So You Completed The Leptin Rx? What’s Next?

Readers Summary

  1. How does The Leptin Rx evolve into the Permanent Epi-paleo Rx Template?
  2. Was finding out about ultradian rhythms key to design The Leptin Rx?
  3. How important are ultradian rhythms to a developing fetus?
  4. How does a fetus hangle circadian rhtyms when it’s leptin receptor is non functional?
  5. What is the postscript for The Leptin Rx?
  6. How does one get to optimal living using circadian cycles?

Once you have added the Leptin Rx to your ancestral template and you have successfully experienced all the “small wins” that I mentioned in the Leptin FAQ’s blog, what should you do next?  If you recall reading the blog on how the leptin Rx works, it basically is a plan to make your gastrointestinal tract perform visceral exercises that it is not accustomed to performing, in order to cause neuroplastic changes in your hypothalamus’ arcuate nucleus.  It uses the vagus nerve as the “stimulator” to send these new messages to the brain.  After a period of time, the inflammation will slowly dissipate at the median eminence, and these afferent signals will force expression of certain genes that have been repressed since we were in utero.  These genes and pathways are hardwired into our DNA at conception, and used until the child is 12-24 months old.  After this time, they are not expressed any longer, because transgenerational epigenetics favors instead the use of the leptin receptor from an evolutionary perspective.  This occurs because the leptin receptor in the arcuate nucleus is far more sensitive and accurate in accounting for electrons from food than was using older circadian and ultradian cycles that we used in uteri during morphogenesis.  The human brain learns “what neural circuits” to use by repetitive firing.  We have a saying in brain surgery,  nerves that fire together wire together.  This is the basis of the theory of Hebbian learning.

These exercises I told you about in the Leptin Rx signal hypothalamic neurons to adapt to these visceral responses to food in a new way, to sensitize the leptin receptor in order to account for electrons from food in precisely how it was designed to do by evolution.  In essence, we are altering the genetic expression of the genes in our arcuate nucleus.  I describe it to my patients as “performing brain surgery on them without using a blade.”  The visceral responses to the Leptin Rx are transcribed  by the vagus nerve, and this information is sent to the brain.  This message is dramatically different than the one the patient is used to giving the leptin receptor, and the new message induces changes to the neuropeptides in the brainstem.  After some time, (6-8 weeks for most) changes will be induced.  These can be followed by the clinician or the patient.  Those clinical signs are outlined in the Leptin FAQ blog post.  In doing this,  we force the neurons to see neurochemical signals that radically confuse the leptin receptor and the brain.  The brain’s response to a signal it does not understand is to revert to an older known pathway or to learn a new way to tackle on old problem.  I would suggest you watch How your brain re-learns from 2007 by Dr. VS Ramachandran in a TED talk.  He exquisitely explains how this type of learning is stimulated in the brain for phantom limb pain and its treatment.  One need not use expensive technology to induce gene expression. It is possible to do without an NIH grant too. It requires some synthesis of thought and experience. When you understand the essence of how the brain works, you just need to design a program and force it upon the brain to decipher what to do.  That is the essence of the Leptin Rx reset.

You can force the hypothalamus to once again rely on circadian and ultradian rhythms during the Leptin Rx reset process.  Once some clinical markers begin to be reported by the patient, we then have the clinical evidence that the leptin receptor has regained its ability to be yoked again to meal timing and to light cycles.  We essentially induced this gene expression by thinking about how to force the change.  The overriding factor in the brains organization ,is that when it is faced with confounding sensory variables, it becomes to rely on things it knows it can count on.  The circadian cycles are among the oldest biologic rhythms found in all  life forms on earth.  Before we had our current leptin receptor, we only had the circadian cycle to use for macronutrient partitioning.  Today, we are going to talk about how one might consider eating and living after the reset is complete.  This method is where a paleo or primal person, who is already fit and healthy,  may consider starting at as well.  It optimizes our biologic clocks and rhythms to lead to optimal performance and optimal body composition when it is performed consistently overtime.  These biologic response are already built into our DNA.  It is our job to rediscover these ancient truths.

I have said in many blog posts that leptin controls oocyte selection in the mother and directs all placental growth all fetal development.  This plays a major role in epigenetics and you will see that when we get to the Energy and Epigenetics series down the road.

Some found this hard to believe initially, but a quick search of the literature will show you this is biologic fact.  I will now show you how this process begins during a period when the leptin receptor is not yet functioning in the fetus.  Circadian rhythms are paramount to how a baby grows in utero.  What I have not told you is how circadian cycle information are transmitted to the fetus by their mother’s hormone system when they are  in the womb.  This neuro-humoral transfer of information is how the child “yokes” external light (it can’t see) to metabolic cycles of their mothers feeding before the leptin receptor is even operational in the fetus. This point is critical to understanding how this neural circuit can be rediscovered when the leptin receptor is non functional.  It is hardwired into every human alive at some point in their maturation.  With time, humans evolved a better accounting system for electrons from food in adult life,  but these systems remain silent and latent because these neurons no longer fire together once the leptin receptor becomes function from 12-24 months of age.  The Leptin Rx is designed to make those neurons fire once again in unison to restart the older ultradian intra- uterean circadian system.  So you must be wondering how does the baby do this?

Circadian variations develop during intrauterine life in many variables that are induced and synchronized from the mother through humoral messengers (hormones) passing through the placenta.  Maternal leptin status is the critical hormone that completely controls placental development and it modulates the changes in human placental hemodynamics.  This is great news if the mother is in optimal health, and LS,  but it can be bad news if she is LR.  This information is directly sent to the mitochondria and this help initially set how they will handle electrons and protons from food and water.  These signals are first sent to the heart.  The heart is the first organ formed and it begins to beat early in embryology, therefore it needs its mitochondria to be earlier adaptors of the information contained in these particles.

This will send a poor humoral response to the child and cause major problems for the developing leptin receptor in the child’s brain regarding the current circadian cycles the mother find herself in.  Fetal development is tied to the mother’s circadian cycle for optimal growth.   In fact, the fetus is 100% dependent upon it to live.  When I finally realized this,  I knew that a adult human could bypass a defective leptin receptor later in life.  How to do it, however,  took me 5 years of thinking and reading.  Circadian and ultradian patterns in fetal movement can be recognized beginning between 24 and 30 weeks of gestation with increasingly prominent peaks during the night hours, especially during REM sleep of the mother. Ultradian rhythms are recurrent periods or cycles repeated throughout a 24-hour circadian day.  One ultradian rhythm has been shown to moderate the ‘hemispheric dominance‘ within the brain.  Although the exact function and interplay of the 2 hemispheres is as yet unknown, we do know that the left hemisphere is more specialized for linear, logical thought, and communication, and the right is more active when we are relaxed, dreaming, and in hypnotic state. But even this can be overridden if a child has an intra uterine stroke that wipes out an entire hemisphere.  That child can be born with totally normal neurologic function and yet have one half a brain.  The reason it occurs is because the brain relearns that all neural circuits will have to be accounted for on a smaller cortical footprint.  This indices epigenetic programs to put all specialized brain function into one hemisphere prior to birth.  The brain is extremely neuroplastic and adaptive.  This was not well known until the last 50 years of neuroscience developed.

Based upon very new sleep research, it appears that maternal ultradian rhythms seem to set the hypocretin neurons in the arcuate nucleus for both sleep and for metabolism before the leptin receptor is functional.  Some of the other common human ultradian rhythms of the body are hormonal release, heart rate, thermoregulation, urination, bowel activity, nostril dilation and appetite.  Appetite is critical to growth and development.  And we can use this ultradian cycle to reset the leptin receptor.  Appetite cycles involve the  rhythmic release of Neuropeptide Y (NPY) and Corticotropin-releasing hormone (CRH).  These two peptides are stimulating and inhibiting appetite peptides of the fetal ultradian rhythms.  This is the key neural circuit that fired together and wired together in all humans before their leptin receptor was fully developed and functional.

The mother’s sleep cycle is vital to a developing fetus ultradian cycles and helps to preset the leptin receptor in the arcuate nucleus.  When the mother’s sleep cycle is off,  none of these signals are transported to the fetus optimally.  The fetus then reverts to sampling the maternal hormonal levels to determine the light and night cycles. High cortisol levels, with low DHEA levels, high IL-6 levels are all sent to the child’s developing heart first and then to the developing brain (via the circumventricular organs) from the mother’s circulation via the placenta and affects how its own leptin receptor will work later in life.  It also appears the fetus can sample serotonin and melatonin levels from the mother as well to distinguish light from dark as well.  This original wiring remains intact in every human, but is not expressed unless we force that issue by altering our environmental circadian cycles.  Modern man is expert at that.

A rhythm in the “breathing” movements of the fetus is present after 30 weeks of gestation with a peak between 2 AM and 7 AM during maternal sleep, and with a superimposed ultradian rhythm component with a cycle length of 100-500 minutes.  The human fetal heart rate shows a trough between 2 AM and 6 AM similar to the maternal rhythm in heart rate.  At times, a drop in heart rate is deep enough to raise clinical concern.  A circadian rhythm in fetal bladder volume with a trough between midnight and 6 AM indicates circadian rhythmicity in fetal cardiovascular, renal and/or adrenal function (Haus and Smolensky 2004).  These rhythms in the mother are teaching the fetal brain how to account for the day night cycle before the child ever sees the sun once.  This is precisely how the arcuate nucleus in the hypothalamus learns the circadian cycle before the leptin receptor even develops in the fetus.  It is clear that we have these cycles hard wired into us while we are in the uterus and they are vital to life in utero.  These neural circuits become useless to us once we are born because we can then sense the circadian cycles for ourselves and from the feeding times from our mothers behavior.  When humans are born, they begin to be able to use the hypothalamic leptin receptor to account for circadian cycles and electrons from food more efficiently.  This occurs when we first get leptin from our mothers colostrum during our first feeding cycle.  This is initially how the leptin receptor is set in a child.  The leptin receptor then is selected for, because it begins to fire with other neurons it is wired to based upon feedings and sleep cycles.  This remain true in human life unless the leptin receptor is overwhelmed by inflammation and no longer works from any etiology.  This is what we see in obesity and leptin resistance.

The endogenous circadian and maternally induced rhythms of the fetus give rise to circadian differences in the susceptibility to toxic agents and to therapeutic interventions.  In animal experiments, the circadian periodicity encountered in the fetus is linked to circadian variations in the susceptibility to teratogenic agents.  The type and severity of embryopathies due to fetal toxicity in experimental models is determined by the interaction of both the circadian time and the developmental stage of exposure (Sauerbier 1992).  This is critical work, that shows how the developing human fetus responds to circadian rhythms.  It has been shown experimentally for cortisol, dexamethasone, hydroxyurea, cyclophosphamide, 5-fluorouracil, cytosine arabinoside and ethanol.  These experiments also showed that we can retrain the leptin receptor by using circadian cycles when many different toxicities maybe present.  Inflammation being the one we are most interested in for a Leptin Rx reset.  These experiments helped me realize that humans could lose weight if we could somehow retrain the adult brain how to “remember” what it learned in utero long ago.  At birth, high-frequency ultradian rhythms predominate over normal adult circadian rhythms.  The leptin receptor is still not functioning well at this time.  The child will not reach adult pattern of circadian rhythmicity before 12-24 months of age.  At this point then leptin receptor takes over.  These processes are still maintained by the human adult but rarely used.  This information was critical in coming up with the Leptin Rx reset. To become an Optimal human, you must live and eat in a biologically congruent fashion to the circadian cycles. Here is how I have done it since my own reset over six years ago.

Once reset on The Leptin Rx, what should I consider doing?

  1. Plan on eating a straight forward paleo template.  If you want to improve performance or longevity I would tell you adding more seafood to that template is a smart move.  If you are active, you can add carbohydrates from 10% to 20-30% of your diet within the proper long light seasons.  The diet is still a high fat moderate protein paleo template outlined in my book, The Epi-Paleo Rx,  Art DeVany’s, Robb Wolf’s, and Mark Sisson’s books.
  2. Upon rising within one hour eat 50% of your daily carbs with 25 grams of protein and 20-30 grams of fats.
  3. Never miss breakfast because eating it stimulates the circadian rhythm for gastric acid secretion in adults.  This will become critical later in the day for body composition optimization.  Many will naturally begin to only eat one meal because their redox potential rises.
  4. Avoid working out prior to breakfast.  It is a circadian cycle breaker because it raises cortisol at a time it is already high.
  5. For Optimal results you must get most of your daily activity between 9AM and 4PM when light cycles are strong year round.  This is another reason I strongly advocate high vitamin D levels year round.  The higher your redox potential the less you will rely on Vitamin D.  We evolved around the equator and equatorial sun has been shown to keep human vitamin D levels 50-150 ng/mL.  Avoid sitting at all costs and consider walking to get lunch or a short run during your mid day break.  The real goal here is to increase Non-Exercise Activity Thermogenesis (NEAT) during strong light hours.  This has major effects when it is done consistently over time.  For example, I run upstairs and avoid elevators and I park far away from my destinations to increase my NEAT daily.  I also carry all my groceries out to the car and never use a shopping cart to make it easier.  I look at every aspect of my actions to make sure I am maximizing it for NEAT.  NEAT is a cheap form of exercise for us all.
  6. For lunch, if you need to eat it, (some won’t eventually) you should consider eating 25% of remaining daily carbs.  I use this meal as a snack now.  Rarely is it a big meal for me any longer and if I am IFing this is the one meal I cut like a bad habit.
  7. Critical point: The best time to work out biologically occurs when it is least likely to be convenient for you because of our neolithic lives wont allow it.  I re-tooled my entire schedule as a surgeon to make this work optimally for me to lose weight and change my body.  It is that important biologically to get to optimal.  1-5 PM is the ideal workout window.  For best results, try to do the exercise in bright sunlight.
  8. Dinner should be eaten within 45 minutes to 1 hour of this late afternoon work out.  During dinner you want to make sure to include a lot of protein (25-75 grams), the remainder of your carb allotment and the balance in fats.  The type of fats at dinner are also critical.  Try to concentrate on 10-18 carbon fats because these are best at stimulating Cholecystokinin (CCK) that destroys the night time appetite.  I use coconut oil, ghee, pastured butter, and bacon lard to get this effect.  I use the fat to cover the carbs and the protein most times in sauces.
  9. Try to complete dinner by 7 PM.  This is critical in autumn and winter time to get to optimal results.  8PM is the outer limit for dinner in spring and summer.  I actually alter my meal times very precisely as the light cycle changes during the year.  Many people might find this too regimented.  I agree with this but I do it because I had a huge clinical move to make from 44% body fat.  Doing this strictly my first year I lost 133 pounds in 11 months.  So the details make a huge difference in good vs. Optimal.
  10. Sleep by 11PM in spring and summer months. I stay up longer June 10th to July 10th due to summer solstice on June 21.  During this time of the year I tend to have higher body fat with longer light cycles.  In autumn and winter I am in bed by 10 PM.  I am in bed earlier when the clocks are set back on hour in fall and heading toward the winter solstice on Dec 21st.  I have found I am leanest during this time of the year. The goal of sleep in any day of the year is an optimal 7.5- 8 hours of sleep a night no matter the season.  You will know when you are doing well because you will no longer need an alarm clock and your sleep wake cycle will be automatic.  I found after one year of using this protocol I no longer needed an alarm clock to wake up for surgery.

What changes should I considers after The Leptin Rx Reset?

  1. If you are active, drop all of the top ten paleo supplements I mentioned in that blog.  They were only meant for the transition from a sugar burning metabolism to a fat burning furnace as the permanent paleo template takes flight.  If you are not active,  I would strongly consider you remain on PQQ and vitamin D3. Try to optimize your vitamin D levels to 70-100 ng/mL naturally using sunlight.
  2. If you decide to Intermittent Fasting do not skip breakfast ever.  It is the key to circadian congruity and optimal body composition.  You will see below how this determines body comp and not the amount of exercise one does.

Key Points to keep in mind

  1. High protein consumption occurs at night now, not at breakfast as it did in the Leptin Rx reset.  The reason is because late afternoon is when the human body is normally programmed to undergo up regulation of protein synthesis biochemically.  This is how our biology is designed by Lady Evolution/deity.  If you remember back earlier in the post,  I told you the key point for breakfast was to use carbs and a small protein load to prime the gastric acid circadian cycle for maximal effect later in the day.  This is precisely the reason why.  Gastric pH should be highest when we are eating our biggest protein load of the day while simultaneously upregulating protein synthesis maximally in our body.  This maneuver actually influences our body composition more than any exercise could if it was added to the equation at all. Doing this on time is akin to an orchestra playing in unison.  It is a huge point to try to follow daily.
  2. Carb macro’s should parallel activity and light cycles.  Too often I hear many in the “primal world” talk about carbs and activity.  They always forget about the light cycle.  If you are real active and work out more than 4 days a week in sunlight, you can handle 30% of your calories from carbs.  If not consider 10-20% range.  The closer I get to June 21st the higher my carb amounts tend to go, and the closer I am to Dec 21st I am at a zero carb diet. I give this to you as a baseline to work from.  It is not meant for you to copy exactly as I do.  This is precisely how I ate to lose 135 pounds the first 11 months I came up with this program.
  3. Exercise/activity is optimal for us between 9AM and 4PM biologically.  I understand this might be hard to fit into your schedule but the payoff is massive.  Let me explain why now.  Remember that cortisol is highest in the AM to allow us to wake up.  If you exercise before breakfast you are risking elevating your cortisol even higher.  This will cause a pregnenolone steal syndrome and ruin your hormonal response that controls your lean muscle mass and fat ratios and eventually your body composition.  If you continue to do this over time,  it will slow your protein synthesis that occurs later in the afternoon and evening, that increases your body comp.  Moreover, it will also ruin your sleep cycle (checked by having low DHEA levels)  and you risk being in an overtrained situation.  I think this is the biggest error I see in the paleo community because they are trying to fit their “neolithic life” into their day best from a time stand point.  My advice is don’t even try it.
  4. You get the best (optimal) protein synthesis benefit if exercise occurs 1-4PM. Make sure your lifting days occur on the days of the week you can accomplish this.  Save sprinting days for days that this wont work for your schedule.  Use common sense about building this into your own life.  Optimize your schedule to benefit your body composition.  If you fight this trend you can still get ripped up but you will exhaust your stem cells in doing so and you will lose years on the back end of your life.  Timing is that important.
  5. To show you how important meal timing to the light cycles are to us humans, consider these facts regarding exercise and meal timing.  If you are able to yoke your workout to your evening protein dinner meal (within 30-45 minutes)  you actually “triple the amount of protein synthesis” that occurs compared to those who do not.  This is how a hunter gatherer attained their optimal body comp without having to do huge amounts of exercises.  Moreover, if this is also yoked to the light cycle in winter when the temperatures are below 40 degrees, you can increase protein synthesis to 400% while inducing uncoupling proteins to burn fat at a tripled rate to baseline.  This allows you to increase fat burning to shred body fat further faster while you are increasing lean muscle mass.  NASA uses this technology for the astronauts that space walk.  They found this data out ironically from the Sherpa’s who help foreigners scale the last 2000 feet of Mount Everest summit.  This is also precisely why I am leanest around December 21st,.  At this time, the light cycle its lowest and the temperature is usually low so exercising in this window is the easiest way I know to shred body fat and gain muscle mass quickly.  I went from 44% BF to 19% BF in one year doing this. I would also like to point out something here that you might not have ever thought about in order to show you how in-congruent humans really are with this timing issue.  When do we see ads in the newspapers for weight loss aids?  The answer is around New Years Day in January.  Why?  Because humans tend to get fat in winter so sports stores place ads when they are most likely to gain revenue.  They are in tune to our behavior.  Now change your mind set and think about wild animals you have seen on the Discovery channel. When are they leanest during the year?  The answer is in winter,  when food is scarce and they have to really forage for food in subzero temperatures.  Most humans live a life that is biologically in-congruent to how our biology is designed to live.  Once I thought about the leptin receptor biology and how I could reset it using circadian rhythms I went back to my veterinarian friends and to the exercise literature (Frank Booth) to figure how to live the rest of my life optimally and regain my optimal body form and metabolism.  This is precisely how I live daily today.  Feel free to call my operating room team and ask them when was the last time they ever saw me operating between 2-5 PM?  For the last 5 years the answer is never.
  6. The high protein and fats we eat at dinner diminish our appetite tremendously and this allows leptin released from your fat cells to enter the hypothalamus from midnight to 2 AM to send second messenger chemicals to the thyroid to allow us to burn excess calories stored in fat to be burned at the uncoupling proteins in muscles as we sleep in stage 3 and 4 sleep. Sleeping is the second critical way in which we increase our body composition.  We use sleep to get rid of excess fat and calories,  using T3, leptin and uncoupling proteins. During sleep, protein synthesis is also simultaneously occurring during the process of autophagy.  This is when we recycle all our proteins that we used during the day cycle.  Sleep deprivation leads to increased levels of IL-6 and TNF alpha, which simultaneously lowers our DHEA levels.  Decreased sleep also blocks the secretion of growth hormone at night and this leads to increase abdominal fat and eventually decreased lean muscle mass.  This is  why patients with sleep apnea have terrible body composition as a rule.  The lowered growth hormone levels leads to high levels night time cortisol release.  This is why so many obese, LR, sleep apnea patients feel the need to get up and eat carbohydrates at night.  Cortisol is supposed to spike at wakefulness not during our sleep.  People who awaken with high cortisol levels will also be drawn to eat a lot of carbohydrates at breakfast. If this occurs chronically, it will diminish the gastric acid cycle and destroy our naturally occurring cycle for developing our ideal body composition.  Why does this occur?  Cortisol directly stimulates gherlin release, which is an incretin hormone, produced by our stomach.  Gherlin is an appetite stimulant.  This hormone increases our drive to eat at wakefulness.  It is usually high when we rise, or it spikes anytime when cortisol is too high.  Elevated cortisol is a constant feature of obesity.  Cortisol should not be high during sleep ever.  When gherlin levels are increased by 30% from its baseline, it drives carbohydrate hunger while simultaneously decreasing leptin endocytosis in to the brain by 50%.  Elevated triglycerides and high inflammatory cytokines further block the action of leptin at the hypothalamus. For leptin to enter the brain, gherlin levels must be low,  and this is why 4-5 hours post dinner is the best time for leptin to enter the brain.  So if you do shift work you must be a great sleeper and run on a ketogenic paleo diet to have a chance of good body composition.  I have met only one person in my life who did this.

That is how I live now and why I do it after the leptin Rx reset.  I hope you found this interesting.  I will be gone for a brief period because my wife wants to get remarried on a boat near the equator.  So I will be optimizing Vitamin D the real way.  Leave a comment and I promise to answer them when I get back.  Happy Thanksgiving to all out there.  Please pay something forward this holiday season.  We all can make each lives better if we just do something to help one another.

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Additional Resources

  • My Leptin Prescription http://jackkruse.com/my-leptin-prescription/
    The Leptin Rx: FAQs http://www.jackkruse.com/the-leptin-rx-faqs/
    Leptin Reset http://www.jackkruse.com/easy-start-guide/
    Vitamin D: The Sunshine of Your Life? http://www.jackkruse.com/the-sunshine-of-your-life/
    Intermittent Fasting and Leptin http://jackkruse.com/intermittent-fasting-and-leptin/

Cites

  • http://www.nature.com/nature/journal/v226/n5252/abs/2261261a0.html
  • Moore JG, Halberg F. Circadian rhythm of gastric acid secretion in active duodenal ulcer: chronobiological statistical characteristics and comparison of acid secretory and plasma gastrin patterns with healthy subjects and post-vagotomy and pyloroplasty patients. Chronobiology International. 1987;4:101-110.
  • Moore JG, Merki H. Gastrointestinal tract. In: Physiology and Physiology of Biological Rhythms. Peter H. Redfern and Bjorn Lemmer, Editors. Berlin, Springer, 1997, pp.351-373.
  • Haus E. and Smolensky M.:  Development of circadian time structure and blood pressure rhythms.  In:  Portman R.J., Sorof J.M., Inglefinger J.R. (eds).  Clinical Hypertension and Vascular Disease:  Pediatric Hypertension.  Humana Press Inc., NJ, pp 45-73, 2004.
  • Haus E., Nicolau G., Lakatua D.J., Sackett-Lundeen L.:  Reference values for chronopharmacology.  Ann. Rev. Chronopharm. 4:333-342, 1988.
  • Rivkees S.A. and Hao H.:  Developing circadian rhythmicity.  Seminar in Perinatology 24(4):232-242, 2000.
  • Sara Mednick  , Ken Nakayama, Jose L. Cantero, Mercedes Atienza, Alicia A. Levin, Neha Pathak & Robert Stickgold (2002).  The restorative effect of naps on perceptual deterioration.  Nature Neuroscience, published online May 28, 2002
  • Aeschbach D, Matthews JR, Postolache TT, Jackson MA, Giesen HA, Wehr TA (1999). Two circadian rhythms in the human electroencephalogram during wakefulness. American Journal of Physiology, 277, R1771-9
  • Meneses Ortega S, Corsi Cabrera M (1990). Ultradian rhythms in the EEG and task performance. Chronobiologia, 17, 183-94
  • Rector RS, Uptergrove GM, Morris EM, Borengasser SJ, Laughlin MH, Booth FW, Thyfault JP, Ibdah JA., Daily exercise vs. caloric restriction for prevention of nonalcoholic fatty liver disease in the OLETF rat model., Am J Physiol Gastrointest Liver Physiol. 2011 May;300(5):G874-83. Epub 2011 Feb 24.PMID:21350190
  • Bjorntorp P. 2001 Do stress reactions cause abdominal obesity and co-morbidities? Obesity Reviews 2: 73-86.
  • Cota, D et al. 2006 Hypothalamic mTor signaling regulates food intake. Science 312:927-930.
  • Woo,R. et al. 1982 Effect of exercise on spontaneous calorie intake in obesity. Amer. Journal of Clin. Nut. 36: 447-47
  • http://www.ted.com/talks/view/lang/en//id/184

Comments

  1. Monte Diaz says:

    You sir, are the true Avant-garde of the paleo world.

  2. Happy Thanksgiving Dr. Kruse.

    I hope that you and your wife have a great vacation! Thanks so much for all the wonderful information that you so graciously make available. I don’t understand a lot of what you write, but by continuing to read your blog, I hope to learn more about improving mine and my husband’s health. My husband has asbestosis and my gut tells me that a paleo diet can only help my husband, not hurt him.

  3. Cú Chulainn says:

    Congratulations, doc, enjoy the wedding!

    Do you have an opinion on these glasses and lights for reducing melatonin loss from indoor light? Would you go with either or both? thanks…

    ttps://www.lowbluelights.com/detail.asp?id=69

    These stylish polycarbonate framed FITOVER glasses provide complete rejection of the light known to cause suppression of melatonin.

    https://www.lowbluelights.com/detail.asp?id=75

    This Dual Flexible Arm Book light has two amber LEDs per arm for a total of four LEDs. It produces light in the AMBER portion of the spectrum, with a peak at 589 nm, which is a part of the spectrum well removed from the blue region responsible for melatonin suppression.

    • @Cu I did a podcast yesterday with @joanneunleashed for 2.5 hours that she is going to unleash while I am gone and it was a leptin fest and we covered amber lights and and bluelights. I love anything that improves light cycles I guess because I have found for my own biology it critical to my success. During my first year I only read in pitch black light using a hunter site using an amber light. Yes, I was that big of tool. My wife still laughs when she sees my hat with the mounted amber light on it. I still use it in Nov and Dec when I am reading literature when I come home.

  4. Thank you!! I’ve been waiting for this! I will need your advice on when I can be sure that I am 100% LS and can start living the optimized life! Have fun on the boat near the equator, getting remarried :)

  5. moreporkplease says:

    I was freaking out reading this, so I went and looked up “chronobiology.” It’s real. And yes, you can train your body clock and hormones with food. Wow. qv:

    ^ Fuller, Patrick M.; Jun Lu, Clifford B. Saper (2008-05-23). “Differential Rescue of Light- and Food-Entrainable Circadian Rhythms” (free abstract). Science 320 (5879): 1074-1077. doi:10.1126/science.1153277. PMID 18497298. Retrieved 2008-05-30.

    • @moreporkplease Yes…….chronobiology is sadly under used and not well known. I hope this post will get the paleo community back on point. Light matters more than activity no matter what.

  6. Hi, thanks for a great post. I’ve done and lived by the reset-protocol for 4 months. I enjoy a big breakfast daily, with mostly protein and only some carbs. This is at 7 am. My lunch is protein-rich w some carbs at 2 pm. Problem is I am never hungry enough to eat dinner at 6 pm. On the odd occasion when I do eat in the evening, it tends to be carb-rich snack, typically bowl of berries with 1/2 banana and coconut cream. I only do this when I feel like I need carbs to avoid fatigue. Is this not good for me to do? Should I do berries at lunch and instead focus on an actual dinner-meal at 6 pm?
    When I do a 24-hour IF I do it from breakfast till breakfast. Is this okay? Often I do a 16-hour IF by skipping dinner/ evening snack. Is this not ideal either? Thanks for your advice, I look forward to taking less supplements too…

    • @Glamorama. This should not complicate you at all. You stay on the reset until you see all the changes I mentioned in the FAQs blog. Once you are there and you are doing your HIIT and sprints and feeling good…….transition to the Leptin Rx post Rx. Your body comp will become rockstarish slowly but steadily. The people who need the reset the longest are the ones with underlying inflammation that is hard to eradicate. The more inflammation will indicate bad hormonal testing on testing. This is not hard to do. It is all based upon timing and light cycles. And since you are in the southern hemisphere and approaching your summer solstice in the next six weeks its the ideal time to transition. Work out in the sun and make sure you follow the timing protocols for dinner. And change your workout time and watch your body put you back in that bikini you want.

  7. Wow – AMAZING!

    Dr Kruse, you said this post would open my eyes and it did!

    When you say a reset, it is quite literally that – in a sense going back all the way to when we were in the womb and starting again!!! Restarting the entire process of energy partition, so that we can “reboot” our leptin system and start again – absolutely amazing.

    I am 12 days into my Leptin Rx, and I am looking forward to being LS again, and putting these recommendations into practice – along with the recomposition of my body to something approaching what evolution/God intended.

    Thank you Dr Kruse. Enjoy your break – and congratulations to you and your wife on the renewal of your vows.

    Cheers, Luke

    • @Luke…….yes reset is precisely it. I would strongly tell you watch Ramachandran 2007 video I linked here. When I saw that video in 2007 it tied the leptin knot together for me. I remember explaining this to my wife the first time the day before thanksgiving the yr i was going to begin it…….and she was like are you kidding me? Brain surgery with out a knife. She is not laughing anymore. In fact she is a disciple of it now. And man does she look good.

  8. That was AWESOME..

    Thank you again, for the effort you make for us all. Your sincerity is unparalleled.

    Against truth, the greatest enemy in the world is the pseudo knowledgeable person ― and the greatest friend is one who knows that he does not know.
    It is better to be ignorant and trust your own experience than to be very ‘knowledgeable’, because all knowledge that is not YOURS is far worse than ignorance.

    Thank you Jack for opening us to the mysteries of existence.

    Have a Great time, Dr. Kruse, wherever near the equator your journey takes you. And wish you and your wife many happy years together.

  9. I’ve been waiting for this; thank you! I hope your trip is all you hope it to be!

    I would love to be pointed to any info that’s good on root causes and treatments of porphyria, as a dear friend’s daughter is suffering tremendously from what we believe may be this. They are paleo & traditional foods, but seeing no success in turning anything around.

    • @MommaGrok I seem to remember Robb Wolf talking about this in a very early Podcast he did with Andy Deas. I would suggest you email him about it. I personally think a true paleo template will help porphyria because at its core it is an autoimmune disease of the liver that can cause hepatocellular carcinoma long term…….it means read the leaky gut post, protect the brush border at all costs, and make sure your HDL is super high…..all that equals the paleo diet. I also would consider a cornucopia of liver protectors…..Sillymarin, R alpha lipoic acid, NAC, turmeric, and resveratrol. And if they take them make sure its not with dairy. And if they want to optimize their liver dairy is a no no anyway. I hope that helps.

  10. Fantastic post that ties so much practical & implementation information together. Absolutely revolutionary!

    Quick question on long-term supplementation. You mention dropping all top 10 suggestions except vitamin D. Would this assume that one does this only AFTER key biomarkers have been tested and found to be optimized?

    I’m a little suprised that vitamin K2 (to go with Vitamin D and EFA/EPA (fish oil) is not retained.

    I know that I (like many) have enough dietary transgressions (lee “cheats”) that I would want to retain fish oil etc and possibly taper dosing if my O6/O3 ratios are sub 3:1 heading to 2:1.

    Thoughts? Clarifications?

    • @Kevin I still test like a madman to this very day. I am do for my pre winter solstice labs as soon as I return. I added this panel at this time of the year because it is my own most difficult time of the year because I am quite sensitive to the light cycle. This is why I will seek equatorial sun at this time of the year to help sustain these six weeks optimally. Once I get to Christmas things dramatically improve form me. I also try to sustain my Vitamin D levels close to 100 in this quarter to offset my sensitivity of light on pineal-thyroid axis.

    • @Kevin It depends. If I am testing you I am likely going to know a lot more about you and I will customize the approach to continually alter your epigenetic expression in your brain stem to get to optimal. K2 is something I still take. But I am not doing it any longer for bone or arterial protection because I have test both of those axis and they are rockstarish. I do it now for my skin! But that is another blog……..unless Colleen Coble comes and tells you why!

  11. The no-breakfast during IF fasting rule might be a bit tricky to do. My easiest IF routine is skip breakfast and lunch, then eat a big dinner. 24 hours of no food.

    Also a bit confused about the “no supplements” but continue to take these rule. In terms of Vit D supplments, fish oil might still be helpful.

    The bit about carbs/light is interesting. I also find I lose the most weight around now (winter). But let’s be honest, winter weight game is about office parties and the crap you eat there.

    I don’t see alcohol mentioned at all.

    Also, thoughts on saunas? I’ve seen research on saunas boosting gherlin. I’d assume that is not optimal. But I’ve also seen studies suggest it boost prolactin, which should help with complete sleep. Anecdotaly, when I do an evening sauna I sleep like a baby. (No pun intended!)

    • @Charlie You can continue to supplement if you like. I use supplements based upon needs found in testing. I still tweek my diet based upon the circadian cycles and by my own testing. I am now 5 yrs out of trying this neuroplastic reset and I have to say once I was able to account for electrons from food correctly again I was not as strict as I was that first year. The first year I was a machine precise. My wife thought I was nuts but I was doing the ultimate biohack…..treating obesity using neurosurgery and no blade…….just a thought.

    • @Charlie Alcohol I am not keen on. I only recommend to my own patients this…..Malbec from Mendoza Argentina and French Piniot Noir. Both have astronomical amounts of resveratrol. If your a white drinker look to Long Island and their whites. Because of their harsh climates these whites also have resveratrol but nothing comes close to an Argentine Malbec. If you must drink booze stick with a non grain one like Tequila. Look at Robb Wolf’s Norcal Margarita for directions on use. Me……I have no had a pur eliquor grain drink since the day I did the reset and changed my life.

  12. Dr K I’m blown away yet again…Why…b/c over the past 2-3weeks(as the light has decreased during the day) I found I naturally moved to eating more carbs w/bkfst, and some carbs w/lunch….and very little carbs w/dinner! Every evening after work – I take the dog for a walk (sometimes w/the kids as well) I have been doing my LHT/HIITs at night after the kids go to bed…but will try to see if I can adjust that to right after work… I’m in no way optimal yet…as I’m starting to see some new hormonal issues – but i think that’s from the LR working…next step is testing to verify and validate I’m ready for the next phase!!!! Thanks so much…

    Enjoy your vacation and your re-commitment of your vows w/your wife!

  13. More and more I need to persuade my mom to do the reset…she has horrible issues w/SAD in the winter time..such that now she and my dad travel to the tropic every year in November for 1 month… they return from Ecuador, Chile, Peru, & the Galapagos next week… this will really help her…

  14. Dr. Kruse. Would you comment on how Prozac and other SSRI’s may screw up Leptin function. I found out recently that Prozac contributes to obesity and type II diabetes. I have been taking Prozac off and on (mostly on) for 20 years. During that time I have gained 100 lbs and am now T2D. I worry that my brain is really damaged and am hoping that you Leptin reset will help me.

    • @Sharron The inhibitory effect of serotonin on libido, ejaculation and orgasm is well documented in the literature. There is no direct evidence of an association involving brain pathways which are related to sexual behaviour, there is an interaction between leptinergic (those using the leptin receptor) and serotonergic neural pathways. In a study I read I remember serum leptin levels (obese men) were high in patients with premature ejaculation. So the fatter a man is the quicker he will come. I have found this to be true when i ask the partners about it. Most are surprised to find out why.
      The inhibitory effect of serotonin sexual function in both sexes has been attributed to a serotonin induced decrease in dopamine (a neurotransmitter enhancing sexual function) level in the CNS. Methylene dioxy metamphetamine (better known as ecstasy) induces serotonin and dopamine release with a central action, and causes an increase in libido and sexual satisfaction by dopamine release (reward tracts), while causing a delay and prominent inhibition of ejaculation and orgasm by serotonin activation. This is why this drug is so popular in colleges. People get sexually excited and can go all night long but can’t come! (Not sure I would use this as my choice method of birth control in college however.) Selective serotonin reuptake inhibitors (SSRIs) are reported to be effective for treating premature ejaculation and they cause major climax issues for many women as well. Im not a psychiatrist nor someone who prescribes these drugs, but their effects seem to render the user not to enjoy sex. And to me that is decidely anti-paleo! Moreover, it is clear evolutionary biologic principles seem to show us that if BMI is too high or too low human biology does not favor having sex or children. I believe this is because it is signaling that energy inefficiencies are so bad that leptin can not support the energy needs for child bearing. And since this is the case it down regulates sexual desire at the reward tracts. All these things add up to a lot of bad mojo to me. I am no fan of these drugs at all and when they only work 50% of the time…….I think I consider other treatments options first that are way more effective and less costly to my sexual being. I think the Leptin Rx reset will help……but talk to your doc about clearing your med list too. That reduces the toxin effects from your gut by these drugs and your liver begins to smile.

      PS: patients suffering from schizophrenia show significantly lower leptin levels than depressed patients. These findings also do not follow their fat mass either. The literature is not deep in this area but I believe personally that leptin plays a massive role yet to be defined in depression. I think schizophrenia it is even worse. I think it is complete neuronal energy in efficiency at play as the etiology. The decreased leptin levels found in depressed and schizophrenics were independent of their psychotropic medications too so this is no drug only effect. I think that depression and schizophrenia are associated with a shocking decrease systemic serum leptin concentration that cannot be explained by medication or an altered BMI. Energy energetics is the most plausible answer since leptin is the master controller of energy signaling in the brain.

  15. This is amazing research, Dr. Kruse! Enjoy your well-earned vacation/renewal of vows :-)

    The post is perfectly timely for me in particular as I recently finished the Reset, and didn’t have too many ideas of what comes next, other than slightly more flexibility in the breakfast timing and protein, slightly more carbs, and LHT/HIIT. This post, besides further explaining the logic and science behind the reset, really gets into finer tweaking for an optimized life. There were quite a few pleasant surprises here on what you discovered!

    Regarding the supplements:
    My assumption (could be wrong) on eliminating many of the transition supplements is that would only be advisable if your diet is now sufficiently diverse and provides many of these critical nutrients. For example, if you eat fish say 2-5 times a week, and barely consume nuts or omega 6, then you very well could discontinue omega 3 supplements if your tests show you in a nice range and you continue to test periodically and it shows you are still in a great range. In other words, part of the goal for post-Reset isn’t to stop getting (most of) the nutrients, but rather it is to make a greater attempt on getting them through food directly.

    Same thing with Vitamin D; it isn’t that Vitamin D is suddenly not so useful, but rather that when you are Leptin Resistant you needed massive supplements to “help get you out of the ditch faster”. You will need less intake of Vitamin D post-Reset to maintain the high blood levels, because your hormones are more optimal and efficient and can maintain you in the ideal range with lower intake than what was previously required. So most people who are post-Reset can maintain those high Vitamin D levels purely via sun most of the year and perhaps supplement (as well as use lamps) only in the darkest months.

    Am I understanding the spirit of this correctly or off base a bit? Thanks!

  16. How do you time your meals when you IF? If you eat breakfast at 7 or 8am, do you then essentially skip lunch, then workout and eat dinner by 2-3pm? How frequently do you IF?

    Also, do you recommend using an alarm clock initially to establish better sleeping habits? I sleep soundly 7.5 to 8 hours a night, but tend to not get sleepy enough to fall asleep until midnight or later, with no seasonal variation.

    Thanks!

    • @Rodney I eat breakfast and then I skip all meals to the next breakfast. I then skip lunch and then I lift 100 max on my lifts and within 30-45 minutes I eat a monster amount of protein at dinner with only 25 gms of carbs. Sometimes three to four pounds of meat. Then that night I go in an ice bath for 30-45 minutes. That is how I do it. Leangains has different ideas but I think IFing is an area where the person must experiment to find what works best. No one IF protocol works well for everyone I have found

  17. Why do we stop ALL supplements? Not even fish oil, Vit D or K2?

    • @DanH you don’t have to stop. But if you are eating a good paleo diet you are getting most things in food. Me personally I will never stop a few of them. I did stop some and I had issues with some. But this PostRx post is written for the normal person coming off a reset on the Leptin Rx. Obviously testing reveals all but mny people keep forgetting that. Doing it without testing is like flying blind.

  18. Wow, I need to read and re-read this during your break. A very powerful document that provides much food for thought. I’ll miss you on PH but have a great holiday!

  19. Hi Jack! I have quite similar thoughts with Cú.

    10000 years ago, humans got ~1000x more light to their eyes in the daytime, than we do get nowadays. According to Wikipedia, the illuminance of family living room is 50lx while direct sunlight is 32 000 – 150 000. The difference might be more than thousandfold!

    10000 years ago, we also didn’t get blue light from anywhere… Today we get it from computers, lamps and TV’s and this might delay our dim-light melatonin onset?

    It sounds plausible to me that we could benefit from more light in daytime and less light (especially blue) in the evenings.

    There also is experimental data that 10000lux light boxes or less bright light boxes with very high color temperature (bluish hue) might help with some conditions (such as SAD or depression). There is also some data that daytime light therapy might improve carb digestion.

    And there is also some data that blue blocker glasses might be useful for bipolar disorder and sleep.

    I have no any n=1 experience of applying these ideas in my life yet, but at least they could work… Light therapy at daytime and blue blocker glasses at evening, I mean.

    Some references: http://www.ncbi.nlm.nih.gov/pubmed/21276222
    http://www.ncbi.nlm.nih.gov/pubmed/20030543
    http://www.ncbi.nlm.nih.gov/pubmed/12638695
    http://www.ncbi.nlm.nih.gov/pubmed/17637502
    http://www.acne.org/messageboard/index.php/topic/243340-a-zinc-less-zinc-regimen-for-adults-draft-4/

    • @Valtsu I have seen no credible data that proves that paleo man got more blasts of light than we do now. Artificial light, LED is way more disruptive than sunlight. Research shows that. Remember artificial city light is a new phenomena…….1924 in Paris. So our biology is not ready for iphones, ipad, and LED HDTV’s

  20. When you body fat creeps up in the summer, do you change anything or just enjoy the ride?

    • @Akman Depends on the yr for me. This summer I kind of let it fly. I at more carbs than I ever have. I did not gain any weight but my body comp suffered. This winter I am pretty darn tight and I plan to do so into spring. Im running some new experiments on myself

  21. Daniel, I will continue D3 and O3 as I see fit, depending on what I have eaten and sun exposure.

    Thanks for your reply, Doc, I have had all signs of LS since late August. I guess it’s time to move onto this new approach. :)

  22. And I always exercise at 10 am, in the sun. :)

  23. Happy Thanksgiving, and congratulations to you and your wife on the renewal of your vows.

  24. Oh my goodness, what a fabulous post, Doc! And I’m just smiling at the thought of such a great experience for you at the equator. You deserve every happy moment! :)

    I got the test results back from my first ever breast thermography. I had abnormal vascularity and a closed vascularity. I found stuff on the net about abnormal vascularity but what the heck is a closed vascularity? There is nothing out there on it. I bet things are better now than they would have been a year ago but this is my baseline. Because of the vascularity they want another thermography in 6 mos.

    • @Colleen I am a huge fan of breast thermography replacing mammograms. My wife’s breast will never see another Xray. It never made sense to me to screen her breasts with xrays…….we use thermography but we are looked at as crazy…….well i like crazy then because using Xrays to scan a breast for CA is beyond madness.

  25. Nice job Jack. You are awakening all I learned about about chronobiology in college and then some. I am channeling my inner Frank Sulzman. Enjoy your trip.

  26. Thanks for this Dr Jack! I also just read “Hardwired for Fitness” that you recommended a while back and it perfectly compliments your work. Here’s hoping your cortisol drops so low on your vacation that you start wondering if you forgot to pack your adrenals! :-)

    • @Jim That is an excellent book…….and i will say that eating to light cycles yokes perfectly to that book…….sadly they never put two and two together. Evolutionary biology and leptin are where optimal lies.

  27. can we still keep our BAB if we want (for optimal) or do we have to tone it down? I’ve come to love it :)

  28. OK, so after reading that I just realized I’m doing everything wrong. Turns out, my 5:30am Crossfit addiction followed by coffee and no-appetite-for-breakfast-for-2-hours-post-workout are not conducive to optimum leptin function. So I need to move my WODs to my backyard at 2pm, pick up my kids at 3pm and eat a cow within an hour of finishing? Another question I have: Do my roasted vegetables fall under the carb allowance? Very importantt factor since I eat them with every meal.

    • @Jodi The veggie addiction is fine. I think if you do the work out 2-5PM and then eat your loaded protein and small carb meal you will increase your body comp faster than any other way.

  29. After touching back on my knowledge of receptor resistances in general, I have a question about regaining LS. Inflammation + chronic elevated leptin leads to LR in hypothalamus. Besides receptor desensitization, wouldn’t there also be a component of cell signaling leading to actual downregulation of the # of leptin receptors as well? I would assume this takes quite some time to reverse during weight loss as LR took years to develop in the first place. Is there any way to expedite the upregulation of leptin receptors or do we simply have to be very patient and consistent during our journeys towards optimal bodyweight? Thanks.

  30. Yeaaaay!!

  31. In comment #39 above, you mentino the effect of serotinin on libido. Is it OK then for my husband to take 5HTP for sleep? And if so, how much do you recommend and for how long? Thanks so much and congrats on your renewed nuptials.

  32. In your research of fetal development of leptin signalling, have you ever given any thought to the paravalbumin-positive GABA neuron? These play a critical role in triggering the start of critical periods early in life. If this neuron is impaired from poor nutrition of the mother, it has major implications for fetal development and can lead to autism, FAS, etc…
    I’m wondering if it also leads to leptin signalling problems and explains the huge increase in childhood obesity we are seeing. Your blog needs to be mandatory reading for pregnancy counsellors and OB docs as well as expecting mothers. Thanks for putting your research out here for everyone!

  33. @maria. I can not answert this without knowing more but I do not like to rubber stamp 5htp without context. This is important stuff to discuss with his doctor

  34. What is a “small carb meal”? Can you give a few examples?

    • @Jodi a side of sweet potatoes covered in coconut oil or pastured butter, Yucca, Pumpkin soup, butter nut squash, liberal use of balsamic vinegar on salads a side of beets or carrots….

  35. Cú Chulainn says:

    Hardwired for Fitness recommends high carb consumption in the morning, more protein & fat later in the day–what is Dr. Kruse’s view on this?

    • @Cu Honestly I have no issue with it but i will tell you the most important part of eating to me is setting the gastric ultradian rhythm in the AM to set the tone for the big huge protein meal 5-6 PM post work out. This is what is the real key.

  36. I understand why there is a lot of attention for burning fat. Is your advice different in any way for people who do not need to lose weight or burn fat?

  37. Ok, I have to admit that this stuff *does* make my head hurt, but now that I know it is just my neurons re-wiring as I learn new things…I say: “Bring it on!” :)

  38. Thank you Dr Kruse for all you do and congratulations on your remarriage.

    I have a question about histamine. I have had multiple food intolerances for a number of years, thinking it was leaky gut, adrenal fatigue, etc., with my main symptom being nasal congestion. I recently started a low-histamine intro GAPS diet and after a week of bone broth and boiled chicken, I am finally seeing improvement in my symptoms. I stopped coconut oil (salicylates) and green tea (blocks DAO enzyme that breaks up histamine). Does this relate to hormones, leptin and inflammation.

    BTW, I went Paleo in 1/2011 and lost 35 lbs in 6 mos, then started the reset on Labor day, no more weight loss, but I love the way I feel, no more cravings, love the BAB. Also, I tested my vit D (53) and am supplementing and this is the first winter without seasonal depression, Yah!!

    Thanks for all your help again.

    • @Mischa If histamine is a big issue you should be using high dose quercetin with vitamin C. I also think considering resveratrol and turmeric simultaneously is a smart move.

  39. Another great post. Still not sure if I should continue on the reset or move on. I have no problem going btw meals, wake refreshed without an alarm clock (although I haven’t used an alarm clock in years). I have not had the warming sensation or increased sex drive yet though. I began the reset upon ending HCG. I gained back about 7 lbs (which pretty much brings me back to where I was before HCG) and have not dropped any of it yet. I am having labs done next Friday. From my testing, what would the critical tell tale signs be for moving on or making other changes?
    I also take bc pills which you said to get off of “or they will kill you”. I just discovered Essure hysteroscopic sterilization. I plan to consult about having the procedure done ASAP. After which I would stay on bc for 3 mos until procedure can be confirmed as effective. Could bc pills be the root of my problems?
    Continal fight to lose 10 lbs, low sex drive, high blood pressure?
    Should I wait on testing and continue with the reset? Wait til off bc pills? I am trying not to overthink this but there are so many variables. I could also request a time slot with you to get hacked.
    Any insight is appreciated.
    Also doc, do you have an opinion on muscle response testing?
    Let me thank you again for your dedication.
    Congrats on renewing your vows! Enjoy your time away! together.

    • @AKgal I am not a fan of any BCP’s I think they cause huge liver and gut issues that complicate many situations. Weight loss and a big B12 or methyl transfer issue being issues high on the list of concerns.

  40. professor de vany does not agree with you on exercising in the morning being bad. he said something like the spike in cortisol is cleared quickly and it is chronic cortisol release that is the problem, not an acute spike in cortisol. one day in the paleo world i hope to find a place where the experts can have an extended conversation about a point of disagreement. but that day hasn’t come yet- and it especially wasn’t in evidence at the ancestral health conference.

    • @ V As I told you before…….I am perfectly fine with disagreements from anyone. The cortisol is cleared quickly in Art and not in patients who are ill. You must remember the context. People I see 98% of the time do not have Art DeVany’s epigenetics.

  41. Dr. Kruse, Great post! I’ve been on the reset now for eleven weeks. I am a 47 yo woman. No weight loss yet, tho I actually stopped weighing. My stomach feels better – less bloated, but I do still have some leaky gut issues. Ready for to lose a few more pounds! Seen many signs LS. Eating the 50 g of protein for BAB – 4T of CO/day – and small amount of protein in 3-4p time frame. Any ideas as to what might speed up the weight loss? I don’t know if the light cycle has affected me – but recently I feel my legs have gotten larger (strange because it’s usually my stomach.)

    Will be testing soon. Are you accepting optimized life patients at your clinic – or hacking over the web? Need more specific help to get optimal! We have come so far…. still so far to go.

    Congrats on your wedding vow renewals – great wishes for many more optimal years together! Thanks so much for all you do here!

    Btw, my daughter is writing her senior thesis on obesity – and hopeful that her obese teacher sees the light in it! Having PCOS at the tender age of 16, is a mom’s heartbreak. You have given us more encouragement than two years worth of working through the traditional health care system. Sadly, she is regaining some of her weight loss from hcg – hoping to keep her from derailing the leptin plan. It is all so slow in results for her. We need to find a doctor that can be hands on with her. Would make the trip to Nashville! Any advice would be much appreciated.

  42. I live further north than 99+% of the world’s population (Fairbanks, AK). Sunlight is a largely gone from Sep-Mar but in great supply in the summer. Could you take a moment to ponder the implications of life in the far north as you sip your pina colada on the promenade deck? Based on your writings, I’m embracing the concept of matching carb intake with sunlight hours as well as up-dosing my Vit D throughout the sunless months. Oh, and you should really turn off your blackberry lest your new bride run off with the purser!

    • @Akman……your carb intake would be really low for extended periods and your work out schedule would require a lot of planning to get to optimal. I think you can do it up there but you have to adapt the general principles I laid out to your specific latitude and longitude. Paying great attn to light cycles is critical to someone who live where you do.

  43. Nov 20, 2011
    Nashville, Tennessee, United States
    Length of day, This day 10h 07m 36s
    Equator,
    for example
    Macapá, Amapá, Brazil
    Length of day, This day 12h 06m 59s

    That is two more hours of high intensity tropical light, use it.

    Hopefully you went prepared for it and do not need any sunscreens.

    MCT-2 two three months before trip would have been helpful.
    I still have small reminds of my last 0.5mg taken on 8/17/2011.

    Happy Oxytocin manufacturing!

  44. this is the BEST BLOG EVER! My dad has FTD at 75. He was a physician. I think I can turn his situation around with the information u provide through diet alone…has it been done?

  45. Dr. K–

    Can you become LS even if you are underweight? I’ve been on the protocol for 7 weeks and still haven’t seen any positive signs… I’m hoping LR will help me regain menstrual cycles, but am wondering about how body weight comes into play. I am not terribly thin anymore, but borderline…

    Thank you!

  46. Doctor Kruse – I have been studying an Indian traditional medicine called Oil Pulling. Oil Pulling involves swishing sesame or sunflower oil in your mouth for several minutes a day and spitting out the emulsified oil. This has numerous well-studied benefits to overall health, not just oral health. I have learned from your blog that the tongue has leptin receptors. Do you suppose that the leptin signalling and resultant neuronal cascade could be responsible for the efficacy of oil pulling? Here is a recent overview from PubMed of one of our articles on Oil Pulling. I would love to hear your thoughts on this, sorry if this is in the wrong place.

    Mechanism of oil-pulling therapy – in vitro study.
    Asokan S, Rathinasamy TK, Inbamani N, Menon T, Kumar SS, Emmadi P, Raghuraman R, Majeesh L.
    SourceDepartment of Pediatric Dentistry, Meenakshi Ammal Dental College, Chennai, India. asokansharath@yahoo.com

    Abstract
    BACKGROUND: Oil pulling has been used extensively as a traditional Indian folk remedy without scientific proof for many years for strengthening teeth, gums and jaws and to prevent decay, oral malodor, bleeding gums and dryness of throat and cracked lips.

    AIM: The aim of this study was to evaluate the antibacterial activity of sesame oil and lignans isolated from sesame oil on oral microorganisms and to check whether saponification or emulsification occurs during oil-pulling therapy.

    MATERIALS AND METHODS: The in vitro study was carried out in three different phases: (1) Antibacterial activity of the lignans and sesame oil were tested by minimum inhibitory concentration assay by agar dilution method and agar well diffusion method, respectively. (2) Increase in free fatty acid level of oil and the quantity of sodium hydroxide (NaOH) used up in the titration are good indicators of saponification process. This was assessed using analytical tests for vegetable oils. (3) Swished oil was observed under light microscope to assess the status of the oil, presence of microorganisms, oral debris and foreign bodies.

    RESULTS: Sesamin and sesamolin isolated from sesame oil did not have any antibacterial effect against oral microorganisms like Streptococcus mutans, Streptococcus mitis and Streptococcus viridans. Emulsification of sesame oil occurs during oil-pulling therapy. Increased consumption of NaOH in titration is a definite indication of a possible saponification process.

    CONCLUSION: The myth that the effect of oil-pulling therapy on oral health was just a placebo effect has been broken and there are clear indications of possible saponification and emulsification process, which enhances its mechanical cleaning action.

    PMID: 21525674 [PubMed – indexed for MEDLINE] Free full text

  47. Cú Chulainn says:

    It’s been a week now since I got the glasses, computer screen cover, reading light and yellow light bulbs from lowbluelights.com (above) and my sleep has improved considerably. Thanks to Dr. Kruse for bringing this issue to my attention.

  48. Excellent post on Dr. Ron Rosedale’s blog regarding “safe starch” discussion with Paul Jaminet.
    Dr. Kruse: Where do you come out on this?

    • @steve I come down with Dr. Rosedale. I think Paul diet recs work really well for a very healthy paleo……but Ron and myself take care of people who are not regular healthy 20-40 yr old paleo’s. I just got home and read Ron’s replies and I thought he would really have a lot to say based upon PJ original replies. I respect them both but I dont think a diet can be retrofitted to everyone. It has to be based upon how they respond to the epigenomic responses.

  49. Cú Chulainn says:
  50. Daniel Han says:

    What’s next is I’ll probably try Stephan Guyenet’s low palatability approach (simple paleo foods, little to no added flavoring/cuisine, no processed foods). I notice I always overeat when I touch sausage and bacon, two of my “Paleo-friendly” foods that really aren’t Paleo. If what he says is true, it seems the best way to reverse LR would be to eat a rich Paleo diet, your top 10 supplements and make sure they’re low in food reward (no fancy cuisines, eating out or processed corporate food). When I first dieted, I didn’t even know about Paleo but all I ate was broccoli/okra, chicken breast and olive oil for 6 mo, dropped 80lbs. As soon as I got fancy with low-carb foods, my weight even climbed 10lbs.

    • @DanH Let me know how it goes with your N-1 I have 12 patients trying it now and so far it has not gone well for any of them using his theory but it is early in the game.

  51. Will do Dr. K, I’ll report back to you in 1 month. I am currently sticking with nothing but grassfed beef (lightly cooked, unsalted), plain baked yams/potatoes, steamed vegs of all kinds, wild blueberries and Kerry Gold butter for K2. No mixing, all eaten totally separate.

  52. Cú Chulainn says:

    Dr K, while doing the leptin reset is it ok to eat breakfast and lunch only, despite what _Hardwired for Fitness_ says about importance of evening meal?
    I ask because I like to exercise in late afternoon, whether HIIT or more moderate physical activity, and would then skip evening meal as you advise for fat burning.

  53. Dr K, Would you modify carb intake timings for athlete training to add considerable muscle mass. I train early afternoon (depending on the training phase/volume maybe 2 – 2.5 hours). This is followed later by metabolic work pushing a prowler. I currently load 70-80% of daily carb intake peri and post workout. If i intermittent fast it is from end of evening meal to next workout.

    • @Rob Yes I would if that was the patients goal. But I would not alter light cycle or timing training. I also am not a fan of mixing heavy lifting and any aerobic training on the same day. That makes no sense biologically. You are best to separate the two on separate days. I have no issues with IFing at all and the more elite one is the more randomization should be introduced to the IFing in my opinion. Standard routine IFing gives standard results.

  54. I became type 2 db march 09 at age 48.Very active, but overweight 5’9″ 185 lb. Stopped drinking alcohol (beer) immediately. Did insulin and metformin for about a year. Modified diet and exercise and was able to stop insulin in may 2010. Spent the next year on metformin and januvia. Due to gastric discomfort and muscle wasting I stopped all meds except Synthroid which i am still taking. I started my own low carb regime for about a month until i was handed a copy of Paleo Body,Paleo Mind by N. Gedgaunas. I have been living paleo ever since with great results. A1c was 5.6 at last checkup in sept. I am very active so body comp is excellent. The problem is lately I have had waking fasting glucose in the 150 range even though I do not eat after 7 pm, eat less than 50g carbs a day. get proper sleep, eat early protein breakfast.Glucose levels do become lower during the day. My activity level is somewhat diminished with the seasonal change, but i am still quite active.I have been following your program for about a week now ,but the glucose levels remain high. The only med I am currently taking is Synthroid 112mcg. for supplements I take a multi, zinc , chromium,d3, alpha lipoic, c0q10,ashwaganda, cal-mag, l-arginine. Waking fasting glucose has been 150 with a rise to 175 within an hour even though my breakfast is completely carb free.Current weight is 164, thank you for this work.

    • @BobS this is pretty common because of hepatic IR. I think with time as you proceed on it will improve as you cure yourself from diabetes. One year might not be enough but it is clear you’re sailing to the correct port now.

  55. Dr. Kruse said: “@ V As I told you before…….I am perfectly fine with disagreements from anyone.” I know that….that was not my point. My point is I wish you and Professor DeVany could have a dialogue on your disagreements like Paul Jaminet and Dr. Rosedale are having. When he disagrees with you on his site, why don’t you have a reply for him?

    Anyway, my ferritin has been 5 or 6 for years and in April it was less than one although my hemoglobin was 13.5 and I was normal with blood cell size and volume. I have been taking Aleve for about a year when my period comes to cut down on blood flow. I have also been sporadically supplementing with iron, although I started to supplement more regularly in September. My latest blood test shows my ferritin is 40 and Hemoglobin is 15. I have read that for optimal thyroid function, ferritin needs to be in the 70s to 90s, but I am concerned about continuing to supplement at the same levels I have been since my hemoglobin is already top of the range.

    As a general question, can a menstruating woman continue to supplement at 325 mg of ferrous sulfate 2x a day in order to further boost ferritin when hemoglobin, hemotocrit and RBC are already top of the range?

    I have never recorded my ferritin as being so high.

    As my ferritin goes up, what changes might I expect to see in any thyroid testing I have?

    Thank you for your time.

    • @V Art and I agree on many things. I choose to focus in on what we agree on and let others decide who is right on what we don’t agree on. I would never bring this up on Art’s site because I personally do not believe it is the correct way to do so. I think Dr. Rosedale and Mr. Jaminet have decided to “go after it” because a proper venue was created for it to occur. I think Paul and Ron see this issue from a different optic. Again, I have my own feelings on this issue myself and I view the problem through a clinical mindset not a theoretical one.

  56. Thanks for your quick reply re Professor De Vany. He does view things through a theoretical lens. I wish I had the scientific background to decide which one of you is right. I just do trial and error. Re my supplementing question, I guess I will continue to supplement at a low level (RDA) and see how I feel until I test again. I know ferritin and hemoglobin levels can drop fast. I’m trying to find some info on the interaction between ferritin and hemoglobin, but can’t find anything on the internet so far. It may be that if I continued to supplement iron at a high level, my hemoglobin and RBC would stay top of the range while my ferritn “bank” filled up. Or I might take in too much iron and damage my organs, have a lot of oxidative damage, etc. So I will take the middle path of the iron RDA.

  57. it is from heavy periods where i pass big clots and bleed for a long time til i get dizzy. that’s why i take aleve. the cause of heavy periods can be perimenopause and the shift in hormones, fibroids, hypothyroidism, etc. when i supplement with iron, i absorb it. i just lose a lot of blood through the periods. extremely heavy periods is one reason why women get uterine ablations and hysterectomies. i’ve managed to avoid both thank you god.

  58. ps heavy periods can also be from a vitamin k deficiency which might have a connection to leaky gut. so per our previous conversation, i have recently started supplementing with k2 mk4.

    many thx for your concern for us.

  59. Cú Chulainn says:

    v, generally Dr K’s advice seems more directed to us mere mortals

  60. @Cu. Mere mortals are who come to see me as their change coach…..Art has already changed his life and does not need me.

  61. I didn’t eat 50 grams of protein within 30 minutes of waking for most of the time I’ve been on the reset. I did for the first couple of weeks, but it made be very sick. So I started eating small breakfasts a little later in the morning, then bigger breakfasts and finally as of about 3 weeks ago (I’m in week 12), I started eating BAB’s everyday within 30 min’s of waking.

    It was worth it for me to go slower and maintain quality of life.

    I ate a very small lunch today at 3:30 when hunger set in. It’s the first lunch I’ve eaten in a week. I’m going to try to eat a bit more for breakfast to see if that counteracts the hunger.

    It’s bizarre but wonderful to no longer be a slave to my hunger. Last Tuesday night I had a meeting and didn’t have time for dinner, I did not have lunch. I ate a hard boiled egg for dinner and that was it. I forgot all about being hungry until I was getting ready for bed and I wasn’t hungry, it was just a thought. “Oh, I was hungry earlier.” Not eating lunch has cut down on the food bill as well!

    I understand intellectually why my hunger has drastically decreased and that my hunger/full signals are returning to normal, it does seem very strange experientially. My stomach seems twice as big at breakfast, when I eat lunch it’s tiny and at dinner I can only eat a small meal before feeling very full. I’m not complaining mind you, it’s just so unfamiliar.

    Oh, and I’m down to 165 lbs today. Down 30 lbs from three years ago and 16 lbs since I started the reset. My waist has gone from 40″ to 34″ since the start of the reset.

    Thanks Dr. K!

  62. Jorge from Venezuela says:

    I haven´t followed the leptin reset to the letter since I was already in good shape and with no hunger problems.
    My only problem was with sleeping patterns since it was very changeable, having good sleep some days and bad disturbing some other days.
    So basically what I did was implementing the rule of not eating 5 hours before sleep. I have only like 3 months doing it and I have come here to report that I sleep like a baby and also have noticed improvement in my skin and hair condition.
    I eat a big breakfast around 8 a.m. and a big lunch around 3 p.m. and thats all for the day. So I kind of do a daily intermittent fasting.
    Also started doing training in the afternoon after Dr. K post http://jackkruse.com/so-you-completed-the-leptin-rx-what-is-next/.
    I am still using some supplements even I have been paleo since 2010 and I was against it, but after this post http://jackkruse.com/what-are-the-top-ten-paleo-supplements/ I re-think about it, so basically now I use CoQ10, Resveratrol, Mitochondrial Optimizer with PQQ, Magnesium, Cod Liver Oil and K2 daily, Selenium every other day and Kelp every third day and after implementing this I have more energy and recover a lot faster from training.
    I am young, only 27 years old so lets see how this regimen evolve. My aim is following Primal plus Dr. K advice to help me keep younger for long time.

    Thanks to Dr. Jack Kruse and Mark Sisson for sharing all this valuable knowledge.

  63. I use this software to create healthier light from my computer screen at night: http://stereopsis.com/flux (it is free)
    Also, if you use an ipad, iphone or itouch for reading the Book application has a sepia mode which is helpful.

  64. cu, please don’t include me as your fellow “mortal”. that is why i am here: to work on the “im” prefix. :) PS I would like Professor DeVany to put out a 2012 calendar of himself for sale, but am too shy to ask. ;)

  65. Hi Jack –

    One of my fitness goals is to gain considerable lean mass (while decreasing bodyfat). Is this even possible on lo-carb Paleo, as everything I’ve read says it’s impossible without 1-1.5g of carbs/lb bodyweight to fuel workouts? I notice I have a hard time pushing myself in the gym on LCP; I poop out after a few reps and don’t have the strength.

    Without carbs – lack of energy to fuel workouts and inability to gain any size. I don’t know if this is right or not – but I cycle carbs as opposed to eliminate them for 2 reasons (eat them only on workout days).

    I have also read that a low carb diet will tend to boost rT3 and TSH and lower T3 which slows metabolism because your body thinks it’s in starvation mode, causing hypothyroidism and weight gain – just the opposite of what we want to accomplish from eating LCP. Do you recommend carb refeeds (as Sisson does) on perhaps workout days to prevent this?

    My fasting insulin has gone from 2.3 to under 2.0 and my leptin levels from 8.2 to 4.0; HGBA1C: 5.3 – down from 5.6. Is this optimal?

    I still find it also difficult to get my avg morning fasting BG under 95 for years. I am starting to use apple cider vinegar before bedtime to help lower morning BG.

    What do you consider an optimal fasting serum insulin, glucose, leptin level?
    What do you consider to be the glucose spike limit? Is it 10-20-30points above fasting bg level?

    I understand that whey protein is highly insulinogenic. What about other protein powders, i.e. rice, pea, bovine serum, etc? I notice that even whole food protein can raise BG up to 25 over fasting.

    I’ve been having a difficult time reducing bf (25%) and gaining lean body mass. I’ve been training hard in the gym, but am not seeing any results. My lean body mass is about 130lbs.

    I avg the following:
    pro: 150-200g
    carbs: <50g
    fat: 90g
    fiber: 30g

    Thanks, Jack!

    • @Mark Low carb diets do not increase your rev T3. This is something in the blogosphere that is just not true. I think you can add carbs to get ripped as long as you follow the rules in this blog. The bigger issue is what are your cortisol revT3 levels and relations to light levels. I will be exploring that soon in a future blog post. Light cycles are critical to this. When you eat them and what the light cycle is are critical to getting this done. I think you can use whey but it should be a good quality whey that is not loaded with processed crap. Most of it is in my view and that is why I stay away from it unless it is summer time. I use protein and fat in the winter and I lean out and lose body fat best then. Gaining mass requires following the work out window and the post workout meal.

  66. Dr K.,
    It works great! It slowly turns color temperature from 6500k to 3400k as the sun goes down.

    I’m not sure if it helps with sleep, but It feels better not having glaring light in my face and it save me from having to adjust my monitor twice a day.

  67. Thanks Dr. Kruse for your response to my histamine question. I am taking high dose vit C already, will add quercetin, resveratrol and turmeric. Could I be under methylated? I am taking activated B6, activated folate, PS, activated B12 and glutathione to improve methylation. Also taking magnesium, fish oil, multimineral, maca, vit K2, vit D3 and probiotics because I can’t tolerate the ferments on the GAPS diet.

    Sometimes I focus on the supplements and don’t see the big picture. Since being on the GAPS diet for 3 weeks (bone broth with egg yolks and meat/veggies/ghee 3 times a day), I am seeing changes in my Asperger’s symptoms (less social anxiety, improved eye contact, happier outlook). I am also working on forgiveness, letting go of the past and living in the now.

    Again many thanks for your help, you are truly changing lives, mine included!

    • @Mischa Make sure you keep your D level and K2 levels at the top quartile with your diagnosis. I also agree with GAPS protocol for your gut health with this disease. I would also advocate a lot of coconut oil here.

  68. I am so looking forward to becoming LS! As suggested on MDA, here is a copy and paste of my situation:

    I started doing the reset almost 4 weeks ago after discovering Dr. Kruse’s blog. I have a lot of challenges and wondered if it would work for me, but I finally decided I had nothing to lose so I jumped in and it has been truly life changing. I have eaten low carb/paleo/no grains/no processed foods/in different variations for the most part of many years due to reactive hypoglycemia, but something still wasn’t working for me because I still had to eat every few hours. Now for the first time ever (and I’m 56 years old) I can go 5-6 hours between meals without difficulty. What this means is that I no longer have to plan my entire life around when, where and how I can eat. I’m freeeeeee!!!!

    Some of my challenges are migraines (which cause me to have to take opiates on occasion), chronic hep c (but with remarkably few liver-related problems, no doubt from eating low carb and no processed foods for so long), diurnal cortisol rhythm is off, blood pressure fluctuates a lot and is sometimes too high, hypothyroid and crazy high reverse T3 (I currently take T3 only), some cognitive issues, no doubt all my hormones are out of whack, and then there are some big financial challenges, too. In spite of these things, I feel very strongly, no, I KNOW that the reset is going to help a lot of these issues. I just feel it in my gut. I do wonder if any of y’all see anything here that might prevent me from being able to reset my leptin, though (I am prepared for it to take a lot longer than the 6-8 weeks for you “normal” folks)? At any rate, I intend to carry on even if I am never able to completely reach that goal.

    Thank you, thank you, thank you!

  69. I whole heartedly endorse this entire post.

  70. My fasting insulin has gone from 2.3 to under 2.0 and my leptin levels from 8.2 to 4.0; HGBA1C: 5.3 – down from 5.6. Is this optimal?

    Also – What do you consider an optimal fasting serum insulin, glucose, leptin level?
    What do you consider to be the glucose spike limit? Is it 10-20-30points above fasting bg level?

    • @Mark I like Fasting insulin levels low…..below 5 is ok below 2 is ideal. FBG I like to see consistently below 85-88 range but the real numbers we should be focusing in is AFTER MEAL BG. This is most important based upon the recent literature. After BG spikes have been shown to to correlate with INCREASED RISK OF DEATH! Heart attack risk increases close to 60% for each 21% increase in after meal blood sugar spikes. This is another reason I think safe starches are just not based on good biology. Post prandial and fasting blood sugars are a better picture to follow!

      If you listened to my JoanneUnleashed.com podcast you’d know the serum leptin answer! As for spikes of BG I am not that big a stickler about this unless youre trying to establish your baselines…..a normal BG is around 85 for me…..staying under 120 post prandially is a great sign………20-25 points is “OK” but I generally never want to see someone go above 140 consistently on their post prandial BG spikes. This increases sudden death from MI and CVA! If certain foods spike this high you need to avoid them. For me wheat bread, Whey, and certain fruits do this so I avoid them.

  71. @Maria on 5 HTP one must be careful with it…..I only use it sparsely for two to four weeks when patients are transition from a sugar to fat burner and when sleep and constipation are present. After this I move to other things.

  72. @Kasra……..thanks. So do I.

  73. @Robin…….just awesome!

  74. @Patty your sleep study indicates that you have a growth hormone problem during the first three hours of sleep. This is the most common abnormal pattern in women. I think you need to sit down with your doctor and your sleep specialist because this is clearly a LR problem. The reset of the Leptin Rx will absolutely help repair this. I would recommend you try this first because GH therapy is costly. Keep me informed of how it goes.

  75. @Shannon I love lactoferrin for resistant gut infections. One can get it from Whey (pure gras fed $$$) or from banked human colostrum. Hundreds of studies have shown lactoferrin to be a potent antibacterial, antifungal, antiviral and parasite killing compound. Recent literature is now revealing that lactoferrin is a key modulator of immune cell functioning, helping to optimize and coordinate their attack on enemies while preventing inappropriate immune system excess. It should be part of the autoimmune protocol in my view.

  76. Speaking of growth hormone, Doc, is that something you think is beneficial to take? There is an endo in my area who just puts a lot of patients on it. I was thinking of getting mine checked.

    I also wish you would do a blog and tell us exactly what HIIT you follow.

    • @Colleen my HIIT routine is coming in the future. I got a lot more science to knock down before we get to the “easy stuff” As fo ryour question of GH, I am a big fan of optimal. If you are GH deficient and meet the current criteria that is required I have zero problems with people using it under a physicians care. I think it has to be an MD with experience. This is a hormone that requires a lot of hands on with a patient. As a neurosurgeon, I deal with many medical conditions that cause growth hormone failure and I can tell you it makes a huge difference to those who need it and don’t and can’t make their own.

  77. I might check this doctor out then! My daughter in law is seeing huge improvement in her energy in just a week. Thanks Doc!

  78. Dr. Kruse,

    I am on TRT and after years of suboptimal levels using topicals, my physician switched me to Testosterone Cypoinate injections (50 mg. 2 x weekly). My first level drawn on 8/12/11 were 673 ng/dL (range 700-1100. She increased my dose to 100 mg. 2 x weekly and on 11/8/11, my level was 1980. Clearly too high so we reduced medication.

    But my question concerns CRP HS levels. On 8/12/11 they were normal for me at 0.07. But on 11/8/11, my CRP HS was 3.0. I was shocked. Could this have anything to do with the excess T?

    • @Paul I think the spike in the HS CRP is either artifactual or from the breakdown of the excess testosterone in the liver. My bet is the latter and not the former.

  79. Hi Dr. Kruse,
    Thanks so much for posting this information. I switched to your post leptin reset protocol a week ago, and feel very well. I still have some difficulty trying to avoid eating in the middle of the day especially if I exercise around 4pm. Would if be OK to have a snack before working out, and if so what do you recommend? Carbs, protein or fat, or a combination? If I try to work out without food, I feel light headed.

  80. Hey Doc, you mentioned on the MDA forum that you use skin wraps and compression garments to speed up the skin tightening process. How often do you recommend the wraps? And any recommendations on the garments?

  81. @Palu Lactoferrin in the stool is not a good sign and indicates a gut issue. I would tell you to get it looked at.

  82. @Shari The Genova assay you referenced clearly shows you need a total clean out and I think your naturopath doc is correct about the antibiotics you need.

  83. @Charlene Great email. I never use sunglasses any more in the winter because we need all the sunlight hitting the retina we can muster during the winter solstice.

  84. @Rob A light box is a great idea but they are quite expensive but they would allow you to optimally do this post reset up in the Artic circle. Hard to believe the sun sets that early now!

  85. @Ashta You can tell your doctor that if he contacts metametrix or enterolabs they will teach him how to interpret the assays you mentioned.

  86. @Cable When my schedule is screwed up because of call or surgery my default is to run sprints or do a quick 75 reps of the kettlebell swing. That is what I do in an scheduling emergency. I hope this helps you too. Your schedule sounds like mine.

  87. I’m already loving the kettlebells, Doc! On the off days I run sprints up my stairs. We just had a big snowstorm and I am a klutz. LOL

  88. Jack –

    This I don’t get: how can my fasting a.m. insulin (<2.0) and a.m. leptin (4.0) be ideal but I can never seem to get my FBG under 90? I notice that if I ate a late meal, even protein only, my FBG will be about 10 pts higher than it should be. I'm assuming this is the main reason?

    Small amounts of complex carbs (20-30g) and even whole protein seem to spike my BG 20-25 pts. I assume this means my body still hasn't shed the leptin/insulin resistance and increased the sensitivity as of yet?

    I also have elevated a.m. BP(140/80) and depressed a.m. serum cortisol (10-12).

    I have been taking T3 for hypothyroid (elevated rT3 and TSH), and after a year now, my thyroid hormones suddenly crashed:

    Just within 4 mos.:
    TSH went from 1.96 to 4.406
    rt3 from 176 to 262
    ferritin from 128 to 94
    TT4 from 7.1 to 6.5
    FT3 from 3.4 to 2.9

    Also, there seems to be some whose lipids were negatively impacted from lo carb diets, so I wonder if such is the cause of my changes in LDL:

    Total cholesterol from 163 to 214
    LDL from 92 to 144
    (however, my TGL (113 down from 147) and HDL (47 up from 42) improved)

    Perhaps I need a VAP test to distinguish between the good LDL (large/fluffy) and the bad (small/dense)?

    Here's the bottom line: the results of a DEXA scan show me with 25% total bodyfat – 34.5% is android fat, 26.2% is gynoid fat – not good! If I'm eating lo carb Paleo, why am I still having problem losing fat?

    I'm assuming that keeping serum leptin levels low with no hunger is the best for fat loss, no hunger (and not acting on it) and the brain's response being more the key than the level itself, correct?

    I know you say lo carb does not increase rt3, however, studies show that low calorie and low carbohydrate diets eventually suppress T3 hormone levels in the body by providing insufficient fuel for the thyroid and body to function properly.

    Solution: carb refeeds?

    My biggest goal: I need to go from 25% bodyfat to <10%….and being hypothyroid doesn't help!

    • @Mark after reading thru all that you clearly have a gut issue and my bet is LR at the liver level and I bet your hormones are seriously off. You need a good doc before you need carb refeeds. I’d be OK with you trying carb refeeds but that is not where the gold is. You need a good work up.

  89. And here’s a very informative blog on the very subject, “Low Carb High Fat Diets and the Thyroid”

    http://perfecthealthdiet.com/?p=4328

  90. Jack, is it possible that if someone has gone to bed at 2 a.m. and risen at 10 a.m. for many years, that all of these things (the 12-2 leptin etc) could actually shift? Could the body have adapted to naturally sleep in this time frame & do its sequences a little later?

    Or is it critical to move bedtime to 10 PM in winter & 11 in summer?

  91. So should I shift & start going to bed at 10 & getting up early? I’m in semi-retirement & can set my own schedule (at least for now). Or should I leave my schedule as it is? I want to get optimal. If I need to make the change, I will, but if not, I probably won’t! :)

  92. What about Anthony Colpo’s and others’ anti-low-carb experiences causing depleted T3? These beliefs go completely against the grain (no pun intended) of the dogmas of what we’re talking about here:

    http://anthonycolpo.com/?p=1743
    http://donmatesz.blogspot.com/2011/06/farewell-to-paleo.html

    “I have returned to eating a whole food, high-starch, gluten-free, low-fat (≤20% energy as fat) plant-based diet with much smaller amounts of animal products, primarily fish and shellfish. Although this accords with both traditional Chinese medical knowledge and modern Western nutrition research, it does not fit with the claim that “paleo diet” consists of a meat-dominated, low-to-moderate carbohydrate, grain-free diet.”

    • @Mark I am at a loss at what you mean? There is nothing in this blog post to indicate I advocate a VLC after the reset. In this post I spoke about carb macro’s as high as 30% as normal. I am really not sure what you are asking me to be honest.

  93. Let me clarify. What I’m really getting at here are two things.

    The first is the carb conundrum:

    Again, I reiterate my concern with respect to eating low carb and thyroid function, as I am hypothyroid, and I wonder if it’s possible that the reason my latest thyroid function results (Dec. 4 post above) reversed from the progress I had made before could be due to eating LC Paleo.

    I eat low-carb Paleo to help reset leptin and to lose bodyfat, however, as Colpo points out in his blog, “Is a Low Carb Diet Bad For Your Thyroid?”, “decreasing carbohydrate intake to low levels results in diminished levels of T3 and/or increased rT3, something most aspiring fat-burners wish to avoid desperately.” Further,
    to get the glucose it needs, the brain will gladly catabolize muscle tissue since doing so kills two birds with one stone: It renders glucose from the destruction of muscle tissue and, because muscle tissue is metabolically “hungry” tissue, it simultaneously reduces the body’s energy needs. A veritable catch-22.

    I realize Colpo is a researcher and not a physician, however, where does one go from here?

    By the way, I am finding it increasingly difficult to maintain on low-carb while resistance training, as I lose weight, but also observe myself losing lean mass, stamina, and strength as well.

    The other issue is the anti-Paleo argument that blogger Don raises here:
    http://donmatesz.blogspot.com/2011/06/farewell-to-paleo.html

    His research advocates that “observable human biochemistry and physiology suggests that modern humans are adapted to a high-carbohydrate, low-fat diet with relatively low or intermittent intake of animal foods (by current Western and especially “paleo diet” standards), mostly of fish and shellfish” based on TCM.

    Another anti-Paleo blog here:
    http://freetheanimal.com/2010/01/paleo-diet-problems-big-problems.html

    Both are direct contradictions to the very tenets of the Paleo diet.

    Then there’s the issue of elevated LDL on Paleo diets which I won’t even get into.

    Lots of mixed signals and totally lost…

    I guess we bite the bullet to reset our leptin relatively short-term by going VLC, and when recovered (hopefully), we bring back carbs to no more than 30% of cals (depending on light cycles), as you’ve suggested? But until I do bring back carbs, how should I get through my workouts? Can I still eat carbs post-workout on a leptin reset?

    • @Mark The Post scription of the Leptin Rx contained in this post is not a LC version of paleo. This is something that you seem to believe is true. It is not. As for Colpo and Don, neither are researchers or clinicians. Colpo is an author and a a trainer and Don is a blogger. I read Colpo often and I enjoy his work. I like that he is very cut and dry and is pretty dogmatic for short spurts until he finds something new tha works for him. I advocate N-1 for people to get to your optimal self. I post here about that I alter carb intakes with light because it is hardwired into us and personally works well for me. I also say in here that it may not work for everyone and you may have to tinker with it. There are some people who do well with a higher carb diet in the winter and I believe it has to do with epigenetic switches and how they are set from out mothers and our diets all of our lives. I totally disagree with Don on that humans are adapted to higher carbs and low fats. If this were true we would not face the problem of rising diabetes in every part of the world who adopts a high carb and low fat diet from their ancesteral one. I suggest you continue to tinker until you find what works best for you. This post is a framework to show you that our DNA is wired to help us if we work with our biologic rhythms and not against. To me that is the core of the post that I think you may have missed.

  94. So Dear Doc, I was sitting here last night at 1AM checking this thread to see if I should not be there (e.g., should I shift & go to bed early). LOL

    Since my sleep is shifted about 4 hours (going to bed at 2AM not 10PM), you said it’s possible & likely that I am still going through all the stages of sleep, just later. (Though I know there’s such a thing as TOO far of a shift, like all-night work.) If I sleep in till ten, I’m getting 8 hours. But would it be BETTER for leptin if I bit the bullet & tried to shift to 10PM for bedtime?

    Thanks so much for all you do & for giving of your time & expertise like this.

  95. Dr. Kruse,
    Do you have any thoughts on pituitary tumors? I was diagnosed a few years ago and have been on cabergoline and BCP since that time (had symptoms for over 15 years, since the time of mensturation). Reading that you think BCP causes gut issues really concerns me since 1.5 years ago I was also diganosed with ulcerative colits.

    Unfortunately I have been vegan for the past 10 years and so only about 8 weeks ago began this new Paleo process.

    I also need to lose weight.

    I also have some respiratory issues that began in July that they orignially thought was pleurisy or costochronditits but it has not gone away. Also had a inflammed lacrimal gland, which was like that for over 2 months and just went away.

    No one knows what to do with me and I am sort of at my end for trying to figure this out on my own. I have had so many doctors and labs and MRIs. They all just seem sort of scared of me and don’t know what to do.

    Do you have any insight? Anything at all? I would be so appreciative! Thanks for all you do, even if you can’t help me. I am pouring over your site and have learned a great deal.

    • @AJM Neurosurgeons know quite a bit about pituitary tumors since we treat then surgically often. It appears your tumor is being treated medically. Cabergoline is a D2 agonist that is used to treat prolactinoma’s which are a type of pituitary tumor that secretes prolactin. There is no reason the reset could not help you. Congratulations for choosing paleo to cure you of many previous ills. I am no fan of BCP at all as they cause many issues that complicate getting back to optimal.

  96. Following up – Do you also disagree with Don that a diet high in read meat (even grass-fed organic), poultry and saturated fats contributes to inflammation, congestion and stagnation? This again runs counter to the evidence that shows his higher carb intake actually causes these problems.

    • @Mark I am a bit shocked that this is even a question to me. I completely reject Don diet. I was going to pipe up at the AHS talk he gave but the talk spoke for itself scientifically and did not need me to say a word to point out the obvious. I wish Don well in his N-1 and I hope he finds whatever it is he is looking for.

  97. As a German, I tend to enjoy beer once in awhile. After reading much of what you have written, it seems that beer may be a very bad thing for one to drink. Am I correct?

    • @Suzanne I think one has to think about their medical condition to make the correct choice about the occasional use of beer. For me personally, I gave beer up 6 years ago and I don’t plan on ever having another one ever.

  98. Mark–the Nat’l Institutes of Health has even admitted that it’s not the sat fats that cause CVD, but the COMBO of high carbs with them…esp’ly high-glycemic carbs. (http://www.ncbi.nlm.nih.gov/pubmed/21978979) Inflammation & CVD are related, are they not? If sat fats aren’t contributing to the end-of-line result (CVD) then they probably aren’t contributing to the middle result that leads to CVD.

    Would that be correct, Dr. Jack?

  99. Jack–read that, brushed my teeth, & went to bed! :) My husband (who had already been in bed 3 hours) is liking you better & better. :)

  100. Dr. K – does the leptin receptor ever heal enough to go back to using it? Do you plan on ever trying that, since it’s a better accounting system for electrons from food?

    • @Owl I said in this post……this precisely how the leptin receptor was designed to work with a diet. It evolved with these things as core issues. Each one has been extensively studied individually by many researchers. But no one has figured out that each one is tied to how our hypothalamus accounts for calories. And yes you can heal a leptin receptor if it is not permanently damaaged. Many who have morbid obesity or anorexia never heal it but can over come it if they learn how to revert to our in utero system for accounting for food. Its hard until you understand how we are all wired by evolution.

  101. nevertoolate says:

    Dr. K – Trying to figure out where I’m at in my LR journey. Background: I’m 60 now – started getting serious about health 3 years ago – @250#, 5’7.5″. Overweight most of my adult life. “Tried everything” with yo-yo results. Lost about 20# in 2009, but losses stopped. Started HCG in 2010 and have lost 80# since. Labs are now amazing! BP went from borderline/high to 102/67; HDL (latest) 64; Tri=46 (used to be astronomical); LDL=55. Weight now 164#. Labs were last January, next appt. Jan 20, 2012. Took 6 months off HCG last Apr-Sept. Maintained so-so until Aug. when it got progressively difficult to keep weight off. Did another HCG round in Oct and found your blog/info about Leptin Resistance. Light bulb went off big-time. This makes so much sense! Started LR 4 weeks ago. Gained 4# first week, but now below starting wt., losing for past several days. Feeling warm!! Esp. while/after eating. Haven’t needed lunch for a couple of weeks now. Sleeping like a baby since first week. No carb cravings since first week – no problem eliminating snacking – in fact, that’s a relief! Used to have lots of skin “tags” but they’re almost all gone now. (were disappearing even prior to LR) skin on feet much smoother now, too.

    Question: even though my history of HCG, given I have eaten almost no sugar or simple carbs for the last year or 2, could I already be LS or close? I’ve asked my PCP for your optimizing labs but that hasn’t happened yet. Would like to start exercising and wondered if you thought I was close to or at LS yet.

    Thanks so much! I now see the answers and with the truth about why there is so much disease (I knew it had to be our food supply!) it is so much easier to make the right choices! Sorry this was so long…

    • @nevertoolate with your inputted data I think you are still LR. But we cant be sure without testing. I would tell you to remain steadfast on the Leptin Rx reset and monitor yourself for HS CRP and the clinical signs I outlined in the Leptin Rx FAQ’s.

  102. @ Matt Great question in your email today about the leptin ultradian rhythm. I want you to pull this paper and read it on Calorie Restriction and longevity in The Journal of Clin. Endocrinology & Metabolism Sept 1, 2011 vol 96; no 9.
    The title is “The Fall in Leptin Concentration Is a Major Determinant of the Metabolic Adaptation Induced by Caloric Restriction Independently of the Changes in Leptin Circadian Rhythms” by V. Lecoultre, E. Ravussin and L. M. Redman

    “Leptin is involved in the hormonal regulation of the reproductive, somatotropic, thyroid, and autonomic axes and ultimately in the regulation of all energy balance. In parallel to the metabolic adaptation observed in response to caloric restriction (CR), plasma leptin concentrations are substantially decreased…Conclusion: Our results confirm an important role for leptin as an independent determinant of the metabolic adaptation in response to CR.”

    This is but another major reason why Leptin is at levee two in the QUILT. Anything that controls energy in the body controls survival. Some may argue that optimal leptin signaling may not lead to optimal performance but all the data I have ever reviewed point to it being a beacon of light to the promise of healthy longevity and in my way of thinking this is the definition of PERFECT OPTIMAL HEALTH. People forget that aging is a biologic novelty of recent times. What may be good for performance when we are hormonally optimally as a younger person may not be what keeps us alive longer and fit. I think this is why we dont see too many bulked up long lived athletes. Not even my idol Jack LaLane cracked the 100 year plateau. Why? In my view there is a heavy stem cell cost of fueling all those muscles with carbs and BCCA which both have been shown to alter longevity to our detriment. The real question is are the macronutrients the bad actors in this “play” or does it require back round cellular inflammation to be present as well? My belief is that inflammation must be present too. I think many view IGF1 and mTor pathways as detriments to longevity but most of those studies never control for the real confounder…….inflammation. I think this is also why we dont see too many body builders and elite athletes in the super centanary groups. The reason is that there is a step metabolic cost to carrying this tissue……and we pay the toll in losing stem cells over time and this subtracts years from our life at its end. This is why Jack LaLane died too early in my view. I am making plans not to do the same.

  103. @Vickie I have not talked much about this yet but let me say this here……serum DHEA levels correlate 98% to IL-6 levels (inflammation) and poor sleep and low serum DHEA levels re most commonly seen in aging over 40 yrs old and in those with high inflammation and high activation of the two pathways that shorten lifespan…..namely IGF1 and mTor. Both of these are levees in my quilt but I have not scratched that surface. I will have to because at the AHS 2012 it looks like I am going to be on a panel to discuss safe starches.

    Both of these reasons above are why I dont totally buy the safe starch theory of Jaminet because he never qualifies his postion with respect to inflammation. If you’re inflammed your diet needs to be bullet proofed to inflammation so you can sustain high mTor and IGF1 signaling as you age. That means a ketogenic existence as your DHEA level and pregnenolone cave. It is clear we can re-adapt to a diet later (where I dont agree with Rosedale)……after we repair the chromosomal damage glycation causes…….but how we do that is a major point of contention clinically. The research point to three drugs……resveratrol, curcumin, and metformin and one dietary measure……calorie restriction. It appears that paleo diet is a mild form of CR for humans and this is why it works so well. Since it allows the human to regain control of the leptin receptor and modulate the inflammation axis (Via Il-6, TNF alpha, and THF beta) we can construct the ideal paleo diet for longevity…….it is based around the ketogenic platform. If one wants to increase mass or body comp one must activate IGF1 and MTor to do so. We know research says this shortens life span but in these studies they never control for back round cellular inflammation. This is essentially where me and Ron Rosedale part company on mTor and IGF1. And soon I will get into so tricky biochemistry that will show you why humans might be different than all other animals with regards to calorie restriction……it has to do with our brain differences and what CR does to an advanced neurologic system. What did I just say? Pay damn close attn to pregenenolone and DHEA serum levels because they are major proxies for Leptin status and inflammation levels and hence neolithic disease generation and aging. Why? In primates the following is what we know to be true already……..CR diets shows higher levels of the adrenal steroid dehydroepiandrosterone sulfate (DHEA-S), with very low levels of insulin, and lowered body temp (low thyroid levels appear optimal) So far in the last ten yrs in human males this is what we know…….high DHEA-s are also associated with increased longevity in human males. (Preliminary studies on human volunteers show the same effects.)

  104. @Blue Your email asking me about the relationship of leptin to thyroid hormone is timely. I am not familiar with Mr. McDonald at all sorry so I can not comment. I covered this in the Oprah blog but I do agree many people have asked this question of me so I am going to address it here.

    Leptin resistance is shown to suppress deiodinase 1 in the thyroid(D1) and it stimulates deiodinase 2 (D2), resulting in reduced cellular T3 but a reduction in serum TSH. Remember that D1 only converts T4 to T3 in the body, while D2 is in charge of controling the conversion of of T4 to T3 in the pituitary. The brain has its own control of its own endogenous thyroid hormone for two main evolutionary reasons that I can see. One is that all nerve cells need adequate T3 to function so it would make great sense for the brain to have a reliable source. Two the brain still has to work when they body is in starvation mode (no T4-T3 conversion and the thyroid is down regulated or in leptin resistance). Moreover, a study by Cettour-Rose et al. published in American Journal of Physiology, Endocrinology and Metabolism demonstrated that physiologic reversal of leptin resistance restored deiodinase activity except In The Presence Of Elevated Reverse T3 . Thus, in the presence of elevated leptin level (above 10 in the obese) there is a reduction of intra cellular T3 and a resultant suppression of TSH, making the TSH a very unreliable indicator of thyroid status, especially when combined with an elevated reverse T3. Remember that reverse T3 is a competitive inhibitor to T3 so it completely shuts down body thyroid T3 levels!!! Thus, for anyone who has difficulty losing weight, a leptin level above 10 demonstrates that low intracellular thyroid levels is contributing to this difficulty, especially if combined with a high normal or elevated reverse T3 (above 150 or an altered T3/revT3 ratio).

    And it gets more interesting…….There is a deiodinase 3 (D3). And all peripheral tissues have D3 but the pituitary does not have any D3. Why might this be important? D3 job is to convert T4 to reverse T3 and it competes with D1 that converts T4 to T3! This makes Reverse T3 a direct competitive inhibitor of T3, blocking T3 from binding to its receptor and blocking T3 effect!!! This immediately reduces metabolism, while simultaneously suppressing D1 and ALL T4 to T3 conversion in the body! Moreover, it blocks T4 and T3 uptake into the cell (meaning all that synthroid your doc gave you is pissing in the lake). This in turn reduces all intracellular T3 levels and thyroid activity. Remember that intracellular T3 is required with Vitamin A to make all hormones from LDL cholesterol too so when this occurs your entire hormone chain grinds to a halt. Starting to see why Leptin is the king pin hormone yet? See why it controls fecundity and oocyte selection and is the reason 1 in 8 couples in this country are infertile? More bad news, because many tissues may have abundant D3 levels while the pituitary is uniquely devoid of any D3, the inhibitory effects on the peripheral tissues causing hypothyroidism are not reflected by TSH testing. Now you can go back and read the Oprah blog and tell Mr McDonald he really needs to read a bit more. No wonder his books are hard to find!

    Understanding leptin is performing brain surgery without a scalpel.

    1.Araujo RL, Andrade BM, da Silva ML, et al. Tissue-specific deiodinase regulation during food restriction and low replacement dose of leptin in rats. Am J Physiol Endocinol Metab 2009;296:E1157-E1163.
    2. Patricia Cristina Lisboa, Karen Jesus Oliveira, Adriana Cabanelas, Tania Maria Ortiga-Carvalho, and Carmen Cabanelas Pazos-Moura Acute cold exposure, leptin, and somatostatin analog (octreotide) modulate thyroid 5′-deiodinase activity
    Am J Physiol Endocrinol Metab 2003;284:E1172-E1176.
    3. Cabanelas, A (A); Lisboa, P C (PC); Moura, E G (EG); Pazos-Moura, Leptin acute modulation of the 5′-deiodinase activities in hypothalamus, pituitary and brown adipose tissue of fed rats. Hormone and metabolic research 2006;38 (8):481-5.
    4. Cettour-Rose P, Burger AG, Meier CA, Visser TJ, et al. Central stimulatory effect of leptin on T3 production is mediated by brown adipose tissue type II deiodinase. Am J Physiology Endocrinol Metab 2002;283(5):E980-7.
    5. Fekete C, Kelly J, Mihaly E, Sarkar S, Rand WM, Legradi G et al. Neuropeptide Y has a central inhibitory action on the hypothalamic-pituitary-thyroid axis. Endocrinology 2001;142:2606-2613. (this one should be required reading for females with HA)
    6. Fekete C, Legradi G, Mihaly E, Huang QH, Tatro JB, Rand WM, et al. a-Melanocyte-stimulating hormone is contained in nerve terminals innervating thyrotropin-releasing hormone-synthesizing neurons in the hypothalamic paraventricular nucleus and prevents fasting-induced suppression of prothyrotropin-releasing hormone gene expression. Journal of Neuroscience 2000;20:1550-1558.
    7. Legradi G, Emerson CH, Ahima RS,et al. Arcuate nucleus ablation prevents fasting-induced suppression of ProTRH mRNA in the hypothalamic paraventricular nucleus. Neuroendocrinology 1998;68:89-97.

  105. I am 60 but have had health problems since I was about 3, with fatigue being the chief one but autoimmune diagnoses taking centre stage in the last years. In 1985 I went on a paleo diet and everything improved for a while but of course when I stopped it things went back the way they were. About 5 years ago I discovered that taking Armor thyroid improved my life in a way that I’ve never had (except during that first time of going paleo). Now I’ve been paleo for most of the last couple of years on a 6 day a week basis and have lost 18 kg. I still have another 10 kg to go. My question is: do you think it would be a good idea to try reducing my thyroid back once I’m not LR any more? I managed without it for about 3 months at the beginning of last year but I was eating a lot of raw lentil sprouts and I ended up very, very ill with gut pain and massive autoimmune disease. I went back on the thyroid and stopped the raw lentils and slowly improved over the next six months to where I am doing well now. I thought I would go strict paleo to see if I can become leptin sensitive again and it would be nice if I could drop back all the supplements and the thyroid as it will be hard to afford them when we retire in a few years time.

    • @Hilary I think this is a goal that you likely will be able to obtain. Since you have been on this for so long you must talk about your plan with your doc so they are aware of what you are doing incase you hit any rough seas. Please keep us aware of how you do.

  106. I’m curious – you have optimized your body for health and longevity. At what age do you think you will die? And barring an accident, what will you die of?

    • @Owl My goal is to get past 122.4 years old. I think I will die of loneliness because of my teether to my wife. The funny thing is she has serious longevity and ridiculous labs so she may out live me even though she is not strict as I am. I doubt many will choose to do what I think it will to get this goal. But It is my goal. To become the change I seek. With respect to aging the preponderance of the scientific evidence indicates that we can change the trajectory of decline by controlling neolithic disease. The best way is to control the diet but if on added weight training to the mix you get another major boost. It appears to me from reading the literature on anti aging we can recover functional years that would otherwise have been lost even if we can extend our life. I think controlling our epigenetic signal via the diet however is the key anti aging modality now. On this point my mind is open and not dogmatic because we clearly do not know. When we have a scientific process that we don’t have a good handle on these are disciplines of science where I like creativity to help us figure it out.

      My biased belief is that we can stay powerful and fit mentally and physically into the ending of our time on earth, before declining quickly by something that kills us when we have run out of stem cells. I believe we can be strong until our ends if we choose to be.

  107. Rereading this blog and pondering over this: Can one’s hypothalamus be paired with circadian rhythms and achieve optimal leptin functioning if the “hard-wiring” did not occur in utero due to the pregnant mother’s high stress and chronic insomnia, nor was breastfed? Would you approach the reset any differently?

    • @Dr. Mommy These are the cases that no one knows the answer. I personally believe this is a problem in people with eating disorders and HA. Its an issue that we do not have the answer to yet.

  108. Seraphina says:

    Hi Dr Kruse,

    I am not sure if I should be doing this or the leptin reset?. I have been following a paleo lifestyle for around 3 months now due to chronic illness (neurological disease) and have had a successful reduction in several symptoms, so this will be a life long change. I no longer have cravings, my sleep is pretty good now and my moods are nice and stable. How ever I currently weigh 262 pounds and I have only lost 1 pound in that time. The other thing is that I put this weight on during the last 10 weeks of pregnancy when I was not over eating or eating junk food. No doctor has been able to tell me why this happened – prior to pregnancy I was a normal healthy weight. I am assuming this is because something caused my body to crap itself (hormones?). Would you have an answer to this? – can leptin resistance begin like this?. It’s been over 6 years now since I was pregnant and obviously I have tried everything possible to get back to where I previously was. It’s driving me nuts.

    Thanks :-)

  109. Thank you for sharing your advice. Now I plan change the time of my exercise to pre-dinner afternoon. You say its optimal to exercise in “bright sunlight”, does this mean direct sunlight.. outside? I live in a snowy winter climate, also I lift weights, so all exercise is inside.

  110. I have completed the reset an have moved onto the post rx. I’m content after breakfast and content with the few carbs and CO at lunch. Around 2:30/3:00 I start to get hungry and then usually workout around 3:30 and eat by 4:30. Is it acceptable to be getting hungry after lunch? Do I just continue to push through it or is it a sign of a needed change? At dinner I’m eating 25grams of protein with 2-3 T of CO, and a few carbs (3).

  111. Thanks for the direction and encouragment. I just started taking DHEA drops the other day and it has seemed to cause the hunger to come even earlier. Is that likely?

  112. Good to know for two reasons. It explains my ability to put away food during dinner last night. Also because although I’m taking pregnenolone which will convert to progesterone, I don’t want my already optimal testosterone and optimal estrogen (all but one estrogen) to get too high. Thanks.

  113. Good Morning Dr. Kruse

    *I apologize if this has already been answered.

    I feel that I’m already LS, but I’d like to get more lean (below 10%, never been there before). Due to a busy work schedule, I only workout on Saturday and Sunday, but I have been using low reps/heavy weights and have been working out between 1:00pm and 4:00pm, so I think I’m covered on the exercise part, therefore my question is about breakfast.

    I tend to get up between 4:00am and 4:30am during the week (not a full 7.5-8.0 hours, but I generally feel pretty good throughout the day). I don’t usually feel up to eating 4 eggs with some rice [I have noticed over the years that I do better (energy-wise and cognitively-wise) with some starch and a little sugar in my diet, as opposed to just meat, fat, and non-starch veggies] and coconut oil at that time, so I have been bringing it to work and having it there (usually around 7:00am, or I’ll split it up and have half at 7:00am and the other half at 3:00pm), along with coffee). So my question is if I make the switch and eat the BAB within an hour of getting up like you prescribe and then IF until dinner (usually around 7:00pm), will that make enough of a difference to help me lean out? My main fear is that I won’t be able to maintain my concentration throughout the day at work (I’m a market analyst, reading research at a desk all day from about 6:00am to 5:00pm).

    Maybe I should just give it a shot, but thought I’d see if you have any comments.

    Thanks for everything. I had a herniated disk in high school and just thought that it was bad genetics. But now think that it may have been my bad diet growing up.
    -Mark

    • @Mark If your not LR you have no business using the BAB. Its pretty clear in the blog post. You need to consider the Leptin Rx postscript manner of eating I posted on in Nov.

  114. I must have misused the BAB term. I was talking about eating 4 eggs with coconut oil and some rice as laid out in the post: 50% of daily carbs (~125g for me), 25g protein, 20-30g fat).

    Maybe my main question just comes down to: Do you think it makes enough of a difference in gastric signaling to eat breakfast within an hour of rising, as opposed to eating that meal about within 2.5 hours of rising.

    Thanks again.

  115. Hi Jack, fascinating work.

    I’ve followed your Leptin RX to the letter for ~12 weeks and in addition to many of the LS signs, I’ve also noticed something strange..

    I horizontal line of little ‘spider veins’ across my lower chest. They are are fairly faint and sparsely distributed in a 1 inch wide, wavey line.

    I’m an active 30yo, 150lb, male. Can’t think of any congenital or acquired reasons for this. This phenomena is a little disturbing! Have you seen it before?

    I did sustain a distil radius fracture 8 weeks ago, but that wouldn’t be related, would it? Apart from your recommends supps, I take astaxanthin twice a day, and was taking some MSM/glucosamine/chondroitin and cissus quadrangularis to heal the arm. Was think of taking some DIM (diindolylmethane) in case this was an estradiol issue.

    • @John mu thought is that it is an E2 issue……but why you are having an E2 increase bothers me and it could be related to injury and diet. You need to really look into what is in your food closely…….interesting issue to say the least.

  116. I recently pieced something together in my mind I wanted to share. In the 1960s, makers of wheat flour changed their recipe to use bromide instead of iodine for monetary reasons. Bromide is very similar to iodine and can even attach itself to iodine receptors in the thyroid. This can’t be good!

  117. An update from the former vegetarian… we have been eating Paleo in our household for 3 months+ now and I did the Leptin reset, too (my husband, also a converted vegetarian, didn’t need to). We are now eating fish or meat of some sort at every meal; we’ve also started Mark Sisson’s training program with the sprints, LHT, etc. We both feel better than we have in decades. (And we’ve got our children 75% of the way there, too!). We have been spreading the word among our friends and colleagues, too, which include mostly mental health/medical folks. Thank you again for your work and your inspiration.

    I have one minor question – I noticed in an answer to a question posted you said that ‘chicken is not optimal’. I’ve really thought about your advice re: good-enough vs optimal and we’re very committed. Can you say more about this? Do you think there is a hierarchy re: meats we should be eating? Are beef/pork/offal better than chicken or fish? We’ve been eating it ALL (even liver, soaked in milk thanks to you) but I want to get the details clear.

    Thanks again.

    • @Lauren this is how my protein pyramid is set in my house.
      Wild Fish>shellfish>offal>pastured eggs>wild game meats like Deer/elk Bison>grass fed skeletal muscle meat>Ostrich>pastured pork>cured grass fed meats>protein from fowl’s

      That is how the Kruse household rolls. Great questions and thank you for the update. You motivate me to keep up the pressure for change in our world.

  118. Dr. Kruse,

    In reference to our exchange in posts #126 &127 above, I recently retested after decreasing the Test Cyp injections from 100 mg. 2 x weekly to 75 mg. 2 x weekly. MY CRP HS levels were 1.0 down from 3.0 on 11/8/11. So it looks as though you were right about that.

    But the strange thing is my Total T levels barely moved. They were 1980 ng/dL (range 700-1100) on 11/8/11 and 1970 most recently. Plus my Estradiol Ultra-sensitive results remain high – 54 pg/mL (normal < or + 29l) despite taking .5 mg. Arimidex 4 x weekly. I’ve been walking around for over 4 months with supraphysiologic T levels. My liver function values have all risen as well. Do I just keep reducing gradually and retesting?

    My reason for taking HRT is to counteract the effects of the phenobarbital I take for epilepsy but I seem to be making things worse. My physician doesn’t seem to think it's a big deal. I welcome your thoughts. Thanks so much.

  119. Jonathan schwartz says:

    Dr. Kruse

    I have a question concerning how to approach your prescription and follow up plan while taking psychiatric medication that I must take for bipolar 1 disorder. I know this medication is horrible on many levels but I need to stay on lower levels at least at this point in my life (28) to avoid severe manic episodes and depressive bouts. I take 1 mg of risperdal 120 mg of geodon 100 mg lamictal and 200 mg of luvox. I’m constantly trying to lower these amounts and become less deponent of this poison but when is the best time to take these medications that I know must alter my metabolism.

    Thanks

    • @Jon I have no idea when it is best but I am quite sure you can take it when you need to and still eat correctly. I would tell you to head over to Dr. Emily Deans blog at Evolutionary Psychiatry and ask her because I am quite sure she has great info on this.

  120. My daughter was diagnosed with Stage 4 Neuroblastoma at age 21 months. Thankfully, her tumor was not MYCN amplified and she responded very well to treatment. My guilt as a mother for “allowing” my child to have such a horrible disease is something that I can barely live with. When I was pregnant with her, I worked full time on the midnight shift. My OB/GYN said that this was irrelevant to my baby’s health. I have always suspected that this was not the case. Your post certainly reinforces my lay suspicions. The other mothers of neuroblastoma patients tended to be night owls as well. I’ve observed that many of the mothers also tend to have a similar body type: very tall and obese. Thank you for putting out this information and attempting to make it as accessible as possible. I can only hope to maximize my family’s lifestyle for the successful future of my daughter’s health.

    • @Sara……..conventional medicine says there is no link but they have can only say it because no one has studied it well enough. CW does not pay much attn to the evolutionary medicine and they would rather spend their time analyzing RCT instead of the 2.5 million RCT that evolution provides. My advice to is going to be strong. Stop beating yourself up over this because you did not know and no one told you anything about how it could be related. Its not your fault. But realize that if you optimize your life style now you are putting a lot of road between your family and future disease going forward. You clearly will be a beacon of light for others out there who have yet to learn what you experienced. Make good of this problem you had. You can help many. But you cant help your family of others if you continue to raise your own cortisol beating yourself up over something you had no control over. You need to find strength in yourself and learn from this. Do not let is destroy you. My profession makes a habit out of blaming genetics or saying it has no cause when the real answer is they really do not know because no one is looking at the problem from a new evolutionary medicine perspective. The future is coming for medicine and that future is tied to technology that uses the owner manual that our bodies came with……..how evolution formed and shaped us over the last 2.5 million yrs. It is an acid test that no current clinical trial can trump even if physicians remain blind to its power

  121. Dr Kruse, I wanted to thank you for your blog! I have read this post a few times now and have a question. I currently follow the Optimum Performance Training program and have seen good results (crossfit for 3 years) I weigh 167lb with 8.9% BF. I have been following the larger breakfast protocol (protein/fat/25G carb), fasting through the day, working out around 5:30 (BCAA’s pre), then doing a PWO shake with 3:1 carb/protein, and a meal after of p/f/c. I take in around 160G carbs a day with about 85% coming PWO, mostly from starch. PWO shake contains waxy maize and meal is usually sweet potato. I have seen great results on this, lowering body fat while increasing strength and power and have put on about 12lb in a year. My question is: Should I up the carbs even more PWO as the days get longer? Thanks for all you do

    • @Nick Yes I think you can but a word of caution……..there is a diminishing returns to the gains you will get from upping the carbs as the light cycle increases and temperature rises. You will need to find out what your carb cycle is best adapted for by emperic testing. for me I top at out about 300 gms per day around June 21. It took me 5 yrs of testing to figure it out. But your premise is correct in your question. Let us know how it goes this spring and summer for you.

  122. Thank you Dr. Jack, you are right in everything you have said. My burden is to translate this evidence into a understanding for my family to support it in practice. My daughter has not relapsed (and in my heart of hearts, I feel that she won’t) but all of the children with whom we went through treatment have relapsed and all but one have died. Often, neuroblastoma relapses in the brain. I have seen evidence of ketogenic diets curbing or reducing brain tumors; I am hoping that I can do something to prevent my daughter from relapse or from future secondary cancers. She is also still experiencing late-effect neuralgia from chemotherapy. Do you know of any evidence that this lifestyle will help ameliorate this? Thank you so much for your bolstering words and for your frank dissemination of information. I am not a doctor, just a lowly mom and research assistant, so I am so humbly appreciative of scientists like you who are so dedicated to improving health outcomes of all people.

    • @Sara Here is a a link off my computer that links neuroblastoma to infections. Obviously if this link is made in the literature it is not too hard a leap to make the leap from a leaky gut from a dietary source. My advice is feed that child a strict autoimmune paleo diet. I would also tell you to look into Dr. Terry Wahl’s story about curing herself of another neurologic disease doing exactly the same thing. She had secondary progressive MS which has a terrible prognosis and she has cured herself with this protocol. When conventional medicine has no good answers for diseases and defaults to genetic arguments you would be wise to migrate to a diet that allows for very low levels of inflammation. This is how we are designed to eat and that is why my family eats this way and we have no life threatening diseases we are running from. We do it to protect ourselves from getting any.

  123. I have two questions: What is the role of magnesium during this phase?

    Also, if one can’t exercise until after 5-6pm, is that still ok (and obviously still better than morning)? Or would you recommend to ‘not bother’ and eat before 7pm as being more important to reach optimal status?

    • @Gladina……you are in the Post Leptin Rx thread……there are no rules on exercise. The recommendations say for optimal body comp exercise should occur in late afternoon when the light is still out. If you want to nail your Mag level down do the Exatest (intracellular RBC MG level) which is tremendously accurate. I have no time to guess on things like this because my guess is likely no better than yours.

  124. Another question from the reformed vegetarian from NZ… I have been re-reading your posts and comments and see that you said your standard breakfast is ‘4 eggs and a healthy side of bacon.’ That sounds like a Leptin Reset breakfast in terms of the amount of protein. Now, doing the post-RX, I’ve dialed down breakfast but am wondering if I should/could be eating more (and then skipping lunch – during the Reset I was never hungry for lunch but now, with the smaller breakfast/big meal in the eve, I am). Was that your Leptin Reset breakfast or current? Also, one specific question re: sauerkraut. We’ve been eating store-bought (imported from Holland, only cabbage and salt as ingredients) about 3-5x week. Do we need to be making our own or is this OK? Thanks!

    • @Lauren Right now this time of the yr I am just eating either the bacon or the eggs. Rarely both. Remember as the season go I change. Soon you will be able to see precisely how my diet evolves because I am coming out with an e cookbook that changes as the seasons change. As for store bought sauerkraut I am not sure what you have in NZ. Here in the states we have a brand called Bubbies that makes pickles and kraut. They have live cultures in them. You could make your own but I do not do this.

  125. Coriander says:

    @Lauren, imported sauerkraut is pasturised to make transport/storage easier. So the probiotics have been killed. If you can’t find someone selling ‘raw’ kraut, you need to make your own. Sandor Katz is a great source of info at http://www.wildfermentation.com/

  126. @Coriander, Thank you very much – this is very helpful!
    Dr Kruse, thanks for that info. Since it’s warm/summer here I’m guessing the bacon and eggs are OK. Can’t wait for your e-book. Thanks again.

  127. I’m trying to diagnose the aftermath of a mistake. This morning I was out of eggs and decided (for the first time) to try a high quality whey protein powder to make a shake – made it with coconut milk and coconut oil added. Two hours later I was hungry and feeling like I had that ancient feeling of blood sugar fluctuation. I know you’ve said that if you’re LR it will raise insulin like a cup of sugar. And I know you’ve said it’s far from optimal even if you are LS. What I’m trying to decipher is this: is this a sign that I’m still LR? (I did the Leptin reset RX and then went on to the post reset diet and this has been the only ‘mess up.) Or is whey protein just a rubbish solution for protein and this is not a sign of leptin resistance? (Btw, no non-pasteurised sauerkraut that I can find so… I have a bucket of homemade currently fermenting on my kitchen counter!). Thank you.

  128. Thank you!

  129. Alex Gatsis says:

    So if a mother developed preclampsia during pregnancy, was probably LR, ran high cortisol due to stress, had periods of difficulty sleeping, she can assume her child will have leptin issues. If she breastfeeds for five years and follows your protocol, can she alter her child’s fate?

    Thanks so much!

  130. Alex Gatsis says:

    I reread and there’s hope!!!! We can retrain! Yay!!!

  131. Thanks for your response Dr Kruse! I will give you some feedback this summer. One more question- If my maternal lineage is mexican/ native american, would this explain why I tend to become leaner with a little more carbs, or would it just be due to the high intensity workload of my training program? I noticed I held on to a little more body fat on VLC.

  132. I’m not sure if this will be interesting to you or relevant to others, but I’ve been reflecting on my process of following the Post Leptin reset RX and going paleo, etc and have realised that a big part of this journey is learning to manage fear and find appropriate support (hence the reason you get bombarded with questions). As a breast cancer survivor and former vegetarian, I was told repeatedly, for example, that fat was my enemy and if I wanted to be healthy/stay healthy I had to eliminate it. I have walked away from that and now, 5 months into this new way of living, feel better than ever. But I still sometimes get blindsided by a voice in my head telling me I’m making a big mistake. This is what you meant about choosing to be the salmon who swims upstream. In the absence of other salmon and salmon mentors, a huge part of this needs to be cultivating a simultaneous openness to new and challenging information AND a mental toughness that allows the ‘stick-to-it-ivenss’ to carry on. The proof is obviously in the paleo pudding. Which is a long-winded way of saying thank you for the information you put out there and the community of support you’re creating.

    • @Lauren Thank you for saying this…….it is important. The essence of this post is why I wrote the Primal Sense blog last month………The most important part of becoming optimal is changing how you think. Nothing more or nothing less. The science behind this diet has 2.5 million years of a randomized controlled clinical trial that trumps any trial I learned about in med school or since. That is the scientific gravity that drew me to follow what is correct and not what I was taught to be correct by my professional training. If you think the personal change is hard…….you should be a neurosurgeon swims against the current in the the middle of a system that reward salmon that swim together in schools of group think…………my personal change was a cake walk compared to what the professional tribulations of thinking differently has caused. When we face tremendous challenges and pressures……..this is where courage sculpts your character and your vision………I now see a diamond optimal healthcare where I used to healthcare filled with lumps of coal. This is most correct scientific thing I have come across in my entire life. My job is now to get the rest of my profession to realize it too.

  133. I cannot even begin to imagine the pressure you find yourself under professionally. And I would guess that the more people like us embrace these understandings, the hotter the pressure will get. I suppose trail blazing is never easy. But to think you are re-shaping health care is such a worthy goal. As we say in New Zealand, “Kia kaha.”

    • @ Lauren…….neurosurgeons are trained to function well in pure chaos. Trust me it is not as bad as you think. What drives me is the how badly the thought processes are in organized medicine, my own hospital, and in the USA in general regarding health. We must give the power to optimal health back to the people and tell them how to tap it routinely even when some issue crop up. That is what the thread at MDA is proving. If you read the whole thing you will see the participants are becoming their own best advocates for their own health and they are slowly learning how to extract what they need from the broken healthcare system to still get to optimal in spite of the system. This makes it all worthwhile.

  134. By the way, what do you think of the newest MDA post suggesting we should eat up to 9 cups of greens every day?

  135. I chose a paleo/primal diet last august 2011 after finding out I was prediabetic. It was an easy move to make since I already didn’t eat sugars, cow dairy (anopholactic),gluten and only eat brown rice and quinoa/potatoe some times. As a result my blood sugar levels have dropped to 5.0 from 6.2. My weight has dropped 38lbs. Although I went into this to control my blood sugars I am finding the weightloss to be a huge bonus factor. Still over weight, I need to loose another 25-30 lbs to be in a more normal healthy weight but I am stuck and not in ketosis. What I have been doing is not working to loose weight anymore. I have hit a plateau.

    I have two questions for you.
    1 – What do you see as being a good first step to get back into weight loss?
    2 – With having a really good physical workup lately my gp is terribly concerned at my blood lab results:
    – total cholesterol in my blood went from 5.80<6.24 Normal Range= 3.80-5.20.
    – cholesterol/HDLRatio went from 4.75<5.07 NR= 0.00-4.90.
    – CRP went from 3.10<6.90 NR=0.00-2.00.
    – ferritin went from 74.00<189.00 NR= 15.00-180.
    – hdl went from 1.22<1.23 NR=1.10-3.00.
    – ldl cholesterol went from 3.831.20 NR= 0.60-2.30.

    With eating a higher saturated fat diet with a higher protein consumption and especially coconut oil my GP has great concerns. She wants me to stop eating the coconut oil completely and eat lean meat. All my readings of paleo/primal diets tells me the good fats are really important and this is contrary to the medical field. What is your opinion as to what is happening with my bodies changes and blood work?
    This reaction from my GP and her comments scare me and now I don’t know what to think….Help….Laurie

    • @Laurie yoru doc should not worry about your diet at all and instead worry about doing their own job of figuring out why your hormones and inflammation levels persist being high. My bet is you have a serious underlying hormone issue. For example your rise in LDL cholesterol is an obvious tip off to your doc……your T3 levels have cratered because your CRH/cortisol has shut off thyroid hormone production and likely caused you to have high levels of rev T3. You posted more proof that this is correct showing your acute phase reactant, ferritin rose dramatically……too. Your HDL is more proof that this is a leaky gut. I have blogs about this very issue you need to read. One is about the VAP test and HDL you can search for here and the other is on the leaky gut Rx. My bet is you are still profoundly LR and likely have a pretty serious leaky gut to go along with it. I see your doc did not follow up with any of this…….by ordering a salivary cortisol to prove this is the seat of your issue and not your diet. Honestly, if I where you I would take things into my own hands because this doctor advice is quite poor………and may hurt you. You need to become the captain of your own ship. I suggest you begging to take back control from them to get you to optimal.

  136. CORRECTION:

    LDL cholesterol went from 3.83<4.46 Normal Range= 2.00-3.40.

  137. Dr Kruse,

    If someone who is/was Obese (Let’s say their BMI was 40), did the Leptin Reset, showed all the signs…Now their BMI is 37 (they dropped 15-20lbs are so.). Now that they are theoretically LS, should they still watch their caloric intake, or is it safe to rely on their LS appetite/thermostat to get their BF down to normal so long as they continue to eat paleo, etc. and pattern you list above. Also, assuming they do HIIT and lift weights at a LS BMI of 37 (still severely obese), should they still lift to put on muscle and eat high protein, etc and things will correct over time?

    • @BenG someone with a BMI of 37 will not be LS……..its an oxymoron. One thing I can tell you……its pretty hard to fool evolution. You can confuse it for a time…….but eventually she wins.

  138. Dr Kruse,

    So you’re either saying they are going to drop a lot more weight in 6-8 weeks and become LS, or it’s going to take a lot more time to become LS for someone starting at 40? Just saying, it sounds like someone starting that high should expect to do the reset for months and months.

    • @BenG this is true……..i say clearly in several blogs the length of time to reset is dependent upon your inflammatory profile……..more inflammed the longer it takes

  139. If that’s the case, what’s the benefit of doing Leptin reset for so long…i.e. say someone did some sort of vanilla VLCD (like a PSMF, Atkins, or any other Paleo LCD and got their weight down to a BMI of say 25-30. Then they started the leptin reset. Since their weight is lower, in theory, it should just as well take 6-8 weeks to get sensitive? Just trying to see what the advantage of the reset before one reaches a weight where it’s possible not to have a pro-inflammatory environment from the excess weight (or especially visceral fat) alone?

    • @BenG no way to answer this without knowing all variables…….but somebody with a 37 BMI is morbidly obese and some with FM is going to have some of the longest reset times…….it really depends upon your inflammatory levels.

  140. Any suggestions when the 25 g protein and 20-30 g fat at breakfast isn’t enough to hold one over until lunch? Is it ok to eat a BAB even if you are LS?

  141. Dr Kruse,

    1. When you did the reset, what BMI were you when all the signs appeared showing LR? Also, do you need to wait until your BMI <26 before switching to the post-leptin reset even if you are showing all the signs before reaching 25?

    2. What is the upper limit of carbs per day (paleo-diet wise) that is "safe" post reset to avoid problems, and can you increase on days of heavy lifting/springs from glycogen depletion–after pm workout–for dinner?

    • @ BenG My issues were different because I had to have surgery because of my knee. SO i could not exercise. So I did some things differently. When I began I had 44% BF and I had some other labs that I think were more eye popping that I have not discussed much. I mentioned it in my Jimmy Moore podcasts…….and this really brought home the point to me how bad off I really was back then.

  142. sorry, meant showing LS in the first sentence and sprints on #2 above. Thanks.

  143. Hey Jack,

    I’m following your program religiously and loving the benefits. My question is totally unrelated but I’m pretty desperate.

    My 10 year old son has major bedwetting problems and I was wondering if any of your amazing research could suggest anything. He is very sporty, extremely bright and has had no other medical problems at all. He has never had a dry bed and the problem is not getting any better and it is obviously starting to impact on his life now as he gets older. Daytime toilet training was normal. The doctor is now suggesting some medication which will not cure the problem and I’m very reluctant to go down this path.

    The reason I ask you if there is a connection is because he hates meat, he always has and refuses to eat it. He is also a very fussy eater unlike his other siblings!! Sorry to be so off topic but I would be very grateful for any ideas you might have! Thanks!

    • @ joanne two things get the doc to try ADH nasal spray and turn down his room temp in the house or the entire house to 55 degrees at night within 7 days you should see some action

  144. Breakfast is to be 20-30 grams of fat which is two tablespoons of coconut oil alone. About what do you project for daily coconut oil consumption? Any particular ratio?

  145. Jack – am I finally there? Did the leptin rx for several weeks, and have been eating primal for several months. Well, possibly a bit more dark chocolate than “occasional”! The past 3 weeks I have a warm feeling occurring approx 1 hour after meals. And I am tossing off most of the blankets all night as I find myself too warm. Generally feel warmer most of the time too. I am about 10 pounds above my goal weight yet so hoping that the weight loss continues. Of course I can’t be 100% certain w/o blood tests but those aren’t in the budget right now. Your thoughts?

  146. Dr Kruse… I can’t thank you enough for ushering in a new era for healthcare. I was wondering about optimizing leptin for a child who didn’t have an optimal beginning. Aside from getting enough sleep and eating according to Jaminet???? Is snacking okay ??? (He’s two years old).

  147. P.S. Jaminet feels children should be getting 40% carb.

  148. Okay. I typically feed him his last meal an hour before bed which is 7:00. Should he be eating on our leptin reset schedule? I am still breast feeding on demand except nighttime…

  149. When we eat dinner between 4-5, he doesn’t eat a lot, and I get concerned about his getting up in the middle of the night hungry. That’s my rationale for eating so late. So scrap that. He can eat our leptin reset meals with us; if he doesn’t eat as much as I think he should, he can eat more in the morning. Should I be concerned about his starchy carb consumption? Thanks so much again and again!

  150. Daniel Han says:

    You’ve been saying safe starches are no good in your recent posts and based on this post, you basically eat 0 ish carbs during winter. Is that okay for maintaining your serotonin levels? I’m just saying I don’t want to do a ketogenic diet and then have serotonin issues…or is some fluctuation of serotonin levels normal throughout the year? lol I’m confused because it seems you’re contradicting everyone who says VLC is bad for serotonin production. I know you’re busy, I just wandered if you could clarify.

  151. hi Jack, one of my ex phys/neurophys papers is currently focussing on stroke rehab and TMS. your comment on intrauterine strokes and the restoration of normal function utilising only one hemisphere has me fascinated and is obviously relevant to rehab. i’m about to hit some journals, but am wondering if you have some favourites in relation to the topic. btw, loving the CT series. i used to resent the weather (bottom of new zealand), now i am going to exploit it for all it’s got. perfect combo: cold antarctic currents, awesome harbour & wild surf beaches!

  152. HI dr, can the very same visceral responses you talk about here be altered by stimulating vagal afference at precise frequencies?
    Thank you,

    G

  153. Q: When does a cheetah run its fastest?
    A: When it is hungry.

    So I see how the “catch and eat” rhythm of exercising then eating would be tailor-made to boost protein uptake etc. The only bit I have trouble comprehending is the injunction not to exercise before breakfast.
    If in a normal leptin rhythm, then leptin levels are low in the morning (and cortisol high)…and it seems to me that low leptin is the trigger for a cheetah moment…
    in other words, low leptin = “feed me” = cue to hunt and gather = movement/exercise.
    What’s really weird is that when I looked for research on the effects of leptin levels on motivation and exercise, ALL the papers that came up were on the effects of exercise on leptin levels. There is some work on leptin levels and how they affect “motivation” in terms of depression and so on, but overall it seems that the exercise physiologists are looking at this exclusively the “wrong” way round. I reckon I run faster when I run hungry (like cheetahs), but CW says I should be manically fuelling up with gels and “energy” drinks and carbs and whatever…
    So, breakfast and exercise.
    The way I am making sense of this rule at the moment is to realise that leptin is sensitive to fluctuations in the food supply. Maybe the brain/body needs to “know” that there is food available and that the overnight fast is not going to be extended and require signalling to slow down the metabolism.
    And anyway, “coincidentally”, I much prefer to train around 4pm.

  154. Dr. K!

    Great info and love your site!

    I have have been athletic my whole life, but despite being very active (I’m on my feet all day work from 3-7pm, I have been training intensely in martial arts for years, and also do CrossFit up to 3x/ week), I just can’t get to the point with my body where I’m very lean. Coming across the topic of hormone optimization on Mike Mahler’s website, I began to wonder if it is Leptin/ Cortisol related. With my activity level, I wouldn’t be surprised if I’m experiencing adrenal fatigue, HIGH CORTISOL, and LR, IR.

    My diet for the most part is good, but I definitely cheat a lot. The last body fat test I got said I was around 13%, but I store most of it in my lower stomach and love handles. For a very active person for years this is frustrating.

    I’m 27 years old, 5’7, and 155lbs. Obviously not a bad thing but I’m intrigued by hormone optimization and its role in the fitness industry.

    After coming across your site info I knew I was on the right track.

    I try to space out my meals as much as I can, but with the amount of workout volume I do, its hard when you want to optimize your post workout recovery with shakes, and make sure that you’re getting enough calories.

    I guess my first step is to decide whether I need a LEPTIN RESET. or if i just need to stick with eating POST LEPTIN RX since I’m very active and may not be LR

    Any help is appreciated!

    Greg

  155. Hi Jack –

    I have been doing paleo style eating for Hashimoto’s and body weight issues for about a year and a half. Last spring I did a combination of GAPS and paleo and was at my leanest since having three children (150 lbs. @ 5’8″). Around that time I had my CRP tested and it was high (1.3 mg/L) This surprised me since I had been doing sugar-free, gluten-free, dairy-free, GAPS for gut health, and of course paleo. I was also sometimes IFing. (I noted in your interview with Jimmy Moore that this was somewhat common in women. What is the solution for that inflammation?)

    I increased my IFing over the summer and fall til I am certain that I was ketogenic b/c I ate so little in general (often just one meal at night). Despite these tweaks I began to gain back weight, this time more belly fat than ever. My mood was edgy and irritable. My libido was low. I felt pretty crappy.

    It seemed like the traditional theories that low-carbing and fasting actually STRESS the system were holding true in my case. I added back in some carbs (not SAD level, probably more Paul Jaminet style). My mood stabilized.

    Since then I have leveled out at about 158 lbs. (which is fine at 5’8″ but definitely leaves me feeling a bit muffin-toppish.) I am in a holding pattern now and all the wind is gone from my sails. It seemed like paleo and low-carb would be magical. But, despite all the research, it ending up being a flop of sorts for me.

    What are your thoughts on Hashimoto’s and low-carbing? There are many conflicting views in the paleosphere. How about raised cortisol from IF or ketogenic diets? What about mood stabilization? I know low-carb might be optimal for health, but I don’t think my family wants me around for all that long if I eat low-carb!

    Lastly, should I try the leptin reset now that I have reintroduced carbs? My reverse T3 as of December was 26 ng/mL.

    Thanks in advance for your help. It feels like there is no one to talk to about this. I am grateful for you. :)

  156. What about mood and a ketogenic diet? Does it get better for people? Scared to take the plunge again!

    • @Crunchy Pickle my mood is great and so are most of my patients…….we do keto in cold…….keto in warm is a mismatch. That is the point of CT 4 and 6. This is why keto gets a bad name.

  157. Thank you

  158. Hi Jack, regarding your comment 257, ‘we do keto in cold..keto in warm is a mismatch’
    Do I only do CT in winter while on low carbs?
    Your post RX prescription of ’20-30% carbs if your active over 4 days a week’, I assume you shouldnt do CT during the spring and summer months when on higher carb cycles?
    Sorry for the confusion!

  159. Members only for the webinar? cant afford that with 2 growing kids!

  160. Michaela says:

    Hallo Dr. Jack.

    I am new here and have to say really love your blog. I am not overweight I do not want to loose any weight, just to be healthy. I have one question can you clarify me why do you reccomend never to skip breakfast? This is new to me cause nutriologist like Natalia Rose advice not to eat anything in the morning only drink green juice and do IF. I would like to ask you also your opinion on green juice only from green veggies spinach lettuce, kale, celery,

    Many thanks for explanation.

    • @Michaela Since green juice is not found in nature naturally my answer should be intuitive. I totally disagree with advice that is contrary to evolutionary biology

  161. Thanks a lot and please can you clarify me why to never skip breakfast? I have also read GAPS diet and Dr. Mc Bride recommend eating after 10 a.m. due to cleansing process. Sorry about question again.
    I live in Vienna Austria so sorry for english I am glad to find your blog

    • @michaela Read this….http://jackkruse.com/so-you-completed-the-leptin-rx-what-is-next/ and focus on the number reasons. When you skip breakfast you throw off your circadian cycles and circadian pacemeakers in the gut. Here are some of the critical points: 1. Plan on eating a straight forward paleo template. If you are active, you can add carbohydrates from 10% to 20-30% of your diet. The diet is still a high fat moderate protein paleo template outlined in Art DeVany’s, Robb Wolf’s, and Mark Sisson’s books.

      2. Upon rising within one hour eat 50% of your daily carbs with 25 grams of protein and 20-30 grams of fats.

      3. Never miss breakfast because eating it stimulates the circadian rhythm for gastric acid secretion in adults. This will become critical later in the day for body composition optimization.

      4. Avoid working out prior to breakfast. It is a circadian cycle breaker because it raises cortisol at a time it is already high.

      5. For Optimal results you must get most of your daily activity between 9AM and 4PM when light cycles are strong year round. This is another reason I strongly advocate high vitamin D levels year round. We evolved around the equator and equatorial sun has been shown to keep human vitamin D levels 50-150 ng/mL. Avoid sitting at all costs and consider walking to get lunch or a short run during your mid day break. The real goal here is to increase Non-Exercise Activity Thermogenesis (NEAT) during strong light hours. This has major effects when it is done consistently over time. For example, I run upstairs and avoid elevators and I park far away from my destinations to increase my NEAT daily. I also carry all my groceries out to the car and never use a shopping cart to make it easier. I look at every aspect of my actions to make sure I am maximizing it for NEAT.

      6. For lunch, if you need to eat it, (some won’t eventually) you should consider eating 25% of remaining daily carbs. I use this meal as a snack now. Rarely is it a big meal for me any longer and if I am IFing this is the one meal I cut like a bad habit.

      7. Critical point: The best time to work out biologically occurs when it is least likely to be convenient for you because of our neolithic lives wont allow it. I re-tooled my entire schedule as a surgeon to make this work optimally for me to lose weight and change my body. It is that important biologically to get to optimal. 1-5 PM is the ideal workout window. For best results, try to do the exercise in bright sunlight.

      8. Dinner should be eaten within 45 minutes to 1 hour of this late afternoon work out. During dinner you want to make sure to include a lot of protein (25-75 grams), the remainder of your carb allotment and the balance in fats. The type of fats at dinner are also critical. Try to concentrate on 10-18 carbon fats because these are best at stimulating Cholecystokinin (CCK) that destroys the night time appetite. I use coconut oil, ghee, pastured butter, and bacon lard to get this effect. I use the fat to cover the carbs and the protein most times in sauces.

      9. Try to complete dinner by 7 PM. This is critical in autumn and winter time to get to optimal results. 8PM is the outer limit for dinner in spring and summer. I actually alter my meal times very precisely as the light cycle changes during the year. Many people might find this too regimented. I agree with this but I do it because I had a huge clinical move to make from 44% body fat. Doing this strictly my first year I lost 133 pounds in 11 months. So the details make a huge difference in good vs. Optimal.

      10. Sleep by 11PM in spring and summer months. I stay up longer June 10th to July 10th due to summer solstice on June 21. During this time of the year I tend to have higher body fat with longer light cycles. In autumn and winter I am in bed by 10 PM. I am in bed earlier when the clocks are set back on hour in fall and heading toward the winter solstice on Dec 21st. I have found I am leanest during this time of the year. The goal of sleep in any day of the year is an optimal 7.5- 8 hours of sleep a night no matter the season. You will know when you are doing well because you will no longer need an alarm clock and your sleep wake cycle will be automatic. I found after one year of using this protocol I no longer needed an alarm clock to wake up for surgery.

      WHAT CHANGES SHOULD I CONSIDER AFTER THE LEPTIN RX RESET?

      1. If you are active, drop all of the top ten paleo supplements I mentioned in that blog. They were only meant for the transition from a sugar burning metabolism to a fat burning furnace as the permanent paleo template takes flight. If you are not active, I would strongly consider you remain on PQQ and vitamin D3. Try to optimize your vitamin D levels to 70-100 ng/mL.

      2. If you decide to Intermittent Fasting do not skip breakfast ever. It is the key to circadian congruity and optimal body composition. You will see below how this determines body comp and not the amount of exercise one does.

      KEY POINTS TO KEEP IN MIND:

      1. High protein consumption occurs at night now, not at breakfast as it did in the Leptin Rx reset. The reason is because late afternoon is when the human body is normally programmed to undergo up regulation of protein synthesis biochemically. This is how our biology is designed by God/evolution. If you remember back earlier in the post, I told you the key point for breakfast was to use carbs and a small protein load to prime the gastric acid circadian cycle for maximal effect later in the day. This is precisely the reason why. Gastric pH should be highest when we are eating our biggest protein load of the day while simultaneously upregulating protein synthesis maximally in our body. This maneuver actually influences our body composition more than any exercise could if it was added to the equation at all. Doing this on time is akin to an orchestra playing in unison. It is a huge point to try to follow daily.

  162. Kristen Dart says:

    Dr. Natasha Campbell-Mcbride recommends not eating until 10AM because the body is detoxing. What do you think about this advice?

    • @Kristen she is treating a different issue with her diet. I personally do not advocate that option at all ever. I also have posted many times here where the GAPS diet falls short. I think if you read my Leaky gut Rx and the comments you will see the differences and why I believe what I do.

  163. Zack leman says:

    Would having some matcha green tea or Bulletproof coffee mixed with 4 tablespoons of ghee and 2 tablespoons of coconut/MCT oil in the morning count as a breakfast and not be in violation of the “never skip breakfast rule”? Basically is this sufficient to stimulate the circadian rhythm for gastric acid secretion? Also when you IF for a few days you do skip breakfast correct? Thanks

  164. dave roberts says:

    Dr Kruse,
    I’ve completed the LR, I think I am doing well. I have a question about exercise and breakfast, you said:

    3. Never miss breakfast because eating it stimulates the circadian rhythm for gastric acid secretion in adults. This will become critical later in the day for body composition optimization.

    4. Avoid working out prior to breakfast. It is a circadian cycle breaker because it raises cortisol at a time it is already high.

    I have been IF’ing the last month from supper until morning. I return home from the gym at 930 am, and then eat a good Paleo breakfast, and some Raw Milk. I could go to the gym later in the day, I am retired, but I go with two friends, and one’s younger wife left him at the end of last year, so I am both working out, and keeping him on a schedule.
    My wife is up between 515 and 530, should I eat then with her, and then hit the gym at 830-9am?
    My M-W-F gym time is 25 minutes of moderate bike, and then it takes me about 15 minutes to do 3 supersets of lifting,week 1 is upper M+F, lower on W and(week 2)Mon.
    Thanks for the program you have designed, I found I have no problems with staying on a Paleo diet, even on a cruise.

  165. jonny h says:

    Jack, I’m curious regarding the post RX protocol and never missing breakfast. The link below is from your forum, where the OP trains 5-6 days a week missing breakfast and trains fasted, you commented on the thread that you think he’s doing the right thing. Can you please explain why you believe the OP was right, but your RX protocol goes against that?
    Many thanks
    http://forum.jackkruse.com/showthread.php?305-Fasted-State-Training-Adaptations

    • @Jonny fasted training goals are different and they are already LS so when you are looking for different results than just optimal health you experiment with different things.

  166. Zack leman says:

    Would having some matcha green tea or Bulletproof coffee mixed with 4 tablespoons of ghee and 2 tablespoons of coconut/MCT oil in the morning count as a breakfast and not be in violation of the “never skip breakfast rule”? Basically is this sufficient to stimulate the circadian rhythm for gastric acid secretion or can only protein an carbs do that? Thanks

  167. Zack leman says:

    For a male who is LS would you recommend having a small carb meal after a workout in the winter if I live in Maine, or should post workout carbs only be consumed in the spring/summer?

    • @Zack depends upon your goals……if it is performance and youre not going to CT use BCAA. If you want to invest 24-36 in CT then I think your best performance comes from this.

  168. Zack leman says:

    What are your thoughts on consuming about 1-2 teaspoons raw honey before bed to improve quality of sleep? Will this screw up the circadian cycles or prevent any needed hormonal process from happening? The few times I have done this I have had my deep sleep increase by up to an hour as measured by a Zeo. Thanks

  169. Zack leman says:

    Question one: How essential is it when consuming carbs in season to split them up between breakfast and dinner? In spring is it ok to just have my carb load post workout? It seems the protein is the key in the morning for stimulating gastric acid circadian cycle.

    Question 2: When you give a range of carbohydrates for consumption, are we to include vegetables as part of that allotment or do they not count as carbs?

    Question 3: Would 250 grams of carrots count as 250 grams of “carbs” out of the allotment or just 17 grams of carbohydrates according to the nutrition facts?

    • @Zack 1. Depends upon your current situation and goals…..but if your healthy and fit I dont see a problem with that plan.
      2. I dont consider low glycemic carbs in my calculations. I am more concerned about glycating carbs like fructose et al.
      3. 17 gms.

  170. -I am only consuming every day on average 35 grams of carbohydrates from 4 eggs, 500 grams low glycemic load vegetables and 4 pounds of fatty meat.
    -If I am LS and healthy would it be a good idea to up my carbs at this time of year through the summer (living in Maine)?
    – Would the best way to do this be through eating berries and sweet potatoes?

  171. Sandra k says:

    When adding in carbs for the summer in addition to my standard ketogenic diet would the best sources be berries and sweet potatoes as mentioned above? Or is something else better?

    • @Sandra Everyone is different but i will tell you berries are my go to fruit for carbs. I also use Coconut manna, pineapple, and I use yams. I eat figs, dates, and apricots too. But I limit my fruits to few varieties.

  172. Sandra k says:

    Question 1: How is raw honey as a source of carbs, maybe when you don’t have fruit available?

    Question 2: Is pure glucose ok to use in meals in the summer to up carbs if I don’t have fruit or tubers on hand?

    • @Sandra K 1. It is OK for some. I only use honey as a dressing and not as a food.
      2. You could use glucose but without the insoluble fiber that is in fruit that to me is a very neolithic issue and I would not do it. Glucose is never found in nature by itself.

  173. Sandra k says:

    Question one: Would taking any of the following supplements taken close to bedtime disrupt sleep or inhibit needed hormonal processes?
    1. L-Theanine
    2. Decaffeinated green tea extract
    3. Calcium-D-Glucarate
    4. Magnesium L-Threonate
    5. Potassium Citrate
    6.Magnesium Citrate in “Natural calm” which contains “natural flavors” and stevia
    6. Bitter Melon when cold adapting

    Thanks. I appreciate it.

  174. I am an overall healthy male in his early twenties who has been on a paleo diet since last november. Since age 15 whenever it is hot outside and I go out in the sun and my body warms up I begin to get itchy all over and I start to get hives. Usually getting out of the sun or cooling myself off can prevent the hives from developing, but I still get the itchy sensation that goes away pretty quickly. This also happens, but I actually get hives, when something embarrassing happens and my body warms up that way. Sometimes it is too uncomfortable to even watch a funny recording of friends because this condition seems to be triggered by some emotional response causing my body to heat up. Any ideas?

    • Sounds like Sun induced histamine release. If I were you I’d get a work up done……one think that can help it if it is due to histamine is apples and grapes. Both are loaded with Quercetin which is a natural anti histamine

  175. Meghan Miller says:

    Hi Jack, in your first webinar you mentioned that bulletproof coffee could help convert WAT to BAT. Sounded like it might be through elevating cortisol. Is elevated cortisol only an issue then when you are trying to become LS then? Otherwise wouldn’t elevating cortisol albeit with coffee be a negative along with exercising first thing in the morning?

    • @Meghan coffee increase NE and epinephrine both of which are adrenergic signals that drive the beta 3 receptors in fat cells to facilitate the adaptation to BAT. Most people who are LR have low levels of cortisol because it has chronically shut down adrenal and central production. When one first becomes LR the cortisol levels are high. I see this in many kids but once they get past teenager yrs they are all low on their ASI test. This is why I also told you in the same webinar that the closer you are too birth the easier it is to convert WAT to BAT. The longer you are exposed to modern life the more BAT atrophies in modern humans.

  176. Andre van Staveren says:

    Just want to say that combining eating behaviour and day cycles really hit me. Haven’t seen this elsewhere on the internet. Your explanation is perfect. You really inpired me. Thanks!

  177. Andre van Staveren says:

    I meant ‘inspired’

Trackbacks

  1. […] HUMAN Obesity Caveat: MCT however, will help the obese human however to reverse weight loss in winter because they are a far better choice than any carbohydrate at this time. It was my number one diesel fuel I used for my own weight loss. It will also make the obese person radiate heat if they use it in fall and winter which is a good sign that they are fat burning and not sugar burning. Coconut oil and palm oil are the ideal fats for spring and summer uses for humans. This works only for reversal of a disease and not for optimal living. I have a plan for optimal living once you reverse your disease here. […]

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