The doc fields your questions about growth hormone, bowel movements on low-carb diets, nighttime eating, and exogenous ketones.
Is HGH Worth It?
Q: For middle-aged men, is human growth hormone worth the price as an anti-aging or longevity treatment? Is there any way to naturally boost GH?
A: This is a great question and currently I'm torn on its use. I've prescribed HGH very sparingly in my career, but have enough data to tell you I find its benefit inconsistent in the general population.
I don't use this medication off label, so I can't give you objective feedback on the use in bodybuilders. I have used it in a couple of elite CrossFit athletes for a time to help speed healing from injuries. Even in this regard, it's hard to pinpoint if HGH was the major driver of results since I was doing several other interventions as well.
At this time, it's not something I feel too excited about in terms of delivering all of those fountain of youth effects we hear so much about.
Human growth hormone levels can also be raised naturally. Quantity and quality sleep, adequate protein, and high volume weight training (the kind that gets the muscles burning and generates that pump) are what I'm talking about. The strain inducing heavy loads do it as well, but that type of training leans a bit more towards testosterone generation.
Start with 8 hours of sleep per night. Go to bed by 10:00 and wake early. Take in 30-40% of daily calories as protein, sticking to a smart training cycle with adequate rest and recovery. These are the best proven ways to raise HGH naturally.
I'm currently exploring the use of injectable peptides like Ipamorelin in my clinic. Several of my physician colleagues have been reporting good success. This peptide is a GH releasing hormone.
You also may want to consider arginine and citrulline supplementation. There's some indication these MAY have the potential to boost GH. A good starting dose is 5-10g arginine or 3g citrulline each day.
One study in 2008 (PMID: 18090659) showed arginine supplementation can boost HGH by 100%. Exercise spiked it 300-500%. I bring this up because supplements always seem to be the way we'd like to do things, yet lifestyle factors often outperform them.
One odd finding was that the combination of exercise and arginine supplementation was not synergistic and seemed to blunt the exercise effect to some degree, only enhancing GH by 200%. Who knows what that means for us as individuals. Perhaps on days you're not in the gym, try the arginine, and days you're hitting it hard, don't bother.
The Night Eating Habit
Q: Is there a scientific reason to avoid snacking right up until bedtime?
A: There is. That being said, we have to be careful using research to guide our individual decisions regarding diet and exercise. Remember, research is a tool for averages not individuals. What this means is that scientific "evidence" is going to work for most people, but not all. Spend just one week in a weight loss clinic and you'll see the futility of using research as the sole guiding influence in your recommendations.
You should let research refine your approach, not define it. The individual (you), needs to be the ultimate consideration. By the way, the very fact you're having a hard time doing the thing, may be an indication it's not a good fit for your metabolic uniqueness, psychological tendencies, and personal preferences. And, at the same time, we all know that very often habitual eating patterns can be retrained and have substantial benefit.
Here are a few tips to make this approach work better for you:
Let's say you're going to eat your last meal at 5:30. If you go to bed around 11:00 you'll be close to 6 hours without food. That could mean a late night burger run for many people.
Think about the types of meals that satisfy and satiate the most and the longest. These meals are usually mixed with plenty of protein, fat, and starch. Like the aforementioned burger. Duplicating that type of meal is a good start. A ribeye (plenty of fat and protein), a large baked potato (keep it bland) and a few cups of broccoli are a great start.
You also may want to consider the use of a "post load." Many know the idea of using a preload – having a protein shake before a meal to preempt overeating. The post load is the same idea except applied after the meal if there's still an itch for a taste of something else.
Make plans to do something with your hands and attend to any oral fixation. Some of our eating behaviors are tied to other late-night behaviors like TV watching. Use a relaxing herbal tea, sparkling water, or some other low-calorie beverage to attend to this.
Finally, go to bed earlier. This approach is going to work far better if your eating time has been circumvented by your sleeping time.
Low Carb, Low Bowel Movements
Q: Every time I try a low carb diet, I stop pooping. Is there any way to make this diet work for someone like me?
A: This is not an uncommon occurrence with the low carb diet. It's thought to be related to a change in bacterial populations, a reduction in fiber, a change in enzymatic secretions and alteration of peristalsis (the rhythmic contraction of the intestinal wall that pushes food and then feces through and out of the digestive tract).
Constipation is such a common clinical complaint that I came up with a nifty six part "cure" for constipation issues that has worked wonders for my patients over the years. It was so effective, I even sold it as a popular program to the lay public for a time. The six F's are:
- Fluid: Make sure you're drinking plenty of water.
- Flow: Make sure you're moving. Get 10,000 steps per day.
- Fiber: Make sure you're eating adequate fiber. If you're a low carber, fiber supplements make sense.
- Fat: People forget that fat stimulates the gall bladder and that has an impact on peristalsis.
- Flora: Consider using a probiotic.
- Fire: Consider a full spectrum digestive enzyme.
Exogenous Ketones: Yay or Nay?
Q:What are your thoughts on exogenous ketones – waste of money or worth it for some?
A: I guess it depends on why you're using them. Right now, they're relatively new on the scene. There's only very slight evidence they're having an impact on performance enhancement, and very little if any evidence they're aiding fat loss.
Science is notoriously slow with answering these questions and that's frustrating for all of us, especially when it means the overzealous people of anecdotes fill the void. Add an MLM (multi-level marketing) component to it and you have a big mess of novelty bias, research gap, bioscience, and monetary motivation to contend with.
I will say this: If you're using the keto diet to lose weight, the use of exogenous ketones does not make much sense. If you eat the ketones, your body sees no need to make its own ketones. You may still be in ketosis on your ketometer, but are those ketones you're making from your own fat stores or from the stuff you just drank?
Where they may have some utility is getting into ketosis faster, exercising under ketogenic conditions, and experiencing satiation.
We know that protein is THE most satiating macronutrient. Some evidence suggests once the body starts making ketones they're on a par with protein in satiating potential.
Exogenous ketones may play a role in controlling SHMEC in that all important three days to get into ketosis. I call that the AKZ (almost keto zone). Most people who try keto can never get past these three miserable days and therefore end up getting fatter. They cut carbs and then binge within three days and repeat that cycle again and again.
So, I think there are some possible beneficial areas to explore the use of exogenous ketones, but right now the science doesn't substantiate the hype. It's also useful to note that the ketosalts widely available currently have shown less potential in research compared to the ketonew esters which, if I am not mistaken, are not available commercially.
Of course, I could be missing something here as I haven't looked at anything related to exogenous ketones for the last several months. I'll keep you posted if my opinion merits an update.