inconclusive about the efficacy of exercise. Anywhere from 60 minutes per week to 150 minutes per week (for those who are able) is prescribed by the National Heart, Lung, and Blood Institute.12

Family History

Many people think they may be at risk of heart disease based on their family history. It’s even one of the boxes you may check when filling out a form in a new doctor’s office.

Family history is a complex risk factor for heart disease. There are many, many genes that control how your heart works, and small changes can have important effects on the function of the heart. Start by looking at your immediate family’s health, and go outward from there. Genes are, unfortunately, inescapable. But they don’t explicitly predict your bill of future health.

Part of the reason doctor’s ask about family history is to help them understand what you may be susceptible to. That way, you can focus on specific strategies to fight against your genetic hand.

Even though there isn’t one genetic fingerprint tightly linked to heart disease, some studies do show a strong correlation between family history and coronary heart disease.13 Some point to an especially strong relationship between heart disease and first-degree family members.14 Others illustrate the problems with linking family history to heart disease, especially in relation to the number of family members with heart disease and an understanding of what, specifically, that heart disease was (leading to misunderstandings about how family history impacts CHD).13 The conclusion? This study denotes how difficult it is to showcase the connection, suggesting that family history and CHD remain largely unexplained.15

At its core, this one is difficult to unpack.

Other Risk Factors

Numerous other risk factors exist that may lead to heart disease. Many of these are related to the conditions above, but they warrant a bit of further exploration.

Diabetes

Diabetes occurs when blood glucose (or blood sugar) levels are too high. Insulin in the hormone that helps shuttle glucose into cells for energy. Type 1 diabetics don’t make insulin (assumed to be caused by genes, or environmental factors like viruses). Type 2 diabetics don’t respond to insulin (assumed to be caused mostly by lifestyle factors and genes).

Overtime, high blood glucose can damage blood vessels and nerves that control the heart.

The National Institute of Diabetes and Digestive and Kidney Diseases claims diabetics have a higher chance of developing heart disease, and have a greater chance of having a heart attack or stroke.16 It seems diabetes increases the risk of all clinical manifestations of CHD.17

There doesn’t seem to be much debate here. The longer you have diabetes, the higher your chances of developing heart disease,18 and those with diabetes are almost twice as likely to die from heart disease or stroke.19 But it’s not clear what to do about this risk, as intense blood sugar control doesn’t appear to reduce the risk of heart disease in diabetics.20

Blood Pressure

When most people think of blood pressure, they think of high blood pressure. This means the force of the pumping blood in arteries is higher than it should be. But how’s this relate to heart disease?

Excess strain from high blood pressure narrows and weakens coronary arteries. Often this is because of plaque in the arteries, basically a buildup of fat and cholesterol (among other things), increasing the risk for a blood clot. When an artery is blocked, blood flow is compromised, and the heart becomes starved of oxygen, resulting in a heart attack.

High blood pressure increases risks of cardiovascular disease.21 It may also cause a stroke (on conjunction with other factors).22 More exercise and changes to diet are often prescribed to help alleviate high blood pressure.

Cholesterol

We’d need a whole article to analyze how cholesterol affects heart disease.

Cholesterol is essential to healthy cells, making hormones, making vitamin D and supporting digestion—but having too much of the “wrong” type in your blood can increase risk of heart disease. Simply speaking, cholesterol, found in dietary fats like meats and dairy, has two types.

HDL is the “good cholesterol,” helping the body rid itself of excess cholesterol and ensure it doesn’t end up in the arteries. LDL is the “bad cholesterol,” collecting in the walls of arteries and leading to plaque. When too much cholesterol builds up in artery walls (a process called atherosclerosis), it can cause a heart attack.

Studies have shown total cholesterol / HDL ratio is better at predicting risk for CHD when compared to total cholesterol or LDL cholesterol levels.23 Furthermore, one study bucked the LDL trend but showing that high LDL cholesterol was inversely associated with mortality in most people over 60.24 But other studies have shown lower HDL cholesterol levels were found in persons with CHD when compared to those without the disease.25 And some studies have pointed to low LDL has being a strong indicator of CHD.26

Studies seem to show inconclusive results for LDL and HDL levels in heart disease. You can learn more here, on our recent episode of the H.V.M.N. Podcast with Dave Feldman (also known as Dave Keto).

Assessing Your Heart Health

There are many, many factors influencing heart health; lifestyle, diet, family history, all these things play a role in what’s a complex medical issue.

Start with consulting your doctor to understand risk factors. Since February is American Heart Health Month, there’s no time like the present.

Scientific Citations

1.Bueno, N. B., de Melo, I. S., de Oliveira, S. L., & da Rocha Ataide, T. (2013). Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr, 110(7), 1178-1187.

2.Underlying Cause of Death 1999-2017. CDC.

3.Different heart diseases. World Heart Federation, 2017.

4.Dehghan, M, Mente, A, Zhang, X, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study, 2017. Lancet

5.Mente, A, Dehghan, M, Rangarajan, S, et al. Association of dietary nutrients,with blood lipids and blood pressure in 18 countries: a cross-sectional analysis from the PURE study, 2017. The Lancet. Diabetes & endocrinology 5, 774-787.

6.Volek, J.S., Gomez, A.L., and Kraemer, W.J. (2000). Fasting lipoprotein and postprandial triacylglycerol responses to a low-carbohydrate diet supplemented with n-3 fatty acids. J. Am. Coll. Nutr. 19, 383-391.

7.FDA Website: Final Determination Regarding Partially Hydrogenated Oils (Removing Trans Fat)

8.Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med. 2010;7(3):e1000252.

9.Micha R, Mozaffarian D. Saturated fat and cardiometabolic risk factors, coronary heart disease, stroke, and diabetes: a fresh look at the evidence. Lipids. 2010;45(10):893-905.

10.Tanasescu M, Leitzmann MF, Rimm EB, Willett WC, Stampfer MJ, Hu FB. Exercise type and intensity in relation to coronary heart disease in men. JAMA. 2002;288(16):1994-2000.

11.Berlin JA, Colditz GA. A meta-analysis of physical activity in the prevention of coronary heart disease. Am J Epidemiol. 1990;132(4):612-28.

12.National Heart Blood and Lung Institute. Physical Activity and Your Heart, 2018.

13.Nasir K, Michos ED, Rumberger JA, et al. Coronary artery calcification and family history of premature coronary heart disease: sibling history is more strongly associated than parental history. Circulation. 2004;110(15):2150-6.

14.Pohjola-sintonen S, Rissanen A, Liskola P, Luomanmäki K. Family history as a risk factor of coronary heart disease in patients under 60 years of age. Eur Heart J. 1998;19(2):235-9.

15.Hawe E, Talmud PJ, Miller GJ, Humphries SE. Family history is a coronary heart disease risk factor in the Second Northwick Park Heart Study. Ann Hum Genet. 2003;67(Pt 2):97-106.

16.Buse, JB. NIH: National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes, Heart Disease, and Stroke, 2017.

17.Kannel WB. Lipids, diabetes, and coronary heart disease: insights from the Framingham Study. Am Heart J. 1985;110(5):1100-7.

18.Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2017.

19.Huo X, Gao L, Guo L, et al. Risk of non-fatal cardiovascular diseases in early-onset versus late-onset type 2 diabetes in China: a cross-sectional study. Lancet Diabetes Endocrinol. 2016;4(2):115-24.

20.Conget I, Giménez M. Glucose control and cardiovascular disease: is it important? No. Diabetes Care. 2009;32 Suppl 2:S334-6.

21.Vasan RS, Larson MG, Leip EP, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med. 2001;345(18):1291-7.

22.Collins R, Peto R, Macmahon S, et al. Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet. 1990;335(8693):827-38

.23.Kinosian B, Glick H, Garland G. Cholesterol and coronary heart disease: predicting risks by levels and ratios. Ann Intern Med. 1994;121(9):641-7.

24.Ravnskov U, Diamond DM, Hama R, et al. Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review. BMJ Open. 2016;6(6):e010401.

25.Castelli WP, Doyle JT, Gordon T, et al. HDL cholesterol and other lipids in coronary heart disease. The cooperative lipoprotein phenotyping study. Circulation. 1977;55(5):767-72.

26.Howard BV, Robbins DC, Sievers ML, et al. LDL cholesterol as a strong predictor of coronary heart disease in diabetic individuals with insulin resistance and low LDL: The Strong Heart Study. Arterioscler Thromb Vasc Biol. 2000;20(3):830-5.

Brain Fog: Why Aren't You Thinking Clearer?

Originally posted on hvmn.com and written by Brady Holmer

The mind is a terrible thing to waste. If you’re having a hard time thinking, trouble focusing, or just not feeling like yourself, you might be experiencing a condition known as brain fog.

It’s not a headache, not depression, but a general feeling that clouds your mind and prevents you from being you. Not only that, if you’re a high-achiever with lofty goals, brain fog could be preventing you from accomplishing them.

Table of Contents

Lost in the Clouds: What is Brain Fog?

What Causes Brain Fog?

Brain Food: How Our Cranium Gets Energy

The Brain and Glucose

Ketone Bodies and the Brain

Do Low-Carb Diets Cause Brain Fog?

Falling Blood Glucose

Insufficient Ketone Body Production and Utilization

Dehydration

Ketones Prevent Brain Fog

Other Reasons Brain Fog Improves on Keto

Fight the Fog

If brain fog sounds like something you might be experiencing, the good news is that there’s hope. Brain fog isn’t a terminal illness or a personality flaw, but rather, a fixable condition. All it takes is a little understanding of how the brain works, and how interventions like diet can work to improve its function.

Lost in the Clouds: What is Brain Fog?

Brain fog is a vague term. This means that the way each individual experiences the symptoms will be highly variable.

However, some common descriptions of brain fog include “forgetful,” “cloudy,” and “difficulty thinking, focusing, and communicating.”1 Low energy, physical and mental fatigue, irritability, headaches, anxiety, confusion, low motivation, hopelessness, memory loss, memory problems, and trouble sleeping—these can be more serious and life altering consequences of brain fog.

If you are suffering from brain fog, it could not only lower your mood and thinking ability, but alter your productivity in other areas of life.

Quality of work might suffer, no matter your profession. A poor ability to communicate or lack of interest in conversation might hamper relationships. Having brain fog may make it difficult to exercise and perform daily tasks that once were easy and enjoyable.

The negative life consequences of brain fog could be the result of a serious underlying condition, which we will cover shortly. Sometimes, it’s due to diseases like chronic fatigue syndrome, depression, Alzheimer’s disease, multiple sclerosis, or other debilitating medical condition. In these cases, medical intervention is sometimes necessary. Brain fog may also be due to some other lifestyle factor that can be easily changed—poor diet, environment, or stress.

Alternatively, brain fog could be a temporary side effect of the ketogenic diet. While this might seem paradoxical (keto is supposed to improve mental clarity, right?), the reason why this happens makes sense. And the good news is that once brain fog is “cured,” you’ll be a lot less likely to experience it again.

What Causes Brain Fog?

There are several potential causes of brain fog. These may take the form of a more serious clinical disease, or a less serious lifestyle-related factor.

One reason may be related to hormonal changes, especially those involving estrogen.

The transition to menopause (perimenopause) has been linked with difficulties in difficulty paying attention, memory complaints, and symptoms of depression, anxiety, and sleep disturbance—which all sound a lot like brain fog.2

Brain fog seems to afflict people with a condition known as fibromyalgia, a disorder characterized by widespread pain throughout the body, particularly in the muscles and the skeletal system. This disease is caused by alterations in the immune system, and may have other effects related to the nervous system. Along with the pain comes fatigue and impairments in memory and sleep.

People with fibromyalgia report difficulty thinking and remembering things, something that has been termed “fibro fog.” Patients with fibromyalgia rank “fibro fog” high on the list of how their disease impacts well-being.3 In one study, over 82% of patients with fibromyalgia reported cognitive dysfunction, and were more likely to report memory decline, mental confusion, and speech difficulty compared with a group of patients without fibromyalgia.4

There are other clinical conditions and treatments which can lead to symptoms of brain fog; these include chemotherapy,5 brain injuries, diabetes,6 neurodegenerative disorders,7,8 allergies,9 and any condition that might impair gut health or cause “leaky gut.” Even certain medications like statins and sleeping pills have been reported to cause brain-fog like symptoms such as cognitive impairment, difficulty in decision making, and poor executive function.10,11

Lifestyle factors may play a role too. Ultra low-fat diets, food additives like MSG, artificial sweeteners, industrial seed and vegetable oils, improper hydration, and nutritional deficiencies are all colloquially proposed to be a cause of brain fog. In addition, it is likely that and sleep deprivation or sleep disorders—which are widespread among Americans and throughout the world, play a causal role in brain fog. However, research is currently unavailable to conclude a causative role of any of these variables in brain fog.

Being physically inactive and a lack of sleep are known to lead to poor cognitive performance, worse memory, and less mental clarity, and may even contribute to cognitive decline throughout life.12,13 What’s more—physical activity and proper sleep are two ways to reverse brain fog and improve cognitive function and wellbeing!14 It’s something we all intrinsically know. Who doesn’t feel better after a great workout or a sound night of sleep?

Another condition where brain fog is reported has nothing to do with underlying disease, and isn’t necessarily due to some poor lifestyle factor. Sometimes, brain fog or related symptoms are reported in people soon after initiating a very-low carb or ketogenic diet. Before going into the specifics of why keto can lead to short-term reversible brain fog, let’s talk about some basics of brain energy metabolism.

Brain Food: How Our Cranium Gets Energy

Our brain is over 60% fat, and while it makes up only 2% of our entire body weight (give or take a little in some people) it consumes a disproportionate amount of the total energy our body uses on any typical day.15

Our brain is an energy-hungry organ. Let’s take a look at how it gets fed.

The Brain and Glucose

In terms of energy consumption, the brain uses about 25% of the total glucose and 20% of the oxygen made available to our body.15

Glucose is the obligatory energy substrate of the brain, with a few exceptions.

The process by which energy is harvested from glucose starts by glucose getting taken up by the brain through a transporter known at GLUT1 (and a few others). This transporter is necessary because the brain is protected by something known as the blood-brain barrier (BBB).

The BBB is a protective layer surrounding the brain, tightly controlling what goes in and out. This is important, since our body undergoes biochemical shifts and is exposed to a variety of environmental toxins and chemicals throughout the day—any one of which could harm the brain if they were allowed entry. Lucky for us, the BBB is a watchful sentry, maintaining our brain health throughout life.

GLUT1 sits on the surface of the BBB. When brain activity increases due to increased cognitive or physical work, the activated neurons in the brain also increase their work rate because energy requirements increase. This increases the amount of blood flow to the brain, carrying glucose along with it.16

Glucose binds to the transporter and is then able to cross the membrane and enter brain regions. Here, brain mitochondria break down glucose in two processes: glycolysis and the Krebs Cycle (a.k.a TCA cycle). ATP produced through these pathways is then used as an energy source for neurons.17

In addition to providing ATP, glucose also seems necessary for the brain to produce neurotransmitters including glutamate, GABA, and acetylcholine (AcH)—without which we could not function properly.

Glucose isn’t the only molecule that is allowed entry into the brain through the BBB.

Turns out that the monocarboxylates lactate and pyruvate (two breakdown products of glucose) are able to cross the BBB and be used for energy.17 This pathway may predominate during situations like moderate to vigorous exercise (when we are producing more lactate and pyruvate through glycolysis).

Ketone Bodies and the Brain

What happens when glucose is no longer available—like during conditions of prolonged fasting or starvation?

If no other route was available, the only option would be for the brain to shut down. This wouldn’t exactly be evolution’s greatest achievement now, would it? Luckily, our brain (and body) has developed adaptive mechanisms that allow utilization of other substrates besides glucose for energy. The adaptive mechanism in humans (and animals) is the utilization of ketone bodies in the brain. In particular, the ketone bodies acetoacetate (AcAc) and beta-hydroxybutyrate (BHB) are energy-rich substrates.

Studies have shown that during “starvation” (3.5 days of fasting), the influx of BHB into the brain increases more than 10x normal levels.18 This corresponds to the amount of ketones present in the blood.

The increase in brain ketones during food deprivation may be due to the fact that the BBB becomes more permeable to ketones during fasting to allow more ketones inside the brain.

Any condition where ketonemia (increased blood ketones) occurs also leads to increased ketone influx to the brain.19

The adaptive mechanism of ketone utilization by the brain ensures humans and animals can survive and function under conditions of low-energy availability. During times of glucose shortage (i.e. lack of carbohydrate), ketone bodies become the “preferred” energy source.

But what about fat? We know that the beta-oxidation of fatty acids is one pathway by which we burn fat to produce energy. Interestingly, unlike other body tissues, the brain does not oxidize fatty acids. While it’s known fatty acids can cross the BBB using a specific carrier—and that the brain even contains the enzymes for beta-oxidation—it appears the brain seems to avoid producing energy from fatty acids in order to protect neurons from oxidative stress and a hypoxic environment, which could result from beta-oxidation. Beta-oxidation is a “slow” process and the brain having to do this under situations where rapid neuronal firing is needed could cause impairment in cognitive abilities. So it looks like the brain avoids producing energy through this pathway in order to protect us and our ability to think.20

We are left with the knowledge that the brain can use two different substrates as an energy source. Under conditions of high-glucose availability, the brain preferentially oxidizes glucose to produce ATP and maintain function. When glucose becomes less available, it is the production and utilization of ketone bodies that dominate the brain-energy production pathways.

Ketone utilization by the brain may exert profound benefits above and beyond glucose—at least when it is adapted to do so.21

Of course, natural ketone production takes time. Whether through fasting or ketogenic dieting, it can take days or even weeks for the body to begin producing its own ketones. And when you cycle in and out of keto, you may experience brain fog more frequently.

“Getting back into ketosis with H.V.M.N. Ketone Ester makes a big difference. It helps get me back on track and powers me through my day.”—Lidice F.

H.V.M.N. Ketone Ester increases ketone levels rapidly,22 providing the body with keto energy as it ramps up to natural ketone production. With the evidence illustrating the power of ketones for the brain, this could be an excellent solution to help reduce symptoms of brain fog and bridge the gap between carb-depletion and ketone production.

The Perfect Keto Shopping List

We've compiled the top keto products and recipes to make your ketogenic diet the best it can be. Subscribe to the newsletter to learn more.

Subscribe

Do Low-Carb Diets Cause Brain Fog?

One of the purported benefits of going on a low-carbohydrate or ketogenic diet is the improved mental clarity.

For this reason, it might seem like a paradox that brain fog is a common symptom of something known as the “keto flu”—the term given to the panoply of symptoms experienced by people who begin a ketogenic diet. Along with brain fog, some of these symptoms include physical fatigue, cramps, irritability, dizziness, food cravings, and sleep problems. Like brain fog, most if not all of these symptoms are transient and resolve after a short adaptation period.

If keto is so good, why does brain fog happen? During the “transition period” from your habitual diet to a keto diet (also known as the “adaptation phase”), several changes can occur in the body and brain that can cause brain fog.

Falling Blood Glucose

Starting a ketogenic diet means you’ll have to cut out a majority (if not all) of your dietary carbohydrates; no external glucose will be coming in through food.

As a result, blood glucose levels will fall. While this is one of the long-term benefits of keto, it might have some short-term consequences. Short term reductions in glucose provision to the brain can lead to brain fog and related symptoms.

We already discussed how, in someone eating a high-carbohydrate diet, energy for the brain is provided mainly by glucose. Taking away this glucose by going low-carb means the brain is left without its main source of ATP and energy. Short term “hypoglycemia” deprives the brain of glucose.

In the initial days or weeks of keto, low glucose can cause brain fog.

What about glycogen? Can’t the brain use this for energy?

We know that stored glucose can be accessed in times when blood glucose is low to provide energy. Lactate and pyruvate from glycogen breakdown can maintain the function of neurons under conditions of hypoglycemia.15 However, glycogen stores in the brain are limited, and are consumed within minutes in the absence of exogenous glucose. What’s more, the process of creating new glucose—gluconeogenesis (GNG)—is negligible in the brain.

It’s important to remember that this period of low glucose availability is likely transient. One study reported that endogenous glucose production declines after one day on a carb-restricted diet and remains low for at least one week.23 This was accompanied by a 20% reduction in plasma glucose concentrations after two days on the low-carb diet. However, levels normalized after three days.

It is interesting to note that the authors of this study concluded that if adequate calories were provided in the form of protein and fat, hypoglycemia could be prevented. This is likely a result of increased GNG and the sparing of glycogen breakdown. These results were apparent at the whole-body level, however, and cannot be said to apply to the brain, per se.

It seems reasonable to conclude that, before sufficient glycogen sparing and GNG begin to occur, the brain may experience a short-term state of energy deprivation. This may be compounded by the fact that even though ketosis might be present, the brain may not be suited to use ketones quite yet. Luckily, this is a transient period and not a form of chronic stress your body will be put through.

A sufficient adaptation phase is probably required before everything starts running smoothly.

Insufficient Ketone Body Production and Utilization

In the absence of glucose, the brain can use alternate routes of energy production like ketolysis (the oxidation of ketones).

It has been shown that during starvation conditions, ketone bodies can provide as much as two-thirds of the total energy required by the brain.24

While a prompt increase in ketone production (ketogenesis) occurs when someone starts a ketogenic diet, this doesn’t necessarily mean that their use of ketones for energy increases at the same rate.

Adaptation must first occur before body tissues and the brain can take full advantage of ketones. Progressive adaptations in the brain need to occur.

A lifetime of a high-carb diet has left many enzymes and pathways of ketosis / ketolysis down-regulated, and we need time to build up these pathways.

The evidence for a downregulation of enzymes specific to ketosis can be seen in how we evolved to eat. The activities of ketone body metabolizing enzymes rise during the weaning period (to allow energy utilization from the high fat diet of breast milk) and fall in adulthood, presumably when diet transitions to contain more carbohydrates.25

For instance, in mice, eight weeks of a ketogenic diet was shown to increase enzymes related to the breakdown of ketones and enhance fatty acid oxidation capacity.26 This suggests these “fat-adapted” rodents were more able to both produce ketones from fat breakdown and use these ketones in metabolism.

Along with enzymatic changes, a high-fat diet and prolonged fastingcan both increase the permeability of the BBB to ketone bodies. Shorter periods of fasting, interestingly, don’t have the same effect.25 Changes may take some time to occur, providing evidence as to why brain fog and other symptoms may only resolve after a few days to weeks of keto.

Prolonged, high concentrations of ketone bodies may be necessary to upregulate the transporters (specifically, the MCT1 transporter) needed to effectively get ketone bodies past the BBB and into the brain along with other peripheral tissues.

Thus, enzyme and transporter activity may be a factor limiting ketone body metabolism in the initial stages of a keto diet, before adaptation occurs.

Dehydration

One of the major changes that occurs when you start a low-carb, ketogenic diet is a drastic difference in the amount of water you have in your body—this is one of the main reasons that quick and perhaps drastic weight loss occurs in the initial phases of a ketogenic diet.

This happens because of two reasons. First, your body will start using its glycogen reserves for fuel. Because glycogen is stored with water, when you lose glycogen, you also lose water, which can contribute to dehydration and rapid weight loss.27

Second, insulin, while normally thought of as regulating blood glucose, also regulates how much sodium our kidney retains. When insulin is high, the kidney holds on to more sodium, and water along with it.

However, insulin falls when you go low-carb, and this leads to more sodium excretion by the kidney.28 To maintain osmotic balance, an increase in sodium excretion means that water excretion will increase as well.

If you aren’t able to make hydration a priority by increasing your water intake a bit, this could lead to dehydration and electrolyte imbalances. Along with other keto flu symptoms, brain fog is a likely outcome of dehydration, imbalanced electrolytes, or both.

Studies have indicated that dehydration of only 2% can cause a deterioration of mental functions.29 Some studies indicate that dehydration of even 1% of body weight can adversely affect cognitive performance, short-term memory, and attention.30 Dehydration can also cause your blood pressure to drop too low—this may also contribute to impaired cognitive performance and brain fog-like symptoms.

Important to note is that most of these studies used experimental procedures like exercise and heat stress to induce dehydration, which adds a variable other than just dehydration to the mix.

Ketones Prevent Brain Fog

Current research is lacking to support the claim that ketosis has mind-altering capabilities that may lead to improved clarity, awareness, and creativity above and beyond your baseline function.

However, this “mental edge” is commonly reported among hard-core keto people. This feeling makes sense if you think about it in terms of evolutionary advantages. Our ancestors went into ketosis when they were starving, so having the advantage of mental clarity and focus would be beneficial for finding sources of food.

It isn’t uncommon to hear someone complain of brain fog when eating a high-carbohydrate diet full of processed foods and refined sugar. Upon transitioning to keto, symptoms of brain fog clear, making people feel better than they ever have before. This could be due to the elimination of processed foods in the diet or the presence of ketones. Most likely, it’s a combination of both.

Improving cognitive function suggests that ketosis—whether dietary or exogenous—has the potential to reduce brain fog.

While enhanced cognitive function in healthy people lacks scientific support, many studies on ketogenic diets have indicated their ability to improve cognition, mental clarity, and brain function in adults with impaired brain energy metabolism and neurological disorders.31,32Research consistently indicates that ketogenic diets have a strong neuroprotective effect in addition to their ability to improve social behavior and cognition.33

Exogenous ketones show similar benefits.

Provision of ketone esters (like the BHB monoester in H.V.M.N. Ketone Ester) and ketone salts provides several benefits for the brain including improved behavior and brain plasticity34, cognitive performance35, and reduced neurological impairment in diseases of metabolism.36

What about healthy individuals without cognitive or neurological impairments? Again, the benefits of ketosis here are largely speculative. We have to base the purported benefits on theoretical mechanisms of action, which are actually quite sound.

A fat-fueled brain may be more energy efficient than one that relies on glucose. This might have several benefits for brain fog and mental function, including the reduction of damaging free radicals and oxidative stress in the brain.37

Oxidation of ketone bodies generates fewer free radicals than does the oxidation of glucose.38 In addition, the metabolism of ketones generates more ATP per gram than does glucose—meaning your brain is getting more “bang for its buck” when using ketones instead of other fuel sources.39

Ketones may allow the brain to process more of the neurotransmitter glutamate to GABA. A proper balance of these two neurotransmitters is necessary to avoid over (and under) stimulation. Too much of either can result in brain fog. By increasing conversion of glutamate to GABA, ketones may improve focus.40

In addition, ketogenic diets might lead to a more robust brain that can produce and utilize more energy. This is because keto has been shown to increase brain mitochondria (known as mitochondrial biogenesis) and mitochondrial energy dynamics.41 The same increase was shown when the ketone body BHB was provided, suggesting this effect is due to ketones and not a different aspect of the low-carb diets.

Brain fog is no match for keto.

Whether you’re suffering from poor energy, reduced mental clarity, or trouble focusing, ketosis may improve symptoms by reducing oxidative stress in the brain, giving your neurons more energy, and boosting neurotransmitters that benefit mental health and function.

If you’re already on a ketogenic diet (or starting one) and want to supercharge it, taking keto supplements might help. An easy, everyday-use supplement is the use of medium-chain triglycerides (MCT).

MCTs aren’t ketones, but are actually highly ketogenic fats that readily convert into ketones. MCT Oil Powder by H.V.M.N. contains pure C8—the MOST ketogenic fat of all the MCTs. Plus, it comes in three delicious flavors that are all zero net-carbs, so it won’t kick you out of ketosis.

Other Reasons Brain Fog Improves on Keto

We’ve just discussed how the addition of ketones through a ketogenic diet or exogenous ketones can fight brain fog. However, the elimination of many things when you go keto could also explain improved brain fog.

One might be dietary clean up. Going keto means eliminating many food groups, several of which may have been harming your health. These might include food containing sugar, gluten (for some), artificial sweeteners, and other processed ingredients. Refined food and a “western diet” categorized by a high intake of saturated fat and refined carbohydrates has been associated with impaired cognitive function and neurodegenerative conditions.42 The modern way of eating isn’t particularly great for anyone.

Furthermore, stable daily blood sugar could explain the improved mental clarity and rock-solid focus that come with keto.

Rather than riding the highs and lows of blood sugar spikes and crashes, keto can lead to fewer and less severe blood glucose fluctuations. When you once may have had a post-lunch brain fog, you now have steady energy and focus until the end of the day.

Fight the Fog

If you are experiencing brain fog, it’s time to end it once and for all.

First, figure out what may be causing brain fog—diet, sedentary time, something in your environment. Next, look at all of the potential strategies that are known to help prevent brain fog, and experiment.

Maybe a ketogenic diet is your first-line strategy. If this is the case, be sure to eat enough fat and calories to provide your brain with all the energy it needs.

Maybe exogenous ketones are the solution. Taking something like H.V.M.N. Ketone Ester or MCT Oil Powder could be the super supplement you need to power through the fog.

Other smaller changes—drinking enough water, getting adequate sodium, exercising more, getting out into the sun—can have a huge impact on your mental function.

Your health is your own responsibility, your own experiment. Take control, and don’t let brain fog impede your journey toward self-optimization.

Experiencing the Keto Flu?

Don't let keto flu symptoms derail your diet. We have the info to make your ketogenic diet experience the best it can be. Subscribe to learn more.

Scientific Citations

1.Ross AJ, Medow MS, Rowe PC, Stewart JM. What is brain fog? An evaluation of the symptom in postural tachycardia syndrome. Clin Auton Res. 2013;23(6):305-11.

2.Jacobs EG, Weiss BK, Makris N, et al. Impact of Sex and Menopausal Status on Episodic Memory Circuitry in Early Midlife. J Neurosci. 2016;36(39):10163-73.

3.Kravitz HM, Katz RS. Fibrofog and fibromyalgia: a narrative review and implications for clinical practice. Rheumatol Int. 2015;35(7):1115-25.

4.Katz RS, Heard AR, Mills M, Leavitt FThe Prevalence and Clinical Impact of Reported Cognitive Difficulties (Fibrofog) in Patients With Rheumatic Disease With and Without Fibromyalgia. JCR: Journal of Clinical Rheumatology. 2004;10(2):53-58.

5.Kovalchuk A, Kolb B. Chemo brain: From discerning mechanisms to lifting the brain fog-An aging connection. Cell Cycle. 2017;16(14):1345-1349.

6.Moheet A, Mangia S, Seaquist ER. Impact of diabetes on cognitive function and brain structure. Ann N Y Acad Sci. 2015;1353:60-71.

7.Hussain R, Zubair H, Pursell S, Shahab M. Neurodegenerative Diseases: Regenerative Mechanisms and Novel Therapeutic Approaches. Brain Sci. 2018;8(9)

8.Trojsi F, Christidi F, Migliaccio R, Santamaría-garcía H, Santangelo G. Behavioural and Cognitive Changes in Neurodegenerative Diseases and Brain Injury. Behav Neurol. 2018;2018:4935915.

9.Trikojat K, Buske-kirschbaum A, Plessow F, Schmitt J, Fischer R. Memory and multitasking performance during acute allergic inflammation in seasonal allergic rhinitis. Clin Exp Allergy. 2017;47(4):479-487.

10.Wagstaff LR, Mitton MW, Arvik BM, Doraiswamy PM. Statin-associated memory loss: analysis of 60 case reports and review of the literature. Pharmacotherapy. 2003;23(7):871-80.

11.Chen PL, Lee WJ, Sun WZ, Oyang YJ, Fuh JL. Risk of dementia in patients with insomnia and long-term use of hypnotics: a population-based retrospective cohort study. PLoS ONE. 2012;7(11):e49113

12.Blair SN. Physical inactivity: the biggest public health problem of the 21st century. Br J Sports Med. 2009;43(1):1-2.

13.Alhola P, Polo-kantola P. Sleep deprivation: Impact on cognitive performance. Neuropsychiatr Dis Treat. 2007;3(5):553-67.

14.Mandolesi L, Polverino A, Montuori S, et al. Effects of Physical Exercise on Cognitive Functioning and Wellbeing: Biological and Psychological Benefits. Front Psychol. 2018;9:509.

15.Bélanger M, Allaman I, Magistretti PJ. Brain energy metabolism: focus on astrocyte-neuron metabolic cooperation. Cell Metab. 2011;14(6):724-38.

16.Laterra J, Keep R, Betz LA, et al. Blood—Brain Barrier. In: Siegel GJ, Agranoff BW, Albers RW, et al., editors. Basic Neurochemistry: Molecular, Cellular and Medical Aspects. 6th edition. Philadelphia: Lippincott-Raven; 1999.

17.Falkowska A, Gutowska I, Goschorska M, Nowacki P, Chlubek D, Baranowska-bosiacka I. Energy Metabolism of the Brain, Including the Cooperation between Astrocytes and Neurons, Especially in the Context of Glycogen Metabolism. Int J Mol Sci. 2015;16(11):25959-81.

18.Hasselbalch SG, Knudsen GM, Jakobsen J, Hageman LP, Holm S, Paulson OB. Blood-brain barrier permeability of glucose and ketone bodies during short-term starvation in humans. Am J Physiol. 1995;268(6 Pt 1):E1161-6.

19.Hasselbalch, S.G., Madsen, P.L., Hageman, L.P., Olsen, K.S., Justesen, N., Holm, S., and Paulson, O.B. (1996). Changes in cerebral blood flow and carbohydrate metabolism during acute hyperketonemia. Am J Physiol 270, E746-751.

20.Schönfeld P, Reiser G. Why does brain metabolism not favor burning of fatty acids to provide energy? Reflections on disadvantages of the use of free fatty acids as fuel for brain. J Cereb Blood Flow Metab. 2013;33(10):1493-9.

21.Veech 2014: The therapeutic implications of ketone bodies: the effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism. Prostaglandins Leukot Essent Fatty Acids. 2004 Mar;70(3):309-19.

22.Stubbs, B.Cox, P.; Evans, R.; Santer, P.; Miller, J.; Faull, O.; Magor-Elliott, S.; Hiyama, S.; Stirling, M.; Clarke, K. (2017). On the metabolism of exogenous ketones in humans. Front. Physiol.

23.Harber MP, Schenk S, Barkan AL, Horowitz JF. Alterations in carbohydrate metabolism in response to short-term dietary carbohydrate restriction. Am J Physiol Endocrinol Metab. 2005;289(2):E306-12.

24.Laffel, L. (1999). Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab. Res. Rev. 15, 412-426.

25.Morris AA. Cerebral ketone body metabolism. J Inherit Metab Dis. 2005;28(2):109-21.

26.Ma S, Huang Q, Tominaga T, Liu C, Suzuki K. An 8-Week Ketogenic Diet Alternated Interleukin-6, Ketolytic and Lipolytic Gene Expression, and Enhanced Exercise Capacity in Mice. Nutrients. 2018;10(11)

27.Kreitzman SN, Coxon AY, Szaz KF. Glycogen storage: illusions of easy weight loss, excessive weight regain, and distortions in estimates of body composition. Am J Clin Nutr. 1992;56(1 Suppl):292S-293S.

28.Rubenstein AH, Mako ME, Horwitz DL. Insulin and the kidney. Nephron. 1975; 15(3-5):306-26.

29.Gopinathan PM, Pichan G, Sharma VM. Role of dehydration in heat stress-induced variations in mental performance. Arch Environ Health. 1988;43(1):15-7.

30.Lieberman HR. Hydration and cognition: a critical review and recommendations for future research. J Am Coll Nutr. 2007;26(5 Suppl):555S-561S.

31.Krikorian, R., Shidler, M.D., Dangelo, K., Couch, S.C., Benoit, S.C., and Clegg, D.J. (2012). Dietary ketosis enhances memory in mild cognitive impairment. Neurobiol. Aging 33, 425 e419-427.

32.Vanitallie, T.B., Nonas, C., Di Rocco, A., Boyar, K., Hyams, K., and Heymsfield, S.B. (2005). Treatment of Parkinson disease with diet-induced hyperketonemia: a feasibility study. Neurology 64, 728-30.

33.Hallböök T, Ji S, Maudsley S, Martin B. The effects of the ketogenic diet on behavior and cognition. Epilepsy Res. 2012;100(3):304-9.

34.Ciarlone SL, Grieco JC, D'agostino DP, Weeber EJ. Ketone ester supplementation attenuates seizure activity, and improves behavior and hippocampal synaptic plasticity in an Angelman syndrome mouse model. Neurobiol Dis. 2016;96:38-46.

35.Murray, A.J., Knight, N.S., Cole, M.A., Cochlin, L.E., Carter, E., Tchabanenko, K., Pichulik, T., Gulston, M.K., Atherton, H.J., Schroeder, M.A., et al. (2016). Novel ketone diet enhances physical and cognitive performance. FASEB J.

36.Van Hove, J.L.K., Grunewald, S., Jaeken, J., Demaerel, P., Declercq, P.E., Bourdoux, P., Niezen-Koning, K., Deanfeld, J.E., and Leonard, J.V. (2003). D,L-3-hydroxybutyrate treatment of multiple acyl-CoA dehydrogenase deficiency (MADD). Lancet 361, 1433-1435.

37.Maalouf M, Sullivan PG, Davis L, Kim DY, Rho JM. Ketones inhibit mitochondrial production of reactive oxygen species production following glutamate excitotoxicity by increasing NADH oxidation. Neuroscience. 2007;145(1):256-64.

38.Sullivan PG, Rippy NA, Dorenbos K, Concepcion RC, Agarwal AK, Rho JM. The ketogenic diet increases mitochondrial uncoupling protein levels and activity. Ann Neurol. 2004;55(4):576-80.

39.Board M, Lopez C, Van den bos C, Callaghan R, Clarke K, Carr C. Acetoacetate is a more efficient energy-yielding substrate for human mesenchymal stem cells than glucose and generates fewer reactive oxygen species. Int J Biochem Cell Biol. 2017;88:75-83.

40.Daikhin Y, Yudkoff M. Ketone bodies and brain glutamate and GABA metabolism. Dev Neurosci. 1998;20(4-5):358-64.

41.Hasan-olive MM, Lauritzen KH, Ali M, Rasmussen LJ, Storm-mathisen J, Bergersen LH. A Ketogenic Diet Improves Mitochondrial Biogenesis and Bioenergetics via the PGC1α-SIRT3-UCP2 Axis. Neurochem Res. 2019;44(1):22-37.

42.Francis H, Stevenson R. The longer-term impacts of Western diet on human cognition and the brain. Appetite. 2013;63:119-28.