Golden Fusion is a modern take on the centuries-old golden milk recipe that is both great-tasting and convenient. Golden Fusion features CurQFen - a highly bioavailable form of curcumin with fenugreek, along with grass-fed collagen peptides.

What is Golden Milk?
Popularized across social media, golden milk is a cross-cultural drink originating in Asian countries and consumed for its anti-inflammatory properties and pungent flavour. Also known as “golden milk latte” or “turmeric tea”, golden milk is made with freshly grated or ground turmeric, a pinch of freshly ground pepper, honey or lemon to taste, and hot water, milk, or dairy alternative. The addition of freshly grated or ground ginger adds extra flavour and additional anti-inflammatory characteristics, with cinnamon, cardamom, cloves and nutmeg rounding out the flavour.

Why Golden Fusion?

• More than just turmeric and collagen, Golden Fusion is formulated using high-quality, targeted ingredients.
• Features CurQfen, a unique, patented, stable curcuminoid (from turmeric) and galactomannan (from fenugreek) compound designed for increased bioavailability
• Curcumin, a major curcuminoid found in turmeric, may beneficially modulate signalling molecules that influence immune function
• Offers VERISOL® Bioactive Collagen Peptides® that help support skin and nail health
• Combines turmeric with collagen peptides for an innovative twist on traditional golden milk

The Golden Milk: Turmeric
While turmeric is the star of the show with its golden colour and unique flavour, golden milk is a purposefully designed elixir including ingredients that aid in the absorption and delivery of turmeric’s polyphenolic compound, curcumin, the primary curcuminoid found in turmeric. Curcumin is a poorly absorbed compound on its own, but the addition of piperine, the active ingredient in black pepper, increases the absorption by approximately 2,000%. Another well-designed feature of the golden milk beverage involves the use of whole fat milk or added fat (such as coconut milk or oil) to facilitate improved bioavailability of the fat-loving (lipophilic) curcuminoid phenols; leveraging a lipophilic design has been shown to allow for greater bio-accessibility of curcuminoids.
How To Enjoy Golden Fusion:
Mix one scoop with 150ml of hot water or your favourite milk (cow's, coconut, or almond) for a great-tasting and comforting way to supplement your diet with curcumin and collagen peptides.
 
Frequently Asked Questions...
 
What’s the Ancient Secret of Golden Milk?
With roots in traditional Chinese and Indian recipes, golden milk dates back thousands of years, and is used within the ancient branch of Indian medicine known as Ayurveda as a nourishing, delicious tonic that supports the mind and body in several ways.
The main ingredient in golden milk is turmeric, which gives it a beautiful yellow colour and healing benefits. Traditionally used to impart colour and flavour to Indian curries, the health benefits of turmeric are well-documented and researched. These include anti-inflammatory properties and support of detoxification, as well as the potential to improve cognitive function, blood sugar balance, joint health, and more.

What is the source is of our golden fusion collagen?
The source is grass-fed bovine collagen.

What is the type of collagen used?

• Primarily type I and type III.
• The collagen is hydrolyzed (pre-digested, resulting in bioactive collagen peptides)

Why does Metagenics list “Predominantly Grass-Fed” Collagen Peptides?
Grass-Fed designation is often desirable because some experts believe that these cows may deliver greater nutritional benefits. However, labeling grass-fed without qualifying with “predominantly” would be is false and misleading. The majority of cows are not exclusively grass-fed because they often eat other food, such as grain, when weather is bad and there is no grass to eat. Many other companies and suppliers do not disclose this information.
We pride ourselves on quality and transparency and will continue to set the standard for clear and accurate labelling.

by Deanna Minich, PhD
As you read through health magazines or blogs, you probably see all kinds of articles or ads promoting the next great miracle product: a detox or cleanse. The influx of products—many of which have no scientific evidence backing their promised efficacy—has led many to think that detox is just a scam or a fad. However, that is not the whole truth.
Although some of these products might be ineffectual, there are also many reputable items and programs out there that actually do work. It is these that will withstand the test of time and demonstrate that true metabolic detox is not merely a fad.
Not convinced? Read on and find out why you should give it a shot!

We Live in a Toxic World
The industrial, chemical, and technological revolutions greatly benefited us in many ways, but they have led to a highly toxic world. Environmental exposure to pollution, chemicals, and other toxins is linked to a variety of noncommunicable diseases,1 including cancer, asthma, neuro-development conditions, obesity, cardiovascular disease, diabetes, and neurodegenerative conditions like Alzheimer’s disease.2
Everyone is exposed to a number of toxins through their water, food, air, personal care products, and other elements in the environment. These include:

• Heavy metals
• Pesticides and herbicides
• Pharmaceuticals
• Plasticizers
• Flame retardants
• PCBs (polychlorinated biphenyls)
• Solvents

The human body can mitigate these toxins, but there comes a time where there is just too much, tapping out the body’s own resources.

It Requires Support
Your body has its own detoxification process, which in the scientific and medical community is often referred to as bio transformation. There are three steps to this process: bio transformation, conjugation, and elimination.
During the first stage, toxic molecules, which might come from the outside world or from metabolites of your own body processes, get molecularity transformed into a different molecule. Sometimes it becomes less toxic, but many times, it actually becomes more toxic! Luckily, the next step mollifies it into a less toxic molecule. In this phase, the molecule combines with another molecule to create something that the body can eliminate. The third step is elimination, which in some discussions on detox is excluded but is just as important as the other two steps. Once your body has transformed the toxic elements into a benign molecule, it must be excreted through your urine, feces, or sweat.
All of these processes occur whether you are on a metabolic detox regimen or not, but they often need help! Each phase requires certain vitamins, minerals, antioxidants, and other nutrients. If you have more toxins, then you will need more of these nutrients to handle the increase in the processes while your body tries to remove them from your system.
Some people have genetic differences that alter their detoxification pathways. In some instances, it speeds up either stage one or stage two. In others, it slows a stage down. Certain foods, medications, and other factors also might impact the efficacy either positively or negatively. In these instances, you might also require additional support to handle the detoxification process.
If two stages are not in sync, problems might arise. If you churn out more toxic molecules from stage one without being able to handle stage two at the same rate, then all of a sudden you have a backup of potentially troublesome molecules in the body. Similarly, if you finish stage two but cannot eliminate the toxins, they might get recycled, causing issues.
Good detox programs provide you with the food, nutrients, and herbs that support your body’s own natural detoxification system to ensure it works smoothly, in sync, and at the speed you need.

Nutrients Needed for Metabolic Detoxification
You want to ensure that you have the nutrients necessary to support the bio transformation and elimination process to get rid of the toxins in your body. You can also incorporate foods known to support the process,6 such as green tea, curcumin, cruciferous vegetables like broccoli, and dandelion. Additionally, you want to support your liver, your kidneys, and your gut, the three systems most heavily involved in detoxification.
First and foremost, the process needs energy to undergo the different stages of detox! Phase one requires antioxidant support, since it typically releases a lot of free radicals. Nutrients to ensure you consume to support your phase one include:

• B vitamins, especially B2, B3, B6, B9, and B12
• Glutathione, the body’s major antioxidant
• Protein, especially branched-chain amino acids
• Flavonoids
• Phospholipids
• Vitamins A, C, and E
• Selenium
• Copper
• Zinc
• Manganese
• Coenzyme Q10
• Thiols
• Silymarin (found in milk thistle)
• Pycnogenol

Many of the molecules needed for conjugation are amino acids, so protein is important to support phase two. Specific nutrients necessary for this phase include:

• Glycine
• Taurine
• Glutamine
• N-acetylcysteine
• Cysteine
• Methionine
• B vitamins, especially B6, B9, and B12
• Sulfur
• Antioxidants and phytonutrients

Don’t forget about getting the toxic metabolites out of your body through supporting your elimination processes. This includes sweating, whether from exercise, saunas, or something else. You also want to ensure you are hydrated and consume plenty of fiber!

Creating a Metabolic Detox Diet
Many of these nutrients are found in a generally healthy diet made up of primarily plant foods and whole foods. Thus, an essential step in providing your body with these nutrients is replacing calorie-dense foods with little to no nutrition, such as the highly processed foods rampant in the typical Western diet, with nutrient-dense foods, such as fruits, vegetables, whole grains, nuts and seeds, lean protein, and healthy fats. Furthermore, switching to an organic diet has been shown to significantly lower the level of pesticides in the body even in a short period of time.
To take it a step further, you want to incorporate a detox diet that emphasises certain foods, nutrients, and herbs known to provide support for the pathways. A good detox diet not only provides you with the nutrients your body needs to process and eliminate the toxins you face every day, but it also should have the nutrients you need for all the other processes your body undertakes, as well as your daily activities!
Don’t forget to mitigate your exposure to environmental toxins as much as possible through using air and water filters, consuming organic foods, limiting your plastic use, and more.
So, is detox a fad? NO!In the highly toxic environment in which most people live, our body requires support to do its natural practice of eliminating toxins. In fact, it is essential not just to do a metabolic detox or a cleanse as a one-off, but to adopt a detoxifying lifestyle that provides a defence against the toxins to which you will be inevitably exposed.

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.References:

1. Norman RE, et al., Environmental exposures: an unrecognised contribution to noncommunicable diseases, Rev Environ Health. 2013;28(1):59-65.
2. Moulton PV, Yang W, Air pollution, oxidative stress, and Alzheimer’s disease, J Environ Public Health. 2012;2012:472751.
3. Fourth National Report on Human Exposure to Environmental Chemicals Updated Tables, January 2017, Volume One. https://www.cdc.gov/exposurereport/pdf/FourthReport_UpdatedTables_Volume1_Jan2017.pdf.
4. Liska D, et al., Detoxification and biotransformational imbalances, Explore (NY). 2006 Mar;2(2):122-40.
5. Marinković N, et al., Polymorphisms of genes involved in polycyclic aromatic hydrocarbons’ biotransformation and atherosclerosis, Biochem Med (Zagreb). 2013;23(3):255-65.
6. Hodges RE and Minich DM, Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application, J Nutr Metab. 2015;2015:760689.
7. Oates L, et al., Reduction in urinary organophosphate pesticide metabolites in adults after a week-long organic diet, Environ Res. 2014 Jul;132:105-11.

​About Deanna MinichGuest blogger Dr. Deanna Minich is an internationally recognized health expert and author with more than 20 years of experience in nutrition, mind-body health, and functional medicine. Dr. Minich holds Master’s and Doctorate degrees in nutrition and has lectured extensively throughout the world on health topics, teaching patients and health professionals about nutrition. She is a Fellow of the American College of Nutrition, a Certified Nutrition Specialist, and a Certified Functional Medicine Practitioner. Currently, Dr. Minich teaches for the Institute for Functional Medicine and for the graduate program in functional medicine at the University of Western States. Her passion is bringing forth a colorful, whole-self approach to nourishment called Whole Detox and bridging the gaps between science, soul, and art in medicine.
View all posts by Deanna Minich →

​When your body’s gut microbiome falls out of balance, there are many ways it can affect your health.
What’s a microbiome? It’s the genetic material of all microbes—bacteria—that live on and inside your body. The good bacteria that contribute to your intestinal microbiome are essential to your health, development, immune function, and nutritional status.
Sound complex? It is! And it’s a delicate balance that can easily be disrupted. Here are five key ways your gut microbiome may be negatively impacted:1

1. Stress
   We all deal with stress, but when it becomes acute and chronic, studies show it can have a physical impact on the gut microbiome, even leading to such gastrointestinal disorders as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), peptic ulcers, and gastroesophageal reflux disease (GERD).
2. Birth Method
   Studies show, babies born by C-section have reduced bacterial diversity and lower levels of good bacteria than babies born via the birth canal.
3. Exercise
   Lack of exercise has been linked to reduced bacterial diversity in the gut and when it comes to the gut, the more types of good bugs, the better. (It’s time to get moving!)
4. Antibiotics
   Taking antibiotics can disrupt the delicate balance of bacteria in the gut, as it kills off microorganisms—the bad and the good.
5. Diet
   Diets low in fiber and high in sugar can have a negative impact on gut bacteria. While fiber feeds good bacteria, sugar feeds bad bacteria, yeast, and parasites. Additionally, excessive alcohol consumption can reduce the good bacteria in your gut.

Do any of these situations apply to you? Fortunately, there are a few things you can do. Lifestyle changes, like effective stress management and more exercise, and dietary modifications, including cutting back on sugar, are a place to start. In addition, a probiotic supplement can help support healthy and balanced intestinal flora by recolonizing the gut with good bacteria.* When choosing a quality probiotic, work with your healthcare practitioner to select one with identified strains at clinically proven doses.
*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.
References:

1. University of Colorado Boulder. Gut Check: Exploring Your Microbiome. Coursera.https://www.coursera.org/learn/microbiome. Accessed August 19, 2016.
2. Konturek PC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinicalconsequences, diagnostic approach and treatment options. J Physiol Pharmacol. 2011;62(6):591-9.

Eat a healthy breakfast. It sounds simple enough. But what exactly does that mean?
While there is no definition of the “perfect breakfast,” it makes sense that there are ideal and less than ideal ways to energize your body. So let’s compare typical breakfast options to various types of fires and ways to fuel your morning right!
​
The Cooking Fire:
This fire is the equivalent of a stove range. It burns slowly, evenly and can literally last all day.

The breakfast equivalent? A breakfast that will keep you energized all day with stable blood sugar levels should always have lean protein as its base. Like seasoned firewood, lean protein is a slow burn fuel. It improves glycemic response, inhibits the secretion of the hunger hormone ghrelin and stimulates the secretion of the satiety hormones peptide YY (PYY), glucagonlike peptide 1 (GLP-1) and cholecystokinin (CKK). 11 The net effect? You feel more satisfied and have fewer food cravings, which may also help maintain a healthy body weight.

In addition to protein, some minimally processed fats, such as avocado, olive or coconut oil, not only add flavor but also further increase satiety. Carbohydrates should ideally be limited to whole food sources (fruits, vegetables, legumes, and whole grains)—as close to their natural form as possible. Think steel cut oats, rather than instant oatmeal.

Here are some examples of slow burn breakfasts and tips to get you started.

• Make a shake. These can be as simple as powder and water in a shake cup or can be dressed up and blended with frozen fruits, dairy or alternative milks, and any number of ingredients for a flavor and nutritional boost. Ideally, select a powder with at least 15 grams of protein. (Check out Tips for Better Shakes!)
• On the go. Enjoy 8 ounces of high-protein, no-sugar-added yogurt (think Greek or Icelandic). Have 2 hard-boiled eggs and a slice of whole-wheat toast. Grab a handful of roasted soynuts and a piece of fruit. Or choose muesli with nuts and dairy or alternative milk (no cooking!).
• Plan ahead. Prep individual portions of frozen berries and greens for quick smoothies. Egg frittata: make in volume in a half-sheet pan. Breakfast burrito (egg or tofu scramble) can be made ahead, individually wrapped, frozen, then warmed in a toaster oven. Or try individual overnight oats.

The Kindling Fire:
This fire burns hot and fast. It ignites quickly, then extinguishes once it has consumed its fuel: paper, leaves, etc. It’s all kindling, no logs.

Think of the typical bagel and juice breakfast as a kindling fire. The more processed, more sugar-laden your breakfast, the faster your body burns it. In the big picture of long-term health effects, within reason, any breakfast is better than no breakfast at all. True, it gives you some fast energy. But keep in mind, it may leave you hungry and needing energy by mid-morning.

No Fire:
Do you skip breakfast? If so, you’re in good company. In fact, according to a national survey, “breaking the fast” is not on the morning agenda of 31 million American adults. How might skipping the most important meal of the day affect you? Research supports the importance of breakfast for better energy and healthier food choices throughout the day, wins for everyone. But if you fit the following criteria, you may have even more to gain from breakfast 1,2.

• You want to maintain a healthy weight
  • Many people routinely skip breakfast in the belief that the missing calories will help their waistline. 3 It doesn’t work that way.
  • In contrast to skipping, those who eat breakfast regularly not only have more adequate micronutrient intakes 3 but also tend to have a lower body mass index, as well as report reduced hunger and food cravings throughout the day 4. Further, eating breakfast is associated with not only lower body weight but also maintained weight loss. This health benefit was shown in a study by the National Weight Control Registry, 3,000 people who maintained a 30-pound weight loss for at least a year. What was one common habit? Nearly 80% of them regularly ate breakfast. 5

• You value your exercise workout performance
  • According to research studies, skipping breakfast may compromise your workout at any point in the day. 6,7 So to get the most from your exercise efforts at any point in the day, consider breakfast part of your workout routine.

• You’re concerned about cardiovascular health
  • Research has long shown an association between breakfast skipping and risk factors for cardiovascular disease, such as obesity, hypertension, dyslipidemia, and glucose intolerance. But a 2016 study of more than 80,000 Japanese men and women showed an even more compelling argument for breakfast: The researchers studied the breakfast patterns of men and women 45-74 years of age with no history of cardiovascular disease. According to the analysis, those who skipped breakfast had significantly higher risk for total cardiovascular disease and stroke compared with those who regularly ate breakfast. 8
  • Breakfast may also help avert atherosclerosis. Analysis of an ongoing study cohort showed that those individuals who skipped breakfast doubled their risk for generalized atherosclerosis—and their risk for subclinical atherosclerosis (considered a serious disease risk warning) increased by 75%! 9

• You want to maintain healthy blood sugar levels
  • The very nature of “breaking the fast” helps metabolism and blood sugar, both of which are lower during the evening “fast,” return to appropriate daytime levels. So skipping breakfast may mean sluggish metabolism—as well as a brain running on empty. However, for those with blood sugar control issues, eating breakfast should be a priority. In fact, new research suggests that for individuals with type 2 diabetes, skipping breakfast may potentially disrupt blood sugar levels all day.
  • In a small clinical trial, researchers found that when patients with type 2 diabetes skipped breakfast, their lunchtime blood sugar levels were 37% higher than on a baseline day with breakfast. Further, on the breakfast-skipping day, blood sugar levels remained 27% higher at dinner time. 10
  • Given that high postprandial blood sugars are strongly associated with a rapid decline in beta-cell function, breakfast skipping should not be taken lightly. Beta cells are the pancreatic cells that produce insulin. Our bodies require insulin in order to use the carbohydrates in food as fuel. Further, insulin spikes, considered inflammatory, are also linked to earlier development of heart disease complications.
  • A simple morning meal can benefit your workouts, weight, and cardiovascular health as well as stabilize blood sugar. So even when life gets in the way, don’t skip it.

What’s your excuse for skipping breakfast?

• I don’t have time.
  Pressed for time? Try planning ahead: Prepare breakfast the night before or make something in bulk for the week.
• I’m not hungry in the morning.
  Your body adapts to eating patterns. If you’ve trained it to not be hungry in the morning, go slowly. Start your day with a piece of fruit, a handful of nuts, a hard-boiled egg, or just a few bites. Over time, your digestive system adjusts to these sensory cues and adapts to your new pattern of eating.
• I’ll make up for it later in the day.
  Eating breakfast provides an extra opportunity to consume valued but often under consumed nutrients and food groups. For example, an orange or apple provides not only a serving of fruit but also fiber, helping you meet recommended daily quantities for both.

References:

1. National Heart Lung, and Blood Institute Obesity Education Initiative Expert Panel (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res. 6 (Suppl 2): 51S–210S.
2. Wadden, TA, Stenberg, JA, Letizia, KA, et al. (1989) Treatment of obesity by very low-calorie diet, behavior therapy, and their combination: a five-year perspective. Int J Obes Relat Metab Disord. 13: 39–46.
3. Nicklas, TA, Myers, L, Reger, C, et al. (1998) Impact of breakfast consumption on nutritional adequacy of the diets of young adults in Bogalusa, Louisiana: ethnic and gender contrasts. J Am Diet Assoc. 98: 1432–1438.
4. Cho E. Dietrich M, Brown CJP, Clark CA, et al. The effect of breakfast type on total daily energy intake and body mass index: results from the Third National Health and Nutrition Examination Survey (NHANES III). J Am Coll Nutr 2003:22(4):296-302.
5. Wyatt HR, Grunwald GK, Mosca CL, et al. Long-term weight loss and breakfast in subjects in the National Weight Control Registry. Obes Res. 2002;10(2):78-82.
6. Sherman WM, Peden CM, Wright, DA. Carbohydrate feedings 1 h before improves cycling performance exercise. Am J Clin Nutr. 1991;54:866-70.
7. Clayton DJ, Barutcu A, Machin C, et al. Effect of Breakfast Omission on Energy Intake and Evening Exercise Performance. Med Sci Sports Exerc. 2015;47(12):2645-2652.
8. Kubota Y, Iso H, Sawada N, et al. Association of Breakfast Intake With Incident Stroke and Coronary Heart Disease. Stroke. 2016;STROKEAHA.115.011350, originally published January 5, 2016.
9. Uzhova I, Fuster V, Fernandez-Ortiz A, et al. The Importance of Breakfast in Atherosclerosis Disease. Journal of the American College of Cardiology Oct 2017, 70 (15) 1833-1842.
10. Jakubowicz D, Wainstein J, Ahren B, et al. Fasting until noon triggers increased postprandial hyperglycemia and impaired insulin response after lunch and dinner in individuals with type 2 diabetes: a randomized clinical trial. Diabetes Care. 2015 Oct;38(10):1820-6.
11. Bolster D, Rahn M, Kamil A, et al. The effects of reduced protein-nutrition bars with enhanced leucine content on ratings of fullness in healthy women. Paper presented at: American Society for Nutrition Scientific Sessions & Annual Meeting at Experimental Biology 2016; April 5, 2016; San Diego, California.

​About Maribeth EvezichMaribeth Evezich, MS, RD is a functional nutrition and therapeutic lifestyle consultant. Maribeth is also a graduate of Bastyr University and the Natural Gourmet Institute. Whether she is in her kitchen experimenting, at her computer researching, or behind the lens of her camera, she is on a mission to inspire others to love whole foods. as much as she does. She lives in Seattle and is the founder of Lifestyle Medicine Consulting, LLC and the culinary nutrition blog, Whole Foods Explorer. Maribeth Evezich is a paid consultant and guest writer for Metagenics.
View all posts by Maribeth Evezich →

​
Why sleeping position matters
By Robert G. Silverman, DC

How do you feel when you wake up in the morning? Refreshed, rested, and ready to go? Or stiff, achy, and wishing you could go back to sleep for another few hours? The difference may depend on your sleeping position.

Sleeping on your back
Most experts agree that sleeping on your back is the ideal position, but it’s not for everyone. When you sleep on your back, you stretch your body out evenly on the mattress. Your head, neck, and spine are aligned in a neutral position—there’s no extra stress on any part of your body. As a chiropractor, I recommend back sleeping, because it puts the least amount of pressure on the vertebrae and discs of the spine.
If you have trouble with acid re-flux, lying on your back with your head elevated a bit by your pillow is a good way to keep acid from coming up. But sleeping on your back has one big drawback: snoring.
If you already snore, lying on your back makes it louder. This is the most likely position to trigger “Honey, roll over” from your bed partner. It’s also the worst position for sleep apnea, a sleep disorder that makes your breathing repeatedly stop and then start again, sometimes with a loud snorting or choking sound, usually because the throat muscles relax during sleep and block the trachea.
Sleep apnea is linked to heart disease and high blood pressure (among other problems), and can even be fatal. If you’re a heavy snorer, talk to your doctor about doing a sleep study to detect sleep apnea.

Sleeping on your side
The side position, with your torso straight and legs stretched, keeps your spine elongated and unstressed. If you tend to wake up with back and neck pain, try this position—after a few days, you’ll notice a positive change in how you feel in the morning. It’s also a good choice if you snore or have sleep apnea, because it helps keep your airway open.
If you have acid reflux, sleeping on your side keeps the acid from coming up. Sleeping on your left side works better for this, because in that position, the stomach is below the esophagus; gravity keeps the acid in the stomach where it belongs.
During pregnancy, many women find that sleeping on their side is the most comfortable position for breathing comfortably and relieving backache. If you can, sleep on your left side to increase the amount of blood that flows to the womb and nourishes the baby. For added comfort and support, put a pillow between your legs.

The fetal position
Curling up on your side, much as babies and small children do, is perhaps the ideal sleeping position. With your torso and legs bent, you’re putting as little stress as possible on your spine while you sleep. This is a great position for reducing snoring and preventing acid reflux.
The drawback is that it can be tough on the joints if you have arthritic hips or spinal stenosis—you might wake up feeling stiff and sore. Put a pillow between your knees to reduce the risk of lower back pain or stiffness.
If you regularly sleep on your side, your pillow matters. You want a pillow that will support your head in a neutral position and avoid putting stress on your neck. Side sleepers who wake up with neck pain or stiffness should take a good look at their pillow. Ideally, it will be firm enough to comfortably support the head and neck. Position yourself so only your head and neck—not your shoulders—are on the pillow.

Sleeping on your stomach
Ordinarily, you would be inclined to tell your patients to sleep in whatever position is most comfortable for them. There’s one exception, however: sleeping on your stomach. This position puts a lot of pressure on the back and neck. Because you have to turn your head to one side to breathe, you’re likely to wake up with stiff and sore neck and shoulder muscles; you might even wake with numbness and tingling in your arms. Sleeping on your stomach also puts a lot of pressure on the lumbar (lower) spine, so you could wake up with lower back pain.
Sleeping on your stomach also puts pressure on your digestive system, heart, and lungs. If you snore, you’ll snore more sleeping on your stomach. And if you have sleep apnea, it will be worse when you sleep on your stomach.
If you’re a stomach sleeper, I suggest trying to alter your sleeping habits and sleep on your side instead. To help you get used to the new position, lie on your side and put a pillow next to you near your abdomen. It will help keep you from rolling onto your stomach.

Choosing the right pillow
Your sleep position is crucial for waking up feeling great, but other factors come into play. Your pillow is critically important for supporting your head and keeping your head and neck aligned while you sleep. Choose a pillow that matches your favourite sleeping position.
Back sleepers usually do best with a medium-soft pillow that supports the natural curve of the neck. If you’re a snorer, elevating your head may lower the volume and help with sleep apnea. Try using two or three firm pillows or a wedge pillow to raise your head, neck, and shoulders.
Side sleepers should look for a firm or even extra-firm pillow that will keep your head and neck aligned. If you must sleep on your stomach, look for a thin soft pillow that won’t bend your neck out of its natural curve. For your patients with neck pain, recommend a cervical pillow.
Pillows are filled with all sorts of materials: latex, polyester, down, even buckwheat hulls. Many chiropractors feel the best choice of material by far is memory foam. The foam adapts to provide pressure-free support for the head and neck and helps keep the spine in alignment during sleep.
Nevertheless, good sleep position won’t make up for a bad mattress. Anecdotal reports from patients that suggest the ideal mattress is made of memory foam. A memory foam mattress contours to the spine’s natural curves and distributes body weight evenly. With no pressure points or sags, memory foam mattresses promote comfortable sleep through the night.
​
Sources:

1. Børge Sivertsen, Tea Lallukka, Keith J Petrie, Ólöf Anna Steingrímsdóttir, Audun Stubhaug, Christopher Sivert Nielsen. Sleep and pain sensitivity in adults. PAIN, 2015; 1.
2. Arie Oksenberg, Ph.D., Elena Arons, Ph.D., Khitam Nasser, PSGT, Tatiana Vander, M.D., and Henryk Radwan, M.D. REM-related obstructive sleep apnea: the effect of body position. J Clin Sleep Med. 2010 Aug 15; 6(4): 343–348.
3. R.M. Khoury, L. Camacho-Lobato, P.O. Katz, M.A. Mohiuddin, D.O. Castell. Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease. Am J Gastroenterol. 1999 Aug;94(8):2069-73.
4. Jennifer N. Felder; Rebecca J. Baer; Larry Rand; Laura L. Jelliffe-Pawlowski; Aric A. Prather. Sleep disorder diagnosis during pregnancy and risk of preterm birth. Obstetrics & Gynecology. 130(3):573–581, 2017.
5. R.A. Lavin, M. Pappagallo, K.V. Kuhlemeier. Cervical pain: a comparison of three pillows. Arch Phys Med Rehabil. 1997 Feb;78(2):193-8.
6. A. Radwan, P. Fess, D. James, J. Murphy, J. Myers, M. Rooney, J. Taylor, A. Torii. Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain; systematic review of controlled trials. Sleep Health. 2015 Dec;1(4):257-267.

​About Robert SilvermanRobert G. Silverman, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC, FAKTR is a chiropractic doctor, clinical nutritionist and author of Inside-Out Health: A Revolutionary Approach to Your Body, an Amazon number-one bestseller in 2016. The ACA Sports Council named Dr. Silverman “Sports Chiropractor of the Year” in 2015. He also maintains a busy private practice as founder of Westchester Integrative Health Center, which specializes in the treatment of joint pain using functional nutrition along with cutting-edge, science-based, nonsurgical approaches. Dr. Silverman is a seasoned health and wellness expert on both the speaking circuits and within the media. He has appeared on FOX News Channel, FOX, NBC, CBS, CW affiliates as well as The Wall Street Journal and NewsMax, to name a few. He was invited as a guest speaker on “Talks at Google” to discuss his current book. As a frequent published author for Dynamic Chiropractic, JACA, ACA News, Chiropractic Economics, The Original Internist and Holistic Primary Care journals, Dr. Silverman is a thought leader in his field and practice.
View all posts by Robert Silverman →

We all experience stress from time to time. The release of stress hormones, including adrenaline and cortisol, helps you cope with immediate challenges. But when your level of stress becomes chronic or goes beyond what your body can handle, it can compromise your physical, emotional, and mental health—which can make it even harder for you to cope with future stress and stressors.
Did you know you can control how your body reacts to friendly and not-so-friendly stressors? Finding quick and effective “tension tamers” that turn off the alarm response and turn on the relaxation response helps your body return to normal functioning following a stressful event.
Try several of these techniques and find out what works best for you in times of stress. You’ll feel calmer within minutes!

1. Breathe from your belly.
   Sit in a comfortable position and take a few deep breaths by expanding your belly (rather than lifting your shoulders). Releasing physical tension and increasing oxygen intake calms you quickly—even if stressful events continue.
2. Take a short walk.
   Change your scenery and change your perspective—indoors or outdoors. Walking gets your blood circulating and helps you blow off stream so you can return with a new frame of mind.
3. Spring into action.
   Even a short burst of exercise (like running up several flights of stairs or several sets of push-ups or abdominal crunches) can reduce stress. Exercise helps deliver more oxygen to your brain and distracts you from stress to give you a fresh perspective. Even simple stretching can help bring a little relief.
4. Listen to music.
   Soft music can help relax tense muscles or get you in the zone when practicing other stress reduction activities: yoga, guided imagery, or soaking in the tub. And upbeat music can help lift your mood or keep you energized.
5. Dance or sing.
   Start moving to your favorite tunes or just sing along. Bursting into song or a silly dance move can transport you to a stress-free zone.
6. Take a mental break.
   Steal a few minutes of peace to gaze out your window or visualize yourself in your favorite space, doing your favorite things, or being with your favorite people. It renews the spirit and breaks the stress response quickly.
7. Laugh.
   Maintaining a sense of humor reminds us that our stressors may not be as menacing as they seem. Purchase or download a laugh track, cartoons, jokes, or your favorite comedy TV show or movies to enjoy when you’re feeling overwhelmed.
8. Write in a journal.
   If you like to write, journaling clarifies your thoughts and feelings for increased self-knowledge. Putting the experience on paper gets it off your mind and helps you refocus—and teaches you to cope the next time it happens.
9. Take a power nap.
   Midday sleep gives you more patience, better reaction time, increased learning, more efficiency, and better health. If you only have five minutes to spare, just close your eyes. Even brief rest reduces stress and helps you relax.

Don’t change your life; change your response to stress
You don’t have to make big changes in your life to reduce your stress level. Just lessen the impact that stressful occurrences can have on you. These quick and simple tips make it easy for you to change your response to stressors and live a more positive, fulfilling life.
For more help with living a lower-stress lifestyle, talk to your healthcare practitioner.

​When you first decide to supplement with fish oils to support your overall health, you may wonder: With so many product options available, how do I know what to look for?
Watch for Purity Testing when selecting a fish oil supplement, know there are various forms of testing that can be done to ensure the source meets quality standards. You should feel confident that the fish oil you choose lives up to its purity and potency claims and has been extensively tested for contaminants that are potentially harmful. Here’s what you need to know.
Something’s Fishy - Don’t settle for a lesser fish oil. Seek out a reputable supplement company that conducts potency testing in addition to testing for the following contaminants and toxins.

• Potency: Testing to verify fatty acid content matches what is listed on the label—EPA, DHA, and other omega fatty acids such as omega-6s.

• Rancidity potential (oxidative measures): Testing to ensure freshness has not been compromised by exposure to air, heat, light, and metals during manufacture, which can affect taste and smell.
  • Peroxides
  • Anisidine
  • TOTOX

• Environmental contaminants & heavy metals: Purity testing for the presence of environmental toxins and industrial chemicals.
  • Dioxins & furans
  • Polychlorinated biphenols (PCBs)
  • Dioxin-like PCBs
  • Heavy metals (lead, tin, cadmium, mercury, arsenic)
  • Other industrial metals (iron, copper)
  • Iodine 131

Reputable third-party laboratories offer reliable, analytical methods for characterising the identity, purity, composition, and authenticity of fish oil formulas. Be sure to look for a quality guarantee with verified testing information that ensures the highest level of purity possible.
If you suspect a bad fish oil, remember: There are plenty of other fish in the sea!
Fishing for Good Health
Experience the benefits of fish oil by choosing a quality formula with proof of testing to meet your standards and support overall health.*

If modern life’s got you feeling frantic, you’re not alone. These days, it seems most of us are living in an almost constant state of ‘on,’ pulled in too many directions at once, pressured from all sides, over-tethered to tech and perpetually behind the eight-ball. Amidst the daily chaos, it can be mind-bogglingly challenging to find the respite that your brain and body so desperately need.
 
While a vacation by the sea or to the mountains always helps, in between getaways, it’s essential to find other ways to unwind your hyped-up mind, relax your too tense body, and feel more peaceful. How to do that without booking a trip to paradise? In a word: meditation.
 
Yes, I know, you say you’ll get around to it when you’re less stressed, when the kids graduate college, when the cows come home, yada, yada, yada. But now, actually, when you’re in the middle of the “Stress-nado,” is as good a time as any to start (or re-start) your meditation practice. Not only is meditation an always-accessible, drug-free stress-buster, you’ll also be gifting your heart, brain and gut with system-wide health benefits no prescription drug can touch. Here are a few ideas to inspire your meditation practice and how to get started:
 
Make meditation your emotional medication.
Meditation cultivates adaptability and resilience and reduces reactivity. A steady practice can help you manage strong emotions and ride the choppy waves of life, be they in the form of an angry teenager, a demanding boss, bumper-to-bumper traffic, or just about anything in between. A regular meditation practice helps create a solid, more chilled-out foundation from which you can never be fully rocked. When you start the day from a calmer place, you’ll be less likely to fly off the handle when life triggers you – and that’s good news for everyone in your life. Think of it this way: meditation is medication without a single downside.
 
Meditation will help keep your brain healthier, longer.
Meditation also delivers plenty of physiological benefit too. This practice has a remarkably positive influence on keeping chromosomes young; helping to improve focus, attention, memory, processing speed, and creativity; and it may even slow brain aging, counteracting the age-related atrophy that can lead to cognitive decline and conditions like dementia. So, no more excuses, eh?
 
Meditation will take the edge off anxiety and high blood pressure.
Meditating is also linked to decreased blood pressure and reduced stress and anxiety, which is why a daily practice “primes the pump” for getting a good night’s sleep. You’ll help trigger the release of feel-good endorphins that boost mood, help curb anxiety and tame pain. You’ll also reduce stroke and heart disease risk. Best of all, you don’t need to retreat to a hut in Nepal to reap the enormous benefits of the practice. Regular sitting for as little as ten minutes a day can have positive effects. With practice, as your sessions grow longer, to 20 or 30 minutes or more, all those physiological and psychological benefits will to!
 
Get into the groove – with as much assistance as you need.
As for learning how to meditate, there are many options available. There are numerous books by established teachers and plenty of YouTube demos – all of which are great for getting your toes wet. But frankly, nothing beats working directly with a live instructor, in real time. Building a relationship with a teacher will help you develop and maintain a lifelong practice, and help keep you engaged and accountable through the peaks and valleys. Remember, meditation is a practice – the more you meditate, the better you’ll get at it, so be patient with yourself and keep practicing. For extra support between sessions with your teacher, you can also incorporate an app into your practice. Among them: Calm; The Mindfulness App; OMG! I Can Meditate! and Stop, Breathe & Think and Smiling Mind to name a few.
 
Give brain and body a vacation, any time you need to.
When you think meditation, images of ancient holy men in the Lotus position may come to mind. That, understandably, may not exactly be your speed. Feel free to sit with feet folded over your thighs if you like, but you can just as easily settle into a comfortable chair or meditate while standing, walking or lying down. Just shut your eyes (or keep them open, if you prefer) and focus on your breathing for a few moments and that will do the trick. The goal is to to put the brakes on your over-revved system and literally just breathe.
 
You have the time. Seriously. You do.
I know you’re probably saying, “But doc, there aren’t enough hours in the day!’ and yes, that’s true to a point. But I’m not asking you to put in hours every day. If you do, bravo! For everyone else, it’s about being creative with your time, and committing to a program that fits into the small slivers of time you do have, right now. Down the road, as your practice grows, you can make more time for meditation if you choose.

​But to begin, feel free to start small with these tips:
 
1.    At the start or end of your day, trade 10 minutes of time-sucking social media, video games or TV for 10 minutes of meditation.
2.   Two to three mornings a week, get up a few minutes earlier to meditate upon rising, before the rest of the family wakes up.
3.   Meditate in the car before or after the drive, instead of listening to the news or making calls.
4.   On the commuter train, put on a pair of noise canceling headphones, and meditate instead of reading email or the headlines.
5.    At lunchtime, pop into a local house of worship and enjoy the silence while you meditate.
6.   ‘Book a cushion’ at a drop-in meditation studio like MNDFL, for a 30-minute group lunchtime session.

1. What is the ketogenic diet?
Low in carbohydrates with moderate protein and high in fat, a ketogenic diet prompts the body to burn fat for energy rather than glucose, which leads to the production of ketone bodies—molecules that can be used as a source of fuel. A typical ketogenic diet consists of ~70% fat, 20% protein, and 10% carbohydrates. Though this can vary slightly depending on the individual, this diet is specifically designed to induce nutritional ketosis.
2. What is ketosis?
When ketone bodies accumulate in the bloodstream (>0.5 mmol/L) due to low glucose availability, they cause a metabolic state called ketosis. The most efficient approach to induce nutritional ketosis is to lower dietary carbohydrate intake while increasing fat intake. This reduction in carbohydrate intake helps the body shift toward a state that promotes the breakdown of fats (from the diet and your body) to produce ketone bodies and enter ketosis.
3. How does the ketogenic diet differ from a paleo diet, Mediterranean, Atkins?
One diet does not fit all—the best diet is the one that you can stick with for long-term. As a lifestyle modification, it should be closely monitored and modified as needed.

​4. What is intermittent fasting? How is this beneficial for someone on ketogenic diet?
Intermittent fasting (IF) limits the eating window to just a few hours a day. However, during this window, one simply eats to feel full. This practice allows the body to increase the amount of food intake at one time, and induce adaptive metabolic changes. There are many different variations of intermittent fasting,and many different reasons for doing so. Some people may experience mental clarity and focus as well as using intermittent fasting to get over a plateau.
5. What are ketones? How are they produced?
Ketone bodies production in the liver is a natural process when the body increases the use of fat as the main source of fuel. This occurs during a fasting state and/or prolonged exercise, or when dietary carbohydrates are very low. There are three endogenous ketone bodies. These are acetone, acetoacetate and beta-hydroxybutyrate (βHB).
When following a ketogenic diet, your brain, as well as other organs and tissues, depend on ketones as an energy source. Ketones can be measured in the blood, breath and urine, and measuring can be helpful when following a ketogenic diet or program to ensure that the desired level of ketosis is reached and maintained.
6. What is keto-adaptation? How long does it take to adapt?
Keto-adaptation is the process the body goes through during the ketogenic diet as it switches to using fat as an energy source rather than glucose. The length of time varies for individuals, but typically starts a few days after being on a ketogenic diet. Within a week to two weeks, many people report positive effects of keto-adaptation, and studies have shown that signs of keto-adaptation (such as increase in fat oxidation) occur within this time-frame.
7. What are exogenous ketones vs. endogenous ketones? Are there benefits to taking exogenous ketones?
Exogenous ketones are ketone bodies in either mineral or ester forms that can be ingested as a nutritional supplement, producing acute elevations in circulating ketone levels. Nutritional ketosis resulting from adherence to a ketogenic diet is often referred to as endogenous ketosis in contrast to peripheral ketosis induced by supplementation, referred to as exogenous ketosis.
8. Which patients or individuals would be excluded or not advised to follow a ketogenic diet?
While the ketogenic program can benefit a wide array of patients, it may not be suitable for patients with possible inborn metabolic disorders (CPTI or II deficiency; β-oxidation defects [LCAD, MCAD, SCAD]; and pyruvate carboxylase deficiency). Caution should also be used in patients with the following conditions:

• Type 1 Diabetes (diabetic ketoacidosis (a mixture of high blood glucose with high KB levels) can result in acidosis)
• Kidney disease (the ketogenic diet has not been studied in people with impaired kidney function)
• Liver disease

9. Is it safe long term? How long should a patient be on the ketogenic diet?
Depending on the health goals, the practitioner may recommend a specific time period for the patient to be on the ketogenic diet. There are many people and cultures that go into ketosis and stay there for a long period of time without any negative effects.
10. Can someone just dabble in keto for a few days/weeks? Can they still get benefits?
While there is evidence to support the long-term use of ketogenic diets without serious side effects, there are also benefits to just doing a cyclical ketogenic diet. We encourage patients to stay on the ketogenic program for a period of 6-12 weeks as it takes some time for the body to be “keto-adapted” and for them to start seeing results.
  11. During the keto-adaptation process, which noticeable changes are expected and what is the “keto flu”?
During the keto-adaptation process, many people may experience symptoms of the “keto flu”. These symptoms occur because the body, being used to utilizing carbohydrates as main source of energy, is going through a metabolic shift to burn fat instead. Some people describe this as a feeling of withdrawal. Symptoms one may experience include feeling drowsy, achy, nauseous, dizzy, and irritable. Some may even experience cramping, stomach pains, and muscle soreness.
 12. How long do these symptoms last?
It varies for the individual, but the keto flu lasts typically a week or less for the average person and not everyone experiences the keto flu. However, below are some anecdotal ways to mitigate symptoms of the keto flu. Increase electrolyte intake, but avoid those electrolyte sports drinks with high sugar.

• Drink more water
• Eat more quality fat
• Take an exogenous ketone supplement
• Increase in exercise
• Get plenty of sleep

 13. How should a patient measure whether they have achieved ketosis?
Ketones can be measured in a variety of ways via a breath meter, urine strips, or a blood meter. The blood meter is the most accurate way to measure the levels of ketones (primarily βHB) in the body. However, this method is more invasive than others, and can also be significantly more expensive. Your healthcare practitioner can advise you on commercially available blood meters to test ketone levels by looking at circulating levels of βHB measured in millimolar (mmol/L) units.
14. What levels should be achieved (millimolars)?
While variable among individuals, βHB ranges >0.5mmol are considered the beginning of the range of nutritional ketosis and a range at which clinical benefits (for example to body weight management) have been described. Work is ongoing to understand the optimal range of circulating ketones for different outcomes.

​15. Why is it important to incorporate as we age?
The healthy young brain relies solely on glucose to obtain energy for its functional and structural needs. During healthy aging, brain glucose uptake is 10-15% lower and can be up to 35% lower in certain brain areas in neurological disorders such as Alzheimer’s Disease. In contrast, brain uptake of ketones appears to still be normal in the brains of Alzheimer’s disease patients. A common misconception is that the brain can only use glucose. Ketone bodies are the only alternative source of energy for the brain as it cannot utilize free fatty acids (FFAs). Both rodent and human studies have shown increase uptake of ketone bodies by the brain following peripheral infusion of ketones, prolonged fasting, or a ketogenic diet. They observed that up to 70% of brain’s energy demands were provided by ketone bodies available in circulation (blood) and taken up by the brain.
16. Why is it used for weight loss?
Ketogenic diets that are rich in fat and low in carbohydrate induce a decrease in blood sugar and insulin levels. A reduction of circulating insulin levels causes an increase in the metabolism of fatty acids (increased lipolysis-the breakdown of lipids) from adipose tissues for utilization as energy. The liver uses FFA derived from dietary source and release from adipose tissue to oxidize and generate ketone bodies in order to meet the energy demand. Ketone bodies in circulation provide a stable source of fuel for the body and the brain, thereby sparing the need to break down muscle protein into glucose as energy supplies. A ketogenic diet encourages the burning of body fat as fuel, as well as inducing satiety between meals. Additionally, a ketogenic diet may help suppress appetite and reduce cravings.
17. Why is it used to prevent cognitive decline?
With a ketogenic diet, the brain utilizes ketone bodies instead of glucose as its primary fuel source. This switch can help encourage more nerve growth factors and synaptic connections between brain cells, and result in increased mental alertness, sharper focus, and improved cognitive capabilities.
 18. Why is it used for diabetes?
Studies have shown that low-carbohydrate diets help support insulin metabolism in the body. This is because the absence of carbohydrates in the diet can reduce circulating insulin concentrations and contribute to glucose control.
 19. Will this affect cholesterol? Isn’t this diet is too high in fat for weight loss or CVD patients?
The ketogenic diet, as many diets, can positively influence body weight and cardiometabolic health and potentially improve dyslipidemia. Ketogenic diets are by design high in fat, and the type of fat is an important consideration as is the overall quality of the foods eaten within the diet. In terms of cholesterol levels, although there are studies to show that total cholesterol and total LDL cholesterol may increase on a ketogenic diets, more detailed analysis of cholesterol profile has shown the following:

•  Increase the concentrations of HDL cholesterol more than low-fat, high-carb diets
•  Lead to higher levels of HDL cholesterol
• Decrease LDL particle concentration (LDL-P) and increase the size of LDL cholesterol
• Decrease the amount of harmful VLDL cholesterol in the blood1

As with any diet, there is variability in how people respond. It is recommended that the practitioner monitor biomarkers of health including blood lipid profile, blood pressure, inflammation, insulin signaling, blood glucose parameters, waist circumference, lean body mass.
20. Why do athletes use it?
Low-carbohydrate, high-fat and ketogenic diets are increasingly adopted by athletes for body composition and sports performance enhancements. There is not one diet that fits all or perhaps most. The literature on ketogenic diets in athletes is limited but variable with some studies showing no negative impact and others suggesting that a ketogenic approach may not be ideal. As the science evolves in this area, current thinking is that the health status of the individual athlete and type of exercise (endurance vs high intensity) they are performing is important. For example, a ketogenic approach has been discussed as being beneficial for those participating in endurance activities, or for those who need to increase power-to-weight ratio, however specific studies in these areas are currently lacking.
21. Isn’t glucose needed for energy for workouts?
Carbohydrates only go so far to sustain energy throughout the day, and especially during a workout. In ketosis, your body uses fat as fuel instead of glucose, to provide the brain with a consistent supply of the ketone bodies necessary to sustain physical performance.
22. Isn’t this diet too low in protein for my patients with sarcopenia or who are athletic?
Studies show that low carbohydrate ketogenic diet is effective in body weight reduction without inducing lean body mass loss, preventing the risk of sarcopenia. Consumption of approximately 25–30 grams of high-quality protein per meal maximally is recommended to stimulate muscle protein synthesis and slow sarcopenic muscle loss. 
23. Doesn’t the brain need glucose to function?
A common misconception is that the brain can only use glucose. Ketone bodies are the only alternative source of energy for the brain as it cannot utilize FFAs. Both rodent and human studies have shown increase uptake of ketone bodies by the brain following peripheral infusion of ketones, prolonged fasting, or a ketogenic diet. They observed that up to 70% of the brain’s energy demands can be provided by ketone bodies available in circulation (blood) and taken up by the brain.
24. Will insulin resistant patients need to be on this diet the rest of their lives?
Modifying lifestyle behaviour including weight-loss and exercise are considered to be methods in restoring the ability of tissues to properly respond to insulin. Although a ketogenic diet with low carbohydrate intake can effectively improve insulin sensitivity, the duration of diet for which these patients should be on is of healthcare practitioner’s decision. As the patient makes other important diet and lifestyle changes and maintains these healthy behaviours, it may be possible to re-introduce dietary carbohydrates (with a focus on lower glycemic index/load sources) which may be tolerated with improved insulin sensitivity.
25. Isn’t this diet too acidic?
Diabetic ketoacidosis happens when extremely high levels of ketone bodies are presented in the blood (normally > 5 mM). Therefore, the blood can turn more acidic. However, during nutritional ketosis you might experience a small, transient decrease in serum bicarbonate in conjunction with mild ketosis which can be minimized by increasing electrolyte intake. Hence the need for following this dietary approach under the supervision of a healthcare practitioner and for periodic monitoring of biological parameters is recommended.
 26. Do I have to restrict calories on the ketogenic diet in order to lose weight or just follow the macronutrient plan? What about if I am not trying to lose weight but just want to follow the keto diet?
A caloric deficit will allow your body to mobilize stored fat deposits for energy utilization. If weight loss is not a goal, there is no need for caloric deficit and you can still get the benefits associated with the keto-adapted state of nutritional ketosis.

27. I can’t recommend this diet because less than 25g of CHO’s would be impossible for my patients to adhere to.
The exact amount of carbohydrate intake to reach nutritional ketosis requires an individual assessment as several parameters need to be taken into account (gender, age, physical activity, insulin sensitivity, among others). Hence, the need for following this dietary approach under the supervision of a healthcare practitioner and for periodic monitoring of biological parameters (see question 19) is recommended. A carbohydrate intake of less than but close to 50 grams per day is acceptable for some individuals to reach a state of nutritional ketosis.
28. How do I count the carbs allowed per day? Are fibre included – do these count towards the total carbs allowed per day?
When following a ketogenic diet, it is important to consider the individual when determining the total amount of carbohydrates per day. Several factors will influence the ‘carb tolerance’ of an individual, such as gender, age, physical activity and insulin sensitivity among others. As a general recommendation, you will want to start with total carbohydrates intake below 50 grams per day. This number can be reassessed after the first two weeks to optimize your individual threshold for carbohydrate intake and maximize the benefits from reaching a state of keto-adaptation.

Please let us know if we can provide any further information
*References available
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Kind regards
The Amipro | Metagenics Team