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How nutrient deficiencies cause fatigue (and the most important minerals and vitamins for fatigue) with Dr. Chris Masterjohn

How nutrient deficiencies cause fatigue (and the most important minerals and vitamins for fatigue) with Dr. Chris Masterjohn, theenergyblueprint.comVitamins and minerals. We know we need these to ensure a long, healthy life filled with energy. Yet, most of us are deficient in at least a few of these vital substances. And these deficiencies, if low enough, will cause fatigue (and maybe even contribute to other diseases). But how do we find out what nutrients we are deficient in? And what are the most important minerals and vitamins for fatigue?

This week, I have a very special guest on the podcast, Dr. Chris Masterjohn. Chris has a Ph.D. in nutritional sciences and he’s widely regarded as one of the top nutritional biochemistry experts in the world. When it comes to understanding the biochemistry of nutrition and metabolism of various foods/nutrients, I personally consider him to be a true genius — literally one of the most brilliant minds in the world. So I invited him on the podcast to discuss his latest work around helping people identify and correct their nutritional deficiencies, and optimize their nutrition for overcoming fatigue. And the information in this podcast is simply GOLD for anyone wanting to figure out what aspects of their diet may be contributing to their fatigue (or other symptoms).

Chris has recently published a brand new online book called Testing Nutritional Status: The Ultimate Cheat Sheet, which is honestly an unbelievable new resource that will show you EXACTLY how to figure out if you have deficiencies and if those deficiencies are contributing to your fatigue. There is nothing else in existence like this — it’s the first practical guide to identifying and correcting nutritional deficiencies, and honestly I am blown away by how good it is. If you have symptoms of any kind, including fatigue, this is simply a MUST-HAVE tool. I am going to recommend it to everyone who goes through my Energy Blueprint program from here on out, because tis is simply the best thing ever created for helping people to figure out how to identify and correct their mineral and vitamin deficiencies.

Honestly, if you have fatigue or symptoms of any kind, go grab your copy right now. You can get the book here. On top of being extraordinarily knowledgeable about nutrition, Chris is also a seriously generous person who really wants to help people. So he has made this new Nutrition Status Cheat Sheet only $30. (Trust me, it’s worth WAY more than that. That price is ridiculously cheap.) If that weren’t enough, he is also giving all my listeners (YOU) an extra $5 discount between Jan 27th-Jan29th. Just remember to add the discount code ARISAVESFIVE .

So go pick up a copy of that right now, and then listen to this podcast. Or listen to the podcast and then go grab the book to figure out your unique imbalances.

In this podcast, you’ll learn

  • Why educating yourself on nutrient deficiencies makes a huge difference in treating fatigue
  • How much potassium you actually need to thrive, and where to get it
  • Should you go keto
  • Which of the B vitamins that support fat metabolism (and which one that can cause blindness)
  • Why there are so many misconceptions and misinformation about the Inuit diet
  • The main minerals and vitamins for fatigue vegans should make sure to supplement
  • The main minerals and vitamins for fatigue in people on a ketogenic or carnivorous diet should make sure to supplement
  • Why you should get antioxidants from foods (this is critical for good health)
  • How you can test for nutrient deficiencies (and where to start)
  • Which dietary lifestyles are bound to cause vitamin and mineral deficiencies
  • The best minerals and vitamins for energy and tiredness
  • The different layers of information you need to figure out what specific deficiencies you have

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How nutrient deficiencies cause fatigue (and the most important minerals and vitamins for fatigue) – Transcript

Ari Whitten: Everyone, welcome back to the Energy Blueprint podcast. I’m Ari Whitten and today, I am with a very special guest, Dr. Chris Masterjohn, whose work I have been following for a very, very long time. And it’s a pleasure and an honor to finally have him on the show. I’ve had to pursue him and be a little bit persistent to finally get him on here and through the help of a mutual friend Guillermo Ruiz, I was finally able to make …

Dr. Chris Masterjohn: It’s all about connections.

Ari Whitten: He’s a Ph.D. in nutritional sciences and he’s widely regarded as one of the top nutritional biochemistry experts, I would say, in the world and in the whole online space as we know it.

Everybody looks to this guy as an expert, so welcome Chris, it’s an honor to have you on.

Dr. Chris Masterjohn: Thank you for having me on, it’s great.

Introducing Dr. Chris Masterjohn’s new book – Testing Nutritional Status: The Ultimate Cheat Sheet

Ari Whitten: Yeah. So you just came out with an awesome new ebook on testing nutritional status, the ultimate cheat sheet.

Dr. Chris Masterjohn: I did.

Ari Whitten: Which I have and it’s phenomenal. It’s actually super impressive what you’ve put together here, how comprehensive it is and how you’ve laid out the algorithm for how people can navigate this and figure out what’s going on for them. I’ve never seen anything like this, so well done on that.

Dr. Chris Masterjohn: That’s what I was going for, I’m glad it’s working out.

Ari Whitten: What I want to do in this podcast with you is basically talk about this, I want to talk about nutritional status and specifically with my audience, everyone’s focused on energy levels.

A lot of people struggling with fatigue, so I want to dig into this topic of what nutritional deficiencies and toxicities are related to fatigue and common things that are connected with fatigue.

Where to start when testing for nutritional status

First of all, let me put it this way. This whole testing of nutritional status is so comprehensive and so complex, and there are so many nuances and layers to it in so many different tests. Where does one even begin?

Dr. Chris Masterjohn: Well, if we take something like fatigue, I think that’s a perfect illustrator of why you need to really take a comprehensive approach. Think about just one of the things that could cause fatigue is any kind of block in your ability to break down energy from food and convert that into ATP which is the basic energy currency of the cell.

If you think about all the things that are needed for that to happen, we inhale oxygen. That oxygen is like the flame that sets our food on fire to extract that energy out. We have to get that oxygen into our cells, so we got to carry it on hemoglobin. As is fairly well known, if you’re deficient in iron, you can become anemic, which means you don’t have enough functional hemoglobin and you’re not going to be able to carry the oxygen to those cells.

But if you’re deficient in copper, you might not be able to use that iron and get it into the hemoglobin. If you’re deficient in vitamin B6, that hemoglobin can become dysfunctional and it accumulates around the edges of the red blood cells and it doesn’t get into its proper place.

Right there, those are three major things that could interfere with your ability to get the oxygen into your cells. But then once you have it there, you have seven B vitamins that play essential roles in energy metabolism. If anyone of those is missing, you can have a backup in your energy metabolism. But then you also have minerals. Iron comes in again in cellular energy production. Copper, sulfur, and then even other things that we have to synthesize with other processes in our bodies.

By the time that you consider, can you break down the food to produce the energy, you’re already talking about a dozen different nutrients that could play a role there. Fatigue is probably one of the least specific signals about which nutrient might be deficient or toxic because it can be a by-product of almost any nutritional imbalance. What you really need to be able to do is take a three-legged, comprehensive approach.

One is to look at, what are the other problems you have. Maybe you only suffer from fatigue. Or, maybe you suffer from fatigue and skin problems. Maybe those skin problems are red skin, maybe it’s itchy skin. Maybe it’s specifically around the corners of your mouth or specifically around your nostrils. Or maybe it’s in your genital regions.

Maybe your skin is perfect, but you feel fatigue and you feel depressed and you feel anxious or you feel lack of motivation. There are so many different patterns that you look at that your experience is one of the three legs of evidence that you want to look at.

In technical terms, you might see the signs and symptoms, but what that really means is, what’s happening in my life right now that gives me clues about what could be wrong. The second thing you want to look at is, what is your diet and lifestyle like?

When we think about nutrition, it’s mainly about diet, but it’s also about lifestyle because the things that we do can impact our nutritional needs. Maybe we’re an athlete, we might need to eat a little bit different. Or do we go outside? That can impact our vitamin D status, for example.

But mainly, it’s looking at your diet. If you look at dietary analyses, you can compare how you match up on nutrients to what the science indicates is probably the right balance for the average person. And that means, looking, compared to the DRIs, the dietary reference intakes, or either the RDI, the recommended dietary allowance.

Or when there’s insufficient evidence, they call it an AI, an adequate intake. Whatever those are is at least whenever the committees met at that time was the state of the signs that you probably need. And that’s a good starting point. You can use a tracking app like Chronometer, for example, to see where you match up.

But it’s really only a starting point because your nutritional needs are going to be different than mine. We’re both going to be different from the average. The state of the science, whenever those were developed, has evolved since then. There are things we don’t know. There are all these nuances that come into play, but at least that gives you a starting place to say, “Wow, I never realized that I only get 15% of the RDA for vitamin B6,” or, “I never realized until I read about it that all the vitamin B6 I’m getting, I’m destroying in the way I cook my food,” or things like that. That gives you a sense of, is it plausible that you could have too little or too much or the wrong balance of those nutrients.

And then the third leg is lab testing because this is … Your subjective experience, at least the symptoms are subjective, how you feel and things like that. Gives you your personal sense of what’s going on as you experience it. But laboratory testing can give you objective numbers about what’s chemically happening inside your body.

That’s where you get to mix and match these and say, “I have the signs and symptoms that could be plausibly interpreted as these three or four problems, but when I look at my diet, it seems like I’m only deficient in this. But maybe I have too much of that. But then when I look at my blood work, which isn’t really comparing me to the theoretical average of the nutrients I need but is actually objectively telling me, I have too much of this or too little of this.” Then you can put that pattern together, and you can make really good decisions. Go ahead.

Why people and doctors need to think like detectives when it comes to nutritional deficiencies

Ari Whitten: Excellent explanation. Basically, what you’re saying is, people need to become their own detective in order to figure out what their health problem is coming from, as far as nutritional deficiencies and toxicities. And what you’ve developed here is really arming people with the knowledge and tools to be able to actually do that work.

Dr. Chris Masterjohn: Yeah, I think we need a lot of detective work. Certainly, people who are actually assisting people with this stuff. They need to think like detectives. Doctors, they need to think like detectives, nutritional consultants need to think like detectives and so on. But as I’m sure most of your audience probably has experience with, you can go to the doctor and say, “I have this, this and this problem,” and they say, “You’re getting older.” Or they say, “You’re fine, it’s in your head.” Or any number of those responses because doctors in medical school don’t really get any meaningful amount of nutrition education.

People who get PhDs in nutritional sciences aren’t usually in a clinical setting at all.

You have this big gap between people like me who have spent a decade or more totally immersed in the scientific literature around nutrition and getting fundamental, basic training that’s years, focused on nutrition, who may not have any communication with people who are in the trenches of the clinical settings.

The doctors understand all kinds of blood testing based on the way they view diseases and which medications they’re going to prescribe, but some of my consulting clients are doctors who are asking me what blood tests they should run for their nutritional status because they just don’t have the education in that.

What I’m really hoping with the cheat sheet that I produced is that, on the one hand, if you’re a clinician, you can use this to much better help your patients. It’s not a substitute for a comprehensive training, you still need to rely on the research and take responsibility for what you’re doing, but at least you have something really simple where within moments, you can figure out, what’s a good starting place as an approach to investigate this problem.

But then, you, as an individual also need to be armed with an understanding of what you’re asking the doctor for. In some cases, you can run these tests yourself, if you go to something like directlabs.com, it depends on what state you live in. But you need information about what you should be doing, and yeah, you do need to play detective with yourself even to be able to approach … Even if you need help interpreting all this stuff, you need to do basic detective work to figure out what your first approach should be.

The most accurate way to test for nutritional deficiencies

Ari Whitten: Yeah, one question I have on all of this, that I’m sure you have the answer to is, within the functional medicine space as a whole, I know that there are a whole lot of tests that are commonly done by a lot of practitioners that really are not well grounded in the evidence. And are just not very accurate.

You can do a test, you can do something that is ostensibly very scientific and very advanced and cutting edge, but when you actually dig a little deeper into the research, you realize, hey, this actually isn’t a scientifically valid way of doing this test and it’s not an accurate result.

When it comes specifically to testing for nutritional deficiencies of toxicities, how accurate are these tests and is it really important how certain things are tested? What part, whether you test it in the serum or in red blood cells and what specific labs are doing what tests?

Dr. Chris Masterjohn: I think there’s … You’re hitting on the surface of a couple really interesting points. One of them is that there’s this trade-off between what’s cutting edge and what is validated. You can have … If you wanted to be cutting edge, that means, necessarily that you’re doing new things that have less of an evidence basis behind them and have a greater probability of, in the future, being proven wrong despite whatever we think they might mean now.

I would say the extreme case of this is a company Spectra Cell that does a comprehensive panel of nutrient testing where the principle of the test is, you look at lymphocytes – which are white blood cells which are taken out of someone – and you look at their ability to grow in response to adding nutrients to the medium. The medium is the liquid they’re growing in.

On the one hand, it’s designed to be more cost efficient because you’re able to test a lot more things more cheaply. And it’s also a really great case of something that’s cutting edge because it’s a novel technology. But on the other hand, it shows the extreme of that trade-off because we don’t really know, there’s not really much scientific validation about what any of that means.

Not only in terms of what … To take an example, white blood cells play a role in the immune system. Vitamin D plays a role in the immune system. When you get sick, your immune system starts taking up more vitamin D, activating more vitamin D to help you fight off an infection. Is it really the case that if you take someone’s white blood cells and you look at, how strongly do they proliferate in response to more vitamin D, is it really the case that that’s just a function of how deficient someone was in vitamin D? Or, does it have something to do with the degree to which their immune system is activated and primed to be taking up more vitamin D? We don’t know.

What we do know, is that there are thousands and thousands and thousands of studies looking at 25OHD, the conventional marker of vitamin D status, correlating it with, what happens if you make someone deficient? Watch it drop. Then you give them vitamin D supplements at different doses for different timeframes in different regions of the world, watch it rise. How much does it rise? Where do the symptoms start appearing and disappearing? We have all kinds of experimental evidence on what that means.

I don’t want to single them out specifically as, “You shouldn’t get that test,” but I’m just saying, that’s one end of the trade-off of cutting edge versus rich validation with scientific evidence. There is an opposite problem where there are really good validated markers of nutritional statues that no one has really said much about since, I don’t know, the 1970’s. Because it was shown that they were the best markers of nutritional status, and those are only found buried in a big panel that’s offered by one of these functional medicine oriented labs, like Genova, for example.

If you want to test your biotin status, biotin is a B vitamin. When you don’t have enough biotin, you can get fatigued. You can also get depressed. In women, about a third of women become biotin deficient during pregnancy, birth defects can result from that.

There are characteristic skin problems especially around the mouth and the genitals that come with biotin deficiency. People take it to support their hair and nail health, it’s really important in those things.

Biotin deficiency, there were really elegant studies decades ago, showing that when you are biotin deficient, the very first thing to change is you start excreting a chemical called 3-hydroxyisovaleric acid into your urine. And this is a breakdown product of the amino acid leucine, and it’s something that if you had enough biotin, you just fully break that down for energy. But because you didn’t have enough, you started breaking down the leucine, you didn’t finish and this spills over into your urine.

Where do you get that? It’s on the Genova ion panel, but if you go to Lab Core Request, which is far more commonly used in medicine, you’re not going to find that there. You might find it, maybe on their urinary organic acids tests, but they’re only running those on people that they suspect have genetic metabolic disorders. If you go there for a test of biotin, they’re just going to give you your blood levels of biotin. Well, guess what, if you get deficient in biotin, eventually your blood levels of biotin decline. But that happens a lot later than your excretion of that chemical I was talking about before starts increasing.

If you only look at blood levels of biotin, you’re going to miss a lot of the people who are borderline early biotin deficient. Who are biotin deficient enough to have symptoms, who could act on that and fix it, you’re going to get a lot of those people who are not just going to know that they’re biotin deficient. And given what I was saying earlier, that one-third of women become spontaneously biotin deficient during pregnancy, just because the needs for biotin increase, then that’s a lot of people.

And we don’t know if that spontaneous increase in biotin deficiency plays a major role in birth defects, but it does in animals in lab studies, so it might in humans. Maybe we could be preventing birth defects, but certainly we might be getting rid of a lot of depression and fatigue and skin problems that might spontaneously be creeping up in pregnancy that we just say is because you’re pregnant, when really, getting pregnant increases your needs for nutrients and you didn’t get the right test to figure out what was wrong.

But also, this can be really expensive and maybe … If you know your way to navigate around what’s safe and what’s not in terms of nutrient toxicities, it might just make sense to eat more egg yolks, which are the best dietary source of biotin. Egg yolks and liver. When you’re pregnant or take a biotin supplement when you’re pregnant if you notice any of those symptoms. If you don’t have the time or the financial resources to get all the testing done.

To answer your question very generally, there is no very general answer to your question. It’s very specific to … Anyone who ever makes any kind of claim like, “Red blood cells are where you should measure the minerals,” or, “Serum is where you should measure the minerals.” Or anything like, “Urine is the best test. Blood is the best test.” Anyone who makes any statement of that kind at all is wrong because the way you determine whether red blood cells or serum or whatever is better is to study it for that nutrient.

And in those studies, we find that there are no general rules. We have to understand how to nutrient works specifically. And that’s why you need something like a comprehensive source that puts all this in one place. And the outgrowth of the cheat sheet that we’re talking about today, that started as me last year doing a two hour podcast on each nutrient where I would go in depth to describe all of that.

I would have to spend two weeks doing the research to make one of those podcasts and then I would have people come to me and say, “I’m trying to search through the transcripts for your … Can you put this in one place somewhere?” That’s where it came from.

How to balance scientific nutrient testing and the idea of humans being able to thrive with lots of different dietary patterns

Ari Whitten: Yeah, beautiful answer to the test question. I want to before we dig into some of the specific nutrients, I want to zoom out and ask more of a big picture question here. Which is, as one looks at this whole thing of, there’s 50 different minerals and vitamins and different nutrients that you can test for and that you may be deficient or toxic in. And you have to do this whole barrage of testing to figure out whether you’re eating the right amount or if you have a deficiency and so on.

To me, it almost implies a paradigm where humans are these really fragile creatures who, if they don’t pay an enormous amount of attention to the specific foods their eating and do this deep analysis of all the 30 different minerals and each different food that they eat and then go get tests done to determine whether they are getting just the precise amount or too little or too much, that we’re going to develop all these health problems.

And then, on the other hand, we know from research looking into the dietary patterns of different hunter-gatherer tribes and the ones who have been studied, modern-day hunter-gatherers not invoking any speculation about 10,000 years ago or whatever. But that their diets differ dramatically in what kinds of foods they eat and they also maybe don’t necessarily eat in a lot of cases, the most balanced diet and what we might think of today as being particularly healthy.

And yet, at least, many of these tribes who have been studied appear to be in good health and have very low rates of lots of different diseases and so on. How do you make sense of that? How do you balance, on the one hand, this scientific nutrient testing, and on the other hand, this idea of humans being able to thrive with lots of different dietary patterns?

Dr. Chris Masterjohn: The first thing to unpack from that is, look, if you feel awesome all the time and you look beautiful all the time and your sleep is perfect and your skin is perfect and you’ve got no complaints, you should probably just do whatever you’re doing and you’re probably not listening to The Energy Blueprint.

There are millions of people out there who don’t need to speculate about whether they might develop health problems if they don’t do the right nutritional analysis, they just have health problems and they’re not getting the right help that they need. Or, they’re spending way more time than they need to, years sometimes, to get to the right conclusion.

The first thing is, if you have health problems, and you don’t have an immediate fix to them, or you don’t know where to start or you’ve been working on it for a while and you’re not getting anywhere, the point here is to try to condense all the investigatory work that you would have to do to what could be years if you didn’t have the proper direction into maybe a couple of hours of looking through this then saying …

In the cheat sheet, I outline a comprehensive approach, a time-saving approach, cost-saving approach. You probably need to do five minutes of reflection to decide what you want to do. And then from there, it’s a couple hours of work to pick one of those things, except maybe in the dietary analysis, but if you don’t have time for that, you do the time-saving approach.

There’s a need for that. But then, the other principle to unpack to that question is like, why should we have to do something like that? Why aren’t we all just healthy if hunter-gatherers just ate whatever was there and they’re healthy.

Now that second question, that has a lot to unpack, actually because there are the hunter-gatherers of 10,000 plus years ago, and there are the hunter-gatherers of today and they’re not the same.

One of the things that you observe in archeology is that during the agricultural revolution, everyone’s height declined. And it rebounded after that, so some of the worst … People with the worst health in the history of humanity as a big group or era of time were the people who were the early experiencers of the agricultural revolution, and the people who were the early experiencers of the industrial revolution. Not really the industrial … The impact of the industrial revolution on food.

Today, there’s a lot of health problems that could be solved in 2018, but it’s nothing like 1918 or 1928 or 38. The people who lived back then, they developed the technology to refine flour, but they didn’t know what vitamins were. If you were eating refined flour back then as 60 or 70 percent or your diet, you were suffering from profound nutrient deficiencies that are borderline unheard of in modern society. Because we’ve developed public health programs to fortify white flour with whatever we think people need.

And there’s a lot of problems with that, and we don’t have to go into that, but you could do a whole podcast about why enriched white flour is not the best food to eat. But eating that is a lot better than eating the version of that back before we knew what vitamins were.

And then, if you look at the agricultural revolution, it’s kind of the same thing. They didn’t know that, yeah, wheat gives you a lot of calories and it’s nutritious and whatever, but if you eat 90% of your diet is wheat, you’re going to be profoundly deficient in a lot of nutrients and maybe have other problems as well. It was a learning experience.

But anyway, if you look before that ever happened at the hunter-gatherer heights, hunter-gatherers today are short by those standards. I don’t know why, but I’ve talked about this with some colleagues and I think probably modern hunter-gatherers, for everything that they do have going for them, have been pushed into marginal areas where they don’t have the same level of resource abundance that they did when they had the whole world to themselves.

But the reason that I bring that up is because I feel like it’s a very important way of thinking about nutrition to look at hunter-gatherers and to look at what we think people used to eat. But you have to do it in the holistic context of evidence. Just because they’re hunter gatherers and they don’t suffer from certain health problems that we do doesn’t mean that their diets are optimal. That’s one issue, and they’re probably not optimal in a lot of cases.

The truth about the Inuit diet

But even if we put that aside, when you’re looking at just the way that human diets have diversified over time as we’ve occupied different niches, there’s been a lot of genetic and cultural evolution that have adapted humans to specific environments. You could look at this and say, the Inuit are healthy and they eat almost nothing but animal foods. They do eat a lot of plant foods, but not as a major source of their calories. They don’t eat much carbohydrate, they have an enormous intake of omega 3 fats from marine oils. And then there’s the Kitavins who eat 70% of their calories as carbohydrates, 20% as fat. That fat is mostly coconut, which doesn’t grow in the Arctic.

It’s almost completely saturated. The omega 3s from marine fat is maybe 2% of their diet. And you say, look at these two groups. Clearly, it doesn’t matter how much omega 3 you eat, it doesn’t matter how much carbohydrate you eat, it doesn’t matter how much fat you eat.

But actually, if you look at the Inuit, just to take one example of a pretty extreme environment, they developed … They ate a lot of things that we might not think about them eating if we’re going to try to emulate their diet. One of the stories that I like, there was a fatty acid researcher named Hugh Sinclair who was studying the Inuit and he wanted to study their bleeding times because they were saying, maybe this high intake of marine oils makes their blood really thin. So let’s see if that’s true.

And there was a weather problem where what was happening with the weather, they had to cancel the trip. And they’re like, “Okay, let’s do the experiment on ourselves.” They ate an Inuit diet or an Eskimo diet, they would have called it. And their definition of an Eskimo diet was, you just eat nothing but fish oil. And in describing the results of this, he said in the talks, Sinclair said, “When I was on this diet, my MDA levels went through the roof.”

MDA is a byproduct of these marine oils, they’re very sensitive to oxidative damage, and MDA’s a byproduct of that. He says, “Although MDA causes birth defects, I wasn’t concerned because my sperm counts dropped to zero.” Now, I don’t think the traditional Inuit had sperm counts of zero because I don’t think there would be any Inuit if the traditional Inuit diet caused sperm counts of zero in the Inuit.

There are two things going on there. One of them is easier to see, and that’s the cultural evolution. They were interested in the marine oils because they were interested in the marine oils. They defined the Inuit diet based on the marine oils because that’s what they cared about. Meanwhile, the Inuit were eating all kinds of other things. They had cultural adaptations to get enough calcium that involved freeze-drying fish bones and grinding them into powders that they could consume so they can maintain their calcium levels through the year and things like that. They ate vitamin C from one of the layers of the stomach of a whale and certain layers of skin and things like that. All kinds of different things that they were doing to make that diet work for them in that environment.

But what’s not so obvious is what we’re discovering only in the last decade as we study more and more about genetics is that the Inuit genetics are almost nothing like ours. In almost everything that’s interesting about the Inuit diet, like, they ate a lot of omega 3 fats from marine oils. They ate a lot of fat. They had low vitamin D levels. Almost every single one of those things that’s different about their diet that’s interesting to us, they have specific genetic adaptations that either better allow them to thrive on that diet, or mitigate some of the harms of consuming that diet.

So yes, but also, evolution is based on people dying. If they have those genetic adaptations, it’s because there were a lot of them of their ancestors that died in the past. When we’re looking at hunter gatherers, we’re not seeing how many of them had to die to produce the genetic adaptations that allow them … And it’s everyone. In our population, a lot of our ancestors died to allow us to follow a specific course of thriving in our environments.

We’re nowhere, first of all, mixing a lot of different stuff from a lot of different areas and a lot of different times. And completely imposing on ourselves an environment that doesn’t reflect any of those environments. We don’t really know who we are, genetically, until we study it. You and me right now, maybe you and I know a little bit because maybe we did some genetic analysis, but take the average person on the street, zero consciousness of how they differ from other people with respect to their nutritional status, and even you and I don’t understand it that well. We understand the tip of the iceberg based on what we’ve been able to study. But 20 years from … Go ahead.

Ari Whitten: Just as you were expressing that and I think the Inuit are such a great example of these genetic adaptations that make them do better on this diet, a couple things popped into my head. One, of course, is that, I think as a natural extension of what you’re saying, people, ought to be careful of adopting diets that are really not in harmony with their ancestral.

As an obvious example, speaking of the Inuit, now keto is obviously a big trend so lots and lots of people are going on keto diets, which is the closest thing that we have to a keto diet is an Inuit diet. And even they were, my understanding from the research is that they were eating something along the lines of a 50% diet. Yet, we have a lot of people now advocating 65 or 70 or 80% fat diets, which are even higher than the Inuit.

Dr. Chris Masterjohn: It’s worse than that. This is a perfect illustration of what we were just talking about. The Inuit have an almost complete penetrance of what is outside the Inuit is considered an inborn error of metabolism, a fatty acid oxidation disorder that makes them unable to make ketones.

The Inuit … If you and I were to engage in a 24 hour fast, we would wake up with measurable ketones in our blood and we would see substantial rising in ketones across the course of that day. We wouldn’t be in deep ketosis, but we’d be in clearly measurable ketosis.

And when they’ve taken Inuit, particularly Inuit who are homozygous for this particular mutation, their ketone levels stay flat. And I actually … I produced a video on this that was very controversial. And my argument was if you’re …

Ari Whitten: By the way, of course, it was controversial. Any time you talk about keto in anything other than extremely glowing terms, there’s going to be a whole bunch of people who attack you.

Dr. Chris Masterjohn: Yeah.

Ari Whitten: The price you pay for trying to talk about the subject.

Dr. Chris Masterjohn: I was thinking of that more, to borrow a technical phrase, more of a feature than a bug. But anyway … More of a benefit than a cost. But anyway, yes, there’s … We don’t really know across the course of history because the modern Inuit aren’t eating exactly the same thing as 100 years ago, but 100 years ago, they weren’t eating exactly the same thing as 5,000 years ago. We don’t really know what their diet was 5,000 years ago.

But one way to see this, and the argument that I made is, if you’re in an environment that forces you into constant ketosis because of the perpetual carbohydrate deprivation, then … And even that, there’s plenty of room for controversy because how much the protein in the diet is going to knock you out of ketosis is controversial, it’s not well tested, but it’s probably suppressive to some degree. But how much protein they were eating, same thing. Anyway. My argument …

Ari Whitten: Sorry to interrupt, real quick. But I also read some research talking about that when you actually consume fresh meat, as the Inuit do, it’s actually still loaded with quite a lot of glycogen. And they’re getting actually a very much, much more carbohydrate than one would think they’re getting by virtue of the glycogen, that stored carbohydrate in the animal flesh.

Dr. Chris Masterjohn: Right. We don’t really know because of a lot of these ideas that were developed to try to understand why … A lot of the things that you’re bringing up were developed as an attempt to explain why in the early part of the 20th century when people would measure their ketone levels in their urine, they wouldn’t have any. And what we didn’t realize until the 1990’s … We had decades of people trying to explain this based on a hypothesis about their diet. Which I’m not saying they’re false, but I’m just saying, I believe that more weight has been given to those things because we spent decades not having the simple observation that we know now, which is that most Inuit are genetically incapable of producing significant amount of ketones no matter what their diet is or whether they’re eating anything at all.

You could put them on a diet of only fish oil, and they’re probably not going to be in very deep ketosis because they have their ability to make ketones so blunted. I do think that there’s merit to all these dietary arguments, but it’s also the case that they have occupied … We really don’t know, again, 5,000 years ago exactly what their diet was. But they were occupying, through that time, the region of the earth that was the single most forceful imposer of a semi or full or whatever ketogenic diet. In other words, there’s nowhere on earth where the environmental imposition of carbohydrate restriction was stronger than in the Arctic. Was it as strong as many people have thought it was? Probably not. But was it stronger than anywhere else? Yes.

How ketoacidosis presents itself in the body

Right, so if everyone … The thing is like, in the low carb world, another problem that we have is that there are people who are making this very clear distinction between nutritional ketosis and ketoacidosis because they don’t want the stigma of the fact that ketoacidosis is the things that diabetics can get where the ketones kill you to impact the reputation of a ketogenic diet.

But that’s kind of a false distinction because when you are in normal nutritional ketosis, the acid load in your blood is 20 times higher than when you’re not in ketosis. You don’t suffer from acidosis not because the level of ketosis isn’t strong enough, it’s because you have a really good PH buffering system that helps you deal with the 20-fold higher acid load.

Now, yes, in diabetic ketoacidosis, the ketone levels do get much higher and overwhelm that buffering system. But diabetic ketoacidosis is usually precipitated by something more complex than not using insulin anyway. It’s usually precipitated by other factors that cause catabolic stress or cause more of a ketone load.

For example, ethanol is ketogenic and so an alcoholic who’s diabetic and who’s lagging on their treatment or something like that. Cocaine use causes catabolic stress. Often, that’s a precipitator of ketoacidosis. Heart attacks cause catabolic stress. Often times, you get a heart attack, you survived it, then you had ketoacidosis. All kinds of things like illnesses, fever, infection, all kinds of things like that contribute to that.

Meanwhile, you can have people who just have something wrong with their PH buffering system, like a zinc deficiency. Zinc is one of the most important minerals in supporting PH balance, and if you’re zinc deficient, you might not be able to buffer that acid load. Potassium, the salt to potassium ratio is … I don’t think there’s anything wrong with salting to taste, for most people, but if you’re deficient in potassium, then the high salt to potassium ratio is going to make you much more vulnerable to acidosis.

If you’re eating a ketogenic diet, you’re not even eating that much potassium. So the standard way to do it right is to add electrolytes including potassium in because you need more potassium and you get less. You can, with the right conspiracy of catabolic stressors or defects in your PH buffering system, get ketoacidosis from eating a ketogenic diet. Will you? Almost certainly not. But can you? Yes.

Why eating according to ancestry can be good for your health

Now, if you take people who are on a ketogenic diet now, how many of them who get an abdominal … Are clutching their stomachs with abdominal pain, which is the earliest sign of ketoacidosis, how many of them are going to stay on that diet if it happens? They’re probably going to say, I feel sick on this diet, I’m going to do something else. But if the Inuit made their way into the Arctic, they didn’t have that choice. They didn’t have the choice to say, “I feel sick on this diet, I’m going to eat potatoes.”

So it’s totally different to have people pick their own diet and have the people who feel great on keto be the ones who choose to stay on keto. Are there problems with that? Sure. But similarly, it’s great to have people who feel great about veganism be the ones that can choose to be vegan. But Weston Price, one of the early nutritional anthropologists, he looked all over the world for a society that was, he didn’t call it vegan, but he ate only plants.

And the closest thing that he found was some people who were isolated to the mountain tops where they had no access to animal foods. And they would often be at war with the people who lived at the bottom of the mountain who were on the coast. But they were so respectful on their ability to eat some animal foods that when they were at war, the people on the bottom would leave animal foods from the sea along this wall of the empty casings of shellfish. And they would leave it there at night and go away so that they could come down and get it.

Now, do you know why they would appease them like that? Because one of the principal causes of war was that the people on the top of the mountain would come down to hunt the people on the bottom of the mountain. And when they came down to hunt, to eat them, and when they came down to hunt them, they looked for the fisherman because they knew that the fisherman’s livers were the most healing animal foods that they could eat.

So the fisherman was like, “Take the fish.” That’s another example where, it wasn’t like, “I tried a vegan diet and I felt really great.” And maybe six months later, that’s different, like, “I give up on it, I was craving meat.” They were forced into an environment where it was just severely restrictive of their ability to acquire animal foods and it wasn’t that happy of a situation. Same thing with the Inuit. They didn’t have a choice about what to eat. And so the evolutionary pressure to modify their genetics is going to be much stronger than it is to modify any of our genetics when we can just pick and choose whatever we want. And if it seems good to us, stay on it until maybe we realize that it’s not so great after all and we change. But then we change and we move on.

Ari Whitten: Yeah. I have to say that I think what you’ve just expressed over the last 15 minutes or is probably the most compelling, logical, rational explanation of why eating ancestrally is probably a good idea.

I don’t know if you’re familiar with Doug Wallace. He’s a well-known researcher on mitochondria who works specifically on mitochondria DNA. Actually, I heard him suggesting recently that the mismatch between our mitochondrial DNA, specifically, and our modern day diets and lifestyle is probably a big reason for a lot of modern-day chronic diseases.

As you know, we don’t have a lot of solid research just yet saying this is the randomized controlled trials that people with this genetic profile have better outcomes when they eat their ancestral health diet compared to so-and-so other diet.

Dr. Chris Masterjohn: The ancestral diet of a maternal line, huh?

Ari Whitten: Yeah. I think that the-

Dr. Chris Masterjohn: Complicated.

Ari Whitten: Yeah. I think the evidence and the amount of smart people suggesting things along those lines are worth taking a very serious look at.

Dr. Chris Masterjohn: Yeah. No matter how closely we adhere to that, we’re always going to run into, basically, two problems. One is that we understand our own ancestry to the best of our ability, but we have an incredibly imperfect understanding of our ancestry as an individual and what our ancestors were actually eating.

A lot of times we have qualitative information, but the quantitative information isn’t that great. We try to do that. I think that’s an excellent starting place. All of us are probably imperfectly emulating whatever our ancestral diets were.

To take a great example of this, how much collagenous tissue should you eat? A lot of people think that they’re eating nose to tail-ish because they use bone broth. A 50% of an animal’s carcass is collagen from bones and skin and other connective tissues. Most of us who are eating bone broth, drinking bone broth, whatever, cooking things in it, are not consuming anywhere near the amount of collagenous tissue that our ancestors, who whether through wisdom that was passed on or just economics of not wanting to throw away food, were eating.

We try to implement these things. It brings us closer to our imperfect understanding of our ancestral diets and that’s awesome, but then we’re also going to suffer from the problem that we are a unique individual. We had some of the genes from this line and some of those and some of those and some of it was mitochondrial and some of it was [inaudible]. There are too many different things. When they get into us, there’s a specific combination that’s going to express uniquely for the same reason that we can just look at each other and we all look different no matter how closely related we are.

We have that starting place, but then we need to evaluate this. I do what I think I should do to be healthy. How healthy am I? Where can I improve? What is the most efficient way for me to get a grasp on what I should do next to get my health better in the center of where it should be?

Ari Whitten: Beautiful. Let’s dig into some of these specific nutrient deficiencies. There’s a couple, I think, entry points that we can go from here. One, you just talked a little about keto and about veganism and maybe hitting at some pitfalls with both of those approaches or we could kind of dig into just nutrient deficiencies pertaining to fatigue. I’ll let you decide which avenue to go down.

The relationship between the ketogenic diet and fatigue

Dr. Chris Masterjohn: Let’s start with the first and then we can hit the second.

Ari Whitten: Cool.

Dr. Chris Masterjohn: Let’s say that you are keto. First of all, there’s the question of exactly how are you doing keto. Some people’s approach would be to be less restrictive on protein. If you’re eating a lot of meat, you’re going to get some nutrients from that meat that you’re not going to get if you’re just mostly eating fat. If you’re really trying to push keto’s to the highest level possible, you’re probably going to eat lower protein, higher fat. How you balance that out is going to be an important determinate of what nutrition you get. We think a lot about macros, protein fat, and carbs, and we think a lot about micros and we tend to not realize that every time you change one, you’re changing the other as incidental to that.

One of the problems that you can get is a deficiency of B vitamins because B vitamins are water soluble. If you’re eating mostly fat, you’re not going to get enough. I think someone who is getting a half a gram to a gram of protein per pound of body weight from meat will probably get enough of most of those B vitamins. Someone who’s really pushing the fat and not eating a lot of meat could be deficient in a number of them, especially thiamine.

One of the ironies is that you need thiamine most to metabolize carbohydrate. If you have a properly supplemented ketogenic diet, you can actually spare your need for thiamine. If you eat mostly fat and you don’t supplement with thiamine and you don’t have much meat in the diet, then you can get a profound clinical thiamine deficiency from that. There are case reports of people getting optic neuritis, which can cause blindness, which is a neurological problem, because they were treating a different neurological problem, seizures, with a ketogenic diet, which is thiamine sparing, but not thiamin sparing enough to not eat any thiamine. That can be a pitfall.

Vitamins for fatigue – The importance of potassium

Another problem that I think is very significant can be potassium. One of the things, first of all, again, potassium is water soluble. There’s no potassium in fat, really. Most, like 98%, of Americans, don’t eat enough potassium according to the RDA. Some people argue that traditional hunter/gatherer diets may have been as much as 12 grams of potassium a day, which compared to RDA, is 4.7 grams. 2% of Americans actually meet the RDA on a regular, mixed diet. Then you take out most of the sources of potassium and put fat in its place, which doesn’t have any potassium, you’re at significant risk there.

If you eat a lot-

Ari Whitten: Actually, real quick. You mention you take out most of the sources of potassium just for people who are confused by that.

Dr. Chris Masterjohn: Yeah. Actually, I should add this in. Here, it’s not just about meat. It’s also about are you doing the high vegetable, high fiber version or are you doing the carnivore version of the keto diet. In the typical person’s diet, it kind of depends on the exact composition. If you’re looking at people who are health conscious and health-minded, even the whole grains in their diet can be a significant course of potassium, but there’s a lot more potassium in potatoes and other non-grain starches than there are even in whole grains. If you meet someone who’s eating … Actually, if you take someone who went to McDonald’s and they got a burger with fries and a coke, most of the potassium in the fries. Not that I advocate for fries as a source of potassium.

It’s probably an improvement in your health if you’re certainly eating more keto. If you just cut out the bun and the fries and make it a diet coke, but that’s not a very well designed keto diet, right?

One of the things that I did on the cheat sheet is I spent a lot of time making a potassium plan for people who are eating low carb, high fat, for people who are eating diets focusing on eating lots of fruits and vegetables, or people who are just focused on kind of getting a real lot of moderate potassium foods where your best approach would be to eat fairly low grain and zero refined carbs and eat fairly low fat. Again, there’s no potassium in fat. Even if you take dairy products, there’s plenty of reasons to eat full-fat dairy products, but the low-fat dairy products are twice as rich in potassium as the full-fat ones are just because there’s no potassium in fat.

It could be fruits and vegetables. It could be potatoes. Probably the average American eats potatoes as the main source of potassium. A real health conscious person eats a lot from fruits and vegetables, a significant portion from whole grains. For a paleo person, it’s mainly their fruits and vegetables that are giving them their potassium.

For a keto person, it’s like are you doing high fiber or high veggie or are you doing carnivore? If you’re doing carnivore, you’re only potassium is coming from the meat you eat. If you’re really chasing ketones and you’re eating mostly fat and you’re trying to keep the meat to a minimum, you’re going to be in this huge potassium deficit. Then, if you cook the meat in a way that does not capture the juices, you’re losing a lot of the potassium in that meat. By that point, if you’re not supplementing with potassium, you’re in a lot of trouble.

Supplementing potassium is not, actually, the ideal way to go. Although there are studies showing no harms of appropriately selected people who have the right health parameters eating 15 grams a day of potassium from potassium supplements, there’s a huge problem if you have anything that can decrease potassium excretion. That can be something as common as taking non-steroidal anti-inflammatory drugs, which are the most prevalent over the counter drugs that anyone uses. Diabetes, or insulin resistance, which is very common, same problem.

For that reason, the FDA mandates that a potassium supplement cannot contain any more than 99 milligrams, which is laughably useless. How are you going to get 4.7 grams of potassium from those? With a lot of tablets or with a bulk powder? If you’re taking the bulk powder, sure you can supplement a gram here or a gram there. It’s pretty easy to spoon it out, but it can be dangerous if you have some problem that you don’t know about that decreases potassium excretion. If you take potassium on an empty stomach, it actually stimulates insulin and you could give yourself hypoglycemia from it.

I’m not totally against using potassium supplements, but it would be way better for someone on a keto diet to do a little bit … In the cheat sheet, I pulled out the top 10 foods with the highest potassium-to-net-carb ratios. To tailor that to your own tastes, go on something like the USDA database or nutritiondata.com and just figure out what other foods are really high in potassium and really low in carbs and try to eat a lot of those.

If you want to do it all from food, on a high fat/low carb diet, staying really keto, if you hit a good protein requirement for meat and you cook the meat in a way that retains the juices, you get a nice portion from that. You need to really eat a few pounds of vegetables to do that. You can do that and stay keto, but you have to think about that. You’re not going to eat that potassium from food if you’re not … Really no one in modern society … This really goes back to your question before, our ancestors in many cases, especially pre-agriculture, were forced into eating high potassium diets. Our ancestors were forced to eat high potassium diets because there weren’t a lot of super high starched foods. We’ve developed a taste for salt so that we’ll seek out salt to balance that potassium.

Now, we have salt in our cupboard and we have nothing imposing on us the need to eat all those vegetables. I think that’s why only 2% of people actually hit that target and why, because of our environment, it’s so easy to eat a high salt/low potassium diet that we really do have to give our attention to that.

Significant nutrient deficiencies found in people on a ketogenic diet

Ari Whitten: With keto diets, are there any other significant nutrient deficiencies that are worth noting here? It’s possible to consume quite a bit of green, leafy vegetables or non-starchy vegetables on a keto diet, but you’re still talking about limiting large amounts of different categories of plant foods. All the starchy vegetables, tubers, root vegetables, and legumes, and all sorts of things like that, which are still going to have to be limited very strictly. Are there any other nutritional deficiencies that might [crosstalk]?

Dr. Chris Masterjohn: Not any that I would specifically target at keto, there’s a lot of other things, a lot of nutrients, that are more found in plant foods than animal foods. Talking about keto is kind of different than talking about carnivore versus omnivore vs vegan, right? There’s some overlap. I think a lot of people in the keto community are going to be vulnerable to some of the carnivore vs omnivore vs vegan issues. I think that anyone who isn’t eating dairy products has to be way more mindful of their calcium than they would otherwise, but I wouldn’t peg that on keto specifically.

What we talked about, I think, is the most keto specific stuff, but then just because you dealt with that doesn’t mean you don’t have to think anymore about your nutrition. Everyone who’s not eating dairy products needs to think about where their calcium is coming from. Anyone who’s eating mostly carnivore, especially if it’s high on the meat aspect of things and is not eating legumes, needs to think about molybdenum. Animal protein raises your need for molybdenum. Molybdenum’s mainly found in legumes. That’s not really a keto thing. That’s probably going to impact paleo people the most. Paleo people eat a lot of meat and they don’t eat legumes, depending on your interpretation of it. I think keto people need to think about those things, but they’re not that specific to keto.

There are other things that could be like not does keto make you deficient in this nutrient, but why do you feel better on keto or why do you feel like crap on keto. For example, thiamine is much more important to carbohydrate metabolism than the metabolism of fat. If you do really well on a high fat/low carbohydrate diet, that could be a sign that you need to think about your thiamine status.

Conversely, riboflavin, vitamin B2, plays a role all across energy metabolism, but for whatever reason when people are deficient in riboflavin, it’s the fat metabolism that drops first. If you feel like crap when you eat fat and you feel great on a really high carb/ low-fat diet, that might be a sign that you need to look at your riboflavin status. There’s a lot of things like that, that come into play as well.

Pitfalls and nutrient deficiencies associated with veganism

Ari Whitten: Got you. Let’s dig into more carnivore vegan stuff and maybe talk about some of the pitfalls and deficiencies that might be associated with veganism.

Dr. Chris Masterjohn: Yeah. With veganism, you, first of all, have a problem where there are many metabolic conversions that need to be done in order to convert whatever is in the plant into what we would have gotten from animal foods and what we actually need in our bodies.

The biggest example of this is vitamin A. You can get vitamin A from keratinoids, which are a group of chemicals that are either beta-carotene is the prime example or relatives of that, that can be converted into retinol, the form of vitamin A that we get from animal foods.

If you are good at making that kind of conversion, then you can be vegan and you can eat a lot of red, orange, and green vegetables and you’re going to get tons of vitamin A. If you’re bad at making that conversion, then you can eat a diet that’s got tons of red, orange, yellow, and green vegetables, but because you didn’t liver, you didn’t eat [inaudible], you didn’t eat eggs, and you didn’t eat dairy, you have no retinol in your diet and you didn’t take a supplement of retinal, so you never got the retinol that you needed.

Maybe your night vision is declining. Maybe you have some flaky skin problems that are developing. Maybe your circadian rhythm is messed up. Many things could start going wrong where you might actually develop systems of vitamin A deficiencies despite when you do a dietary analysis, it tells you, you’ve got tons of vitamin A.

Part of that is genetics. If we took a room of a hundred people, we could separate that room into two halves. On the left, we’d have the people who are the best at making that conversion. Everyone on the right would be at least half as bad as them at making that conversion. That half on the right, we could split that about in half and the quarter on the furthest right, a quarter of that room, would be four times worse than the good converters on the left only for genetic reasons.

Regardless of your genetics, you have your thyroid health. You have your other nutrient deficiencies like iron, zinc, vitamin A. You have oxidative stress, which could be driven by toxins, metabolic disorders, metabolic dysfunction associated with insulin resistance, deficiencies of antioxidant nutrients like vitamin C and vitamin E and many others, parasites. A whole host of circumstantial health issues, besides your genetics, that can hurt your ability to derive vitamin A from plant foods.

Really, no one knows how good of a converter they are unless you were to take a standardized test meal that has a defined amount of beta-carotene in it and then you measure the increase in retinol in your blood and you can get a good estimate of it, which is approximately no one who is listening to this show will ever do.

This isn’t vegan specific, it’s just the average person who’s a bad converter is getting, maybe, a third of the RDA from eggs and dairy products and maybe they’re getting fortified cereal. Maybe they eat Total for breakfast and they’re getting more. Maybe they’re taking a multi-vitamin and they’re getting more. If you’re just talking about foods, the average person is getting a third of the RDA from eggs and dairy. If they’re a bad converter, they’re going to be kind of borderline vitamin A deficient, or at least you can call it inadequate, suboptimal, or whatever.

Then you have a vegan and that person’s not eating the eggs and dairy. All of a sudden, the number one source of retinol in their diet is gone and they’re going to be in a much worse position. Vitamin A is not the only one. Vitamin B6 also undergoes metabolic conversions like that. The essential fatty acids undergo metabolic conversions like that. Those are the prime examples, but there are probably others as well. Really, for metabolic conversions, it’s vitamin A, vitamin B6, and essential fatty acids.

Why vegans often experience a mineral imbalance

There are other things where vegan diets just aren’t very high enough. Zinc and iron are great examples. You can get a lot of iron from plant foods, but there’s also a lot of inhibitors of iron absorption in those plant foods. The bioavailability is a lot lower. If you’re a man, probably nothing to worry about, but if you’re a woman with a high menstrual and you’re losing a lot of blood and you’re losing a lot of iron, your needs are higher or you become pregnant and your needs for iron triple, then eating only plant foods is not putting you in a good position for iron.

Zinc is much worse. First of all, the best sources of zinc are oysters, beef, and cheese, none of which are vegan. Second of all, animal foods, in general, are just much higher in zinc than plant foods almost across the board. Then, the principal inhibitor of zinc absorption is phytate. Phytate is found in whole grains, nuts, seeds, and legumes, which are the best sources of vegan zinc. Globally, the World Health Organization estimates that 50% of the world’s population is at significant risk of zinc deficiency. The prime determinate of that is the zinc-to-phytate ratio in the diet. The prime determinate of that is the animal-to-plant food ratio in the diet.

Is everyone who’s vegan going to become zinc deficient? No, but everyone who’s vegan … Oh, and animal meat has an amino-acid composition that enhances zinc absorption in contrast to the plant foods having phytate that inhibits zinc absorption. There’s like a four to a five-fold difference in bioavailability of zinc between animal and plant foods. You are not necessarily going to become zinc deficient as a vegan, but you have a lot of strikes against you in that department.

Those are the big ones and leaving out the most famous one, which is vitamin B12. There’s either no B12 in foods that are not animal foods or there is some evidence that, I think it’s unclear how consistently they’re found in these foods, but there’s some evidence that there is real, usable B12 in a select handful of vegan foods that include green and purple nori, which is also known as laver, which is a specific seaweed, but not seaweed in general. In chlorella, although it’s been demonstrated that chlorella’s B12 content is extremely inconsistent, and in a few species of mushrooms, chanterelle and I forgot the other couple.

If you look at vegetarians and vegans … Actually, most people are deficient in B12 because most people are not vegans or vegetarians or people with digestive disorders, especially elderly people with gastritis. If you look at most people who are omnivores, then maybe 15 or 16% of them are B12 deficient. If you look at a sample of vegetarians and vegans, you’re looking at 70% of the vegetarians, 90% of the vegans. Wherever the B12 might be in some vegan foods and however much the advice out there all tells vegetarians and vegans to supplement, either they’re not taking the supplements that are being recommended, or the supplements aren’t good enough at improving your B12 status. Being vegetarian and vegan is the biggest risk factor for B12 deficiency. I think that’s the big ones for veganism.

Typical nutrient deficiencies or toxicities that are particularly relevant to fatigue

Ari Whitten: Okay. Cool. I don’t want to take too much of your time here. I know we’ve been going for quite a while here, but are there any other nutrient deficiencies or toxicities that you feel are particularly relevant to fatigue?

Dr. Chris Masterjohn: I would say that it’s almost all of them. We kind of hit on this in the beginning and I think it’s worth coming back to it in a little bit more detail. Anemia is going to be a big one, especially among women, just because menstruation is such an important risk factor for iron deficiency. You don’t have to be a woman. Exercise increases your need for iron. Intense exercise can cause some occult loss of blood in the intestines. There are other things that increase your need, but losing blood every month for decades is a huge risk factor for women.

On the other hand, there is a large percentage of people, minority, but a substantial percentage, including myself, who are genetically predisposed to iron overload. Iron overload causes fatigue, too. You can actually switch from one to the other. Imagine a woman who has the genes predisposing to hemochromatosis, which is the clinical iron overload disorder. Imagine she goes through life with a heavy menstrual flow that causes her to be predisposed to anemia. All of sudden, her menstrual flow changes and suddenly the biggest thing determining her iron status is these hemochromatosis genes. All of a sudden, maybe in a matter of months, but probably in a matter of years, flip into the opposite pole where she also develops a form of fatigue that associated with iron overload.

Any of the B vitamins involved with energy metabolism; vitamin B1, which is thiamine, B2, which is riboflavin, B3, which is niacin, B5, which is pantothenic acid, B6, and biotin. Those B vitamins are really centrally related to energy metabolism. The other B vitamins that I’m leaving out, such as folate, B9, and vitamin B12, and choline is sort of like a B vitamin, these are supporting a process known as methylation. The 45% of what you do with methylation is you make creatine. If you’re not making enough creatine, you’re going to be fatigued. You’ll be fatigued more easily in response to exercise, intense exercise. You’re using creatine to recycle your ATP all the time. If you’re not making enough creatine, that could be a cause of fatigue.

Also, these methylation-related nutrients are playing a role in the brain. What are you calling fatigue? If your dopamine depleted and you’re having a difficult time attaching your attention and motivation to anything, then that can feel like fatigue. It’s probably more like apathy, but sometimes it’s not going to make a difference in terms of how you’re actually perceiving, or what you call that. Choline, another one of the methylation nutrients, is producing acetylcholine. Acetylcholine in the brain, one of the things it does is where dopamine might help you attach your motivation and attention to something, acetylcholine empowers the focus while your motivated and paying attention to it to get the cognitive performance that you need out of that. Acetylcholine in your muscles is what’s actually powering the muscular contraction. If your acetylcholine levels are low, that’s probably going to feel like something you’d describe as fatigued even though it’s a little bit different.

If you understood the mechanisms, you can start to think through what kind of fatigue is it? Is it really bodily or is it really mental? Is it mental, is it really about my motivation or is it really about my focus? There’s a lot of things to break down there and I think that can be kind of hard to think through. What makes it a lot easier is to say what are these things combined with and what can we measure.

Routine blood screening usually includes a complete blood count, CBC. That’ll usually have signs of anemia. It won’t necessarily catch all early anemia, it depends on how closely your looking. That’s a huge clue that puts you in that direction. You say, okay, am I deficient in iron? Am I deficient in copper? Am I deficient in B6 and the other nutrients that can cause anemia? Blood work, for most people routinely, is not going to be good at all for looking at the status of the B vitamins and in methylation or energy metabolism.

Antioxidant support is really important energy metabolism. The B vitamins are helping you burn the energy, but your antioxidants are helping make that fuel burn cleanly. If you can burn the energy, but you’re creating a big mess when you’re doing it, all of a sudden, you’re just going to downright [inaudible] your energy production because you’re actually hurting yourself by metabolizing that energy.

How antioxidants work inside your body

Ari Whitten: Real quick on that point. When you are talking about your antioxidants, can you explain a little bit more what you mean by that? A lot of people might interpret that as just taking antioxidant pill supplements.

Dr. Chris Masterjohn: I think antioxidants are the most profoundly misunderstood group of nutrients that there is out there. The antioxidant system, the main components of it are vitamin E, vitamin C, and then a series of enzymes that are dependent on iron, copper, zinc, and selenium, and manganese, and also on glutathione, which is something that you make out of dietary protein. Most people, when they think about antioxidants, are thinking of eating fruits and vegetables. Eating fruits and vegetables is important to your antioxidant support because the polyphenols in those foods increase the synthesis of glutathione, which is a good thing, but worthless if you don’t have enough protein in your diet. You make glutathione from that. They are providing vitamin C, especially, but they might also be providing some of those other nutrients, some vitamin E a little bit.

That’s only one small part of the picture. Zinc. Where do you get zinc? Oysters, beef, and cheese are the top sources. Most people don’t bite into a hamburger saying I’m going to get my antioxidants, but that hamburger’s got a lot of zinc that might, could be very important in your diet to supporting your antioxidant system. It is quite a lot more complex than what people are thinking about when they think about the term antioxidants.

Ultimately, it boils down to almost any of these nutrients can play a role in fatigue and maybe some of them are more common than others. You can hit the low hanging fruit. Probably anemia occurred to a lot of people or it occurred to their doctor if they’re complaining about fatigue. Maybe they found it, maybe they didn’t. If you didn’t, then that’s kind of positive evidence that there’s something else going on. That doesn’t mean that whatever’s going on is fundamentally nutritional. It might not be. You could have some infection that’s driving the fatigue. There are many things that could be at play, but nutrition is one of those.

When it comes to nutrition, it’s so complex that it really falls back on the need to comprehensively screen the nutrients. If you don’t want to spend years going in too many different directions that went nowhere, you really need to look at it in that comprehensive and holistic way from the get-go.

How to get the best out of the Testing Nutritional Status: The Ultimate Cheat Sheet process

Ari Whitten: Yeah. Beautiful. On that note, my last question to you is where should somebody think about incorporating this into the process of trying to fix their health problems? What I mean by that is let’s say somebody has some symptoms, they go to the doctor, and they get a standard blood test done. The nutrient deficiency test and your cheat sheet, should this be done alongside that right from the get-go? Should somebody already be looking at nutrient deficiencies right from there or should they get the standard blood test done first and only if there’s something wrong there, should they then try to pursue nutrient deficiencies?

Dr. Chris Masterjohn: Yeah. I think it depends on your resources. It depends mainly on your resources. I outline three approaches on the cheat sheet depending on how you want to play that game. One is a comprehensive approach where you just say these pages of test, I’m just going to do all these tests. If you really want the thing that’s going to give you the right actionable guidelines the fastest, doing all of that blood work, and urine work in some cases is an important part of that process. The alternative is to rely on less information and less information is just going to get you there more slowly.

That testing can be expensive. Sometimes, if your insurance doesn’t cover it, you might have to cough up out of pocket $2,000 to get everything that is comprehensive. Some people, maybe their insurance covers everything and it’s fine. Some people might live in a state where they can order it directly and they have no problem with that. Some people might need to ask their doctor about it. They don’t really have a doctor who understands it, so it’s a lot of work to try and convince them. Some people have a lot of money to burn and they just want the cream of the crop of everything they can do. Different people are going to look at that differently.

If you have no limitations on your resources, I say you do all the comprehensive stuff upfront. You do dietary analysis, take your blood pressure, and you consider all your signs and symptoms. In the cheat sheet, what I did is, I produced an index where you can just look in alphabetical order and stream through and say I’ve got this and got that and click on the thing and it just drives you to whatever is the highest probability thing there.

If you don’t have a lot of time, you skip the dietary analysis. The dietary analysis is time-consuming. I would say the majority of people, they have more time than extra money. There’s more extra time that they can re-prioritize what to do with then there is money. If your insurance and your doctor and your cash flow are not aligned to do all the lab testing comprehensively, which I think is going to be the majority of people listening to this, then what you do is you save the lab work for when it becomes really critical to differentiate between the correct actionable strategies.

For most people, I think you consider what your signs and symptoms are, if any, you look through what are the plausible causes of that. Using the dietary analysis to say my skin could be x, y, and z, but my dietary analysis says this is most likely. Maybe what that means is you could try a supplement or a simple, obvious change to your diet that has no risk associated with it and you just do it and see if it works. Maybe whatever would be the right way to fix it actually has some potential downsides, so you want to get better information or you’re down to two or three things that are actually competing with each other in their interpretation.

Iron is a great example. I could be iron deficient. I could have too much iron. Necessarily, if either of those is true, acting on one and being wrong is going to make everything worse. When testing is needed to help you decide between these competing explanations, that’s when you say okay, I’ve narrowed it down to these two nutrients. I’ve narrowed it down to toxicity or deficiency of this one nutrient. I’m going to do this, this, and this test to help me really figure out which practical strategy to use. Really, the final leg of evidence, the true confirmation, is now you engage in a practical strategy around that and you get better. If you engaged in a practical strategy around that and you get worse or you don’t get better, then that’s a critical piece of information that feeds into how you revise what you think is going on and what you think your next step should be.

Why you should invest in the Testing Nutritional Status: The Ultimate Cheat Sheet e-book

Ari Whitten: Yeah. Beautifully explained. With that in mind, I would like to give my personal pitch for your new nutritional deficiency cheat sheet. I mentioned this in the beginning, but honestly, it’s amazing that you’ve put this together in such a short format, I think it’s like 75 pages or something like that. The amount of information that’s contained there, I think, is encyclopedic. The fact that you’ve also made it so easy to navigate for people with this kind of algorithm like if you’ve done this past and came out with this result, see this section. One thing we didn’t really mention in this is you’ve also integrated strategy gene testing into this as well. Based on your results on the gene testing, see this section and this section and this section.

Honestly, just phenomenal work on this. For everyone listening to this, I cannot recommend this more highly. If you have any symptoms, go learn how to do this detective work. There’s no other resource like this that you can get. Most likely, the physician that you’re seeing probably doesn’t know how to do any of this detective work. Unfortunately, that’s the case. Most of them won’t. Go get this cheat sheet and learn how to do the right test and then do the right dietary analysis and then figure out what’s going on with you.

Chris, can people get that? I know we’ll put a link in the show notes page, which is going to be at the energyblueprint.com/masterjohn, your last name. Where else can people go to get this?

Dr. Chris Masterjohn: This is all sold by me. If your good at remembering links when you’re listening, you can go to chrismasterjohnphd.com/ari or you can go to the show notes that Ari set up and you can just click on the link to go to the page for this. Ari for your listeners, I’m offering a special discount for one week. The cheat sheet costs $30. You can save $5 by putting in ARISAVESFIVE, which is all caps, one word, and you can put that in the show notes so people can copy and paste it.

It’s ARISAVESFIVE. If you go on there and you put that in the discount box at checkout and you click the apply button, you’ll see the price drop from $30 to $25 and then you check out and you get that discount. That discount expires one week from this broadcast. Keep in mind that maybe you’re listening to him the day it came out, maybe you’re not. That translates to midnight, or more precisely, 11:59 p.m. Eastern time on February 2nd. Don’t take your chances. Get it by February 1st.

Ari Whitten: That’s pretty precise, 11:59 and 31 seconds Eastern time.

Dr. Chris Masterjohn: It’s going to be close, man.

Ari Whitten: Yeah. [crosstalk]

Dr. Chris Masterjohn: On the West Coast, man, they could really mess that one up.

Ari Whitten: Exactly. One thing I want to mention, also, is as far as the discount, I think that’s wonderful, but honestly what you’ve put together here is a huge amount of work and this is just an amazing reference. I think the fact that you’re selling it for $30 is, in itself, extremely discounted. I think you worked a whole lot more than $30. It’s just extraordinarily cheap for what you’re offering people.

Dr. Chris Masterjohn: Yeah. I could have found a way to market this towards a small number of people who are just working with clients and they’re going to pay $2,000 to get this as the text to some course that I teach or something like that. I really want to empower everyone who wants this information with this information. Making it easy and simple to do and making it affordable just go hand-in-hand with trying to push the empowerment out to the most number of people possible.

Ari Whitten: Yes. Absolutely. I really appreciate that about your work and I think it shows the fact that you’re offering this at the price you are. Chris, thank you so much for taking the time and taking a lot of time to do this podcast with me.

Dr. Chris Masterjohn: My pleasure.

Ari Whitten: It’s been an absolute pleasure and an honor to do this with you. I look forward to getting this out there and helping a lot of people.

Dr. Chris Masterjohn: Awesome. Thanks, man.

Ari Whitten: Yeah. Take care.

How nutrient deficiencies cause fatigue (and the most important minerals and vitamins for fatigue) – Show Notes

Introducing Dr. Chris Masterjohn’s new book – Testing Nutritional Status: The Ultimate Cheat Sheet (0:56)
Where to start when testing for nutritional status (1:55)
Why people and doctors need to think like detectives when it comes to nutritional deficiencies (8:33)
The most accurate way to test for nutritional deficiencies (11:35)
How to balance scientific nutrient testing and the idea of humans being able to thrive with lots of different dietary patterns (21:05)
The truth about the Inuit diet (28:49)
How ketoacidosis presents itself in the body (40:42)
Why eating according to ancestry can be good for your health (43:43)
The relationship between the ketogenic diet and fatigue (51:08)
Vitamins for fatigue – The importance of potassium (53:28)
Significant nutrient deficiencies found in people on a ketogenic diet (1:00:36)
Pitfalls and nutrient deficiencies associated with veganism (1:04:08)
Why vegans often experience a mineral imbalance (1:08:43)
Typical nutrient deficiencies or toxicities that are particularly relevant to fatigue (1:12:36)
How antioxidants work inside your body (1:18:18)
How to get the best out of the Testing Nutritional Status: The Ultimate Cheat Sheet process (1:22:07)
Why you should invest in the Testing Nutritional Status: The Ultimate Cheat Sheet e-book (1:26:23)

Links

To get the Book Testing Nutritional Status: The Ultimate Cheat Sheet. Follow the link https://chrismasterjohnphd.com/ari/. (Remember to enter the code ARISAVESFIVE if you want $5 off the purchase price. This offer expires on 02/02/18 at11:59 p.m. Eastern time)

Do Carbs Make You Fat? Separating Science From Pseudoscience On Carbs And Fats, theenergyblueprint.com
If you want to know more about carbs in fat loss, check out my podcast with Dr. Alan Christianson. Here we discuss the science of fat loss when it comes to carbohydrates.

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