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A Surprising Reason Why You May Need More Carbs in Your Diet

STORY AT-A-GLANCE In this interview, Georgi Dinkov and I continue our discussion about diet, diving into some of the finer details that can make or break your health.

A Surprising Reason Why You May Need More Carbs in Your Diet

Dinkov is a student of Ray Peat, who passed away around Thanksgiving 2022, leaving behind a legacy of iconoclastic wisdom on how to optimize biological health.

For example, a ketogenic diet can be very useful initially when transitioning people who are metabolically infiexible, which is about 95% of the population of the United States. So, in the short term, the vast majority of people can benefit from going keto. However, if you continue in ketosis long term, you're going to run into problems.

Elevated Cortisol Leads to Central Obesity

As just one example, while weight loss is a typical response when going on a ketogenic diet, months later, maintaining that weight loss often becomes a struggle again. Dinkov experienced this firsthand. Once he started following Ray Peat's recommendations, he lost the weight again and kept it off.

"My take is it's an endocrine problem,"

Dinkov says.

"So if you're struggling withweight you cannot lose, I think it's a good idea to do a blood work [panel] for thesteroids … Every single person that has been struggling with excessive weightthat has emailed [me] their blood results, without exception, their cortisol iseither high-normal or above the range, both the AM and the PM value.Their thyroid is less than optimal, in fact, pretty bad for most people … They'reat the upper limit of normal. A very large number of people are basicallyhypothyroid … I think we are eating foods that are lowering our metabolic rate.We're living an excessively stressful lifestyle.That's probably not a surprise for anybody. Many people think, well, stress isgood for you. It's good as a hormetic response in an acute situation, but notwhen you have chronically elevated cortisol. Every doctor will tell you if youhave a chronic elevated cortisol, you will develop the so-called spectrum ofCushing syndrome …One of the defining features of elevated cortisol is that you have central obesity.So that, to me, is really the problem. We have higher than desirable levels ofstress, suboptimal diet, and we're surrounded by a number of differentendocrine disrupters which are now proven to reliably cause obesity in animalmodels, even in very small amounts. Most of those are found in plastics."

How High Fructose Corn Syrup Causes Disease

One factor that makes a big difference in your metabolic rate is the type of sugar you consume. Contrary to popular belief, there's a dramatic difference between high fructose corn syrup and cane sugar. They're really two different foods. If the high fructose corn syrup is properly processed to remove all starch, then it's very similar to cane sugar because it's about 55% fructose and 45% glucose. However, studies have shown beverages sweetened with high fructose corn syrup contain a tremendous amount of starch, which isn't accounted for in the calories listed on the label. Once the starch is factored in, the caloric content of many sodas can easily quadruple that on the label, so you're getting FAR more calories than you think. Additionally, because the starch is made up of such tiny particles, they can enter your blood circulation unprocessed via your digestive system, potentially causing an allergic reaction. They can also trigger a low-grade infiammatory reaction, which will trigger the release of histamine, nitric oxide and serotonin. As noted by Dinkov, if you're sneezing and have itchy eyes even though it's not allergy season, you may well be having a reaction to something you ate or drank, and high fructose corn syrup may be the culprit. Starch particles also serve as fuel for pathogenic bacteria in your gut, and the endotoxins from these bacteria contribute to infiammatory conditions. Small intestine bacterial overgrowth (SIBO) is one example of what can happen, especially if you're on a proton pump inhibitor, as these drugs decrease the amount of stomach acid you're producing. Stomach acid is there not only to help with digestion but also to keep bacteria in check.

"If you're not producing a suficient amount of acid, you're going to get bacteriacolonizing your small intestine, either from food or creeping up from the largeintestine. And that's not a good thing. Basically … the portion of the intestinethat is supposed to be clean and just focused on absorbing food is nowharboring a microbiome.And then, if you give it any kind of a food that the bacteria can process, you'reincreasing the turnover [which] result in the endotoxemia that is now acceptedto cause a large number of diseases, especially cardiovascular disease, obesityand neurological disease.Alzheimer's has been conclusively tied to chronic low-grade endotoxemia.They're still claiming there's a genetic component to it, but they're nowadmitting that endotoxin is a causative factor in Alzheimer's disease,"

Dinkov says.

Cane Sugar Can Be Part of a Healthy Diet

Most people who embrace natural health believe sugar is a pernicious evil, but Peat's and Dinkov's position is that the negative effects are primarily caused by high fructose corns syrup, and that pure cane sugar can actually be a useful strategy to counteract some of the challenges that people can get into when on a strict low-carb diet. Dinkov explains:

"Cane sugar, if it's pure, has a very different overall systemic health effect thanhigh fructose corn syrup … I think most of the sugar sold in the crystal form,especially organic ones, is pretty safe. Heavy metal contamination used to be aproblem in sugar distillation but it looks like most of the western countries havesorted this out …Now, some people that have an issue with sugar are saying, 'Well, it's just emptycalories and whatnot.' Multiple studies demonstrated that honey, which is verysimilar in composition to plain white sugar, does not trigger the normalhyperglycemic response that most of the other simple carbohydrates do. Infact, it improves the hyperglycemia in Type 2 diabetic patients despite beingpure sugar.I think that's the greatest confirmation that we have that sugar is not evil. Itdepends how you're getting it and in what form. One animal study demonstratedthat rats, when given free access to [Mexican] Coke sweetened with cane sugar,they were eating the equivalent of 8,000 calories daily … without gaining anounce of fat.So sugar is not dangerous. It's perhaps the only nutrient that we evolved tometabolize for fuel. But the other two micronutrients, even though we canmetabolize them as fuel, come with a lot of strings attached …If you're oxidizing PUFA, then all hell breaks loose. If you're oxidizing saturatedfats, it's far less dangerous. But in the long run it still puts you, due to theRandle cycle, into the semi-diabetic state because it decreases your insulinsensitivity.So pure sugar is what we are meant to oxidize for fuel. If you get it from ripefruit, great. If you can get it from [raw unadulterated] honey, probably just asgood if not even better. But if not, then the pure white variety, preferably organic,that you get from the store, I think is a very good source of most of the carbcalories that you intend to eat throughout the day."

The Glucose-Cortisol Link

In my book "Fat for Fuel," I argued that healthy saturated fats generate fewer free radical species in the electron transport chain than sugar. However, I'm starting to revise my views on this, based on Peat's work. The problem is that if your glucose level is low because you're on a low-carb diet, your body is going to compensate by self-generating glucose, and that stimulus to make glucose is part of the obesity puzzle, because one of the ways in which your body produces glucose is by secreting cortisol. And, as explained by Dinkov, if your cortisol is chronically elevated, you end up with central obesity and chronic infiammation, which clearly isn't good. So, you've got to have a certain amount of glucose, and it's best to get it from your diet rather than forcing your liver to make it, as cortisol is then also being churned out. Dinkov explains:

"If glucose is oxidized properly going through the Krebs Cycle and electrontransport chain, it generates more carbon dioxide per molecule of glucoseoxidized than do fats.Now, carbon dioxide has this kind of controversial role in medicine. It used to beconsidered a metabolic byproduct that could potentially be dangerous. Peoplewith chronic obstructive pulmonary disease have higher than normal levels ofcarbon dioxide in the blood.But then, medicine started to look into this more closely, I think, over the last 10years, outside of Dr. Pete's research, and said, 'Hm. Carbon dioxide seems tohave a lot of positive effects in the body.' One of them is vasodilation.So basically, if your metabolism is not working properly, if you're not oxidizingglucose properly, you're not going to produce suficient amounts of carbondioxide. What happens then? Vasoconstriction. And since that is actually aproblem, it raises blood pressure and all kinds of other things; all hell breaksloose. The body then releases an emergency vasodilator, known as nitric oxide.And that is now acquiring a bad reputation.Even in mainstream medical circles, they've started seeing that people who aretaking the drug nitroglycerin, which used to be the mainstream drug for angina— chest pain — for cardiovascular disease and blood pressure.With nitroglycerin, you'll quickly lower blood pressure. But over time, theinfiammatory nature of nitric oxide ensures that these people actually getworse. And, in fact, most people who take nitroglycerin on a long-term basis diefrom a heart attack or ischemic stroke.So, if you're not eating enough glucose, your body will make it. And, in fact, theprimary evolutionary role of cortisol, the acute role, is actually preventing bloodglucose from dropping too low, because that will put you into a hypoglycemiccoma.In the longer run its secondary role is to dampen down infiammation. So really,the acute, the lifesaving role of cortisol on a daily basis, is to prevent you fromdropping into a coma because your blood glucose went too low.But we don't want that process because it's going to get the glucose from thetissues. So, we need glucose [in our diet]. I think even the ketogenic proponentsare now getting to the point of saying, 'We cannot be always in ketosis.' In thelong term, it's not good."

Will Sugar Feed Cancer?

In recent years, ketogenic diets have also been hailed for their ability to prevent and treat cancer, but even this may turn out to be a misunderstanding in the end.

"I think some of the ideas around glucose feeding cancer stem from two basicmisunderstandings,"

Dinkov says.

"One is that cancer is an evil cell, geneticallymutated, and that your only chance is to kill all of those cells because they'renot going away by themselves.First of all, that's not true. Spontaneous remissions of cancer are known, andthey vary depending on the cancer. Prostate cancer has a pretty high rate ofspontaneous remission … A paper that came about five years ago … from theMD Anderson cancer center in Texas … said it's always been the position ofmedicine that cancerous mutations [happen] and after that, the cell becomesmetabolically deranged.But it looks like we've had it backwards. It's the metabolic derangement thathappens first, and, over time, this triggers the genetic mutations, because thecell, being in an energetic deficiency, cannot properly maintain its structure.That was a huge admission …So what we need to be doing here is not trying to kill the cancer cell, because itis not a cancer cell. It is actually a normal cell that is metabolically deranged.If we could compare it to anything, it'd be a diabetic cell [and] diabetes is nowknown to be caused by hyperlipidemia — too much fat in the body, too much fatin the blood. Basically, the cells are getting stuck in oxidizing fats, due to theRandle cycle.And then, the glucose that's fioating around in diabetes, a good portion of it —because it cannot be metabolized — is being peed out … or you're converting itinto lactic acid. This [MD Anderson] paper said the exact same thing ishappening in cancer.We are seeing an abnormal rate of fatty acid oxidation, because the cell is stuckin the cycle due to oversupply of fat.The glucose, the 'cancer cell' cannot actually metabolize it, but because the cellneeds its glucose for a variety of purposes — not just synthesizing energy, butalso synthesizing DNA and RNA, and those two … can only be synthesized fromglucose, not from fats — the cancer cell says, 'Oh, I'm in a state of extremedeficiency of glucose. Give me more.'So, it increases the synthesis of these glucose transporters known as GLUT1through GLUT4. Basically, that's why when you give a patient with cancer a littlebit of radioactive sugar, it accumulates mostly into the tumor, because thetumor has a much higher capacity for uptake of sugar.However, and this is the key difference, it has a much lower capacity foroxidizing that sugar. So, you're going to see a lot of radioactive sugaraccumulation in the tumor, but most of it will get converted to lactic acid. Sothis paper that came out said, 'We need to do something that gets the cell out ofits stressed state.'And I think we already agreed that excessive oxidation of fat is a stress state.Right? We don't want to produce lactic acid, and as long as we are over-oxidizing fat, we will be producing lactic acid, and we will be uptaking moreglucose …Several studies have come out since then … and they said, 'OK, how can werestrict the supply of fat?' assuming the fat is the problem. There's only reallytwo macronutrients that can go to the cell. Assuming cancer is a metabolicdisease, and assuming a cell can only oxidize fat or sugar, then if it's not thesugar, it's got to be the fat. There's nothing else.And if it's not the mutations, if the mutations are secondary to the metabolicderangement, it's got to be one of these two macronutrients that we canmanipulate to actually try to cure the cancer. They already tried glucoserestriction … That did not cure cancer. It did have a sensitizing effect tochemotherapy, but it did not result in actual cancer remission.So now we're back to the other micronutrient, restricting the supply of fat.Multiple studies … I have at least 30 on my blog … have shown that restrictinglipolysis by administering the beta blocker propranolol … lowers lipolysis.The way [propranolol] lowers blood pressure is by blocking adrenaline. If you'reblocking adrenaline, you're also lowering lipolysis, because adrenaline is theprimary activator of the hormone-sensitive lipase enzyme. Basically, you'regoing to be restricting the supply of fat from your own tissues to the tumor.What else can be done? Well, that's not the only source of fat. You're alsogetting it through the diet. Other studies have tried doing low-fat diets forcancer, and are getting actually good results. Not cure, but good results. Thepropranolol induced full remission in the cancer."


Dinkov also cites research in which the beta oxidation inhibitor etomoxir, prescribed for heart disease, induced full remission in neuro glioblastoma, which is thought to be incurable. So, in summary, either restricting dietary fat or blocking the oxidation of fat inside the cell appears to have strong therapeutic effects against cancer by forcing the cell out of its excessive fatty acid oxidation state.

"And, once you do that, there's no metabolic damage preventing the cell fromoxidizing glucose,"

Dinkov says.

"It's all functional. If you fiood the cell with fatthen, basically, that's what the cell will oxidize, because it's overabundantrelative to the glucose that is getting to the cell. If you stop that process, or atleast greatly restrict it, the cell starts oxidizing glucose again."

The Devil in the Details

Here, I'd like to share a personal story. In an effort to adopt this new knowledge, I increased my carbohydrate intake to about 250 grams to 300 grams, depending on the day and the fruit availability. When I got my blood work back, I was surprised to find my triglycerides were in the low triple digits, just over 100, which is abnormal. Normally, I'm closer to 50. In my clinical experience, elevated triglycerides is almost always related to excessive carbohydrate intake, which seems to confiict with what Dinkov just explained. But here's the key: When you increase carbohydrates, you also have to lower fat. If you don't, you could end up with complications, as just happened to me. So, now I'm lowering my fat intake. Dinkov confirms my experience:

"Most of the animal studies say, 'High sugar diet causes this. High sugar dietcauses that.' But if you look at their diets, these animals are already on a highfat diet. All they did was add more sugar on top of it. Well, of course, in asituation like that, you're going to have an increase in the triglycerides, increasein LDL cholesterol, because the body can synthesize cholesterol from thesugars.So, you're going to get these biomarkers associated with cardiovasculardisease to increase, but it's actually not really a fair comparison. What youshould be doing is keeping the diets isocaloric, the same. And also, not increasethe total amount of calories, just replace some of that fat with sugar …Another thing that is probably important is that since there's always somebaseline lipolysis going on, when you're increasing the carbohydrate intake, theexcess that cannot get metabolized will get converted to triglycerides and thenstored.When you are increasing the carbohydrate intake, you should be decreasing theamount of fat. If you're not, then at least you should be taking something thatstimulates the oxidation of carbohydrate so that it doesn't result in the raisingof triglycerides.Aspirin, caffeine, especially vitamin B-3 niacinamide, all of these are known tolower triglycerides and, by now, the consensus mechanism of action is that allthree of these components are increasing the oxidation of carbohydrates.So, if you're increasing carbohydrates and you're getting an increase intriglycerides, two things, either you're eating too much fat or your baselinemetabolic rate is not where it should be, so you can use some metabolicstimulation from these substances."

In addition to increasing the oxidation of glucose as fuel, aspirin, caffeine and niacinamide may also inhibit the oxidation of fatty acids, specifically linoleic acid, and the most foundational strategy that anyone could implement to improve their health is to lower their linoleic acid, the omega-6 intake. These supplements will also lower infiammation, which in turn will lower your baseline cortisol. The metabolite of aspirin, salicylic acid, also has an inhibitory infect on the enzyme 11- beta-hydroxysteroid dehydrogenase Type 1. This enzyme synthesizes active cortisol from the inactive precursor cortisone.

"So, aspirin will actually lower your synthesis of cortisol directly, not just bylowering infiammation, but also lowering the actual synthesis of cortisol,"

Dinkov explains.

"A recent study demonstrated that baby aspirin, 81-100milligrams daily, decreased fatty acid oxidation by about 30% …Aspirin also has an anti-lipolytic effect, not as strong as niacinamide, but it's gotthese three different things that are basically helping to lower both the supplyof fat to the cell and excessive oxidation of fats even at these tiny dosages."

Be mindful about the aspirin you use, though. Immediate-release aspirin made with cornstarch is the preferred version that is now hard to find. Extended-release aspirin is not recommended due to the additives they put in it. Your best option would be to use a salicylic acid or willow bark supplement.

Benefits of Vitamin E

Dinkov also reviews the benefits of other supplements, such as vitamin E, which inhibits lipolysis, improves glucose metabolism, acts as an estrogen antagonist and helps counteract much of the damage caused by linoleic acid and other polyunsaturated fats (PUFAs). According to Dinkov, research suggests your need for vitamin E can be directly calculated by your PUFA intake. You need about 2 milligrams of vitamin E from all sources per gram of PUFA that you're eating. So, if you're eating 50 grams of PUFA daily — which is about 10 times what you should be getting — you need about 100 mg of total tocopherol. Importantly, PUFAs aren't just the omega-6s. It's also omega-3. In the interview, Dinkov goes into detail as to why omega-3 supplements such as fish oil are mostly garbage and shouldn't be used. I also recently wrote an article about this very topic . Whole food, in this case, small fatty fish and wild-caught Alaskan salmon are really your best bet. It's virtually impossible to find fish oil that's not rancid. So, to review, when you're calculating your PUFA intake you also need to include your omega-3s. Ideally, your daily PUFA intake would be below 10 grams.

Dinkov's Dietary Suggestions

  • antiobesity effects
  • NAD+, which has
  • important health benefits

In closing, Dinkov reviews some of his top dietary recommendations for optimal health. No. 1 is keeping PUFA intake below 10 grams; below 5 grams would be even better. No. 2 is to avoid high fructose corn syrup when adding carbs. Stick with the simple sugars from ripe fruit, raw honey (make sure it's not adulterated with high fructose corn syrup, as many are) and/or pure organic cane sugar. As for the macro composition of your diet, equal amounts of fat, carbs and protein seem to be best for otherwise healthy individuals, so he recommends getting one-third or 33% of your daily calories from each. If you have metabolic problems or some kind of infiammatory disease, he recommends cutting down on fats. Lower fat intake will also allow your body to digest protein better, as bile acids are released in response to fat, and bile interferes with the absorption of protein. Next, he recommends adding: Vitamin E, based on your PUFA intake (as detailed above) Aspirin or willow bark extract Niacinamide at a dose of 50 mg to a max of 100 mg, three times a day. In addition to antiobesity effects , niacinamide will also help synthesize NAD+, which has important health benefits Caffeine — BC powder, sold as a headache remedy, contains both aspirin and caffeine. According to Dinkov, research has shown that taking caffeine with aspirin increases the blood concentrations of both and prolongs their effects. Taking 50 mg of aspirin with 50 mg of caffeine can raise your metabolic rate by about 7% and keep it elevated for up to 12 hours Copper — Copper is the rate limiting factor for cytochrome c oxidase, (Complex 4). With aging, the amount of copper in that enzyme decreases while iron increases, and the less copper you have, the lower your metabolic rate. Ideally, get your copper from whole foods such as liver, oysters, shrimp or acerola cherry. If using a supplement, bisglycinate is a good option with high bioavailability

How to Apply This When Using Time-Restricted Eating (TRE)

If you're using time-restricted eating, or considering starting, then this final side note will be important. If you're metabolically infiexible, insulin resistant, and unable to easily switch between burning sugar and fat as your primary fuel, then a TRE program, such as that described by Dr. Mindy Pelz in my recent interview with her, may be quite beneficial, and this is true whether you're eating a ketogenic diet or not. However, once you regain your metabolic fiexibility, which can take anywhere from a few weeks to a few months, you will need to increase your eating window. The reason for this goes back to the glucose-cortisol connection, Dinkov explains in this interview. Your body needs glucose, and if you deprive it for too long, it will produce cortisol to stimulate your liver to make it. This increased cortisol can contribute to chronic infiammation and cellular damage. Therefore, once you are no longer insulin resistant, it is best to vary your eating window between eight and 12 hours, and avoid going lower or higher than that window. It is also best to avoid eating before sunrise or after sunset and at least three hours before bedtime.

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