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

September 24, 2019

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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!