Dear Mark: Oily Fish Limit, Diet and Posture, Acid Reflux, Whey Replacement, Milk and Fasting, and Remembering to Live

For today’s edition of Dear Mark, I’m answering six questions from some of my Twitter followers. Yesterday, I asked the community for questions and got some great ones in return. For instance, how much oily fish should one eat each week? And how does diet and nutrition influence posture and coordination? Third, how should a low-carb diet affect acid reflux? Fourth, is there a good replacement for whey protein? Fifth, does milk with your coffee break a fast? And sixth, how does one stop viewing and using food as an indulgence? I’ll get to the rest next time.

Let’s go:

I’m wondering, should the average person limit oily fish per week? Kresser says eat up to a pound. Masterjohn says fish PUFA should be no more than 4-8 ounces per week.

I’ll defer to the Chrises on matters concerning biochemistry, but here’s how I look at fish consumption:

It’s very self-regulating. I’ll go on wild salmon benders where I’m eating it every single day for a week or two, then none for awhile. Back in Malibu, I used to have my fish guy save King salmon heads for me, which I would then roast—the things were huge, fatty, and extremely filling. Between the brains, the cheeks, the collars, and all the skin, I reckon a King salmon head had about 20-30 grams of omega-3 fatty acids. Maybe more. Every time I ate one of those I didn’t feel like even looking at fish (or fish oil) for a week or so.

Ancestral background matters here. Your average Inuit is going to have a very high tolerance of (and likely requirement for) dietary long-chained omega-3 fatty acids because that’s the environment his or her ancestors inhabited. As someone of Northern European ancestry, I have a higher baseline tolerance for and requirement of long chained omega-3s; my ancestral food environment was very high in cold fatty fish. Someone with South Asian background is going to be better at converting shorter-chained omega-3s (ALA) into the long chained ones, so they don’t need to eat as much marine fat as a guy like me.

What is the influence of diet and nutrition on posture and coordination?

First and foremost, the micronutrients and macronutrients in the food we eat help program and provide substrate for the hormones, neurotransmitters, proteins, and energy used to coordinate movements and maintain posture. Every physiological process has a physical corollary; a good diet full of vital vitamins and minerals and absent toxic foods is a diet that supports good posture, energy generation, and movement.

One specific example is thiamine, a B-vitamin. Extreme thiamine deficiency is a disease called beri-beri, characterized by nerve tremors, difficulty moving, and extreme fatigue (among other serious symptoms). Almost no one in developed nations gets beri-beri anymore, but low level thiamine deficiency is common enough and can most likely result in deficient neuromuscular coordination.

I know that a diet deficient in collagenous materials (collagen powder, connective tissue, bone broth, skin) will worsen the health and resilience of your bones, tendons, ligaments, and fascia—the connective tissues that support and enable your mobility.

And finally, a diet that results in low energy levels, unwanted weight gain, and bad aesthetics will worsen your mental health and leave you down in the dumps—itself an independent predictor of poor posture.

But this is a difficult question to answer with specific references to individual nutrients or foods because no one I’m aware of is running studies on the connection between diet and posture. Just know that “it matters.”

Perhaps I’ll revisit this in greater depth.

What is a low-carbber to do if he deals with acid reflux? I’m told that a high fat diet aggravates symptoms… and it has for me. Is there any way I can stick to a healthy diet without having to resort to a “conventional wisdom” reflux plan?

That’s pretty strange. Normally, low-carb diets are great for acid reflux. There’s actually a lot of evidence showing that low-carb is the best diet for the condition, even a “cure.”

However, there’s also evidence that high caloric density within meals (in other words, huge meals) can worsen GERD severity and high fat intakes can increase the frequency of acid reflux episodes.

How do we square this evidence away?

In one study, the very low carb (under 20 grams a day) anti-GERD diet that treated obese individuals allowed unlimited meat and eggs with limited portions of hard cheeses and low-carb vegetables. That’s a standard Primal diet, but it doesn’t say anything about the fat content of the diet. If you’re eating ribeyes, that could be a pretty high-fat diet. If you’re eating sirloin, that could be a very high-protein and moderate-fat diet.

I’d stay low carb, but try eating more protein and not overeating. Avoid huge meals; don’t drink melted butter.

I’m allergic to whey protein. What can I use instead?

Egg protein powder is a good option. High bioavailability of the protein, good amino acid profile. Although whole eggs do work better.

Does coffee with milk impact fasting effects on keto?

It depends on how much milk you’re using.

Milk itself is rather insulinogenic, owing to its lactose and protein content. That doesn’t mean it’s bad, but anything more than a few tablespoons will effectively “break the fast.” I’d opt for heavy cream over milk. It tastes better in coffee, provokes a much lower insulin response, is mostly just fat, and thus allows the fat-burning metabolism of fasting to continue relatively unabated.

Hello Mark! Thank you for everything! – Question – what can be done to change how food is viewed? As life – not as a indulgent part of our lives?

That’s a good one.

You have to LIVE. You have to stop mulling over the thoughts swirling through your head. You have to go outside and do the things you’ve been considering doing.

I know people who have all the knowledge they’d ever need to know (and some they wouldn’t) about health and human happiness and nutrition and productivity and business, yet they act on very little of it. Instead of taking the lessons to heart and living out the conclusions of the latest study, they just move on to the next bit of research.

Food, like any substance or activity that triggers the reward systems of our brains, can fill a void in a destructive way. Fill that void with meaning, with love, with purpose and direction. The food will still taste good (or even better), but it won’t become an end in itself.

That’s it for today, everyone. Take care. Be well. And write in down below with any further questions or comments!

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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28 thoughts on “Dear Mark: Oily Fish Limit, Diet and Posture, Acid Reflux, Whey Replacement, Milk and Fasting, and Remembering to Live”

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  1. Thanks for answering my question about acid reflux, Mark! A while back, my doctor had put me on the usual medications (PPI and H2 blockers) and recommended a low fat diet, and it was one of the most miserable times of my life, and gained a lot of weight! I eased back into a low carb diet afterwards for my health’s sake, but the burning returned.

    I’ll be paying closer attention to my caloric intake moving forward. Thanks again!

    1. From my personal experience dealing with GI issues, the kind of fat I eat has to do a lot with my digestion. I don’t do well with liquid (coconut, olive, avocado) or rendered fats (lard, tallow), but I do great with intact animal fat (think lightly cooked pieces of beef suet or trimmings). Hope that helps.

    2. Pay attention to your stress patterns, as well. I’ve recently realized that high stress situations where I can’t dump the adrenaline through physical activity turn into heartburn that will light up the eastern seaboard. The most recent example was driving through Indianapolis last week where the entire drive was under construction and traffic was very heavy and compressed for miles and miles. It’s a neat little trick my body is playing on me.

    3. You may actually have low stomach acid. Try adding betaine HCL and digestive enzymes (NOW brand is a good one) to help digest the fat. Don’t snack; allow the stomach to empty. Stop eating 3-4 hours before bedtime.

      1. I am mostly eating a variety of meat these days plus lots of eggs and real Holland Rotterdam cheese and was having heartburn all the time – not diagnosed with GERD, but heartburn nevertheless. I had been taking digestive enzymes, which helped a bit, and then ox bile to help with fat digestion, which didn’t seem to do anything. I finally decided one week ago to try giving up my one cup a day of home-brewed coffee with cream. Voila! Completely fine that day until this.

  2. When I found MDA and began eating primally, my heartburn went away and has never returned. Previously, if I boarded an aircraft without a roll or two of Tums, I considered it a medical emergency. Have never looked back.

  3. I’ve already posted a similar question, but if you have hypermobility/EDS would you need more collagen than the average person, or does it not work that way since the joints are just naturally over flexible? Would it help prevent injuries that are common to people with EDS??

  4. On diet and posture: It’s important also to follow Dr. Mew and others who argue that the jaw and therefore posture are affected by the toughness of the diet. According to this theory, modern humans have a soft diet which negatively affects oral posture (which affects head posture) and jaw development. So kids should be chewing hard food, keeping their mouths closed and tongues on the roof of the mouth (no mouthbreathing) to have a face that grows forward and wide like the populations Weston Price studied. Dentist Dan Hanson argues that an inflammatory diet in itself increases chronic hyperventilation which shrinks the airway/face, which, again, affects posture. To learn more: Mike Mew and Sarah Hornsby have youtube channels explaining all this. Dr. Steven Lin has been on Kresser’s podcast talking about the topic. And Dr. Zaghi’s Breathe Institute in Los Angeles is also a great resource.

  5. Hi Mark, I’m part way through your Primal Blueprint audiobook when I get a call telling me I have Lynch Syndrome. I found a LS diet page which advocates a low fat, low red meat eating plan.
    I’m new to keto but it makes a lot more sense to me than the usual low calorie, fat free recommended junk foods.
    As I understand it, cancer feeds on sugar so I think I’m on the right track but there’s so much info out there, I don’t want to get it wrong.
    I guess I’ll keep in listening to your audiobook and follow my gut…

  6. So if one is allergic to dairy AND eggs, is pea protein the only option? (I have autoimmune disease and simply can’t seem to reintroduce these foods without problems.)

    1. Interested in this too- and the new golden pea variety particularly. It’s supposedly has all of the essential amino acids- thoughts Mark?

    2. A steak will be hands down way better than any pea protein you can buy

  7. That last question – food as an indulgence – resonated with me… I have always loved food. That was my impetus to learn baking and cooking! It is all too easy for me to over-indulge in something delicious! But I have learrned a few things to keep it in line.
    First, I try not to do food as entertainment. There needs to be another event or activity for the night to focus on.
    Next, I try to follow healthy food rules. I eat meats and vegetables. I try to keep my luxuries inside those bounds. Lobster, for instance! Or some fresh baby greens.
    Lastly, I try not to give myself time with my food to go back for too many seconds.
    Good luck! Mark is right – try to find other life pleasures to balance it out.

  8. I had what I thought was GERD that got worse on low-carb.

    Turned out I had two things going on; I had developed an intolerance to tomatoes and I’m pretty sure I had a hiatal hernia.

    Got rid of the tomatoes and worked on breathing exercises and some massage for the hiatal hernia, and I’m fine.

  9. Acid reflux was a problem for me until I read about aging affects digestive enzyme levels.
    I now take a digestive enzyme an hour before each meal (Vitazyme). As soon as I begin a meal a Aiken’s several Betain HCL capsules. My acid reflux is 90% better. The Betain HCL replaces stomach acid that helps digest even more than the digestive enzymes. Acid-reducing medications can actually cause us to digest even less.

    1. Agreed! Betain HCL is lifesaver for me. Big Pharma pushes antacids saying we have too much stomach acid, when in fact we don’t have enough.

    2. REFLUX/GERD – I had serious GERD issues before stumbling on The Primal Blueprint. I was scoped 3 times over about 10 years and the 2nd time had “suspicious cells, possibly Barrett’s”. The 3rd scope, after one year Primal, The esophagus was clear and healthy. No Barrett’s! After being primal/keto for 8 years (thank you so much Mark Sisson), although greatly improved, I still had occasional probs with reflux. About a year ago my wife and I did a 30 day carnivore trial. After week one there was zero reflux/heartburn/discomfort, and minimal to no burping. BTW, my wife’s arthritic inflammation in her fingers cleared up that month! Because of these and many other benefits I won’t go into here, we are still carnivore. When I cheat (rarely, and I don’t mean pizza, pasta, etc. – just vegetables) I’ll occasionally get some burn! I’m just fine without veggies now 🙂

      1. So interested in carnivore! Sounds like it was a healing experiment for you guys? Wondering if Mark has time for a post on the any new info regarding the growing carnivore diet. I’m currently considering it for my severe ulcerative colitis. Any insights and updates would be appreciated? Cheers Lily

  10. Regarding acid reflux. I suffer from it, too, even though I eat a low -carb diet (around 30 grams whole carbs a day) and have for years. My protein is up around 90 grams per day, and I really don’t add much fat, so I suppose it would be referred to as a higher protein diet.

    When it’s the worst for me is not after meals, but in the middle of the afternoon when I haven’t eaten in 3 or 4 hours. No problems in the mornings, even though I haven’t eaten for 12+ hours.

    I’d love an answer to this. I hate taking anything for it, but admit to taking a Pepcid on occasion, which makes the discomfort go away almost immediately.

  11. Hi Mark,
    I am allergic to corn and its’ derivatives. Which sweetener can I use.
    Thank you.

  12. Posture: Since I have gut issues, I noticed that there are times when my gut hurts, but it’s not a sharp pain and my mind filters it out. However, I can detect it if I do some kind of backbending exercise, or lie down with my back arched over a pillow. When it happens, I tend to go fetal, I wan to sit in a fetal position, lie down that way, etc. If it triggers a headache, I often have to sit on the edge of the couch, resting my head on my knees. My posture has definitely been affected by routinely being in low level gut pain. Also what you said about Vitamin B1 is really helpful. Natural sources of it seem to be primarily grains, but there are decent animal foods with it as well:

  13. Evening Mark
    I’m French so my english is not perfect.
    Do you know if the keto diet is a good life style for people with a pancreatic problem?
    Thank you very much for everything. I can’t wait to read your book in French langage. Isabela.

  14. I recently had acid reflux for the very first time at age 52 when I was deviating pretty badly from my normal keto diet, traveling and eating non-keto at restaurants and celebrating over about 2 weeks. I think it was a combination of milk, or half and half in my coffee, some small amounts of gluten, but mostly because I was eating a lot of sugary desserts. Lesson learned!

  15. I’m mildly sensitive to cow dairy and have been liking goat protein post-workout. I’m considering rotating in egg white protein and maybe beef powder protein as well. How do you balance finding what works and sticking to it versus trying new things out? Don’t the body & microbiome become more efficient at taking in foods the more used to them they get? Up to a point though. I sort of gave myself a dairy allergy back when I was 16 and drinking two gallons of whole milk a day trying to do the bodybuilding thingie. So yeah. What say y’all?

  16. I do not eat fish .what can I substitute in my keto diet?

  17. As for oily fish- apparently sablefish or ‘black cod’ is super high in omega 3. Some sources say higher than most salmon species, is this a good alternative for those of us not able to access fresh wild salmon or perhaps have very young kids who don’t like salmon? My children will eat white fish but find salmon overwhelming (trying to change this) Love to know if it is a good choice and indeed if it REALLY has as much omega 3 as claimed. Cheers Rachel

    P.S- love everything you write mark and your products 🙂

    1. I’ve been so interested in black cod lately after all the attention it’s getting. I’m not a salmon fan sadly so would love to know if it legitimately does contain as much omega 3 as claimed and if there are any other benefits as it’s quite pricey.

      1. I’ve been searching everywhere for info on this!! Please Mark let us know how black cod (sablefish) stacks up for omegas!