Dear Mark: EVOO, Supplements, Autoimmune Arthritis, Sauna, Keto Camping, Ketones for Autoimmune

For today’s edition of Dear Mark, I’m answering another round of questions asked by Twitter followers. First up is a three-parter, including a query about extra virgin olive oil, one about supplements everyone should take, and one about autoimmune arthritis in an athlete. Second, I cover whether sauna is a hormetic stressor or a way to relax (or both). Next, I give my recommendation for staying keto or carnivore while camping (it’s a quick one). And finally, I explore a potential protocol for using exogenous ketones to curb autoimmune inflammation.

Let’s go:

1. Is very-high-polyphenol EVOO legitly far superior to easily-avail. qual EVOO?
2. What handful of supplems (broadly defined) make sense for almost everyone?
3. Any advice for age 20 elite athlete cursed w genetic autoimmune arthritis where keto, paleo, Mediterranean all failed? Carnivore?

Olive oil:

All else being equal, very high polyphenol EVOO should be superior to normal EVOO. Be careful in weighing messaging around this, however.

But, yes, the more polyphenols your oil has, the better it will resist oxidative damage when exposed to heat, light, and the ravages of time. By extension, the more an olive oil is sheltered from heat, light and the ravages of time, the more polyphenol content will be preserved.

And when you consume high polyphenol EVOO, your LDL actually becomes more resistant to oxidative damage. One study found that men who ate high polyphenol extra virgin olive oil had lower oxidized LDL levels than men who ate normal EVOO. They even had higher HDL levels, another indication of improved heart health.

Supplements for all:

Collagen—vast majority of people don’t get enough collagen/gelatin in their diets, whereas historically people were eating the entire animal, including skin, bones, tendons, fascia, ligaments, and cartilage (about 40-50% of animal by weight). A couple scoops of collagen gets you most of the way there.

Magnesium—vast majority of people don’t get enough magnesium. Our water is stripped of it and our soil is deficient in it. Foods that a generation or two ago were excellent sources of magnesium are now middling. Get one of the magnesium “-ates,” like citrate, glycinate, or threonate.

Vitamin K2—another nutrient most people miss that’s absolutely crucial to heart, bone, dental, and hormonal health.

Egg yolks—best source of choline and a great source of many other nutrients in a highly bioavailable package.

Liver—eat it once a week at least.

If you don’t get sunlight or eat a lot of vitamin D-rich foods (wild salmon, pastured eggs, salmon eggs), vitamin D is a good one.

If you don’t eat seafood regularly, a good fish oil is worthwhile. Omega-3s are a critical nutrient.

Autoimmune arthritis in athlete:

I saw that the athlete in question has done “everything right”: Primal, paleo, the whole nine. Right?

Assuming that’s the case and they’re not eating grains, seed oils, sugar, and other things known to be inflammatory and irritating:

Carnivore is an option. Mikhaila Peterson battled a particularly severe case of autoimmune arthritis for most of her life and reports that going carnivore was the only thing that really fixed things.

Elite athletes often overdo it. I certainly did. And although exercise is a crucial part of preventing, recovering from and defeating arthritis, too much exercise can have the opposite effect. It can be too much. It can increase stress rather than mitigate it. It can overload the tissues rather than strengthen them.

I’d also consider trying exogenous ketones to blunt autoimmune inflammation. Check out the last answer in today’s post for more insight on that one.

Is sauna best utilized as a relaxing tool for recovery like meditation or as a hormetic stressor like a challenging workout?

Physiologically, saunas are stressful. A 30-minute sauna session at 174 ºF/80 ºC raises body temperature by almost 1 degree C, spikes your flight-or-flight hormones, raises cortisol, and triggers a powerful hormetic response by the rest of your body. That’s a stressor.

But ultimately, they reduce stress by making you more resistant to it. After such a sauna session, for example, subjects report feeling “calm” and “pleasant.” This isn’t a surprise, if you’ve ever completed a tough workout. That’s how a training session makes you feel, isn’t it?

Just because sauna resembles exercise doesn’t mean you have to keep them separate. It even gets better when you stack the two. For instance, people who frequent the sauna and the gym have a drastically lower risk of heart attack death than people who do either alone. That combo also reduces 24-hour blood pressure in hypertensive patients and confers special protection against all-cause mortality above and beyond either variable alone.

That said, post-workout sauna appears to be especially good at enhancing the training effect.

In runners, post workout sauna use increased time to exhaustion by 32%, plasma cell volume by 7.1%, and red cell volume by 3.2% (both plasma cell and red cell volume are markers of increased endurance performance).

In cyclists, post workout sauna increased plasma volume. This is important because increasing plasma volume improves heat dissipation, thermoregulation, heart rate, and cardiac stroke volume during exercise.

Any thoughts on how to stay keto/ carnivore when camping or backpacking?

There’s a Facebook group devoted to Ketogenic Backpacking. Join that for some ideas.

As for car camping, it’s the easiest thing in the world to do keto or carnivore.

Bring some cast iron pans, some meat, and a cooler full of ice.

Gather a ton of wood.

Light the wood on fire. Allow it to cook down to coals.

Place cast iron over fire. Cook meat on cast iron.

Repeat as needed.

What should the timing and dosage be if you are planning to use exogenous ketone supplements as part of treatment for an autoimmune condition or flare?

Unfortunately, this stuff is so new that there aren’t any established guidelines. However, a recent case study gives a hint at a protocol someone might want to try. This isn’t medical advice, mind you—just a suggestion for further reading and consideration.

The subject had Crohn’s disease, a pretty serious autoimmune gastrointestinal condition characterized by chronic inflammation, painful and frequent bowel movements (around ten per day in this subject’s case), and elevated inflammatory markers. In other words, something that ketone bodies should be able to help.

Every morning for two weeks, he took 4 grams of sodium betahydroxybutyrate (BHB). This helped, but after two weeks he increased the dosage to 8 grams split between sodium BHB, magnesium BHB, and calcium BHB. He took half in the morning and half in the early afternoon. Did it work?

Following the intervention, the subject reported feeling “dramatically better” with significantly lower GI issues and trips to the bathroom. The subject provided weekly urinary and blood ketones following supplementation to ensure a significant rise in ketone levels. Blood glucose levels fell back into the normal range after the intervention (105 mg/dl to 94 mg/dl). White blood cell (WBC) count, neutrophils, and monocytes returned to the normal range following the intervention. The most remarkable finding was that following the intervention, C-reactive protein returned to the normal range from 62.5 mg/l to 4.4 mg/l.

I’d say 4 grams of BHB would be a safe start. If your bowels tolerate it—no small feat, as exogenous ketones can really hit that hard—and they seem to be helping, move toward 8 grams. As always, work with your physician and discuss supplement protocols or changes to them.

That’s it for today, everyone. Take care, be well, and comment down below if you have anything to add or ask.

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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24 thoughts on “Dear Mark: EVOO, Supplements, Autoimmune Arthritis, Sauna, Keto Camping, Ketones for Autoimmune”

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  1. Hi Mark,
    Any studies or studies from which you can extrapolate to optimize sauna use for resistance training. It seems to benefit cardio workouts, but I’m not sure how to best use it in relation to lifting.

  2. Sisson says sea shack sauna sessions surely support superb system synergy.

  3. Does anyone know where to buy “very-high-polyphenol EVOO” that’s affordable? How do you know what the polyphenol content is? And if a bottle is labeled as “very-high-polyphenol,” how do you know that’s accurate?

    It seems as if basic, high-quality varieties of EVOO are cheaper and easier to find (and less likely to be adulterated or counterfeit) than they used to be, in stores such as Trader Joe’s, Costco and Whole Foods. Is there any reason to switch away from those?

    1. Hi Ted,

      For high polyphenol olive oil, check out Apollo Olive Oil. They’re based in California. They even offer a discount for first time buyers. But if you buy now, you’ll be getting oil from last year’s harvest. If you wait a few more months, you’ll get this year’s harvest.

      Yes, there are some high quality olive oils at the three stores you mentioned. At Whole Foods, look for the small batch California olive oil (store brand). Last January my local Costco had a good quality Italian olive oil from the recent harvest.

  4. Aside from the moisture, is there any difference between the sauna and the steam room? While at the gym, I have heard trainers selling memberships that one is to relax muscles while the other one preps for a workout. I always thought it was nonsense, myself.

    1. Heat, either moist or dry, will generally relax muscles and blood vessels. Increased circulation to your peripherals and muscles is going to do either job! Your muscles would be warmed and full of blood to start a workout, OR to heal after a workout. I don’t think it should be an either or…

  5. 6 out of 7 on the supplements! Sorry, no liver for me.

    1. If you chop it in with meatloaf or meatballs, you will never know.

    2. A suggestion for people who have a hard time with liver. There is a brand of smooth pate mousse by Trois Petits Cochons called Mousse Royale au Sauternes. It is available in higher end grocery stores where you’d find the expensive cheeses. It has duck and goose liver, mushrooms, and is covered in a layer of gelatinous aspic. It’s amazing.

      I recently served a ton of it to guests who are very much into bread beer and pizza and they all loved it. It was fun turning people on to organ meats.

      They may go back to their food routines when they leave, but while they’re here I had them covered on Vit A and K2.

    3. You could also take desiccated liver as a supplement. I read that tablets may not break down well in the stomach, so capsules might be the better choice.

      1. My body can’t process vitamin D into the active form very well, and the liver stores vitamin D. There’s a whole series of reactions that lack of vitamin D causes in the liver if the hepatocytes start being starved of it. The end result is always cirrhosis or at least fibrosis. Over time I’m realizing that my deficiencies are all of one piece: Beta carotene doesn’t convert well for me either so I’m down to two sources for Retinol, Milk and Liver. Of the two, Liver is less irritating to me, but i do eat some milk products in moderation. Magnesium doesn’t seem to ever be enough for me, and it’s involved in Vitamin D formation. That could be parathyroid but I’d have to go for one of those clinics that specializes in that to find out.

        So liver is kind of critical to my health. Such as it is. I wouldn’t call myself recovered yet. Luckily if I forget to eat liver, I get pain in my upper right quadrant of my abdomen and since it’s not gallbladder (don’t have one), it’s pretty likely to be liver pain. It stops once I eat some liver. Freaky, but a good way to remember. I did an experiment where I ate liver daily for a while. It really made a difference.

        Vitamin A:

        How I eat liver:

        I’ve been having it rare lately and it’s much better that way. I won’t claim that everyone NEEDS it or any such nonsense, but my body seems to need it. I suspect part of my problem is the more than a decade I was vegan. Big mistake.

    4. I was totally in the same camp until I found out I was severely iron deficient and ended up having a lot of side effects from various iron pills. I found a liver pate recipe that contains a lot of allspice and my husband kindly made it for me (he’s been pushing me to eat liver for years 🙂 The pate is really quite palatable, no liver taste, and the energy it gives! Wow! I’m thinking I was also deficient in B12 given the resolution of my swollen tongue and the energy I get from the liver. I try to eat a couple ounces of the pate with celery every day. I’m a convert, might even try eating liver in other forms.

  6. I can help suggest something for the magnesium in water thing. There’s a company in Austria that makes BWT water filters, which look a lot like fancy Britas. They don’t do all that filtering stuff, they do an exchange, so that magnesium is returned to the water. It uses silver to maintain sterility, but you have to boil the filter occasionally (they say once a week, but twice a month seems enough for me). Kind of cool, and I think the water tastes really good.

  7. I’m throwing my vote in for carnivore, has transformed my health. I have a severe autoimmune disease, and it’s worked wonders.

    I have some tips-

    Do a wide variety of animal based foods.

    Lots of different seafood and shellfish of all kinds

    Do organs- pasture raised and ruminants are best. Gently cook them- brain is delicious gently poached with salt and vinegar.

    Meat for me is best raw or very lightly cooked- or gently cooked. Raw obviously you need to get high quality. If worried just make sure to not overcook your meats.

    Bone broth- with just grass fed bones or pastured chicken carcasses or necks! Slowly slowly and gentle makes the most healing broth if you are sensitive.

    Don’t be to die hard- it’s your body. I still use lemon juice and take aloe Vera.

    Would love to hear if you’d add anything Mark? And your thoughts on my diet above? I really respect your opinion would love any advice or additions you think could be beneficial.


    1. The availability of organ meats is a problem for me. Where do you find organs beyond liver, gizzards, and tongue? I love the idea and I have the genetics for carnivore, I think. But even to try it I have to plan it out.

  8. Question: Polyphenols are all the rage right now with everyone jumping on the blueberry and olive oil bandwagon. So I was disconcerted to read that they can be a double-edged sword and potentially have negative as well as positive effects. Is it possible to eat to many polyphenols from diet alone without resorting to supplements?

  9. So, do I have to stay 30 mins in the sauna to get the benefits? Or what is the recommended time?
    My local pool has a sauna that averages 195F(90C) most of the time. I can, after swimming, stay in there around 10 mins. Any more and I start to feel faint.

    Does anybody know?