For today’s edition of Dear Mark , I’m responding to four reader comments. First up, if a person can’t eat eggs, doesn’t like liver, but really wants choline, can they just supplement? Second, are a couple handfuls of almonds  too much omega-6  for the average person? What if they eat fish? Third, a new study claims to show that keto dieting tanks hepatic insulin sensitivity. What should we make of it? Are we giving ourselves type 2 diabetes by going keto? And fourth, I highlight a great approach to drinking alcohol (and living in general) from one of our readers.
If I can’t eat eggs, and don’t like liver, can I supplement with choline? What would be a good dose?
Yes, you can supplement with choline. Men need around 550 mg per day. Women, 425 mg. Those requirements go up if you’re pregnant or nursing, and they very likely go up if you’re drinking.
It’s very possible that those are good levels for the average person eating a low-moderate fat diet. If you’re eating a high-fat diet or engaging in cognitively-demanding work, you may benefit from higher doses.
What jumped out at me was high O6 from snacking on almonds…this was in the fish oil post too, and it’s got me looking twice at how much is too much. I have a handful or two almost every day, and not supplementing with O3 ( although just started an experiment with daily supplements or fish). Too much?
Thanks as always for the excellent post—I’ve been wondering about alcohol too!
Don’t get me wrong. Almonds are a nutrient-dense whole food. They’ve got tons of magnesium, prebiotic fiber, polyphenols. Their health effect profile is impressive:
- Almond consumption improves fatty acid profile of serum lipids .
- Almonds reduce lipid oxidation biomarkers in older adults .
- Almonds reduce 24-hour insulin secretion in non-diabetics .
- Almonds improve glycemic control in type 2 diabetics. 
- Almonds improve satiety and postprandial glucose when consumed as snacks  and do not increase overall energy intake .
- Almonds possess potent prebiotic fibers , particularly in the skins.
- Almond consumption improves the endocrine profile of women with PCOS .
But they are high in linoleic acid. Absent fish, two handfuls a day is probably excessive. Having some fish fat will balance it nicely.
Try this: Replace one of your handfuls of almonds with a can of sardines or smoked oysters.
Does keto cause liver insulin resistance? Just saw this study and don’t want type 2 diabetes…
First of all, it’s a mouse study.
Second of all, it was a three-day study designed to look at the short-term transitory effects of going keto. Anyone who’s gone keto knows that the early days are a bit rough. Your mitochondria aren’t good at burning fat or ketones yet. You haven’t built the metabolic machinery required to extract the energy you need from the new balance of macronutrients. This period of transition coincides with the “keto flu”—that period of fatigue, listlessness, and headaches.
If you stick with the diet and make it through to the point where you can crank out and utilize ketones, everything changes. You can suddenly start making ATP from all that body fat you’re burning off, giving you a virtually limitless supply of energy at all times. It’s great.
But in the meantime, for that early period it’s rough. You’re insulin resistant,  yet unable to burn much fat. Your liver is perpetually overloaded with energy, making insulin resistance almost unavoidable (if transitory).
Third, the composition of this study’s “keto” diet was about as bad as you could get (PDF ). The fat came from Crisco—the classic trans-fat laden version—rounded out with a bit of corn oil. Trans-fats and omega-6 linoleic acid. Does this look like the diet you’re eating? Does this look like the keto diet  anyone is eating? If the researchers set out to get the worst possible results for the keto group, it wouldn’t have looked any different. almost looks like they were trying to get the worst possible results.
Alcohol in ketosis is just one aspect of alcohol use in a healthy lifestyle. For me personally I perceive alcohol to play not a vital but an extremely useful role.
I drink about 40 gm of ethanol just about every day in the form of a classic gin martini made with 3.5 oz of premium gin (healthy fats in that olive, brother). I consider gin to be a very special spirit because it is comprised of water, ethanol, and botanical substances like the l-terpenes from juniper berries which are known to have a tonic effect on the human organism – and none of the hundreds of dubious organic chemicals (referred to as “cogeners”) contained in whisky or tequila. I always consume this martini between 5:00 and 7:00pm, and I very rarely drink anything else at any time of day or night. I have this drink immediately before and with the evening meal which I personally prepare from scratch with fresh ingredients and consume with my wife of 51 years.
The martini seems to me to punctuate and enhance the transition from “doing” – being responsible, making things happen, solving problems, exerting myself – to “not doing” – resting, refreshing, nourishing, regenerating. Subjectively, I feel like this one drink, consumed with food, stimulates the parasympathetic nervous system. The alcohol research, so-called, tends to produce the opposite result, but in my opinion, virtually all of the alcohol effects research is dreadful – just about the junkiest junk science you can find anywhere.
I will be 80 on my next birthday, my resting heart rate, measured with a Polar FT7 heart rate monitor as an average over 3-5 minutes is 51-52. I ride a mountain bike on intermediate level trails – often in a fasted state – and recently recorded a maximum heart rate of 167. This is considerably higher than the HRmax predicted by any of the recently validated formulas. My GGT level is 16, so I have to conclude that my liver thrives on classic gin martinis. I take no prescription medications and no over-the-counter medications. I am not trying to brag here, I am just trying to document that by just about any measure my health and physical condition is exceptional for a person my age.
My personal belief is that alcohol in the right form and used properly is a health food. This conclusion is based on my personal experience, but I dearly wish that some enterprising biochemists, neurologists, and social psychologists would get together and design a quality research program to examine alcohol’s health effects under various real-world conditions. People like to drink, but a lot of what they drink is full of cogeners and sugar and genuinely toxic crap. Almost nobody has a clue what is in what they are drinking and what its health effects – positive or negative – might be. Millennials are currently destroying their livers in droves and even killing themselves with booze at distressingly early ages. Beliefs about alcohol and drinking in our culture are pathetically primitive.
I think I’ve got it figured out for me, but I think it would wonderful for the rest of the world to know the score.
I’m highlighting Daniel’s words even though he wasn’t asking a question. This man gets it. This is how to approach, appreciate, and consume alcohol. He’s drinking with complete lucidity, total awareness, and mindfulness. Alcohol isn’t “just” something you use to get loaded. It’s a sacred chemical that marks the transition from “doing” to “being.”
Many people blur the lines, drinking for the hell of it. Make it more of a special occasion, consume it mindfully and purposefully. Having a couple glasses of wine at night because I’m bored will ruin my sleep  and throw off my tomorrow. Having those same two glasses of wine and some conversation with my wife or dear friends over cheese and olives has an entirely different physiological—not just psychological—effect. My liver actually processes the wine consumed with mindfulness differently.
That’s it for this week, everyone. Thanks for reading and be sure to chime in down below with your own comments, answers, or concerns.