72-Hour Colostrum & Water Fast
– You Can Benefit –

Dr. Al Danenberg ● Nutritional Periodontist

January 9, 2022 [printfriendly]

 

I just completed another experiment on myself. I’m starting to feel like a lab rat. But my results can benefit you as well as me.  I’ll summarize your benefits in the last section, Your Takeaway.

On 11/21/21, I wrote about my Bovine Colostrum Experiment and the many health benefits of this whole food when eaten daily. In that blog, I cited 10 recent medical articles about Bovine Colostrum’s effects on the human body.

And on 4/11/21, I wrote about my 72-hour water-only fast. This was one way to put me into a high level of optimum ketosis.

But this time, my goal is different. I wanted to continue to gain potentially reparative benefits by eating bovine colostrum daily, AND at the same time I wanted to maintain optimal dietary ketosis for my metabolic flexibility. This experiment allowed me to focus only on colostrum’s unique nutrients while still metabolizing fat as my primary fuel source and benefiting from my liver’s creation of ketones.

But I shouldn’t call this a “fast”. This is not a true “fast”. Colostrum has fat, carbs, and protein. So, the body is not really “fasting”.  Some people might call this a “detox protocol”. But I’m not fond of the term “detox protocol”. Here’s why …

 

I’m Not a Fan of the Term “Detox Protocol”

“Detox protocol” mostly refers to short-duration processes that are touted to be a way of removing toxic substances from the body. But short-term programs might not really work.[1] In addition, many of the detox products contain emulsifiers and additives which have been shown to damage the gut microbiome.[2] The fact is that the body naturally detoxifies daily through the kidneys, liver, and skin. Remember, your body has evolved for thousands and thousands of years learning what it needs to do to function at peak performance. Why do you think we need to put processed concoctions into the body to make it work better? Instead, we should be concentrating on giving our body what it requires and avoiding anything that is potentially toxic to our body – 24/7. And I already eat a healthy diet based on my Better Belly Blueprint.

So, I don’t like the concept of “detox protocols”.

 

My 72-hour Colostrum & Water Fast

I’m not doing this fast to detoxify my body during this 72-hour period.

This fast is relevant for me on two specific fronts:

  1. Bovine colostrum has the potential to assist many of the body’s pathways to heal. I wrote about it on 11/21/21. This fast only includes Bovine Colostrum as a nutrient source, and it may benefit my current cancer therapy. I receive a monthly injection of a human-based monoclonal antibody (Darzalex) to assist my immune system in killing malignant plasma cells. The Darzalex effects may be enhanced with a colostrum and water fast starting the morning of and ending two days after the immunotherapy. Some of my future monthly blood work might show improvement with this protocol. I’m looking forward to evaluating future monthly lab results as is my oncologist.
  2. I want to be metabolically flexible, which I wrote about HERE and HERE. It is important for me to be in ketosis and cycle out of ketosis regularly. This helps enhance my immune system. So, this 72-hour colostrum & water fast will show me how my metabolism can enter and stay in ketosis even though I eat colostrum. If I were unable to be in ketosis while eating colostrum daily, I would need to either reduce my daily intake of colostrum or eliminate it entirely. As you will see, I was able to enter a significant level of dietary ketosis during this fast.

Colostrum is a whole food, and my choice in a commercially produced product must have nothing added or removed from this whole-food source except the water. I have tried several colostrum products, but I’ve settled on Colostrum-6 powder as the best. It is obtained within 6 hours of calving but only after calves have consumed their fill. Here is an independent analysis of the components of Colostrum-6.

 

Below is a chart summarizing the percentage of macronutrients contained in my daily dose of 6 tablespoons of Colostrum-6:

 

 

I needed to understand how a 72-hour fast including only water and colostrum would affect my ketones levels. To do this, I began monitoring my ketones frequently each day of the fast using the BioSense Breath Ketone Monitor.

I started the fast on Monday, 12/27/21 upon waking and ended it when I went to bed on Wednesday, 12/30/21. I’m an old guy who is almost 75. So, I go to bed early. You’ll see that I ended my fast at 9 PM and said, “Goodnight!”

Here is a summary of what I did for my 3-day fast …

  1. Recorded my ketone levels at the start of the fast on Monday morning, 12/27/21 and continued every several hours until bedtime for the entire fast
  2. Drank SOLE hydrating water first thing in the morning
  3. Continued to drink natural spring water replete with trace minerals when thirsty for all 3 days
  4. At 9 AM, 2PM, and 7PM, I ate 2 tablespoons of Colostrum-6 Powder mixed in a little spring water daily
  5. On Tuesday, 1/4/22, I had my monthly CBC (complete blood count) and CMP (comprehensive metabolic panel) blood tests performed during my regular oncologist appointment. I also had serum protein electrophoresis (SPEP) and immunofixation blood work performed that day, which is repeated every 2-3 months.

 

Details of the Fast

As I said, I measure my ketone levels with the BioSense Monitor. These levels are reported in ACEs.

“ACEs” are BioSense’s scoring system for breath acetones. Essentially, if you divide ACEs by 10, you will get an accurate interpretation of blood ketones. Blood ketones are reported in mmol/L units. For example, a score of “28 ACES” is equal to a “blood ketone level of 2.8 mmol/L”.)

The following Table explains the interpretation of breath acetone levels measured in ACEs.

 

 

Below is a graph showing the optimal blood ketone levels that the body can use as clean-burning fuel:

 

 

Day 1:

My morning ketone level at 8:20 AM was “0 ACEs” measured on the BioSense Breath Ketone Monitor. I had no appreciable ketones in my blood.

The first day of the fast was the most difficult for me because I felt hungry and wanted to eat. But I didn’t give into the hunger, which most likely was psychological. I also felt that my energy level was not as good as it was before the fast.

In the graph below, you can see most of my liver glycogen was depleted by 4PM when my ketones began to rise above 5 ACEs

 

Day 2:

Hunger was not a problem on the second day of the fast. I still felt my energy level was not as high as I expected it would be, but it was improving.

In the graph below, my ketone levels rose rapidly after the liver glycogen stores essentially were depleted. For the entire day, these levels rose from 15 ACEs to 24 ACEs. Obviously, the colostrum never kept me from easily moving into optimal dietary ketosis. That was my goal. I was pleasantly surprised!

 

Day 3:

My energy level was excellent, and I had no hunger whatsoever. I felt terrific, and I knew I could continue the fast for additional days if I wanted. However, I ended the fast that evening.

The graph also showed my ketone levels were at the upper end of optimal. All day I was well above 25 ACEs.

 

My Takeaway

I recorded my body weight and percentage of body fat using the Eat Smart Precision GetFit Bathroom Scale. At the start of this fast, I weighted 151 pounds and my body fat was 15.0%. At the end of the fast, my weight dropped to 148 pounds and body fat dropped to 14.3%. I took these measurements at the same times – 7 AM on the first day of the fast and 7 AM on the morning after the third day of the fast.

Metabolically, as insulin levels drop from the start of a fast and you enter dietary ketosis, the body is becoming increasingly insulin sensitive. In addition, ketosis has been shown to upregulate autophagy, extend longevity, improve memory, and create a poor environment for cancer cells to grow. [3],[4],[5],[6],[7] Ketones also reduce excessive free radicals, increase glutathione production, and improve mitochondrial function.[8],[9] All these benefits are vitally important to me.

So, this 72-hour colostrum and water fast has confirmed to me that while I’m assisting my body with the unique nutritional benefits from eating 6 tablespoons of Colostrum-6 daily, I am able to maintain optimal dietary ketosis.

 

Your Takeaway

You might benefit from a 72-hour colostrum and water fast as I have.

You can benefit from the nutritional benefits of eating bovine colostrum daily. I cited many articles in previous blogs about the peer-reviewed research, but here is an excellent summary published in 2021.

Also, your immune system will benefit by becoming metabolically flexible.

Metabolic flexibility is where your body can efficiently burn carbohydrates for fuel but can switch to burning fat for fuel seamlessly when appropriate. The facts that you can be in ketosis where your liver is creating ketones to improve many aspects of your biological system and at the same time benefit from the nutrients in colostrum are impressive.

Obtaining unique nutritional support from colostrum, eating a healthy diet as I detail in my Better Belly Blueprint, and cycling in and out of ketosis will help you to create a robust immune system.

And a robust immune system is your ticket to overall wellness.

That’s your takeaway!

 

[1] https://www.medicalnewstoday.com/articles/does-science-support-the-claims

[2] https://microbiomejournal.biomedcentral.com/articles/10.1186/s40168-020-00996-6

[3] https://www.sciencedirect.com/science/article/abs/pii/S0955286321000401?via%3Dihub

[4] https://www.cell.com/cell-metabolism/fulltext/S1550-4131(17)30490-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1550413117304904%3Fshowall%3Dtrue

[5] https://www.cell.com/cell-metabolism/fulltext/S1550-4131(17)30489-8?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1550413117304898%3Fshowall%3Dtrue

[6] https://www.sciencedirect.com/science/article/pii/S1568163718301478?via%3Dihub

[7] https://pubmed.ncbi.nlm.nih.gov/31399389/

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5981249/pdf/antioxidants-07-00063.pdf

[9] https://pubmed.ncbi.nlm.nih.gov/26661201/

 

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My Plates of Food
– Animal-Based –

Dr. Al Danenberg ● Nutritional Periodontist

October 17, 2021 [printfriendly]

When I began the “Carnivore Diet” on 1/1/20, I was strict – 100% muscle meat, bones, collagen, bone marrow, organs, and the animal fat. My diet was based on the Paleomedicina Clinic’s way of eating for cancer patients.[1]

But about a year later, I added a few fruits and vegetables that were low in phytates, lectins, and oxalates. As a matter of fact, the Paleomedicina Clinic allows their patients who have had success with the strict diet to become less strict. They are allowed to eat as little as 70% animal products by volume on a dinner plate and as much as 30% select plants.

I designed my Better Belly Blueprint way of eating with a 70%/30% proportion. My typical plate of food by volume consists of as little as 70% animal products and as much as 30% select plants. And the animal-based foods have a fat-to-protein ratio of approximately 2:1 measured in grams.

My goal is to recreate a robust immune system and assist my body in healing. Today, the means to that end include providing nutrient-dense, anti-inflammatory foods. But most importantly, this also includes the avoidance and removal of any irritants that could damage my gut or create chronic inflammation that could affect all my organ systems.

My Better Belly Blueprint way of eating is part of my overall solution, which is outlined in my Unconventional Cancer Protocols. This way of eating assists my body to be metabolically flexible.

Metabolic flexibility basically allows my body to do what it was created to do metabolically. My body knows how to use carbohydrates for fuel. My body also knows how to burn fat as fuel when consumed carbohydrates are not available. By being metabolically flexible, I can cycle back and forth between burning fat and burning carbohydrates as fuel.

To maintain metabolic flexibility, I need to eat differently on my “fat burning days” and on my “carb burning days”. My typical meals are different. My plates of food are different.

 

Typical Meals …

I eat when I am hungry and drink when I am thirsty. But I eat to satiety and drink until my thirst is quenched. I drink SOLE first thing in the morning to help hydrate my cells. Many days of the week I eat only one meal. Some days I eat twice a day. Rarely do I eat more than two times a day.

To be metabolically flexible, I eat to be a “fat burner” about 5-6 days a week. In contrast, I eat to be a “carb burner” 1-2 days a week.

 

Fat Burning

Here’s a photo of my typical “fat-burning meal”:

 

Starting at the bottom of the picture and moving counterclockwise:

  • A portion of grilled ribeye cooked rare with ghee
  • Several fresh blueberries
  • 1 teaspoon of Manuka honey
  • Beef bone broth with collagen peptides
  • A slice of raw Gouda cheese
  • 6 desiccated bovine bone marrow capsules
  • A slice of liver pâté

This way of eating helps me stay in ketosis for 5-6 days a week. The fat-to-protein ratio is approximately 2:1 measured in grams. I consume less than 20 grams of carbs daily on my fat-burning days.

 

Carb Burning

About 1-2 days a week, I cycle out of ketosis. I become a “carb burner” rather than a “fat burner” for a couple of days. After that, I go back to my “fat burner” way of eating by returning to ketosis. This maintains my personal metabolic flexibility.

The total grams of carbs on my carb-burning days are over 100 grams. Eating this way will keep me out of ketosis.

Here is a picture of my typical “carb-burning meal”:

 

Starting at the bottom of the picture and moving counterclockwise:

 

My Ketone Levels

I can tell when I am in ketosis. My energy level is higher, and my mind is clearer when in ketosis. Also, I know I am in a “fat-burning” mode because I measure my ketone levels.

Ketosis is a metabolic state in which there’s a high concentration of ketones in the blood. Ketones can pass through the blood-brain barrier and supply the neural tissues with 70% of their energy needs. Ketosis occurs when fat provides most of the fuel for the body, and there’s limited access to glucose.

I use the BioSense Breath Ketone Monitor, which measures acetones in the breath resulting from ketones in the blood. The monitor’s unit of measurement is ACEs. ACEs are BioSense’s units of measurement for breath acetones. Essentially, if you divide ACEs by 10, you will get an approximation of blood ketones, which are reported in mmol/L units. For example, a score of “18 ACES” is equal to a “ketone blood level of 1.8 mmol/L”.)

The following Table explains the interpretation of ketone levels measured in ACEs.

 

My Ketone Levels for Fat-Burning Days

As I previously mentioned, I measure my breath acetone level to be sure I am in ketosis. Here is a graph during my “fat burning” days that registers my acetone levels measured by the BioSense Breath Ketone Monitor. It shows my ACE levels are between 6 ACEs and 19 ACEs:

As I said, the ACE units measure acetone in the exhaled breath from ketones in the blood. The acetone level is directly correlated to the ketones in the blood.

 

My Ketone Levels for Carb-Burning Days

Here is a graph of my breath acetone levels measured with the BioSense Breath Ketone Monitor. This graph is the day after my “Fat Burning Day”. You can see that I cycle into ketosis on my “carb day” with my ACE levels below 5 during my waking hours:

 

My Continued Research

This way of eating has impressed me. It has assisted my goal to recreate my robust immune system and increase my overall energy.

My continuing research of the NIH PubMed website has revealed many published medical abstracts that clearly show the production and circulation of ketones in the blood system to be beneficial for continued wellness.

[1] https://nutriintervention.com/paleolithic-ketogenic-diet-pkd-efficacy-and-applicability-faq/

 

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5 Important Tools
for a
Robust Immune System

Dr. Al Danenberg ● Nutritional Periodontist

December 13, 2020 [printfriendly]

 

Image by Bruno /Germany from Pixabay

I’m obsessed with getting it right.

From all the research I’ve read and from my personal cancer journey, there is one fact that stands out above all: A robust immune system is critical for wellness.

It’s vital for healthy people; it’s vital for sick people; it’s vital for all who want to be proactive as well as those who are reactive.

A robust immune system is the ticket for fighting diseases arising from external and internal sources. It protects us from pathogens as well as our own cells which become cancerous.

I’m fixated on recreating my robust immune system and evaluating my success along the way. And I’ve assembled a toolbox – my biological measuring tools. It includes 5 biomarkers which tell me what I need to know. I’ve used these measurements to guide me on my journey to a healthier immune system.

You also can use these tools to assess your progress and success.

 

5 Important Tools

#1. Healthy Gum Tissue

Your mouth can tell a lot about the health of your immune system. One prominent sign is the gum tissue around your teeth. It should never bleed unless it is cut. Never!

If you were to scrub your nails with a nail brush, you should be concerned if the cuticles around your nails started bleeding. Similarly, when you brush your teeth with a toothbrush, you should be concerned if you see any bleeding. The gums are as tough and protective as are your cuticles.

However, if you have a compromised immune system, the gum tissues may become inflamed or infected (i.e., gingivitis). They then may bleed when you clean or rub them. They even may bleed spontaneously. This is a strong indication that your immune system is not functioning ideally.

An excellent method to determine if you have bleeding gums around any tooth is to use a TePe Easy Pick. This is a small, silicone brush used to clean between the teeth at the gum line.

If you see any bleeding when using the TePe Easy Pick around any tooth/gum area in your mouth, you have some form of gum disease. This suggests that you have a compromised immune system.

Here are two pictures demonstrating how to use the TePe Easy Pick between teeth at the gum/tooth margin.

 

#2. Ketone Breath Meter

Metabolic flexibility is necessary to support a responsive immune system. And ketosis is part of being metabolically flexible.

I want to be in ketosis 6 days a week and then cycle into a carb-burning mode on the 7th day. The benefits of ketosis and carb-cycling are documented in the medical literature. Travis Christofferson summarized the unique qualities of ketones in his book, Ketones: The Fourth Fuel.

To help me gauge my ketone levels and document how well I’m doing, I researched three options.

  1. Urine ketone strips are easy and inexpensive. But they are not accurate once your body begins to utilize its blood ketones efficiently and effectively.
  2. Blood ketone levels can be monitored with finger sticks using a blood ketone meter. The readings are accurate, but I would need to prick my finger several times a day, every day. Not for me! I don’t know about you, but it hurts when done repeatedly. Another drawback is that it only gives a static picture at that moment in time.
  3. A ketone breath meter recently came on the market that has clinical research to support its efficacy. It’s was created and is sold by MyBiosense. This meter is unique because it registers acetone levels that are blown out in the latter part of the exhale, which is called Deep Lung Sampling. The readings correlate to the mmol/L of blood ketone levels. Using this device, I can monitor my ketone levels as often as I want with no finger sticks! And the data is stored in the MyBiosense App on my phone for me to review.

My goal is to average a ketone level between 1.5 – 2.5 mmol/L per day while in ketosis. On my “carb” day, my ketone levels will drop below 0.5 mmol/L that day.

 

#3. Standard Deviation of Glycemic Variability

Glycemic variability is the up and down variations in blood glucose level. It indicates the efficiency of insulin to make glucose available as a fuel or to store it appropriately. If insulin is not effective, glucose levels will get out of control leading to diabetes and various forms of metabolic dysfunction.

Various medical papers have shown that the standard deviation of glycemic variability directly correlates with the risk of chronic disease and cancer. It is inversely correlated with the robustness of the immune system.

I want my glycemic variability to be as low as practical.

I could take finger sticks frequently using a glucometer to register my moment-in-time blood glucose level. But that would not give me a running graph 24/7. It certainly would leave me with painful fingertips. I prefer not.

However, a continuous glucose monitor (CGM) by NutriSense is a device that is worn for two continuous weeks. The CGM inserts a microfiber into the interstitial tissues and attaches to an inconspicuous area of the body with an adhesive. It is painless to insert and wear. But it registers glucose levels every 5 minutes, 24/7. The data is transferred to a NutriSense App, which calculates the standard deviation.

 

#4. Alpha Diversity of Gut Microbiome

The gut microbiome is made up of about 38 trillion microbes. Our body only has about 30 trillion human cells. We are more “microbial” than “human”!

Many studies have been published describing the variety of species in the gut. These medical papers clearly demonstrate that the greater the diversity and numbers of specific microbes, the healthier the immune system. [1],[2],[3]

A measurement including (1) the diversity of various microbial species in the gut and (2) the number of each of these species is called “Alpha Diversity”. It is generally reported as a percentile compared to the microbial ecosystem in a population of metabolically healthy individuals.

BiomeFx is a stool test marketed by Microbiome Labs and evaluated by CosmosID. Among the many biomarkers reported in this test, Alpha Diversity stands out to me as one of the most significant results.

 

#5. Blood Level of Vitamin D

Recently, blood levels of Vitamin D have been widely reported as important in the fight against the COVID-19 virus.[4] Previous to the Pandemic, much research has been published emphasizing the importance of adequate levels of Vitamin D to assure a robust innate and adaptive immune function.[5], [6],[7],[8]

Vitamin D is reported to …

  • Prevent excessive expression of inflammatory cytokines
  • Increase the “oxidative burst” potential of macrophages
  • Stimulate the expression of potent anti-microbial peptides, which exist in neutrophils, monocytes, natural killer cells, and in epithelial cells lining the respiratory tract where they play a major role in protecting the lung from infection
  • Affect the action of T cells, key players in adaptive immunity

My Personal Results

#1. Healthy Gum Tissues:

My gums do not bleed. I use the TePe Easy Picks every day.

If you have bleeding gums, you need to address your diet, the health of your gut microbiome, and your oral hygiene techniques. You also need to seek the services of a general dentist or a periodontist (a dentist specializing in periodontal disease).

 

#2. Ketones:

I stay in ketosis with my animal-based diet 6 days a week. My highest mmol/L while in ketosis has been 2.8; the lowest on those days has been 0.5. My average for 6 days running is 1.5. On my cycle day out of ketosis, I eat between 100 – 150 grams of carbs for that day, and my ketone reading drops to an average of 0.3.

 

#3. Glycemic Variability:

In July 2020, I wore the CGM from NutriSense for two weeks. My average standard deviation of glycemic variability for that time period was 10. Here is a table showing ranges and their interpretations:

 

#4. Alpha Diversity:

My Alpha Diversity was reported in the BiomeFx stool test I took in August 2020. The results indicated my Alpha Diversity was in the 98th percentile. That meant that 98% of metabolically healthy individuals had less variation of species and numbers of individual microbes than I had.

 

#5. 25 Hydroxy Vitamin D:

My last blood test for 25 Hydroxy Vitamin D was in 6/2020. At that time, my blood level was 89 ng/mL. and I was taking 5,000 IU of Vitamin D3 daily. I have reduced that dosage to every other day, and I’ll have another test shortly. As a cancer patient, I want to keep my Vitamin D level between 60-80 ng/mL.

 

Bottom Line

A robust immune system is our internal armed forces to fight the fight. My ultimate goal is to make my immune system as robust as I can. The 5 important tools I described will guide me along my path and document my success. They also will confirm that I am remaining where I want to be.

I firmly believe that my cancer journey has been as successful as it has because I have significantly improved my immune system along the way. You may find that my 5 Important Tools will help you monitor your journey to a stronger and more responsive immune system.

 

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906406/

[2] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200728

[3] https://www.frontiersin.org/articles/10.3389/fmicb.2016.00455/full

[4] https://articles.mercola.com/sites/articles/archive/2020/12/11/do-vitamin-d-supplements-help-prevent-respiratory-tract-infections.aspx?ui=baff764f733a1f4f602b56b0683839cc74ea77293ab586e40b1b7b0b93d42111&cid_source=dnl&cid_medium=email&cid_content=art1HL&cid=20201211&mid=DM744365&rid=1032114513

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166406/

[6] https://health.ucsd.edu/news/releases/pages/2018-06-15-greater-levels-of-vitamin-d-associated-with-decreased-risk-of-breast-cancer.aspx

[7] https://www.mdpi.com/2072-6643/12/4/1140

[8] https://www.mdpi.com/2072-6643/12/5/1248

 

 

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Metabolic Flexibility
– The Way of Your Body –

Dr. Al Danenberg ● Nutritional Periodontist

October 25, 2020 [printfriendly]

I write and lecture about diet. The nutrients we consume must come from nutrient-dense, anti-inflammatory foods. I connect the medical dots relating to our way of eating, gut health, and immune system strength. Everything I discuss about diet, nutrition, and the immune system is critical for health. But it all comes down to one basic concept – metabolic flexibility.

Paul Saladino, MD has recorded many videos and interviews about the importance of metabolic flexibility for overall metabolic health HERE. And Travis Christofferson published his latest book titled, Ketones: The Fourth Fuel, which explains the essence of metabolic flexibility.

 

Factors of Metabolic Flexibility

Metabolic flexibility is the ability for our body to use carbohydrates and fats for fuel from a healthy diet.[1],[2] Nothing more; nothing less.

But of course, there are other factors than the foods we eat that affect metabolic flexibility. Some of them are efficient exercise, restorative sleep, and reduction of overall stress. Also, the frequency of eating is a big player. Intermittent fasting as well as multiday fasting improve metabolic flexibility as long as the food that is ingested is nutritious with no addition of irritants or chemicals.

That being said, a widely reported medical study was published on 9/22/20, which made two summary statements that I believe are misleading. The study evaluated a group of overweight and obese participants who only ate between the window of noon to 8 PM for 12 weeks compared to a control group who ate three meals a day with no time window. The authors observed that participants who did intermittent fasting statistically did not experience significantly more weight loss compared to the control group. In addition, the investigators pointed out that those who practiced intermittent fasting had a loss of muscle mass compared to the control group. Unfortunately, there was an important caveat that was not emphasized in the abstract although it was reported at the end of the paper. The caveat was that participants did not eat a nutrient-dense, anti-inflammatory diet, which I have stated is critical for intermittent fasting to be effective and healthy. In my opinion, this limitation makes the publication not relevant.

Another important factor of metabolic flexibility is a diverse and abundant gut microbiome. This is required for healthy digestion, proper absorption of nutrients, a robust immune system, and an intact gut epithelial barrier.

With all these vital factors in mind, let’s take a look at our primal ancestors for a broader perspective.

 

Carbs & Fats

Throughout our modern human evolution over the last 200,000 years, our body has been effective in using both carbohydrates and fats for fuel. Our human machine has the hormones and chemical pathways to tell fat cells to release their fat storage when the body needs fuel and is not consuming carbohydrates. In addition, our human machine has the hormones and chemical pathways to burn consumed carbohydrates as fuel when dietary fats are not available.

When insulin levels are turned on with carb consumption, our fat cells are turned off from breaking down their stored fat. In addition, insulin converts excess carbs into fatty acids and stores them as fat. As blood glucose levels drop, we get hungry again.

Unfortunately, if we are used to consuming an abundance of carbs, our body does not resort to burning fats when we get hungry. Instead, we develop cravings for more carbs! We are not metabolic flexible. We are not “fat adapted”. We are “carb addicted”.

Why do we crave carbs when we get hungry? If we are “carb addicted”, our body yearns for more carbs because they stimulate dopamine production in the brain. Dopamine gives us a “rush”. If you refrain from carbs at this time, you will experience “withdrawal” symptoms just as you would if you tried to withdraw from other addictive substances. So, you just keep eating more processed carbs.

Even worse, when we consume an abundance of fats along with an abundance of processed carbohydrates, the body will not burn the excess fats. The end result is that fats and excess carbs are stored as more fat. Also, the liver is compromised with excess carbs coursing through the circulatory system. Excess carbs in the liver can cause non-alcoholic fatty liver disease.

A vicious cycle ensues, where fat and glucose cannot be metabolized effectively.

As time goes on, and we eat an abundance of carbohydrates several times a day, day after day, our metabolic hormones become strained. Problems with sleep, exercise, stress reduction, and gut health also will affect glucose metabolism.

 

Development of Diabetes

Insulin levels work hard to store the excess carbohydrates as fat. But if overeating continues, the effects of insulin become compromised. The cells in our muscles, body fat, and liver start resisting or ignoring the signal that insulin is trying to send out. That important signal is to grab glucose out of the bloodstream and put it into our cells. This is called insulin resistance.

The pancreas compensates by producing even more insulin in order to create the same results that it provided before the continuous overloading of carbs. In time, the pancreas can’t produce enough insulin and blood glucose can’t be directed into the cells. We become prediabetic. If the condition worsens, we become a true diabetic because glucose is not being metabolized effectively. Ultimately, the pancreas could weaken to the point of shutting down its production of insulin.

 

Steps to Become Metabolically Flexible

So, how do we become metabolically flexible? We must address our sleep habits, exercise routine, and ability to deal with stress. It’s also critical we become fat adapted by eating nutrient-dense, anti-inflammatory foods. In addition, we have to maintain a healthy gut. And finally, we should investigate the benefits of fasting.

To become metabolic flexible, our body needs to relearn how to burn fat as fuel. To do this, we must eat a diet that is extremely low in carbs for at least 2-3 weeks. Sometimes it might take several months before our body adapts. Eventually, our liver will start producing ketones as a clean burning fuel as our metabolism shifts into ketosis. Usually, this requires us to consume less than 30 grams of carbs a day. Think about this: one large apple has 30 grams of carbohydrate – your maximum allotment for that day!

An ideal way of eating is to primarily consume animal-based foods from nose-to-tail. These will provide the necessary source of nutrients contained in the animal muscle meat, organs, collagenous parts, and their healthy saturated fats. The fat-to-protein ratio in terms of grams should be 2:1. Eating fats and proteins are satiating and will curb hunger. Animal foods are extremely low in carbs. In addition, a few plants that are low in phytates, lectins, and oxalates could be included as long as the total carbs are less than 30 grams.

As I stated, this eating lifestyle will put the body into ketosis, where fatty acids are being mobilized from fat cells to be used as fuel for the body, and the liver in now producing ketones as an additional clean-burning fuel. This is the protocol I describe in my Better Belly Blueprint.

After your healthy metabolic flexibility has been reestablished, you can cycle in and out of burning fat and burning carbohydrates. To do this, you could reduce your fat consumption once a week and eat about 100-150 grams of carbohydrates that one day. Your body will burn the carbs for fuel and store some of it in the liver and muscle as glycogen. Also, the release of insulin at that time will assist your body in various repair pathways that are required. Over the following 6 days, you can go back to a high fat and low carb way of eating. Your protein levels will remain moderate. And you will stay metabolically flexible.

 

My Personal Metabolic Cycling

First of all, MCT (medium chain triglycerides) Oil acts as an exogenous ketone source. When a person consumes it and is eating low carbs, the liver will immediately convert MCT Oil into ketones. The rush of ketones into the blood system will cross the blood brain barrier and will benefit cognition and neural tissues since it is a perfect brain fuel. It also decreases overall free radical creation, improves the production of ATP by mitochondria, and enhances the natural production of endogenous antioxidants. Basically, it extends ketosis and improves energy.

Now for my personal metabolic cycling regimen. I am not recommending the following regimen to anyone. This is for information only.

I eat an animal-based diet, which includes less than 10% plants as I described previously. In my morning coffee, I add MCT Oil. Starting at 6 AM, I blend 2 tablespoons of ghee and 2 tablespoons of MCT Oil in 16 ounces of pressed coffee. And I’ll drink this over the next couple of hours.

My ketone levels stay high. Then I continue my animal-based diet with my first main meal sometime between 2PM and 5PM.

I will cycle out of ketosis every 7th day by increasing my carbs to 100-150 grams and significantly reducing my fats that day. I get my carbs primarily from raw manuka honey, some bee bread, and occasional fruits. On “carb” day, I do not drink any coffee. This protocol keeps me metabolically flexible and boosts my overall wellbeing.

Be aware of this: It was critical for me to titrate up to my daily dose of 2 tablespoons of ghee and 2 tablespoons of MCT Oil per day. I started with 1 teaspoon daily until I finally reached 2 tablespoons. If I had jumped in with a total of 2 tablespoons of both the first day, I would have experienced nausea, stomach distress, and diarrhea.

Concluding comment: Our DNA blueprint wants us to be metabolically flexible. This is the way our body is supposed to work. This was how humans have survived and thrived throughout our evolution over the last 200,000 years.

One way to determine your metabolic flexibility is to understand how your body metabolizes ingested carbohydrates by measuring your glycemic variability (GV). You can do this 24/7 by using a Continuous Glucose Monitor (CGM). I describe the details in my personal experiment. Read the facts and how you can get a CGM to monitor your own GV HERE.

My bottom-line recommendation is: Don’t fool with Mother Nature!

 

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513193/

[2] https://academic.oup.com/edrv/article/39/4/489/4982126

 

 

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How Often Should You Eat?

Dr. Al Danenberg ● Nutritional Periodontist

October 11, 2020 [printfriendly]

 

 

Should you eat every 3-5 hours? Should you eat only when you’re hungry? Should you eat as soon as you wake? And should you eat just before going to bed?

 

What about fasting?

 

Lots of questions. Certainly, there are lots of opinions. But is there science-based research that can offer some insight and direction?

 

The answer is, “Yes, there is science.” Let’s get into it.

 

 

Published Medical Review

For most people, eating frequently is not healthy. Eating shortly before going to bed is not good for the digestive system. In fact, medical research shows “not eating” for long stretches of time during a 24-hour day is beneficial. Eating within a specific time window over the course of the day is considered intermittent fasting. This is my focus in this article.

 

The New England Journal of Medicine published an in-depth review of intermittent fasting in its December 16, 2019 edition. Eighty medical, peer-reviewed papers were cited in this article to substantiate its claims. This is one of the most inclusive medical papers supporting the fact that intermittent fasting is healthy. It is the way our primal ancestors survived and thrived, and it is the path to overall wellness.

 

Intermittent fasting is safe for the far majority of people. But it is safe only if you eat a nutrient-dense, anti-inflammatory diet. If you are eating a “standard American diet” consisting of high carbohydrates, added sugars, unhealthy fats, and devoid of other necessary nutrients, then intermittent fasting as well as any other frequency of eating is not healthy.

 

For example, a medical study published on 9/22/20 summarized that intermittent fasting did not significantly cause weight loss compared to its control group. In fact, the study also showed that there was a loss of muscle mass in the experimental group. However, the study participants did not eat a nutrient-dense, anti-inflammatory diet that I believe is critical for intermittent fasting to be effective and healthy. Actually, the authors of the study write about these limitations in their Conclusion at the end of their paper.

 

 

Summary of Benefits of Intermittent Fasting:

  • Improves blood glucose fluctuations
  • Strengthens the immune system
  • Reduces the risk of metabolic diseases
  • Helps create metabolic flexibility
  • Increases fat metabolism
  • Contributes to weight loss
  • Cleanses the body by causing weak cells to die or renew themselves
  • Assists in preventing Alzheimer’s Disease
  • Extends life expectancy

 

Our primal ancestors never consumed three meals a day. And in-between snacks were not their “M.O.” How absurd is the notion that primitive man ate on a schedule? Humans always have eaten when they were hungry and drank when they were thirsty. Frequently, they could not find food. They had to fast until the next meal was secured. But their metabolism was capable of utilizing stored fat in their body to provide the fuel to function. There is no such thing as a time to eat breakfast, lunch, and dinner.

 

 

Intermittent Fasting (Time Restricted Eating)

The most popular and efficient method of restricted eating is not eating for 16 to 20 hours at a time. In other words, you only eat within the window of 4-8 hours and fast the remaining 16-20 hours of a 24-hour day. As an example, you might finish your last meal of the day by 8 PM and then not have any food to eat until the next day between noon and 4 PM.

 

There are other methods of restricted eating. Two approaches are:

  • Alternate-day fasting. Eat a normal diet one day and fast the next day.
  • 5:2 fasting. Eat a normal diet for five consecutive days a week and fast the other two days of the week.

 

After one stops eating for 12-18 hours, liver glycogen (stored glucose) becomes depleted. Then, lipolysis can become a major energy pathway, producing energy from body fat if additional carbohydrates are not consumed. Triglycerides in fat cells begin to break down into glycerol and free fatty acids.[1] The free fatty acids that travel to the liver can be converted into ketones. Ketones are easily used by the body’s cells to burn as fuel.

 

During the fasting stage, insulin levels are low. With low insulin, damaged cells are encouraged to repair themselves and clean themselves out. This is called autophagy. When damaged cells are beyond repair, they could trigger themselves to commit suicide. This is called apoptosis.

 

 

However, you should consult with your medical doctor before trying intermittent fasting if you …

  • Have diabetes
  • Have problems with blood sugar regulation
  • Have low blood pressure
  • Take medications
  • Are underweight
  • Have a history of eating disorders
  • Are a woman who is trying to conceive
  • Are a woman with a history of amenorrhea
  • Are pregnant or breastfeeding

 

 

Research

Here are specific benefits of fasting which are reported in various published peer-reviewed papers. Most are from animal studies, but a few are with human participants.

 

 

Affects Cells and Hormones

Insulin levels drop during fasting periods, which allows fats cells to release their stored fat as fuel.[2] At the same time, human growth hormone increases as much as five times its normal level. Higher growth hormone assists in fat burning and muscle development.[3] Also, cells begin to repair themselves by removing accumulated waste material.[4],[5] Other benefits include improved longevity and protection against disease. [6],[7]

 

Regular switching between burning fat for fuel and burning carbohydrates for fuel promotes long-term maintenance of a variety of organ systems, disease resistance, and improved performance.[8] The ability for the body to switch back and forth efficiently and effectively between fuel sources is called metabolic flexibility.[9]

 

A clinical study of 1422 participants clearly showed significant health benefits from various types of fasting.[10]

 

Reduces body Weight and Belly Fat

When you fast, you eat fewer meals. Fewer meals mean fewer calories. Serum glucose declines, norepinephrine increases, and the metabolic rate increases, which burns more calories. The result is weight loss as well as loss of belly fat.[11],[12]

 

Improves Insulin Sensitivity and Type 2 Diabetes

Insulin sensitivity is when the body reacts to normal insulin production by the pancreas. However, when the body’s cells fail to respond to normal levels of insulin, it is called insulin resistance. Insulin resistance causes an increase in blood sugar and the development of type 2 diabetes. But fasting improves insulin sensitivity and can protect against type 2 diabetes. In a small study of three patients, intermittent fasting reversed their type 2 diabetes.[13]

 

Lowers Oxidative Stress and Systemic Inflammation

Oxidative stress is when unstable molecules (called free radicals) damage important molecules like protein and DNA.[14] Medical studies show that intermittent fasting helps the body to neutralize excessive free radicals and reduce inflammation.[15],[16],[17]

 

Decreases the Risk of Cardiovascular Disease

Intermittent fasting has been shown to improve different risk factors for cardiovascular disease. Specifically, it lowers blood pressure, total and LDL cholesterol, blood triglycerides, inflammatory markers and blood sugar levels.[18]

 

Assists in Cancer Prevention and Cancer Treatment

Cancer is characterized by uncontrolled growth of cells. Various animal studies have shown that caloric restriction can prevent cancer. In addition, human studies also have suggested that intermittent fasting could improve outcomes with conventional cancer treatment.[19]

 

May Improve Brain Health

Fasting improves metabolism and optimizes brain cell growth in a way that may counteract a broad array of neurological disorders. In animal studies, fasting improves cognition, stalls age-related cognitive decline, slows neurodegeneration, enhances functional recovery after stroke, and lowers the pathological and clinical features of epilepsy and multiple sclerosis (MS).[20] Here is a study, which is the first clinical trial investigating the effects of a ketogenic diet and fasting on disease progression in MS patients.

 

Helps to Prevent Alzheimer’s Disease

Alzheimer’s disease is the world’s most common neurodegenerative disease, and there is no cure today. But in a recent animal study, intermittent fasting prevented memory decline.[21] Also, animal studies have shown that intermittent fasting may improve Alzheimer’s disease though the process of autophagy.[22]

 

 

My Personal Path

The research I have cited clearly shows that fasting improves overall health. But the choice of foods must be nutrient-dense and anti-inflammatory. However, it is important for some individuals with underlying medical conditions to check with their medical practitioners before starting any fasting program.

 

I incorporate intermittent fasting in my Unconventional Cancer Protocols. Up until recently, my last meal of the day ended about 7 PM. I usually went to sleep around 9:30 PM and woke around 5:30 AM. Generally, I ate my first meal of the day around 2 PM. That’s about the time I got hungry. But now I have made some changes.

 

I follow my Better Belly Blueprint (my way of eating). My diet is a relatively strict animal-based way of eating with less than 20 grams of carbs. I eat this way for 6 continuous days. But now, I may not eat my first meal until 4-5 PM. And on those days, I might feel satiated from eating that one meal and won’t eat again until the next day.

 

Then on the 7th day, I cycle out of my ketogenic diet and eat about 100 – 150 grams of carbohydrates and reduce my fat intake to encourage metabolic flexibility. On this 7th day, I select my carbs from raw honey, bee bread, and a few fruits and vegetables that are low in phytates, lectins, and oxalates.

 

From the medical trials and published articles I have read, intermittent fasting might be the healthiest path to a robust immune system, quality of life, and longevity. Cycling in and out of a ketogenic way of eating will keep me metabolically flexible. But it is vital that the foods I consume (and that you consume) must be nutrient-dense and anti-inflammatory.

 

An excellent book that describes the benefits of ketones, cycling in and out of keto, and metabolic flexibility is Ketones: The Fourth Fuel by Travis Christofferson. I think you’ll enjoy Travis’s way of writing. It reads like a novel but is packed full of great science. Also, Carnivore Aurelius is an excellent resource to dive into more information about the animal-based diet.

 

[1] https://www.ncbi.nlm.nih.gov/books/NBK22581/

[2] https://pubmed.ncbi.nlm.nih.gov/15640462/

[3] https://pubmed.ncbi.nlm.nih.gov/12425705/

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3106288/

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6257056/

[6] https://pubmed.ncbi.nlm.nih.gov/24048020/

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622429/

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5783752/

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513193/

[10] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209353

[11] https://pubmed.ncbi.nlm.nih.gov/10837292/

[12] https://www.translationalres.com/article/S1931-5244(14)00200-X/fulltext

[13] https://casereports.bmj.com/content/2018/bcr-2017-221854

[14] https://www.hindawi.com/journals/bmri/2014/761264/

[15] https://pubmed.ncbi.nlm.nih.gov/17291990/

[16] https://pubmed.ncbi.nlm.nih.gov/17374948/

[17] https://pubmed.ncbi.nlm.nih.gov/23244540/

[18] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471315/

[19] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530042/

[20] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836141/

[21] https://pubmed.ncbi.nlm.nih.gov/29307281/

[22] https://pubmed.ncbi.nlm.nih.gov/32068753/

 

 

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Why I Eat Carnivore?
– Ketones & Metabolic Flexibility –

Dr. Al Danenberg ● Nutritional Periodontist

September 13, 2020 [printfriendly]

 

Carnivore Diet Foods

 

I Eat a Carnivore Diet Because:

  • I have cancer
     
  • It reduces dietary carbohydrates to minimal levels and allows my body to enter ketosis and become metabolically flexible
     
  • When I am in ketosis, my body uses ketones as a clean burning fuel with less production of free radicals and less dependence on insulin
     
  • Restricting glucose prevents growth of some cancer cells[1]
     
  • Most cancer cells are unable to effectively use ketones for energy[2],[3]
     
  • By keeping carbs and insulin low, I improve my natural antioxidant capacity and reduce the fluctuations in my blood glucose levels (i.e. glycemic variability)
     
  • A low glycemic variability is a biomarker for improved function of the immune system[4]
     
  • A robust immune system can help my body heal from cancer

 

My Carnivore Diet

If you have been following my cancer journey since I was diagnosed in September 2018, you know that my diet has played a key role in my health. Diet is one of the critical elements in my Unconventional Cancer Protocols.

I started a Paleo-type diet about 6 years before I was diagnosed in September 2018. My Paleo style of eating allowed me to become fat adapted. When I was diagnosed with IgA Kappa Light Chain Multiple Myeloma, I changed my Paleo-type diet to a modified Paleo Autoimmune Diet. Basically, I eliminated pasteurized dairy, nightshades, nuts and seeds from my way of eating. But after doing some additional due diligence, I tweaked my diet on 1/1/20 to start a strict Carnivore Diet. At that time, I eliminated all plants. The reason was abundantly clear to me after doing my research.

As I documented in my Blog in January, individual case reports of a strict animal-based diet showed profound beneficial effects for cancer patients. Specifically, the Paleomedicina Medical Clinic[5] in Budapest, Hungary identified that ketosis along with an intact gut epithelial barrier were vital factors in resolving or reducing the progression of many malignances.

 

Ketosis & Ketones

My body went into ketosis about two weeks after I reduced my carbohydrate level to less than 10 grams a day. I also increased my fat-to-protein ratio to 2:l measured in grams.

The science reported by the Paleomedicina Clinic and by Dr. Paul Saladino[6] proved that the Carnivore Diet provided all the nutrients my body required in a biologically available form. In addition, this animal-based way of eating eliminated all plants that contained antinutrients. Antinutrients are substances that might damage my gut microbiome, the mucus layer in my gut, and the epithelial barrier that prevents toxic substances from entering the circulatory system from the gut lumen. These include phytates, lectins, and oxalates.

With carbohydrates at extremely low levels, fat levels high, and protein levels moderate, my insulin levels remained low. Low insulin tells fat cells to breakdown triglycerides, which are the stored body fat. Triglycerides are broken down in the fat cells into fatty acids and glycerol, both of which then enter the circulation. The free fatty acids bind to serum albumin in the blood stream, which carries the free fatty acids to the tissues that need energy. Glycerol is absorbed by the liver, where it is converted into glucose.

With insulin levels low, fatty acids are converted in the liver into ketones (called acetoacetate and later beta-hydroxybutyrate). Ketones are released into the bloodstream and are a preferred and efficient fuel for cells to burn. In addition, ketones can cross the blood-brain barrier and are available as fuel for the brain.

 

Cycling In & Out Of Ketosis

My goal is to maintain metabolic flexibility. Metabolic flexibility is when the body can switch back and forth between burning fat or carbohydrates as fuel based on their availability. By being metabolically flexible, I rarely have any food cravings. I eat when I’m hungry, and I drink when I’m thirsty.

I practice intermittent fasting along with cycling in and out of ketosis to improve my metabolic flexibility. Cycling gets my body used to using the fuel that’s available.

To maintain metabolic flexibility, I cycle about every 7 days. I decrease the amount of fat I eat and increase my carbohydrate intake to about 100 -150 grams once a week. To do this, I eat plants that are low in phytates, oxalates, and lectins as well as some raw honey during the course of a day. The benefit of cycling out of ketosis about once a week is to stimulate my insulin production to activate pathways to repair my body.[7]

 

Ketosis and Antioxidant Efficiency[8]

Beta-hydroxybutyrate, the most studied ketone body, has been shown to reduce the excessive production of free radicals. It also improves the creation of energy in the mitochondria of the cells in the body. In addition, ketones stimulate our own cell’s ability to produce endogenous antioxidants.

 

Immune System and Cancer[9]

The immune system protects the body against bacteria, viruses, parasites, and toxins. It also fights disease-causing changes in the body, such as cancer cells. So, a robust immune system is critical for health and healing.  However, cancer can weaken the immune system, and conventional cancer treatment can weaken the immune system further.

Cancer can weaken the immune system by creating systemic inflammation and by spreading into the bone marrow. Since bone marrow makes blood cells for the immune system, a malignancy spreading into the bone marrow will decrease the production of healthy blood cells.

Specific cancer treatments also can weaken the immune system by decreasing the number of white blood cells made in the bone marrow. Some of the cancer treatments that will weaken the immune system are:

  • Chemotherapy
  • Targeted cancer drugs
  • Radiation therapy
  • High dose steroids

If possible, someone with cancer should do everything in his or her power to improve the immune system. A robust immune system has the ability to recognize cancer cells as abnormal and kill them.

 

Glycemic Variability as a Biomarker

I wrote two Blogs where I described the benefits of monitoring my glycemic variability (GV) over a 2-week span (HERE, HERE). The data collected through the use of a continuous glucose monitor (CGM) will provide a record of the fluctuations of tissue glucose 24/7. The GV can suggest the robustness of your immune system and your future risk for metabolic and chronic diseases. The statistical measurement of the fluctuation of glucose levels is called the standard deviation (SD). The SD of GV is a relatively new biomarker. It may be one of the most important biomarkers that a proactive individual should know. If the SD were not in a healthy range, the individual could take steps to improve his or her diet and other environmental factors that could improve glycemic variability, thereby improving the immune system.

Here is a table that suggests an interpretation of the SD of GV[10],[11]:

 

Standard Deviation of Glycemic Variability 

My Bottom Line

My Carnivore Diet is one of my Unconventional Cancer Protocols. It has been a significant factor for me to improve my immune system to help my body heal from cancer.

 

[1] https://www.cell.com/cell-reports/fulltext/S2211-1247(19)30924-6?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2211124719309246%3Fshowall%3Dtrue

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235292/

[3] https://cancerandmetabolism.biomedcentral.com/articles/10.1186/s40170-018-0180-9

[4] https://cardiab.biomedcentral.com/articles/10.1186/s12933-020-01085-6

[5] https://paleomedicina.com/en/#blog

[6] https://carnivoremd.com/podcast/

[7] https://www.ncbi.nlm.nih.gov/books/NBK525983/

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5981249/#sec5-antioxidants-07-00063title

[9] https://www.cancerresearchuk.org/about-cancer/what-is-cancer/body-systems-and-cancer/the-immune-system-and-cancer

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455369/#!po=34.6154

[11] https://diabetes.diabetesjournals.org/content/67/Supplement_1/1542-P

 

 

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