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.
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?
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.