# Optimal An overview of our open-access database of performance and longevity protocols. Welcome to Optimal's open-access database of performance and longevity protocols! Our philosophy is to provide as much information as possible to our users and the public at no cost. The protocol database is updated on a regular basis by our research team. We welcome feedback, so feel free to e-mail us as support \[at] beoptimal.ca with any thoughts about our protocols and how their scientific accuracy might be further improved. If you're interested in joining our research team on a contractual basis (we hire for short-term work), please DM us on [Twitter](https://twitter.com/optimaltoronto). # VO2max Optimization Protocol A protocol to optimize cardiorespiratory fitness (as measured by VO2max). {% hint style="success" %} Last updated: May 15, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} ## SUMMARY POINTS
What is VO2max and why is it so important? * VO2max is a measure of maximal oxygen uptake during exercise, which is in turn a measure of cardiorespiratory fitness and is **strongly associated** with human longevity. In addition to directly improving physical performance by increasing your fitness level, the aerobic exercise required to optimize VO2max also improves your brain health, and by extension, your cognitive performance as well. * VO2max training can be done via walking, running, cycling, rowing, using an elliptical machine, or any other similarly-paced modality of aerobic exercise.
What is Zone 2 training and how can it help me to increase my VO2max? * Zone 2 training consists of aerobic exercise where you train well under your lactate threshold (the level above which lactate is produced faster than it can be cleared). [In Zone 2, your primary source of energy is fat metabolism. At this level of exertion, your body is not building up lactic acid](https://www.insidetracker.com/a/articles/zone-2-heart-rate-training-promote-endurance-and-longevity) and hydrogen ions. * The intensity of exercise required to get you into Zone 2 varies depending on your fitness level. For some individuals, a brisk walk might get them into Zone 2; for those in better condition, Zone 2 means walking uphill or a light jog. * There are multiple valid strategies for optimizing VO2 max. This protocol reflects the increasingly recommended practice of **combining** *longer* duration **Zone 2** training sessions with *shorter* duration High-Intensity Interval Training (**HIIT**) sessions.
How can I know if I'm training in Zone 2? The most accurate way to know if you're in Zone 2 is to measure your lactate level in your blood using a lactate meter. For most people, this is impractical because it requires a pinprick blood testing device which costs hundreds of dollars. **Note that your target HR for Zone 2 will shift up and down depending on your fitness level, with more fit people having a higher target HR.** Without relying on a lactate meter, you can *approximate* a Zone 2 heart rate (HR) with the following tools: * The Talk Test: In Zone 2, you can carry out a conversation but it’s not as comfortable as a regular discussion - i.e., you should be a little more strained. If you can’t maintain a conversation, then that’s too high intensity and you are out of Zone. If you were to have a phone conversation in this state, the person on the other end of your conversation should be able to know that you are exercising based on the way you sound. * Dedicated Smartphone Apps: You can also use dedicated apps ([like Morpheus](https://trainwithmorpheus.com/)) that combine wearable-data to calculate your approximate Zone 2 by extrapolating from heart-rate variability. * By way of crude HR measurement (try to line-up these approximate HR targets with the "Talk Test"): * Approximation method 1: [Zone 2 target HR = 180 - (your age). If you're fitter than average, add 5-10 bpm to that figure.](https://www.youtube.com/watch?v=UThuWiIKEBc) Use this if you don't know your measured maximum heart rate. * Approximation method 2: Zone 2 target HR = 70 - 85% of your known, measured maximum heart rate, depending on your fitness level.
Can I rely on Zone 2 training alone to reliably increase my VO2max or do I need to combine this with higher-intensity training for a better result? * [No—it is more effective to supplement Zone 2 training with HIIT sessions.](https://www.youtube.com/watch?v=Go4CkZS3Yv0) While Zone 2 training has various health benefits (e.g. improving mitochondrial health), [up to 40% of individuals will not respond to lower-intensity Zone 2 training](https://pubmed.ncbi.nlm.nih.gov/35736835/). * It is therefore necessary to combine Zone 2 training with High-Intensity Interval Training to produce a greater increase in VO2max relative to Zone 2 alone.
What is High-Intensity Interval Training (HIIT) and how can I train in this zone? * High-Intensity Interval Training (**HIIT**) consists of alternating between time intervals of higher-intensity and lower-intensity training. Consider the following 32 minute example workout: * High-intensity interval: A 4 minute-interval with the *highest* intensity pace you can sustain *for the entire 4 minutes* (i.e. not "all-out"). * Low-intensity interval: Follow the high-intensity interval with a 4 minute-interval at a low-intensity pace such that your heart rate can recover to less than 100 beats per minute. * Repeat the cycle above three more times for a total of four cycles. * [For a video overview of different possible HIIT workouts, Rhonda Patrick has a good summary here. ](https://www.youtube.com/watch?v=IxYdkMmtjBs)
What is your recommended weekly protocol for VO2max optimization? * Our recommended protocl is taken from Dr. Peter Attia's book on human longevity, *Outlive*. Note that this requires 3.5 hours of weekly training, *in addition* to time spent strength training every week as well. * **ATTIA'S PROTOCOL: A weekly training schedule with an \~80:20 | Zone 2:HIIT ratio.** * 3 hours (or more) of Zone 2 training per week split into 2 90 minute sessions OR 3 one-hour sessions OR 4 forty-five minute sessions. * \~30 minutes (or more) of HIIT training consisting of 4 minutes of the highest-intensity pace you can. * Maintain an \~80:20 ratio of training time in each of these 2 training modalities. * [A video summary of this protocol is available here.](https://www.youtube.com/watch?v=klz9VouT0h8) * [Note that you can also do your HIIT session *immediately after* a Zone 2 training session for increased scheduling efficiency.](https://www.youtube.com/watch?v=m78er6UD8Dk) * Be mindful that increasing your weekly duration of HIIT training will tax your body more than increasing your weekly duration of Zone 2 training due to its higher intensity, and may require more rest and recovery to avoid overtraining.
I don't have 3.5 hours to train just cardio every week as required by your recommended weekly protocol. Is there a more time efficient way for me to train? * Yes. * Individuals who are more time-restricted in their weekly training schedule may focus on only using HIIT training sessions alone, which may produce similar improvements in VO2max with significantly less total exercise time required, albeit without some of the unique benefits and advantages of Zone 2 exercise, such as boosting mitochondrial health and metabolic flexibility. The following session takes \~1.5 hours a week. * **TIME-RESTRICTED PROTOCOL:** * Three weekly sessions of the Norwegian Protocol ([discussed at \~7:38 here](https://www.youtube.com/watch?v=IxYdkMmtjBs)): * A 4 minute interval at the highest-intensity pace you can sustain through the entire four minutes. * Followed by a 3 minute lower-intensity interval at a much lower pace where you can recover and where your HR can come down significantly. * Repeat the cycle above three more times for a total of four cycles.
How can I measure my VO2max? 1. The most reliable measurement is in an exercise laboratory. **We are currently working on a partnership to** 2. Some wearable health devices, like the Apple Watch, can also approximately estimate your VO2max. 3. There are also numerous simple manual exercise tests that can approximate your VO2max, [such as the Cooper Test](https://www.verywellfit.com/fitness-test-for-endurance-12-minute-run-3120264). An easier test to complete is the [3-minute step test.](https://www.brianmac.co.uk/stepvo2max.htm)
What kind of VO2max do I want to aim for? * [A 2018 study in JAMA indicated that increased cardiorespiratory fitness was inversely associated with mortality *with no observed upper limit.*](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2707428) * While it is going to be challenging for most people to achieve an elite level of cardiorespiratory fitness, achieving the 75th percentile for your age group ([see table 2 here](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326491/))- is a more realistically achievable goal for many with consistent training. Alternatively, you can also use [this calculator](https://www.kumc.edu/research/alzheimers-disease-research-center/fitness-ranking.html). * Note that even going from a low to an average VO2 produces a substantial improvement in longevity, and there are decreasing marginal returns to improving VO2max the fitter you are.
*** ### Potential Biomarker Impact of Protocol **Biomarkers this protocol can improve:** * `Hemoglobin A1c` * `Fasting insulin level` * `Fasting glucose level` **Non-biomarker metrics this protocol can improve:** * Increased `VO2 max` * Decreased `Blood Pressure` * Improves `Cognitive Performance` {% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Dietary Optimization Meta-Protocol This is the master document for dietary optimization. Click through the summary points to dive into the decision-tree for picking the right diet and caloric energy balance for you. {% hint style="info" %} Last updated: May 12, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} ## SUMMARY POINTS
Why does diet matter for human optimization? * **Importance:** Dietary optimization can improve physical performance, cognitive performance, and human longevity. By combining dietary optimization with an exercise protocol, you will receive a synergistic effect greater than solely optimizing for one of these domains alone. * For all of the reasons noted above, we offer the ability to **monitor** your metabolic markers when implementing a new dietary protocol of your choosing. Many individuals may, for example, change their diet in order to lower their cholesterol or improve their metabolic health. By checking your biomarkers following a dietary intervention, you can get objective information about how your body is responding to a dietary change.
Is there a general framework that you can use to think about dietary optimization? Yes. The following framework is taken from Peter Attia's *Outlive:* * The **first** **principle** when providing any kind of standardized dietary protocol is the relevance of *personalization*: what constitutes an optimal diet for *you* is contingent on a variety of individual factors related to your metabolism, biomarker profile, body composition, and personal goals. Thus, it is not possible to recommend a universally-optimal diet for all persons in all circumstances. * The **second principle** is that a dietary protocol generally falls into one of two goal-oriented categories: to *treat* a medical issue (e.g. Type 2 diabetes, obesity, hypercholesterolemia), or, to *maintain* a generally optimal state of health (e.g. in patients who have already achieved metabolic optimization). To give but one example, an optimal diet for weight loss is not the same as an optimal diet for maintaining your existing, already-optimized body composition. * [The **third** **principle** is that there are numerous systemic limitations with regard to the study of human nutrition that are related pragmatic constraints in possible study designs:](https://med.stanford.edu/news/all-news/2018/07/john-ioannidis-calls-for-more-rigorous-nutrition-research.html) human beings aren't lab rats that we can confine and surveill for the purposes of nutritional research! Further to that, food is a composed of an enormous variety of biochemical compounds which impact each person differently, creating a sort of combinatorial explosion of complex interactions between food particles and your body. This makes it very challenging to identify an optimal dietary pattern *with extreme precision* (which is one reason why post-diet-implementation biomarker monitoring can be useful).
What's the first step in approaching dietary optimization? * There are multiple valid ways of thinking about dietary optimization. Peter Attia has a simple three-step approach to crafting a strategy for dietary optimization, which he outlines in his book, *Outlive*. We've tweaked this approach and summarized it as follows: * **First****,** figure out if you're in energy balance or not. Are you overeating calories, causing ongoing fat gain? Are you under-eating calories **and in particular, are you under-eating protein,** causing ongoing muscle loss? Ideally, you are eating calories at a maintenance rate that matches your metabolic needs? * If you're eating too many calories and gaining fat, you will need to reduce the number of calories you consume. * If you're eating too few calories and/or too little protein, you'll need to increase your calories and/or protein intake. * Irrespective of your energy balance, you will still need to determine your **daily protein needs**, [you can use this daily recommended protein calculator here.](https://examine.com/protein-intake-calculator/) A good overview of the literature around protein requirements [is available here](https://examine.com/guides/protein-intake/#72cN-tip-calculating-your-protein-needs).
What's the second step in approaching dietary optimization? * **Second****,** figure out if you are metabolically healthy or not. [Metabolic health](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2675814/) can be determined through a combination of body measurements (e.g. waist circumference to measure fatty tissue around your abdomen, blood pressure, etc.) and lab biomarkers (e.g. fasting glucose levels, lipid levels, etc.) with the assistance of your healthcare provider. * If you are not metabolically healthy, a dietary intervention is typically required as part of a broader strategy to return your body to a state of metabolic health. * These dietary interventions can include specific diets like [the low glycemic-load diet ](https://pubmed.ncbi.nlm.nih.gov/23316283/)discussed in the [2021 Canadian Cardiovascular Society Guideline document for dyslipidemia](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext) (high cholesterol).
What's the third step in approaching dietary optimization? * **Third****,** figure out if you're adequately muscled or not. Strength, which is correlated to muscularity, is an important driver of human longevity (it is also, by definition, a measure of human performance). * Strength is vital for lengthening both healthspan and lifespan. If you lack strength for your age cohort, you will be at increased risk of frailty and catastrophic falls as you age. * While it is not necessary for most people to count macronutrient ratios (e.g. fats, carbs, etc.), it's important to have an approximate idea of how many of grams of protein you're getting on a daily basis, *particularly* if you're physically active or looking to change your body composition (e.g. gain muscle). This comes out of the data on grip strength and longevity as grip strength is a lagging indicator of functional strength. * To help you to determine how you stack up in strength relative to your age cohort, **we are developing a service to assess your strength (from a longevity perspective) in-person**. * Approximate benchmarks that Attia uses in his longevity clinic include: * Be able to farmer carry your body weight (half your body-weight in each hand) for 2 minutes for males (this is a grip strength measure), and 75% of your body weight for females. (Grip-strength measure) * Be able to dead hang at least 2 minutes for a 40 yo male, 1.5 minutes for a 40 yo woman. (Grip-strength measure) * Be able to do a 90-degree air squat for 2 minutes for 40 yo males or females. (Functional strength measure) * If you lack strength for your age cohort, it may be necessary to undergo a strength-building program that requires a small caloric surplus so that you can increase your muscularity. Using a so-called "dirty-bulk" (where you eat a large caloric surplus that includes junk food) is not an optimal way to do this due to the risks that it poses to your metabolic health. Also remember that muscle-building diets require more daily protein intake relative to maintenance-only diets, so [you can use this daily recommended protein calculator here.](https://examine.com/protein-intake-calculator/)
Okay - I've gone through the three steps - which diet do I select for myself? * [To select your optimal diet using the general framework and strategy outline above, click here to see the 'sub-protocol.](/foundational-protocols/dietary-optimization-meta-protocol/diet-selection-sub-protocol)'
How effective are the specific diets recommended in the dietary 'sub-protocol' for changing cholesterol biomarkers? * Click here to see the evidence summarized in a table.
### Potential Biomarker Impact of Protocol **Biomarkers this protocol can improve:** * `Hemoglobin A1c` * `Fasting insulin level` * `Fasting glucose level` * `ApoB` * `LDL` * `HDL` * `Total Cholesterol` **Non-biomarker metrics this protocol can improve:** * Increased `VO2 max` * Decreased `Blood Pressure` * Improves `Cognitive Performance` *** ### What's coming next from Optimal's dietary optimization protocols? We are currently working on adding the following services to provide **full-stack human optimization services** to our members: 1. Continuous Glucose Monitoring (CGM) dietary optimization program - for monitoring your blood glucose and insulin levels in response to specific dietary foods. This can assist in the overall process of dietary optimization. 2. An Optimal meal-delivery service with optional individualized portion/calorie-control (for those in need of caloric restriction). {% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Diet Selection Sub-Protocol This sub-protocol is to assist you in selecting an optimal dietary approach relative to the three key variables in the "meta-protocol" above. {% hint style="info" %} Last updated: May 6, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} The following diagram summarizes the dietary selection protocol we are using:

Our dietary selection sub-protocol.

Diet OptionsSpecific diets to consider
Box 1:
- Eating too many calories and gaining fat
- You are metabolically healthy		Proceed to 'Options for Scenario 1.'
Box 2:
- Eating too many calories and gaining fat
- You are not metabolically healthy		Proceed to 'Options for Scenario 2.'
Box 3:
- Eating maintenance calories with stable weight
- You are metabolically healthy		Proceed to 'Options for Scenario 3.'
Box 4:
- Eating maintenance calories with stable weight
- You are not metabolically healthy		Proceed to 'Options for Scenario 4.'
Box 5: (in a caloric and/or protein deficit, but metabolically healthy)Proceed to 'Options for Scenario 5.'
Box 6: (in a caloric and/or protein deficit, but not metabolically healthy)Proceed to 'Options for Scenario 6.'
Box 7: (eating maintenance calories with stable weight, and adequately strong & muscled)Proceed to 'Options for Scenario 7.'
Box 8: (eating maintenance calories with stable weight, but not adequately strong & muscled)Proceed to 'Options for Scenario 8.'
{% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Dietary options for Scenario 1 This page summarizes the dietary options for Box 1 from the Diet Selection Sub-Protocol. {% hint style="info" %} Last updated: May 7, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} {% hint style="success" %} In this scenario, you have observed that you are: (a) Eating too many calories **and** gaining fat\ (b) You **are** metabolically healthy. \ (c) Your clinician has assessed that **no** weight loss is required for medical purposes. \ (d) This also assumes that you have no diet-restricting medical conditions (e.g. kidney disease that would restrict volume of protein intake). {% endhint %}
First, reduce your total caloric intake (while ensuring adequate protein intake) to prevent continued additional weight gain. * [You can approximate daily caloric requirements with simple calculators](https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/calorie-calculator/itt-20402304), but this should always be referenced to body weight/body composition changes over time.
Second, consider adding the following general heuristics to your diet: *Note:* *These heuristics may not apply for carbohydrate-restricted diets, and are taken from* [*the 2021 CCS guidelines*](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028)*:* 1\. Aim for ≥30g nuts/day (can reduce `LDL-C` by 5-7%). 2\. Aim for extra-virgin olive oil as your oil of choice (≥60 mL/day). 3\. Aim for regular intake of fruits and vegetables (≥5 servings/day). *P.S. - be careful with fruit or sugar-containing smoothies, since fruit juice and/or the process of blending away the fruit-fibre-matrix can deliver a sudden spike in blood glucose upon consumption.* 4\. Aim for regular intake of legumes (≥4 servings/week). 5\. Aim for >30 grams of fibre a day (whether through food or through fibre supplements like MetaMucil pills) *Sub-recommendation: Consider a targeted aiming for fibre from specific sources: high viscous soluble fibre from oats, barley, psyllium, pectin, or konjac mannan (≥10 g/day) (e.g. MetaMucil powder/pills) (can reduce `LDL-C` by 5-10%).* 6\. Eating ≥ 3 servings of whole grains a day (assuming no carbohydrate-restricted diet). [A simple 2-page guide that includes most of these heuristics is also available here. ](https://dhhs.ne.gov/Documents/Foods%20to%20Choose%20to%20Lower%20Your%20Cholesterol.pdf)
Third, pick an specific dietary protocol from one of the following options: 1\. [**Mediterranean diet.**](https://www.heartandstroke.ca/articles/an-all-canadian-healthy-diet) * [This is the standard omnivorous diet recommended *for most* patients in the 2021 Canadian Cardiovascular Society Guidelines for dyslipidemia](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028). * This diet is easier for most people to adhere to relative to a carbohydrate-restricted diet or a plant-based diet since it includes animal foods. * Note: [A low glycemic-index variation of the Mediterranean diet can also be implemented. ](https://www.mdpi.com/2072-6643/14/3/706) 2\. [**Plant-based vegan diet.**](https://www.heartandstroke.ca/articles/what-is-a-plant-based-diet) * This is a viable alternative for individuals who do not wish to consume animal food products. * This diet can[ lower `LDL` and `ApoB`.](https://academic.oup.com/eurheartj/article/44/28/2609/7177660) * There is[ some limited evidence suggesting that, unique among dietary interventions, it may lower `Lp(a)`](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489854/)). * Pay special attention to micronutrient supplementation (e.g. Vitamin B12, creatine) if you are not consuming any animal products. * Be mindful of your protein intake quality in particular - plant protein is less bioavailable than animal protein. [Click here for information on how to adjust your protein intake calculation for vegans. ](/foundational-protocols/dietary-optimization-meta-protocol/diet-selection-sub-protocol/protein-quality-for-vegans) * Some individuals may wish to eat a primarily plant-based diet and include some limited elements of animal protein (e.g. dairy, fish, eggs), although some research suggests that healthy omnivorous diets[ may not be as effective as vegan diets in lowering LDL.](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812392) (on the positive side, they can provide easier access to higher protein quality and may be easier to adhere to). 3. **Low-glycemic index diet.** * [This is a diet that is designed to avoid sudden spikes in blood glucose](https://www.health.harvard.edu/healthbeat/a-good-guide-to-good-carbs-the-glycemic-index), but unlike a ketogenic diet, it still allows for larger quantities of carbohydrates to be consumed, and may be easier to adhere to. * [Note that low-glycemic foods can be selected *within* the parameters of a mediterranean diet, and some researchers have found benefit from this combination of approaches.](https://medicalxpress.com/news/2022-06-health-benefits-mediterranean-diet-glycemic.html) * If you are already eating this diet, you may continue doing so as you have already achieved metabolic optimization, however, we don't recommend *starting* this diet if you are already metabolically healthy and at a normal weight.
Fourth, implement the dietary protocol you picked in step 3, while incorporating the general heuristics from step two. * We are currently working on an individualized meal-delivery service to assist our members in implementation.
{% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Dietary options for Scenario 2 This page summarizes the dietary options for Box 2 from the Diet Selection Sub-Protocol. {% hint style="info" %} Last updated: May 7, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} {% hint style="success" %} In this scenario, you have observed that you are: (a) Eating too many calories **and** gaining fat \ (b) You **are not** metabolically healthy. \ (c) After an assessment, your clinician **may** assess that weight loss is required for the purpose of optimizing your metabolic health. \ (d) This also assumes that you have no diet-restricting medical conditions (e.g. kidney disease that would restrict volume of protein intake). {% endhint %}
First, reduce your total caloric intake (while ensuring adequate protein intake) to prevent continued additional weight gain. Discuss whether or not you require a caloric deficit with your healthcare provider. * [You can approximate daily caloric requirements for keeping a stable body-weight with simple calculators](https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/calorie-calculator/itt-20402304), but this should always be referenced to body weight/body composition changes over time. * **Talk to your licensed healthcare provider about whether or not you need to aim for a caloric deficit for the purposes of weight loss.** This decision may be informed by body measurements such as waist circumference or imaging such as a DEXA scan. * [Note that in some circumstances, it is possible to lose fat and gain muscle at the same time - this is referred to as body recomposition.](https://www.researchgate.net/publication/343549590_Body_Recomposition_Can_Trained_Individuals_Build_Muscle_and_Lose_Fat_at_the_Same_Time) * Some (but not all) patients who are metabolically unhealthy will require a caloric deficit (to eat fewer calories than the maintenance rate) in order to achieve metabolic health and optimization (e.g. individuals with a "skinnyfat" body composition may not need weight loss in the way that someone with obesity may require). * [Remember that individuals undergoing a weight loss program need to do resistance training to prevent them from losing too much muscle.](https://pubmed.ncbi.nlm.nih.gov/29532476/)
Second, consider adding the following general heuristics to your diet: *Note:* *These heuristics may not apply for carbohydrate-restricted diets, and are taken from* [*the 2021 CCS guidelines*](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028)*:* 1\. Aim for ≥30g nuts/day (can reduce `LDL-C` by 5-7%). 2\. Aim for extra-virgin olive oil as your oil of choice (≥60 mL/day). 3\. Aim for regular intake of fruits and vegetables (≥5 servings/day). *P.S. - be careful with fruit or sugar-containing smoothies, since fruit juice and/or the process of blending away the fruit-fibre-matrix can deliver a sudden spike in blood glucose upon consumption.* 4\. Aim for regular intake of legumes (≥4 servings/week). 5\. Aim for >30 grams of fibre a day (whether through food or through fibre supplements like MetaMucil pills) *Sub-recommendation: Consider a targeted aiming for fibre from specific sources: high viscous soluble fibre from oats, barley, psyllium, pectin, or konjac mannan (≥10 g/day) (e.g. MetaMucil powder/pills) (can reduce `LDL-C` by 5-10%).* 6\. Eating ≥ 3 servings of whole grains a day (assuming no carbohydrate-restricted diet). [A simple 2-page guide that includes most of these heuristics is also available here. ](https://dhhs.ne.gov/Documents/Foods%20to%20Choose%20to%20Lower%20Your%20Cholesterol.pdf)
Third, pick an specific dietary protocol from one of the following options: 1\. [**Mediterranean diet.**](https://www.heartandstroke.ca/articles/an-all-canadian-healthy-diet) * [This is the standard omnivorous diet recommended *for most* patients in the 2021 Canadian Cardiovascular Society Guidelines for dyslipidemia](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028). * This diet is easier for most people to adhere to relative to a carbohydrate-restricted diet or a plant-based diet since it includes animal foods. * Note: [A low glycemic-index variation of the Mediterranean diet can also be implemented. ](https://www.mdpi.com/2072-6643/14/3/706) 2\. [**Plant-based vegan diet.**](https://www.heartandstroke.ca/articles/what-is-a-plant-based-diet) * This is a viable alternative for individuals who do not wish to consume animal food products. * This diet can[ lower `LDL` and `ApoB`.](https://academic.oup.com/eurheartj/article/44/28/2609/7177660) * There is[ some limited evidence suggesting that, unique among dietary interventions, it may lower `Lp(a)`](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489854/)). * Pay special attention to micronutrient supplementation (e.g. Vitamin B12, creatine) if you are not consuming any animal products. * Be mindful of your protein intake quality in particular - plant protein is less bioavailable than animal protein. [Click here for information on how to adjust your protein intake calculation for vegans. ](/foundational-protocols/dietary-optimization-meta-protocol/diet-selection-sub-protocol/protein-quality-for-vegans) * Some individuals may wish to eat a primarily plant-based diet and include some limited elements of animal protein (e.g. dairy, fish, eggs), although some research suggests that healthy omnivorous diets[ may not be as effective as vegan diets in lowering LDL.](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812392) (on the positive side, they can provide easier access to higher protein quality and may be easier to adhere to). 3. **Low-glycemic index diet.** * [This is a diet that is designed to avoid sudden spikes in blood glucose](https://www.health.harvard.edu/healthbeat/a-good-guide-to-good-carbs-the-glycemic-index), but unlike a ketogenic diet, it still allows for larger quantities of carbohydrates to be consumed, and may be easier to adhere to. * [Note that low-glycemic foods can be selected *within* the parameters of a mediterranean diet, and some researchers have found benefit from this combination of approaches.](https://medicalxpress.com/news/2022-06-health-benefits-mediterranean-diet-glycemic.html)
Fourth, implement the dietary protocol you picked in step 3, while incorporating the general heuristics from step two. * We are currently working on an individualized meal-delivery service to assist our members in implementation.
{% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Dietary options for Scenario 3 This page summarizes the dietary options for Box 3 from the Diet Selection Sub-Protocol. {% hint style="info" %} Last updated: May 7, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} {% hint style="success" %} In this scenario, you have observed that you are: (a) Eating a maintenance level of calories such that your weight is stable, \ (b) You **are** metabolically healthy. \ (c) Your clinician has assessed that **no** weight loss is required for medical purposes. \ (d) This also assumes that you have no diet-restricting medical conditions (e.g. kidney disease that would restrict volume of protein intake). {% endhint %}
Maintain your existing daily caloric intake (while ensuring adequate protein intake). * [You can approximate daily caloric requirements with simple calculators](https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/calorie-calculator/itt-20402304), but this should always be referenced to body weight/body composition changes over time.
Second, consider adding the following general heuristics to your diet: *Note:* *These heuristics may not apply for carbohydrate-restricted diets, and are taken from* [*the 2021 CCS guidelines*](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028)*:* 1\. Aim for ≥30g nuts/day (can reduce `LDL-C` by 5-7%). 2\. Aim for extra-virgin olive oil as your oil of choice (≥60 mL/day). 3\. Aim for regular intake of fruits and vegetables (≥5 servings/day). *P.S. - be careful with fruit or sugar-containing smoothies, since fruit juice and/or the process of blending away the fruit-fibre-matrix can deliver a sudden spike in blood glucose upon conumtpion.* 4\. Aim for regular intake of legumes (≥4 servings/week). 5\. Aim for >30 grams of fibre a day (whether through food or through fibre supplements like MetaMucil pills) *Sub-recommendation: Consider a targeted aiming for fibre from specific sources: high viscous soluble fibre from oats, barley, psyllium, pectin, or konjac mannan (≥10 g/day) (e.g. MetaMucil powder/pills) (can reduce `LDL-C` by 5-10%).* 6\. Eating ≥ 3 servings of whole grains a day (assuming no carbohydrate-restricted diet). [A simple 2-page guide that includes most of these heuristics is also available here. ](https://dhhs.ne.gov/Documents/Foods%20to%20Choose%20to%20Lower%20Your%20Cholesterol.pdf)
Third, pick an specific dietary protocol from one of the following options: 1\. [**Mediterranean diet.**](https://www.heartandstroke.ca/articles/an-all-canadian-healthy-diet) * [This is the standard omnivorous diet recommended *for most* patients in the 2021 Canadian Cardiovascular Society Guidelines for dyslipidemia](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028). * This diet is easier for most people to adhere to relative to a carbohydrate-restricted diet or a plant-based diet since it includes animal foods. * Note: [A low glycemic-index variation of the Mediterranean diet can also be implemented. ](https://www.mdpi.com/2072-6643/14/3/706) 2\. [**Plant-based vegan diet.**](https://www.heartandstroke.ca/articles/what-is-a-plant-based-diet) * This is a viable alternative for individuals who do not wish to consume animal food products. * This diet can[ lower `LDL` and `ApoB`.](https://academic.oup.com/eurheartj/article/44/28/2609/7177660) * There is[ some limited evidence suggesting that, unique among dietary interventions, it may lower `Lp(a)`](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489854/)). * Pay special attention to micronutrient supplementation (e.g. Vitamin B12, creatine) if you are not consuming any animal products. * Be mindful of your protein intake quality in particular - plant protein is less bioavailable than animal protein. [Click here for information on how to adjust your protein intake calculation for vegans. ](/foundational-protocols/dietary-optimization-meta-protocol/diet-selection-sub-protocol/protein-quality-for-vegans) * Some individuals may wish to eat a primarily plant-based diet and include some limited elements of animal protein (e.g. dairy, fish, eggs), although some research suggests that healthy omnivorous diets[ may not be as effective as vegan diets in lowering LDL.](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812392) (on the positive side, they can provide easier access to higher protein quality and may be easier to adhere to). 3. **Low-glycemic index diet.** * [This is a diet that is designed to avoid sudden spikes in blood glucose](https://www.health.harvard.edu/healthbeat/a-good-guide-to-good-carbs-the-glycemic-index), but unlike a ketogenic diet, it still allows for larger quantities of carbohydrates to be consumed, and may be easier to adhere to. * [Note that low-glycemic foods can be selected *within* the parameters of a Mediterranean diet, and some researchers have found benefit from this combination of approaches.](https://medicalxpress.com/news/2022-06-health-benefits-mediterranean-diet-glycemic.html) * If you are already eating this diet, you may continue doing so as you have already achieved metabolic optimization, however, we don't recommend *starting* this diet if you are already metabolically healthy and at a normal weight.
Fourth, implement the dietary protocol you picked in step 3, while incorporating the general heuristics from step two. * We are currently working on an individualized meal-delivery service to assist our members in implementation.
{% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Dietary options for Scenario 4 This page summarizes the dietary options for Box 4 from the Diet Selection Sub-Protocol. {% hint style="info" %} Last updated: May 7, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} {% hint style="success" %} In this scenario, you have observed that you are: (a) Eating a maintenance level of calories such that your weight is stable, \ (b) You are **not** metabolically healthy. \ (c) After an assessment, your clinician **may** assess that weight loss is required for the purpose of optimizing your metabolic health. \ (d) This also assumes that you have no diet-restricting medical conditions (e.g. kidney disease that would restrict volume of protein intake). {% endhint %}
First, reduce your total caloric intake (while ensuring adequate protein intake) to prevent continued additional weight gain. Discuss whether or not you require a caloric deficit with your healthcare provider. * [You can approximate daily caloric requirements for keeping a stable body-weight with simple calculators](https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/calorie-calculator/itt-20402304), but this should always be referenced to body weight/body composition changes over time. * **Talk to your licensed healthcare provider about whether or not you need to aim for a caloric deficit for the purposes of weight loss.** This decision may be informed by body measurements such as waist circumference or imaging such as a DEXA scan. * [Note that in some circumstances, it is possible to lose fat and gain muscle at the same time - this is referred to as body recomposition.](https://www.researchgate.net/publication/343549590_Body_Recomposition_Can_Trained_Individuals_Build_Muscle_and_Lose_Fat_at_the_Same_Time) * Some (but not all) patients who are metabolically unhealthy will require a caloric deficit (to eat fewer calories than the maintenance rate) in order to achieve metabolic health and optimization (e.g. individuals with a "skinnyfat" body composition may not need weight loss in the way that someone with obesity may require). * [Remember that individuals undergoing a weight loss program need to do resistance training to prevent them from losing too much muscle.](https://pubmed.ncbi.nlm.nih.gov/29532476/)
Second, consider adding the following general heuristics to your diet: *Note:* *These heuristics may not apply for carbohydrate-restricted diets, and are taken from* [*the 2021 CCS guidelines*](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028)*:* 1\. Aim for ≥30g nuts/day (can reduce `LDL-C` by 5-7%). 2\. Aim for extra-virgin olive oil as your oil of choice (≥60 mL/day). 3\. Aim for regular intake of fruits and vegetables (≥5 servings/day). *P.S. - be careful with fruit or sugar-containing smoothies, since fruit juice and/or the process of blending away the fruit-fibre-matrix can deliver a sudden spike in blood glucose upon consumption.* 4\. Aim for regular intake of legumes (≥4 servings/week). 5\. Aim for >30 grams of fibre a day (whether through food or through fibre supplements like MetaMucil pills) *Sub-recommendation: Consider a targeted aiming for fibre from specific sources: high viscous soluble fibre from oats, barley, psyllium, pectin, or konjac mannan (≥10 g/day) (e.g. MetaMucil powder/pills) (can reduce `LDL-C` by 5-10%).* 6\. Eating ≥ 3 servings of whole grains a day (assuming no carbohydrate-restricted diet). [A simple 2-page guide that includes most of these heuristics is also available here. ](https://dhhs.ne.gov/Documents/Foods%20to%20Choose%20to%20Lower%20Your%20Cholesterol.pdf)
Third, pick an specific dietary protocol from one of the following options: 1\. [**Mediterranean diet.**](https://www.heartandstroke.ca/articles/an-all-canadian-healthy-diet) * [This is the standard omnivorous diet recommended *for most* patients in the 2021 Canadian Cardiovascular Society Guidelines for dyslipidemia](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028). * This diet is easier for most people to adhere to relative to a carbohydrate-restricted diet or a plant-based diet since it includes animal foods. * Note: [A low glycemic-index variation of the Mediterranean diet can also be implemented. ](https://www.mdpi.com/2072-6643/14/3/706) 2\. [**Plant-based vegan diet.**](https://www.heartandstroke.ca/articles/what-is-a-plant-based-diet) * This is a viable alternative for individuals who do not wish to consume animal food products. * This diet can[ lower `LDL` and `ApoB`.](https://academic.oup.com/eurheartj/article/44/28/2609/7177660) * There is[ some limited evidence suggesting that, unique among dietary interventions, it may lower `Lp(a)`](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489854/)). * Pay special attention to micronutrient supplementation (e.g. Vitamin B12, creatine) if you are not consuming any animal products. * Be mindful of your protein intake quality in particular - plant protein is less bioavailable than animal protein. [Click here for information on how to adjust your protein intake calculation for vegans. ](/foundational-protocols/dietary-optimization-meta-protocol/diet-selection-sub-protocol/protein-quality-for-vegans) * Some individuals may wish to eat a primarily plant-based diet and include some limited elements of animal protein (e.g. dairy, fish, eggs), although some research suggests that healthy omnivorous diets[ may not be as effective as vegan diets in lowering LDL.](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812392) (on the positive side, they can provide easier access to higher protein quality and may be easier to adhere to). 3. **Low-glycemic index diet.** * [This is a diet that is designed to avoid sudden spikes in blood glucose](https://www.health.harvard.edu/healthbeat/a-good-guide-to-good-carbs-the-glycemic-index), but unlike a ketogenic diet, it still allows for larger quantities of carbohydrates to be consumed, and may be easier to adhere to. * [Note that low-glycemic foods can be selected *within* the parameters of a mediterranean diet, and some researchers have found benefit from this combination of approaches.](https://medicalxpress.com/news/2022-06-health-benefits-mediterranean-diet-glycemic.html)
Fourth, implement the dietary protocol you picked in step 3, while incorporating the general heuristics from step two. * We are currently working on an individualized meal-delivery service to assist our members in implementation.
{% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Dietary options for Scenario 5 This page summarizes the dietary options for Box 5 from the Diet Selection Sub-Protocol. {% hint style="info" %} Last updated: May 7, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} {% hint style="success" %} In this scenario, you have observed that you are: (a) You are in a caloric deficit and losing weight, \ (b) You **are** metabolically healthy. \ (c) Your clinician has assessed that **no** weight loss is required for medical purposes. \ (c) This also assumes that you have no diet-restricting medical conditions (e.g. kidney disease that would restrict volume of protein intake). {% endhint %}
Discuss your dietary goals with your healthcare provider. * Is your caloric deficit inadvertent? (For example, you might be too busy to get regular meals in). In that case, given that you are already metabolically healthy, unless you want to lose weight, you may want to increase your daily caloric intake. * [You can approximate daily caloric requirements with simple calculators](https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/calorie-calculator/itt-20402304), but this should always be referenced to body weight/body composition changes over time. * Alternatively, your caloric deficit may be part of a pre-existing personal goal to lose weight. * [In either case, remember to ensure that you're getting enough protein, which can be easy to miss for individuals eating a hypocaloric diet. ](https://examine.com/guides/protein-intake/)
Second, consider adding the following general heuristics to your diet: *Note:* *These heuristics may not apply for carbohydrate-restricted diets, and are taken from* [*the 2021 CCS guidelines*](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028)*:* 1\. Aim for ≥30g nuts/day (can reduce `LDL-C` by 5-7%). 2\. Aim for extra-virgin olive oil as your oil of choice (≥60 mL/day). 3\. Aim for regular intake of fruits and vegetables (≥5 servings/day). *P.S. - be careful with fruit or sugar-containing smoothies, since fruit juice and/or the process of blending away the fruit-fibre-matrix can deliver a sudden spike in blood glucose upon consumption.* 4\. Aim for regular intake of legumes (≥4 servings/week). 5\. Aim for >30 grams of fibre a day (whether through food or through fibre supplements like MetaMucil pills) *Sub-recommendation: Consider a targeted aiming for fibre from specific sources: high viscous soluble fibre from oats, barley, psyllium, pectin, or konjac mannan (≥10 g/day) (e.g. MetaMucil powder/pills) (can reduce `LDL-C` by 5-10%).* 6\. Eating ≥ 3 servings of whole grains a day (assuming no carbohydrate-restricted diet). [A simple 2-page guide that includes most of these heuristics is also available here. ](https://dhhs.ne.gov/Documents/Foods%20to%20Choose%20to%20Lower%20Your%20Cholesterol.pdf)
Third, pick an specific dietary protocol from one of the following options: 1\. [**Mediterranean diet.**](https://www.heartandstroke.ca/articles/an-all-canadian-healthy-diet) * [This is the standard omnivorous diet recommended *for most* patients in the 2021 Canadian Cardiovascular Society Guidelines for dyslipidemia](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028). * This diet is easier for most people to adhere to relative to a carbohydrate-restricted diet or a plant-based diet since it includes animal foods. * Note: [A low glycemic-index variation of the Mediterranean diet can also be implemented. ](https://www.mdpi.com/2072-6643/14/3/706) 2\. [**Plant-based vegan diet.**](https://www.heartandstroke.ca/articles/what-is-a-plant-based-diet) * This is a viable alternative for individuals who do not wish to consume animal food products. * This diet can[ lower `LDL` and `ApoB`.](https://academic.oup.com/eurheartj/article/44/28/2609/7177660) * There is[ some limited evidence suggesting that, unique among dietary interventions, it may lower `Lp(a)`](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489854/)). * Pay special attention to micronutrient supplementation (e.g. Vitamin B12, creatine) if you are not consuming any animal products. * Be mindful of your protein intake quality in particular - plant protein is less bioavailable than animal protein. [Click here for information on how to adjust your protein intake calculation for vegans. ](/foundational-protocols/dietary-optimization-meta-protocol/diet-selection-sub-protocol/protein-quality-for-vegans) * Some individuals may wish to eat a primarily plant-based diet and include some limited elements of animal protein (e.g. dairy, fish, eggs), although some research suggests that healthy omnivorous diets[ may not be as effective as vegan diets in lowering LDL.](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812392) (on the positive side, they can provide easier access to higher protein quality and may be easier to adhere to). 3. **Low-glycemic index diet.** * [This is a diet that is designed to avoid sudden spikes in blood glucose](https://www.health.harvard.edu/healthbeat/a-good-guide-to-good-carbs-the-glycemic-index), but unlike a ketogenic diet, it still allows for larger quantities of carbohydrates to be consumed, and may be easier to adhere to. * [Note that low-glycemic foods can be selected *within* the parameters of a Mediterranean diet, and some researchers have found benefit from this combination of approaches.](https://medicalxpress.com/news/2022-06-health-benefits-mediterranean-diet-glycemic.html) * If you are already eating this diet, you may continue doing so as you have already achieved metabolic optimization, however, we don't recommend *starting* this diet if you are already metabolically healthy and at a normal weight.
Fourth, implement the dietary protocol you picked in step 3, while incorporating the general heuristics from step two. * We are currently working on an individualized meal-delivery service to assist our members in implementation.
{% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Dietary options for Scenario 6 This page summarizes the dietary options for Box 6 from the Diet Selection Sub-Protocol. {% hint style="info" %} Last updated: May 7, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} {% hint style="success" %} In this scenario, you have observed that you are: (a) You are in a caloric deficit and losing weight, \ (b) You are **not** metabolically healthy. \ (c) After an assessment, your clinician **may** assess that weight loss is required for the purpose of optimizing your metabolic health. \ (d) This also assumes that you have no diet-restricting medical conditions (e.g. kidney disease that would restrict volume of protein intake). {% endhint %}
First, discuss your dietary goals with your healthcare provider. * In this scenario, you are are already in a deliberate calorie deficit to lose weight. * [While in a calorie deficit, remember to ensure that you're getting enough protein, which can be easy to miss for individuals eating a hypocaloric diet. ](https://examine.com/guides/protein-intake/) * **Please discuss your personal dietary goals with your healthcare provider.** [In some circumstances, it may be possible for you to undero body recomposition (to lose fat and gain muscle) in a eucaloric state (without going into a calorie deficit).](https://www.youtube.com/watch?v=oGDrwik1duM) Alternatively, some individuals may require a calorie deficit to achieve metabolic optimization.
Second, consider adding the following general heuristics to your diet: *Note:* *These heuristics may not apply for carbohydrate-restricted diets, and are taken from* [*the 2021 CCS guidelines*](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028)*:* 1\. Aim for ≥30g nuts/day (can reduce `LDL-C` by 5-7%). 2\. Aim for extra-virgin olive oil as your oil of choice (≥60 mL/day). 3\. Aim for regular intake of fruits and vegetables (≥5 servings/day). *P.S. - be careful with fruit or sugar-containing smoothies, since fruit juice and/or the process of blending away the fruit-fibre-matrix can deliver a sudden spike in blood glucose upon consumption.* 4\. Aim for regular intake of legumes (≥4 servings/week). 5\. Aim for >30 grams of fibre a day (whether through food or through fibre supplements like MetaMucil pills) *Sub-recommendation: Consider a targeted aiming for fibre from specific sources: high viscous soluble fibre from oats, barley, psyllium, pectin, or konjac mannan (≥10 g/day) (e.g. MetaMucil powder/pills) (can reduce `LDL-C` by 5-10%).* 6\. Eating ≥ 3 servings of whole grains a day (assuming no carbohydrate-restricted diet). [A simple 2-page guide that includes most of these heuristics is also available here. ](https://dhhs.ne.gov/Documents/Foods%20to%20Choose%20to%20Lower%20Your%20Cholesterol.pdf)
Third, pick an specific dietary protocol from one of the following options: 1\. [**Mediterranean diet.**](https://www.heartandstroke.ca/articles/an-all-canadian-healthy-diet) * [This is the standard omnivorous diet recommended *for most* patients in the 2021 Canadian Cardiovascular Society Guidelines for dyslipidemia](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028). * This diet is easier for most people to adhere to relative to a carbohydrate-restricted diet or a plant-based diet since it includes animal foods. * Note: [A low glycemic-index variation of the Mediterranean diet can also be implemented. ](https://www.mdpi.com/2072-6643/14/3/706) 2\. [**Plant-based vegan diet.**](https://www.heartandstroke.ca/articles/what-is-a-plant-based-diet) * This is a viable alternative for individuals who do not wish to consume animal food products. * This diet can[ lower `LDL` and `ApoB`.](https://academic.oup.com/eurheartj/article/44/28/2609/7177660) * There is[ some limited evidence suggesting that, unique among dietary interventions, it may lower `Lp(a)`](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489854/)). * Pay special attention to micronutrient supplementation (e.g. Vitamin B12, creatine) if you are not consuming any animal products. * Be mindful of your protein intake quality in particular - plant protein is less bioavailable than animal protein. [Click here for information on how to adjust your protein intake calculation for vegans. ](/foundational-protocols/dietary-optimization-meta-protocol/diet-selection-sub-protocol/protein-quality-for-vegans) * Some individuals may wish to eat a primarily plant-based diet and include some limited elements of animal protein (e.g. dairy, fish, eggs), although some research suggests that healthy omnivorous diets[ may not be as effective as vegan diets in lowering LDL.](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812392) (on the positive side, they can provide easier access to higher protein quality and may be easier to adhere to). 3. **Low-glycemic index diet.** * [This is a diet that is designed to avoid sudden spikes in blood glucose](https://www.health.harvard.edu/healthbeat/a-good-guide-to-good-carbs-the-glycemic-index), but unlike a ketogenic diet, it still allows for larger quantities of carbohydrates to be consumed, and may be easier to adhere to. * [Note that low-glycemic foods can be selected *within* the parameters of a mediterranean diet, and some researchers have found benefit from this combination of approaches.](https://medicalxpress.com/news/2022-06-health-benefits-mediterranean-diet-glycemic.html)
Fourth, implement the dietary protocol you picked in step 3, while incorporating the general heuristics from step two. * We are currently working on an individualized meal-delivery service to assist our members in implementation.
{% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Dietary options for Scenario 7 This page summarizes the dietary options for Box 1 from the Diet Selection Sub-Protocol. {% hint style="info" %} Last updated: May 7, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} {% hint style="success" %} In this scenario, you have observed that you are: (a) Eating a maintenance level of calories such that your weight is stable, \ (b) You **are** metabolically healthy. \ (c) You are **adequately muscled** - meaning you have a sufficient level of strength (relative to your age cohort) that falls within an optimal zone for longevity. \ (c) This also assumes that you have no diet-restricting medical conditions (e.g. kidney disease that would restrict volume of protein intake). {% endhint %}
Discuss your dietary goals with your healthcare provider. * Congratulations! Your strength and metabolic health fall within an optimal zone. * What follows comes down to mainenance. There may be some room to make minor dietary adjustments to achieve additional improvements in various biomarkers or your long-term longevity.
Second, consider adding the following general heuristics to your diet (these are all still good for you): *Note:* *These heuristics may not apply for carbohydrate-restricted diets, and are taken from* [*the 2021 CCS guidelines*](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028)*:* 1\. Aim for ≥30g nuts/day (can reduce `LDL-C` by 5-7%). 2\. Aim for extra-virgin olive oil as your oil of choice (≥60 mL/day). 3\. Aim for regular intake of fruits and vegetables (≥5 servings/day). *P.S. - be careful with fruit or sugar-containing smoothies, since fruit juice and/or the process of blending away the fruit-fibre-matrix can deliver a sudden spike in blood glucose upon consumption.* 4\. Aim for regular intake of legumes (≥4 servings/week). 5\. Aim for >30 grams of fibre a day (whether through food or through fibre supplements like MetaMucil pills) *Sub-recommendation: Consider a targeted aiming for fibre from specific sources: high viscous soluble fibre from oats, barley, psyllium, pectin, or konjac mannan (≥10 g/day) (e.g. MetaMucil powder/pills) (can reduce `LDL-C` by 5-10%).* 6\. Eating ≥ 3 servings of whole grains a day (assuming no carbohydrate-restricted diet). [A simple 2-page guide that includes most of these heuristics is also available here. ](https://dhhs.ne.gov/Documents/Foods%20to%20Choose%20to%20Lower%20Your%20Cholesterol.pdf)
Third, pick an specific dietary protocol from one of the following options: Chances are you're already eating well and eat many of the foods mentioned in Step 2, meaning you probably already have good dietary habits. That said, the following diets have evidence for long-term cardiovascular benefits: 1\. [**Mediterranean diet.**](https://www.heartandstroke.ca/articles/an-all-canadian-healthy-diet) * [This is the standard omnivorous diet recommended *for most* patients in the 2021 Canadian Cardiovascular Society Guidelines for dyslipidemia](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028). * This diet is easier for most people to adhere to relative to a carbohydrate-restricted diet or a plant-based diet since it includes animal foods. * Note: [A low glycemic-index variation of the Mediterranean diet can also be implemented. ](https://www.mdpi.com/2072-6643/14/3/706) 2\. [**Plant-based vegan diet.**](https://www.heartandstroke.ca/articles/what-is-a-plant-based-diet) * This is a viable alternative for individuals who do not wish to consume animal food products. * This diet can[ lower `LDL` and `ApoB`.](https://academic.oup.com/eurheartj/article/44/28/2609/7177660) * There is[ some limited evidence suggesting that, unique among dietary interventions, it may lower `Lp(a)`](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489854/)). * Pay special attention to micronutrient supplementation (e.g. Vitamin B12, creatine) if you are not consuming any animal products. * Be mindful of your protein intake quality in particular - plant protein is less bioavailable than animal protein. [Click here for information on how to adjust your protein intake calculation for vegans. ](/foundational-protocols/dietary-optimization-meta-protocol/diet-selection-sub-protocol/protein-quality-for-vegans) * Some individuals may wish to eat a primarily plant-based diet and include some limited elements of animal protein (e.g. dairy, fish, eggs), although some research suggests that healthy omnivorous diets[ may not be as effective as vegan diets in lowering LDL.](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812392) (on the positive side, they can provide easier access to higher protein quality and may be easier to adhere to). 3. **Low-glycemic index diet.** * [This is a diet that is designed to avoid sudden spikes in blood glucose](https://www.health.harvard.edu/healthbeat/a-good-guide-to-good-carbs-the-glycemic-index), but unlike a ketogenic diet, it still allows for larger quantities of carbohydrates to be consumed, and may be easier to adhere to. * [Note that low-glycemic foods can be selected *within* the parameters of a Mediterranean diet, and some researchers have found benefit from this combination of approaches.](https://medicalxpress.com/news/2022-06-health-benefits-mediterranean-diet-glycemic.html) * If you are already eating this diet, you may continue doing so as you have already achieved metabolic optimization, however, we don't recommend *starting* this diet if you are already metabolically healthy and at a normal weight.
Fourth, implement the dietary protocol you picked in step 3, while incorporating the general heuristics from step two. * We are currently working on an individualized meal-delivery service to assist our members in implementation.
{% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Dietary options for Scenario 8 This page summarizes the dietary options for Box 1 from the Diet Selection Sub-Protocol. {% hint style="info" %} Last updated: May 7, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} {% hint style="success" %} In this scenario, you have observed that you are: (a) Eating a maintenance level of calories such that your weight is stable, \ (b) You **are** metabolically healthy. \ (c) You are **not** adequately muscled - relative to your age cohort, you need to work on gaining strength for the purpose of optimizing longevity. \ (c) This also assumes that you have no diet-restricting medical conditions (e.g. kidney disease that would restrict volume of protein intake). {% endhint %}
First, discuss your dietary goals with your healthcare provider. * In this scenario, you may need to enter into a small caloric surplus in order to build muscle. This will require biomarker monitoring and ongoing weight measurement due to the risk of over-eating and gaining too much fat (i.e. a sometimes-deliberate strategy that has been referred to as a "dirty bulk"). * [While you are trying to gain muscle, remember to ensure that you're getting enough protein.](https://examine.com/guides/protein-intake/) * **Please discuss your personal dietary goals with your healthcare provider.** [In some circumstances, it may be possible for you to undero body recomposition (to lose fat and gain muscle) in a eucaloric state (without going into a calorie deficit).](https://www.youtube.com/watch?v=oGDrwik1duM) Alternatively, some individuals may require a calorie deficit to achieve metabolic optimization.
Second, consider adding the following general heuristics to your diet: *Note:* *These heuristics may not apply for carbohydrate-restricted diets, and are taken from* [*the 2021 CCS guidelines*](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028)*:* 1\. Aim for ≥30g nuts/day (can reduce `LDL-C` by 5-7%). 2\. Aim for extra-virgin olive oil as your oil of choice (≥60 mL/day). 3\. Aim for regular intake of fruits and vegetables (≥5 servings/day). *P.S. - be careful with fruit or sugar-containing smoothies, since fruit juice and/or the process of blending away the fruit-fibre-matrix can deliver a sudden spike in blood glucose upon consumption.* 4\. Aim for regular intake of legumes (≥4 servings/week). 5\. Aim for >30 grams of fibre a day (whether through food or through fibre supplements like MetaMucil pills) *Sub-recommendation: Consider a targeted aiming for fibre from specific sources: high viscous soluble fibre from oats, barley, psyllium, pectin, or konjac mannan (≥10 g/day) (e.g. MetaMucil powder/pills) (can reduce `LDL-C` by 5-10%).* 6\. Eating ≥ 3 servings of whole grains a day (assuming no carbohydrate-restricted diet). [A simple 2-page guide that includes most of these heuristics is also available here. ](https://dhhs.ne.gov/Documents/Foods%20to%20Choose%20to%20Lower%20Your%20Cholesterol.pdf)
Third, pick an specific dietary protocol from one of the following options: 1\. [**Mediterranean diet.**](https://www.heartandstroke.ca/articles/an-all-canadian-healthy-diet) * [This is the standard omnivorous diet recommended *for most* patients in the 2021 Canadian Cardiovascular Society Guidelines for dyslipidemia](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028). * This diet is easier for most people to adhere to relative to a carbohydrate-restricted diet or a plant-based diet since it includes animal foods. * Note: [A low glycemic-index variation of the Mediterranean diet can also be implemented. ](https://www.mdpi.com/2072-6643/14/3/706) 2\. [**Plant-based vegan diet.**](https://www.heartandstroke.ca/articles/what-is-a-plant-based-diet) * This is a viable alternative for individuals who do not wish to consume animal food products. * This diet can[ lower `LDL` and `ApoB`.](https://academic.oup.com/eurheartj/article/44/28/2609/7177660) * There is[ some limited evidence suggesting that, unique among dietary interventions, it may lower `Lp(a)`](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489854/)). * Pay special attention to micronutrient supplementation (e.g. Vitamin B12, creatine) if you are not consuming any animal products. * Be mindful of your protein intake quality in particular - plant protein is less bioavailable than animal protein. [Click here for information on how to adjust your protein intake calculation for vegans. ](/foundational-protocols/dietary-optimization-meta-protocol/diet-selection-sub-protocol/protein-quality-for-vegans) * Some individuals may wish to eat a primarily plant-based diet and include some limited elements of animal protein (e.g. dairy, fish, eggs), although some research suggests that healthy omnivorous diets[ may not be as effective as vegan diets in lowering LDL.](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812392) (on the positive side, they can provide easier access to higher protein quality and may be easier to adhere to). 3. **Low-glycemic index diet.** * [This is a diet that is designed to avoid sudden spikes in blood glucose](https://www.health.harvard.edu/healthbeat/a-good-guide-to-good-carbs-the-glycemic-index), but unlike a ketogenic diet, it still allows for larger quantities of carbohydrates to be consumed, and may be easier to adhere to. * [Note that low-glycemic foods can be selected *within* the parameters of a mediterranean diet, and some researchers have found benefit from this combination of approaches.](https://medicalxpress.com/news/2022-06-health-benefits-mediterranean-diet-glycemic.html)
Fourth, implement the dietary protocol you picked in step 3, while incorporating the general heuristics from step two. * We are currently working on an individualized meal-delivery service to assist our members in implementation.
{% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Summary of dietary protocol effectiveness This page summarizes the beneficial effects of different dietary protocols. {% hint style="info" %} Last updated: May 6, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} The evidence for specific dietary protocols has been taken from [the Canadian Cardiovascular Society 2021 guideline document on dyslipidemia (high cholesterol).](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext#sec0028) Outside of high cholesterol, the following table ([taken from Appendix S4 of the guideline document](https://onlinecjc.ca/cms/10.1016/j.cjca.2021.03.016/attachment/39f9128c-f265-4776-a437-ee3374136df0/mmc1.pdf)) applies in situation where you do **not** need a dietary intervention to address **a specific medical disorder**, in which case you should consult with your healthcare provider and a licensed dietician prior to implementing a diet.

"major CV events" = heart attack or stroke, "LDL-C" = low-density lipoprotein cholesterol (calculated), "CVD" = cardiovascular disease, "CHD" = coronary heart disease, "CV mortality" = cardiovascular mortality, "TG" = triglycerides

"HDL-C" = high-density lipoprotein cholesterol (calculated)

{% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Protein quality for vegans Challenges and concerns for people who get their protein from plant-based sources. {% hint style="info" %} Last updated: May 7, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %}
What's the issue with vegan protein relative to animal protein? * In short: quality and bioavailability. Vegan protein doesn't have the same amino acid profile as animal protein, and it's not absorbed as effectively. * In many cases, for the sake of practicality (e.g. total volume of food and/or total calories consumed), supplementation with vegan protein powder can help to close the gap. * Some have raised concerns about heavy metal exposure in protein powders due to bioaccumulation associated with the preparation of animal or plant protein powders (which concentrate protein from a base animal or plant material). [This study ran some simple calculations to suggest that consuming three servings of protein powder a day - ("a typical intake") would not result in adverse health effects due to heavy metals.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509468/)
Okay, I understand the general principles at play. How do I put this into practice? * **For all vegans,** aim for: * 3-4 grams of leucine per day. * 3-4 grams of lycine per day. * **For vegans who only need to maintain muscle mass,** aim for: * At least 1 gram of methionine per day. * **For vegans who need to gain muscle mass,** aim for: * 2 to 3 grams per serving, four times per day.
### More on the differences between animal protein and plant protein: From Chapter 15 of Peter Attia's *Outlive:* > Now, a word on plant protein. Do you need to eat meat, fish, and dairy to get sufficient protein? No. But if you choose to get all your potein from plants, you need to understand two things. First, the protein found in plants is there for the benefit of the plant, which means it is largely tied up in indigestible fiber, and therefore less bioavailable to the person eating it. **Because much of the plant's protein is tied to its roots, leaves, and other structures, only about 60 to 70 percent of what you consume is contributed to your needs**, according to Don Layman, professor emeritus of food science and human nutrition at the University of Illinois Urbana-Champaign, and an expert on protein. Here we run into the first issue with plant protein: it's less bioavailable than animal protein partly because it is embedded in indigestible fibre. For plant protein powders, there is no indigestible fibre to prevent absorption, but [according to other metrics (DIAAS & PDCAAS), it is still not as high quality](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723444/table/nutrients-11-01825-t001/?report=objectonly). Attia goes on to explain why: > Some of this can be overcome by cooking the plants, but that still leaves us with the second issue. The distribution of amino acids is not the same as in animal protein. In particular, **plant protein has less of the essential amino acids methionine, lysine, and tryptophan, potentially leading to reduced protein synthesis.** Taken together, these two factors tell us that the overall quality of protein derived from plants is significantly lower than that from animal products. Here's where the nuance around plant protein supplementation comes in: > The same is true of protein supplements. Whey protein isolate (from dairy) is richer in available amino acids than soy protein isolate. So if you forgo protein from animal sources, you need to do the math on your protein quality score. In truth, this can get pretty complicated pretty quick, because you get wrapped around the axle of something called the Digestible Indispensible Amino Acid Score (DIAAS) and the Protein Digestibility-Corrected Amino Acid Score (PDCAAS). These are great if you ahve the time to comb through databases all day, but for those of us with day jobs, **Layman suggests focusing on a handful of important amino acids, such as leucine, lycine, and methionine. Focus on the absolute amount of these amino acids found in each meal, and be sure to get about three to four grams per day of leucine and lycine and at least one gram per day of methionine for maintenance of lean mass. If you are trying to increase lean mass, you'll need even more leucine, closer to two to three grams per serving, four times per day.** {% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Supplementation and micronutrient protocol This page covers high-yield, evidence-based supplementation protocols. {% hint style="info" %} Last updated: May 12, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} {% hint style="danger" %} This protocol is under active development. {% endhint %} ## The Big Picture:
What's the purpose of a supplementation and micronutrient protocol? * Broadly speaking, there are three potential reasons for supplementation: * To **corre**ct a pre-existing deficiency. * To **maintain** an optimal micronutrient level or to **prevent** a new deficiency due to environmental conditions (e.g. lack of sunlight in northern climates requires most of us to take Vitamin D) or dietary conditions (e.g. a vegan diet requires some supplementation such as Vitamin B12). * To enhance **performance** (cognitive performance or physical performance). * To improve **longevity** or reduce mortality.
What's a general framework for thinking about the evidence for and against supplements? * **The first** principle to understand is that human physiology is a complex system. This means that simple intuitions that we have about nutritional deficiency do not necessarily cleanly map onto reality and actual outcomes. * Consider the widely-held belief that multivitamins are an effective tool for preventing (or correcting) a broad spectrum of vitamin & micronutrient-related deficiencies. [Large studies have actually shown that multivitamin supplementation does not appear to be effective and may even be harmful in some cases.](https://www.bmj.com/content/369/bmj.m2511) * [A large study in 2013, for example, demonstrated no cognitive benefit to multivitamin supplementation in older men.](https://www.acpjournals.org/doi/10.7326/0003-4819-159-12-201312170-00002) * **The second** principle to understand comes down to another common problem that people run into: over-extrapolating from small, statistically under-powered studies. In general, it has been persuasively argued that [*most published medical research is false.*](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182327/) This is because of systemic issues in scientific publishing, such as publication bias, low sample sizes, and poor statistical methodolgy. The burden of proof comes down to high-quality evidence, and our standard of evidence should be high. * **The third** principle is the sum of the first two: we believe that supplement stacks should be *weighted according to the quality of evidence.* This means, simply, that the strength of the recommendation should match the strength of evidence. This almost instantly eliminates a huge swath of common supplement stacks which contain a very high numberb of supplements, most of which have a weak evidentiary base.
## Supplements we currently recommend:
Vitamin D - 2000 IU per day Strong Recommendation * Rationale: * **Maintenance of an optimal level:** Vitamin D is a crucial nutrient and hormone vital for overall health and plays a significant role in longevity. It supports bone health by aiding calcium absorption and has broader effects, including muscle strength enhancement, inflammation reduction, and immune function improvement. Research indicates that vitamin D influences longevity genes and [may impact aging processes](https://www.mdpi.com/1422-0067/24/5/4546) and age-related diseases such as [cancer](https://pubmed.ncbi.nlm.nih.gov/30796437/), heart disease, and cognitive decline. Vitamin D is also utilized and correlated with immune function. Maintaining adequate vitamin D levels, through sunlight exposure, diet, or supplementation, [could be beneficial for extending lifespan](https://link.springer.com/article/10.1007/s12603-023-1964-3) and [improving health span](https://ec.bioscientifica.com/view/journals/ec/12/4/EC-22-0501.xml), underscoring its importance beyond just bone health. * Dosing: * [Canadian osteoporosis guidelines discuss 1,000 IU/day as a target dose with an upper daily bound of 2,000 IU/day (assuming no known deficiency).](https://www.cmaj.ca/content/182/12/e610) * [In the absence of a measured deficiency, dosing levels above 4,000 IU/day are of particular concern due to the risk of kidney damage with long term supplementation.](https://choosingwiselycanada.org/pamphlet/vitamin-d-tests/) * Based on a study from Osteoporosis International, [we recommend 2,000 IU/day, with potentially higher doses depending on your blood levels.](https://link.springer.com/article/10.1007/s00198-009-1119-3) * This higher dose also accords with [a healthy aging study in Europe also used a 2,000 IU/day dose as well. ](https://www.sciencedirect.com/science/article/pii/S1551714420302020)
## Supplements under literature review:
Omega-3 * **Rationale:** Reduction in mortality and for maintaining overall brain health and cognitive performance. * [The latest Canadian Cardiovascular Society 2021 guidelines do not recommend omega-3 supplementation for the purposes of preventing cardiovascular disease based on lack of evidence for benefit.](https://onlinecjc.ca/article/S0828-282X\(21\)00165-3/fulltext) * [Conversely, another large study has found that Omega-3 levels are inversely associated with all-cause mortality. ](https://www.nature.com/articles/s41467-021-22370-2)This study, among authors, [has been cited by Rhonda Patrick as part of her overall argument in favour of Omega-3 supplementation.](https://www.foundmyfitness.com/topics/omega-3#bibid-40c895bcda9ec47ebf585b955f199f41) * Conversely, data has accumulated to suggest that Omega-3 supplementation is good for maintaining cognitive health from middle age onward. * [In 2002, a study about 2,000 people, suggested that "higher omega-3 fatty acid concentrations are related to better brain structure and cognitive function in a predominantly middle-aged cohort free of clinical dementia."](https://www.neurology.org/doi/10.1212/WNL.0000000000201296) * [A small study in 2023 with a mean patient age of 76 years found that Omega-3 levels were positively associated with "better memory, processing speed, and structural brain measures."](https://www.mdpi.com/2076-3425/13/9/1278) * [A 2018 review indicated that Omega-3 supplementation could be useful for maintaining brain health and summarized a number of small studies in Table 2.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116096/) * `Under review.` * Dosing and formulation: * `Under review.`
Creatine * **Rationale:** Numerous. ([Muscle-building & strength-building benefits are already well established and well known](https://www.foundmyfitness.com/topics/creatine#creatine-and-physical-performance)). * `Under review:` Cognitive benefits, particularly in vegans and vegetarians who are not eating meat as part of their diet. Evidence for benefit in vegetarians is stronger than it is for non-vegetarians. However, evidence for cognitive
Magnesium * **Rationale:** Multiple potential indications. `Under review` * For reduced inflammation: [A 2022 meta-analysis of 17 randomized controlled trials (RCTs) found that magnesium supplementation significantly decreased serum C-reactive protein (CRP), a marker of inflammation, and increased nitric oxide levels.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8838086/) * For glycemic control: [A national survey of Canadians found associations between higher serum magnesium concentrations and lower prevalence of diabetes, poor glycemic control, and insulin resistance. ](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812344/) * For insomnia: ["This review confirms that the quality of literature is substandard for physicians to make well-informed recommendations on usage of oral magnesium for older adults with insomnia. However, given that oral magnesium is very cheap and widely available, RCT evidence may support oral magnesium supplements (less than 1 g quantities given up to three times a day) for insomnia symptoms."](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053283/)
Various supplements for vegan diets * `Under review.` * ["Veganism is also associated with low intake of vitamins B2, (B3), B12, D, iodine, zinc, calcium, potassium, selenium," however, the same study noted that "low micro- and macronutrient intakes are not always associated with health impairments."](https://www.sciencedirect.com/science/article/pii/S0261561420306567) This folds into the broader question of whether or not asymptomatic micronutrient deficiencies lead to suboptimal health and performance (i.e., not just disease).
Andrew Huberman's sleep supplement protocol * 50 mg of apigenin `under review` * 300-400 mg of magnesium threonate or bisglycinate `covered under 'Magnesium' above` * 200-400 mg of theanine `under review`
{% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Heat Exposure Protocol Last updated: May 13, 2024. {% hint style="info" %} Last updated: May 13, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %}
What are the potential benefits of regular sauna use? Based on observational studies from Finland, there are several findings that suggest regular sauna use (4-7 times/week) may be beneficial for healthspan and lifespan: 1. Regular sauna use is associated with a lower risk of death from cardiovascular disease and stroke. [One long-term study of over 2,300 Finnish men found that those who used the sauna 4-7 times per week had a 50% lower risk of fatal cardiovascular events compared to those who only used it once per week and a 40% lower risk of all-cause mortality (death).](https://cdn.jamanetwork.com/ama/content_public/journal/intemed/933657/ioi140152t2.png?Expires=1718507797\&Signature=OSf4zx0s2F-leGEFnPs2HhRlLuli9u9585ns29eBRvms1Ub0Tx5yc0rlGTxDgZ-cSLjbFBxxPM8sj7coAFMSE~BphFQVmCzdXV-yyNqRuL3trzAR0BuCnByJ~n-6J3Hq7dK40iZESlABKvs5R1HeEfv4425Unu6yxYqY6EJZgNz8bZL35b4C2tsWBwYYBv3QwZb3pEPtO44eVsPqZ8PFQAuT1i50szRzX9qkEit47BmxywK~lyrxVXxJ71N2CVKNyOmIG8JU7oURV1Ptb0ZOEMGVwRAyRp2Z5JJ-xrCixBdufOR1sFvUk8F0D4jkNuyM-Sqrw3cAW3lGv0Nt3eQ36g__\&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA) 2. [Sauna bathing can lead to beneficial short-term cardiovascular effects similar to moderate exercise, including increased heart rate, improved circulation, lower blood pressure, and reduced arterial stiffness.](https://www.mayoclinicproceedings.org/action/showPdf?pii=S0025-6196%2818%2930275-1) These effects are thought to be mediated by improved endothelial function, changes in autonomic nervous system activity, and better lipid profiles. [It may also reduce inflammation by lowering C-Reactive Protein (CRP).](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9792415/) 3. [Combining sauna use with exercise may provide added cardiovascular benefits. One study found that using the sauna for 15 minutes after a workout, 3 times per week, resulted in greater improvements in blood pressure compared to exercise alone. ](https://journals.physiology.org/doi/full/10.1152/ajpregu.00076.2022) 4. [It has also been associated with a 66% reduced risk of dementia and a 65% reduced risk of Alzheimer's Disease. ](https://pubmed.ncbi.nlm.nih.gov/27932366/)
How strong is the evidence in favour of sauna use? While not definitive, the cumulative evidence suggests moderate support for the longevity benefits of regular sauna use, particularly in the context of cardiovascular and cognitive health. The effects appear biologically plausible and exhibit a dose-response relationship. 1. [A large, long-term observational study of over 2,300 Finnish men found that frequent sauna use (4-7 times per week) was associated with a 40% lower risk of all-cause mortality compared to infrequent use (once per week). Sauna use 2-3 times per week was linked to a 24% lower risk. This suggests a dose-dependent effect of sauna frequency on longevity.](https://cdn.jamanetwork.com/ama/content_public/journal/intemed/933657/ioi140152t2.png?Expires=1718507797\&Signature=OSf4zx0s2F-leGEFnPs2HhRlLuli9u9585ns29eBRvms1Ub0Tx5yc0rlGTxDgZ-cSLjbFBxxPM8sj7coAFMSE~BphFQVmCzdXV-yyNqRuL3trzAR0BuCnByJ~n-6J3Hq7dK40iZESlABKvs5R1HeEfv4425Unu6yxYqY6EJZgNz8bZL35b4C2tsWBwYYBv3QwZb3pEPtO44eVsPqZ8PFQAuT1i50szRzX9qkEit47BmxywK~lyrxVXxJ71N2CVKNyOmIG8JU7oURV1Ptb0ZOEMGVwRAyRp2Z5JJ-xrCixBdufOR1sFvUk8F0D4jkNuyM-Sqrw3cAW3lGv0Nt3eQ36g__\&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA) 2. The same study found sauna use 4-7 times weekly was associated with a 50% lower risk of cardiovascular mortality and 66% lower risk of dementia compared to once weekly use. Again, a dose-response was seen. 3. [Proposed mechanisms for sauna's longevity benefits include improved cardiovascular health markers like blood pressure and lipid profiles, increased expression of neuroprotective factors like BDNF, and induction of heat shock proteins that protect against cellular damage.](https://www.foundmyfitness.com/topics/sauna#molecular-mechanisms-involved-in-the-heat-stress-response) As an exercise-mimetic, sauna elicits physiological effects similar to moderate exercise. 4. While the main study cited above was observational in nature, its large sample size, long follow-up period, dose-dependent findings, and biological plausibility lend weight to the results. A few small interventional studies support the effects of sauna on cardiovascular risk factors, including 5. However, the bulk of the evidence comes from studies in Finnish men, so generalizability to other populations is uncertain. More research is needed on the long-term effects and safety of sauna in different groups to arrive at a more definitive and strongly-supported conclusion, but given the aforementioned findings, we have reason to believe that they generalize to larger populations.
Alright, I've reviewed the evidence - what's the sauna protocol? Speak to your healthcare provider prior to embarking on the use of a sauna for health benefits. [Men attempting to conceive should also be aware of reversible heat-induced negative impacts on male fertility, which can be reversed after 6 months of abstaining from sauna use.](https://pubmed.ncbi.nlm.nih.gov/23411620/) Various [consumer products](https://www.amazon.ca/Kiwi-Kooler-Packs-Vasectomy-Varicocele/dp/B083MTJYFL) are now available to allow men to apply an ice pack to their scrotal region to mitigate the effects of heat on spermatogenesis. **Our recommended protocol is as follows:** * ≥80°C * ≥20 min * ≥4 times/week * In a dry sauna, however, it is reasonable to believe that wet saunas confer similar benefits since the proposed mechanisms for benefit are from heat stress.
I'm curious and want to read more. Where can I learn more about heat exposure? * [We suggest this review article from Dr. Rhonda Patrick](https://www.foundmyfitness.com/topics/sauna), PhD, one of the first figures in the longevity space to advocate for the health benefits of heat exposure.
### Potential Biomarker Impact of Protocol **Biomarkers this protocol can improve:** * `Total Cholesterol` * `LDL-C` * `HDL` * `Triglycerides` * `CRP` **Non-biomarker metrics this protocol can improve:** * Decreased `Blood Pressure` {% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Sleep & Circadian Health Optimization Protocol Sleep and circadian health protocol. {% hint style="info" %} Last updated: May 13, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} {% hint style="danger" %} Andrew Huberman's approach on sleep and circadian health has become an enormously popular toolkit for enhancing sleep and energy levels. This protocol is a work-in-progress and is currently presented as a 1-to1 duplication of Andrew Huberman's morning light and sleep protocol. We are currently working with a third-party researcher to evaluate the evidentiary basis behind each of these specific claims and synthesize a third-party survey of the literature with his popular methodology. {% endhint %} `This protocol is under ongoing review.` Relevant Huberman podcast timestamps taken from [HubermanProtocols.org](https://www.hubermanprotocols.org/).
Waking: "Prioritize light exposure each morning." claims under review ["Outdoor light exposure causes a beneficial cortisol peak early in the morning; increases daytime mood, energy and alertness; and helps you fall asleep more easily at night."](https://uploads-ssl.webflow.com/64416928859cbdd1716d79ce/650dfec53cce61ec4901c585_The%20Daily%20Blueprint.pdf) ["Do this within 30-60 minutes of waking, outside. The cloudiest day is going to be MUCH brighter than your indoor environment."](https://uploads-ssl.webflow.com/64416928859cbdd1716d79ce/650dfec53cce61ec4901c585_The%20Daily%20Blueprint.pdf) * Sunny day = 5–10 mins * Cloudy day = 10–15 mins * Overcast day = up to 30 mins ["Look towards the sunrise or sun, but never stare directly at the sun. Blink as necessary. Wearing contact lenses and prescription glasses are fine, but aim to avoid using sunglasses or hats that are meant to block sunlight from your eyes."](https://uploads-ssl.webflow.com/64416928859cbdd1716d79ce/650dfec53cce61ec4901c585_The%20Daily%20Blueprint.pdf) ["By looking at sunlight through a window, it’s 50, five zero, times less effective than if that window were to be open — mostly because those windows filter out a lot of the wavelengths of blue light that are essential for stimulating the eyes and this wake-up signal."](https://www.youtube.com/watch?v=Ze2pc6NwsHQ\&t=907s) ["If you wake up before the sun is out, you can and probably should flip on artificial lights in your internal home environment \[...\] Once the sun is out, however, once the sun has risen, then you still want to get outside and view sunlight."](https://www.youtube.com/watch?time_continue=1279\&v=h2aWYjSA1Jc\&embeds_referring_euri=https%3A%2F%2Fwww.hubermanprotocols.org%2F\&source_ve_path=MjM4NTE\&feature=emb_title)
Sundown: [bonus] "View afternoon light to partially offset the negative effects of viewing artificial light at night." claims under review ["Viewing that afternoon light, the low solar angle light as the sun is heading down in the sky, so it could be sunset or what I call circa sunset (around sunset), well, doing that is going to slightly but not completely offset any of the negative effects of viewing artificial light at night."](https://www.youtube.com/watch?v=h2aWYjSA1Jc\&t=3821s)
Evening: claims under review "**Prioritize a consistent sleep schedule:"** * ["It is crucial to wake up at the same time (+/- 1 hour) each morning, days off included."](https://uploads-ssl.webflow.com/64416928859cbdd1716d79ce/650dfec53cce61ec4901c585_The%20Daily%20Blueprint.pdf) * ["Sleeping in later than that on the weekend is likely going to disrupt your circadian rhythm and make waking on your regular schedule that much harder." ](https://uploads-ssl.webflow.com/64416928859cbdd1716d79ce/650dfec53cce61ec4901c585_The%20Daily%20Blueprint.pdf) **"Optimize your sleep environment:"** * ["Dim computer and phone screens as much as possible, or use a red-hue filter to reduce blue light exposure."](https://uploads-ssl.webflow.com/64416928859cbdd1716d79ce/650dfec53cce61ec4901c585_The%20Daily%20Blueprint.pdf) * ["Cool your bedroom to 1– 3 degrees lower than usual."](https://uploads-ssl.webflow.com/64416928859cbdd1716d79ce/650dfec53cce61ec4901c585_The%20Daily%20Blueprint.pdf) * ["Make your room as dark as possible using blackout blinds or an eye mask."](https://uploads-ssl.webflow.com/64416928859cbdd1716d79ce/650dfec53cce61ec4901c585_The%20Daily%20Blueprint.pdf)
{% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Protocols in development What are we currently working on? {% hint style="info" %} Last updated: May 16, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} 1. [Natural Testosterone Optimization Protocol](/foundational-protocols/protocols-in-development/natural-testosterone-optimization-protocol) `in progress` 2. What studies support (or do not support) the specific steps included in the popular Huberman sleep protocol? `protocol update` 3. How can we summarize the evidence in the scientific literature that favours earlier than standard efforts to lower ApoB for the purpose of reducing the long-term risk of ASCVD? What are the arguments against this position? What is the risk of iatrogenic harm if pharmaceutical medications are used to lower ApoB in younger individuals with otherwise "normal" ApoB levels? `article` 4. How can we summarize the evidence in the scientific literature that favours earlier efforts to lower HbA1c and insulin levels for the purpose of longevity? `article` 5. How good is the evidence for the purported health effects of cold plunges? `protocol genesis` 6. Is there a role for empiric Zinc supplementation in a male with low-normal testosterone levels and some symptoms suggestive of lower-than optimal testosterone who has a dietary history potentially suggestive of inadequate dietary Zinc intake and an equivocal or low-normal plasma zinc serum concentration? (i.e. given the lack of sensitivity of plasma zinc testing to detect underlying zinc deficiency). `protocol update` 7. How strong is the evidence for the Zone 2's unique benefits for mitochondrial health (or other longevity metrics, like cardiac stroke volume) relative to HIIT? `protocol update` 8. Basic strength-training aside, what specific protocls can be used to develop functional strength that is positively correlatd to longevity (as measured by grip strength)? `protocol genesis` 9. What reasonable and proportionate evidence-based practices can be recommended to avoid exposure to environmental toxins and endocrine disruptors like microplastics and phtalates, some of which have been causally linked to the development of atherosclerotic cardiovascular disease? `protocol genesis` {% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Natural Testosterone Optimization Protocol Our natural, non-pharmaceutical testosterone optimization protocol. {% hint style="info" %} Last updated: May 16, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} {% hint style="danger" %} This protocol is currently being finalized from the following collected abstracts: {% endhint %} ## Sleep and circadian health * **Leproult, R., & Van Cauter, E. (2010). Effect of 1 week of sleep restriction on testosterone levels in young healthy men. *****JAMA, 303*****(19), 1961-1962.** * This study investigates the impact of sleep restriction on testosterone levels in young healthy men and demonstrates a significant decrease in testosterone levels following one week of sleep restriction. * **Axelsson, J., Ingre, M., Akerstedt, T., & Holmbäck, U. (2005). Effects of acutely displaced sleep on testosterone. *****Journal of Clinical Endocrinology & Metabolism, 90*****(8), 4530-4535.** * This study examines the effects of acute sleep displacement on testosterone levels and demonstrates a decrease in testosterone following sleep disruption. * **Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA. 2011 Jun 1;305(21):2173-4. doi: 10.1001/jama.2011.710. PMID: 21632481; PMCID: PMC4445839.** * Daytime testosterone levels were decreased by 10% to 15% in this small convenience sample of young healthy men who underwent 1 week of sleep restriction to 5 hours per night. This testosterone decline was associated with lower vigor scores but not with increased levels of cortisol, a stress-responsive hormone that can inhibit gonadal function. ## Stress control * **Chida, Y., & Steptoe, A. (2009). Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis. *****Biological Psychology, 80*****(3), 265-278.** * Chronic stress can elevate cortisol levels, which may suppress testosterone production. Incorporate stress-reducing activities like meditation, yoga, or deep breathing exercises into your routine to help manage stress levels ## Exercise * **Kumagai H, Zempo-Miyaki A, Yoshikawa T, Tsujimoto T, Tanaka K, Maeda S. Increased physical activity has a greater effect than reduced energy intake on lifestyle modification-induced increases in testosterone. J Clin Biochem Nutr. 2016 Jan;58(1):84-9. doi: 10.3164/jcbn.15-48. Epub 2015 Nov 27. PMID: 26798202; PMCID: PMC4706091.** * We found a significant positive correlation between the changes in serum testosterone levels and the number of steps. Our results suggested that an increase in physical activity greatly affected the increased serum testosterone levels in overweight and obese men during lifestyle modification. * **Resistance Training:** Engaging in regular strength training exercises, such as weightlifting or bodyweight exercises, can stimulate testosterone production. Focus on compound exercises like squats, deadlifts, bench presses, and rows, as they target multiple muscle groups simultaneously. * West, D. W., & Phillips, S. M. (2010). Anabolic processes in human skeletal muscle: restoring the identities of growth hormone and testosterone. *Physiological Reports, 98*(3), 531-532. * West, D. W., & Phillips, S. M. (2010). Anabolic processes in human skeletal muscle: restoring the identities of growth hormone and testosterone. *Physiological Reports, 98*(3), 531-532. * Kraemer, W. J., Ratamess, N. A., & Nindl, B. C. (2017). Recovery responses of testosterone, growth hormone, and IGF-1 after resistance exercise. *Journal of Applied Physiology, 122*(3), 549-558. * **High-Intensity Interval Training (HIIT):** HIIT workouts involve short bursts of intense activity followed by brief rest periods. This type of exercise has been shown to boost testosterone levels effectively. * Ratamess, N. A., Faigenbaum, A. D., Bush, J. A., & Kang, J. (2015). The effects of high-intensity interval training on hormonal responses to resistance exercise in overweight young men. *Journal of Strength and Conditioning Research, 29*(5), 1446-1454. * Hackney, A. C., Hosick, K. P., Myer, A., & Rubin, D. A. (2012). Testosterone responses to intensive interval versus steady-state endurance exercise. *Journal of Endocrinological Investigation, 35*(11), 947-950. * **Endurance Exercise:** While intense, short-duration exercises are effective, moderate endurance activities like running, cycling, or swimming can also contribute to increasing testosterone levels, especially when done consistently. * Hackney, A. C. (1989). Effects of endurance exercise on the reproductive system of men: the “exercise-hypogonadal male condition”. *Journal of Endocrinological Investigation, 12*(4), 274-283. * Tosti, V., Bertozzi, B., Fontana, L., Bernardi, F., Cannata, D., Castellucci, M., ... & Brandi, M. L. (2016). Relationship between testosterone deficiency and cardiovascular risk and mortality in adult men. *Journal of Endocrinological Investigation, 39*(9), 1045-1053. ## Weight management and caloric restriction 1. - A bidirectional relationship between testosterone and obesity underpins this association indicated by the hypogonadal-obesity cycle and evidence weight loss can lead to increased testosterone levels 2. - Body weight loss is also associated with a decrease in estradiol and an increase in gonadotropins levels. When males starts gaining weight from extra fat tissue, he’s got more and more aromatases converting his testosterone into estrogen. And thus, his testosterone levels will begin to fall. 3. - More severe obesity is additionally associated with reductions in free testosterone levels due to suppression of the HPT axis. Low testosterone by itself leads to increasing adiposity, creating a self-perpetuating cycle of metabolic complications. Obesity-associated hypotestosteronemia is a functional, non-permanent state, which can be reversible, but this requires substantial weight loss. 4. **Cangemi, R., Friedmann, A. J., Holloszy, J. O., & Fontana, L. (2010). Long-term effects of calorie restriction on serum sex-hormone concentrations in men. *****Aging Cell, 9*****(2), 236-242.** 5. **Isidori, A. M., Giannetta, E., Greco, E. A., Gianfrilli, D., Bonifacio, V., Aversa, A., ... & Lenzi, A. (2005). Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. *****Clinical Endocrinology, 63*****(3), 280-293.** 6. **Kapoor, D., Goodwin, E., Channer, K. S., & Jones, T. H. (2006). Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. *****European Journal of Endocrinology, 154*****(6), 899-906.** ## Vitamin D and testosterone ### Relationship between Vitamin D & Testosterone * **Holick, M. F. (2007). Vitamin D deficiency. *****New England Journal of Medicine, 357*****(3), 266-281.** * This review article discusses the importance of vitamin D, its synthesis in the skin through sunlight exposure, and its role in various physiological processes, including hormone regulation. * **Pilz, S., Frisch, S., Koertke, H., Kuhn, J., Dreier, J., Obermayer-Pietsch, B., ... & Zittermann, A. (2011). Effect of vitamin D supplementation on testosterone levels in men. *****Hormone and Metabolic Research, 43*****(3), 223-225.** * This study investigates the effect of vitamin D supplementation on testosterone levels in men with vitamin D deficiency and found a significant increase in testosterone levels following supplementation. * **Nimptsch, K., Platz, E. A., Willett, W. C., & Giovannucci, E. (2012). Association between plasma 25-OH vitamin D and testosterone levels in men. *****Clinical Endocrinology, 77*****(1), 106-112.** * This research examines the association between plasma vitamin D levels and testosterone levels in men and suggests a positive correlation between the two, with higher vitamin D levels associated with higher testosterone levels. * **Wang, N., Han, B., Li, Q., Chen, Y., Chen, Y., Xia, F., ... & Xia, Y. (2020). Relationship between serum 25-hydroxyvitamin D and testosterone levels in men. *****Clinical Endocrinology, 93*****(6), 631-637.** * This study explores the relationship between serum vitamin D levels and testosterone levels in men and finds a positive correlation between the two, indicating that adequate vitamin D status may support healthy testosterone levels. * **Wehr, E., Pilz, S., Boehm, B. O., März, W., & Obermayer‐Pietsch, B. (2010). Association of vitamin D status with serum androgen levels in men. *****Clinical Endocrinology, 73*****(2), 243-248.** * This study investigates the association between vitamin D status and serum androgen levels in men and suggests a positive correlation between vitamin D levels and testosterone levels. ### Supplementing with Vitamin D for testosterone * **Pilz S, Frisch S, Koertke H, Kuhn J, Dreier J, Obermayer-Pietsch B, Wehr E, Zittermann A. Effect of vitamin D supplementation on testosterone levels in men. Horm Metab Res. 2011 Mar;43(3):223-5. doi: 10.1055/s-0030-1269854. Epub 2010 Dec 10. PMID: 21154195.** * Compared to baseline values, a significant increase in total testosterone levels (from 10.7 ± 3.9 nmol/l to 13.4 ± 4.7 nmol/l; p < 0.001), bioactive testosterone (from 5.21 ± 1.87 nmol/l to 6.25 ± 2.01 nmol/l; p = 0.001), and free testosterone levels (from 0.222 ± 0.080 nmol/l to 0.267 ± 0.087 nmol/l; p = 0.001) were observed in the vitamin D supplemented group. By contrast, there was no significant change in any testosterone measure in the placebo group. ### **Health risks of excessive vitamin D supplementation** * **Galior K, Grebe S, Singh R. Development of Vitamin D Toxicity from Overcorrection of Vitamin D Deficiency: A Review of Case Reports. Nutrients. 2018 Jul 24;10(8):953. doi: 10.3390/nu10080953. PMID: 30042334; PMCID: PMC6115827.** * Excess amounts of vitamin D are toxic because vitamin D increases calcium absorption in the gastrointestinal tract, vitamin D toxicity results in marked hypercalcemia (total calcium greater than 11.1 mg/dL, beyond the normal range of 8.4 to 10.2 mg/dL), hypercalciuria, and high serum 25(OH)D levels (typically greater than 375 nmol/l \[150 ng/mL]). * Hypercalcemia, in turn, can lead to nausea, vomiting, muscle weakness, neuropsychiatric disturbances, pain, loss of appetite, dehydration, polyuria, excessive thirst, and kidney stones. * In extreme cases, vitamin D toxicity causes renal failure, calcification of soft tissues throughout the body (including in coronary vessels and heart valves), cardiac arrhythmias, and even death. * The combination of high intakes of calcium (about 2,100 mg/day from food and supplements) with moderate amounts of vitamin D (about 19 mcg \[765 IU]/day from food and supplements) increased the risk of kidney stones by 17% over 7 years among 36,282 postmenopausal women who were randomly assigned to take 1,000 mg/day calcium and 10 mcg (400 IU)/day vitamin D or a placebo ## Zinc and testosterone ### Relationship between Zinc and testosterone levels * - Zinc supplementation of marginally zinc-deficient normal elderly men for six months resulted in an increase in serum testosterone from 8.3 +/- 6.3 to 16.0 +/- 4.4 nmol/L (p = 0.02). We conclude that zinc may play an important role in modulating serum testosterone levels in normal men. * - We concluded that zinc deficiency reduces testosterone levels and zinc supplementation improves testosterone levels. Furthermore, the effect degree of zinc on serum testosterone may vary depending on basal zinc and testosterone levels, zinc dosage form, elementary zinc dose, and duration. In conclusion, serum zinc was positively correlated with total testosterone, and moderate supplementation plays an important role in improving androgen. * - serum testosterone concentration decreased as serum zinc concentration decreased, although sexual symptoms were not associated with this decrease. ### Supplementing with Zinc * Zinc dosing - [https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/#:\~:text=The average daily zinc intake from foods and supplements is,12.6 mg%2Fday in women](https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/#:~:text=The%20average%20daily%20zinc%20intake%20from%20foods%20and%20supplements%20is,12.6%20mg%2Fday%20in%20women). ### Health risks of excessive Zinc supplementation * From CUA TRT Q & A document: *“It is worrisome that two supplements had greater than the UL of zinc. Relatively low levels of zinc over-supplementation have been shown to interfere with the utilization of copper and iron and to adversely affect high-density lipoprotein cholesterol concentrations. Slightly higher doses have been shown to result in anemia and neutropenia, as well as impaired immune function.”* * High zinc intakes can cause nausea, dizziness, headaches, gastric distress, vomiting, and loss of appetite * Very high doses of zinc from supplements (142 mg/day) might also interfere with magnesium absorption and disrupt magnesium balance * **Recommended Dietary Allowance (RDA):** * For adult males, the recommended daily intake of zinc is typically around 11 milligrams (mg). * For adult females, the recommended daily intake is generally lower, around 8 mg. * **Tolerable Upper Intake Level (UL):** * The tolerable upper intake level is the maximum daily intake unlikely to cause adverse health effects. For zinc, the UL for adults is 40 mg per day. ### Zinc testing * **Sensitivity:** Moderate for detecting severe zinc deficiency, but may be lower for detecting mild or moderate deficiency. * **Specificity:** Generally higher, meaning that the test is more likely to correctly identify individuals who do not have zinc deficiency. ## Magnesium and testosterone ### Relationship between magnesium and testosterone: 1. - Our results show that supplementation with magnesium increases free and total testosterone values in sedentary and in athletes. The increases are higher in those who exercise than in sedentary individuals. 2. -The permissive role that several micronutrients, such as magnesium, might exert on the serum concentration and the biological activity of T could be of undoubted interest for future clinical approaches. Male individuals with impaired magnesium status and T deficiency (accurately assessed) could benefit from magnesium and/or T treatment targeting physical performance. 3. ### Magnesium Dosing * Magnesium dosing - ### Health risks of excessive magnesium * Too much magnesium from food does not pose a health risk in healthy individuals because the kidneys eliminate excess amounts in the urine * However, high doses of magnesium from dietary supplements or medications often result in diarrhea that can be accompanied by nausea and abdominal cramping ### Magnesium Recommended Daily Intake * **Recommended Dietary Allowance (RDA):** * For adult males, the recommended daily intake of magnesium is typically between 400 to 420 milligrams (mg). * **Tolerable Upper Intake Level (UL):** * The tolerable upper intake level is the maximum daily intake unlikely to cause adverse health effects. For magnesium, the UL for adults from dietary sources is 350 mg per day. ### Magnesium testing * **Sensitivity**: Plasma magnesium tests typically have moderate sensitivity for detecting magnesium deficiency, especially severe cases. However, the sensitivity may be lower for mild or moderate deficiencies. * **Specificity**: Plasma magnesium tests tend to have higher specificity, meaning they are more likely to correctly identify individuals who do not have magnesium deficiency. {% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Focused Longevity Panel What is our focused longevity panel? {% hint style="info" %} Last updated: May 16, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} {% hint style="danger" %} This article is about to receive a near-term update from our research team. {% endhint %} This panel is designed around the selection of specific longevity related biomarkers with a focus on three areas: optimizing cholesterol-related biomarkers, optimizing glucose-metabolism related biomarkers, and optimizing Vitamin D. [Both cholesterol and glucose-related biomarkers are causally related to the development of ASCVD (atherosclerotic cardiovascular disease) and are increasingly targeted for risk-reduction by physicians in the longevity space. ](https://www.instalab.com/newsletter/why-be-aggressive-about-lowering-cholesterol) The high-impact biomarkers for this focused panel have been selected as follows: * [ApoB](/biomarker-panels/focused-longevity-panel/apob) * [Lp(a)](/biomarker-panels/focused-longevity-panel/lp-a) * [Standard Lipid Panel](/biomarker-panels/focused-longevity-panel/standard-lipid-panel) * [Fasting Glucose](/biomarker-panels/focused-longevity-panel/fasting-glucose) * [Hemoglobin A1c](/biomarker-panels/focused-longevity-panel/hemoglobin-a1c) * [Fasting insulin](/biomarker-panels/focused-longevity-panel/fasting-insulin) * [Vitamin D](/biomarker-panels/focused-longevity-panel/vitamin-d) {% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # ApoB What is ApoB and why does it matter? **Apolipoprotein B (ApoB)** is a protein present on the surface of all lipoproteins that can potentially cause atherosclerosis by clogging arteries. These lipoproteins, which include HDL and LDL, are responsible for transporting cholesterol throughout the body. The ApoB test directly measures the quantity of these particles in the blood, offering a more precise assessment of the risk they pose. Maintaining ApoB at optimal levels is crucial for ensuring efficient cholesterol transport and removal, which supports cardiovascular health and promotes longevity. # Lp(a) What is Lp(a)? **Lipoprotein(a), or Lp(a)**, is a type of LDL cholesterol with an added protein, apolipoprotein(a). It's a significant, genetically determined risk factor for cardiovascular diseases, including heart attacks and strokes. High Lp(a) levels are associated with an increased risk of atherosclerosis, coronary artery disease, and other vascular conditions. Unlike other lipid levels, Lp(a) levels are largely unaffected by lifestyle changes and are consistent throughout life, making it a challenging risk factor to modify. # Standard Lipid Panel **LDL (calculated).** Low-density lipoproteins, commonly abbreviated as LDL, are frequently labeled as "bad" cholesterol. LDL is responsible for transporting cholesterol to various parts of the body, as cholesterol plays a crucial role in forming cell membranes, hormones, and digestive substances. However, LDL earns its "bad" reputation because, when its levels are high over prolonged periods and combined with inflammation, it can lead to the formation of plaques within the blood vessel linings. These plaques narrow and restrict blood flow, increasing the risk of adverse cardiovascular events. Thus, higher LDL levels are associated with an elevated risk of heart health issues. **Triglycerides** are a type of fat found in your blood, originating from the food you eat. They are stored in fat cells and released for energy between meals. High levels can increase the risk of heart disease and stroke, especially when combined with low HDL (good) cholesterol or in the context of type 2 diabetes. Elevated triglycerides are also linked to obesity, uncontrolled diabetes, regular alcohol consumption, and certain medications. Managing high triglycerides involves lifestyle changes such as diet, exercise, and in some patients, medication. **Cholesterol** is a waxy substance similar to fat, produced by the liver. It's a crucial part of every cell in the body and is instrumental in creating hormones such as testosterone and vitamin D, as well as substances that aid in digestion. Maintaining balanced cholesterol levels is vital for heart health. The total cholesterol in your body is made up of various types of lipoproteins, which are the carriers of cholesterol, in addition to triglycerides. **HDL, or high-density lipoprotein**, is often referred to as "good" cholesterol because it helps remove other forms of cholesterol from your bloodstream. High levels of HDL cholesterol can reduce your risk for heart disease and stroke by transporting cholesterol to your liver, where it's expelled from your body. The **total cholesterol/HDL ratio** is a measure used to assess the risk of heart disease. It is calculated by dividing the total cholesterol level by the HDL (high-density lipoprotein) level. HDL is known as "good" cholesterol because it helps remove other forms of cholesterol from your bloodstream. A lower ratio indicates a lower risk of heart disease, with an optimal ratio being between 3.5 to 1. A higher ratio suggests a greater risk of heart disease. **Non-HDL cholesterol** encompasses all cholesterol types that contribute to the buildup of plaque in your arteries, excluding HDL or "good" cholesterol. It includes LDL ("bad" cholesterol) as well as other lipid particles like VLDL and IDL, which carry triglycerides and can transform into LDL. Unlike LDL cholesterol, which requires fasting for accurate measurement, non-HDL cholesterol levels can be assessed without fasting, making it a practical marker for cardiovascular risk. Non-HDL cholesterol accounts for all cholesterol that can clog arteries, not just LDL particles. # Fasting Glucose # Hemoglobin A1c What is Hemoglobin A1c and why does it matter for my health? **HbA1c, or glycated hemoglobin**, is a critical marker for assessing long-term blood glucose control, with implications for longevity. Elevated HbA1c levels have been linked to a higher risk of cardiovascular diseases, stroke, and mortality, even in individuals without diabetes. Maintaining HbA1c within recommended levels is crucial not only for managing diabetes but also for enhancing cardiovascular health and potentially extending longevity. # Fasting insulin What is fasting insulin and why does it matter? {% hint style="danger" %} This test cannot be completed via a mobile collection service. {% endhint %} **Fasting insulin** levels measure the amount of insulin in your blood after you've fasted for at least 8 hours. These levels are crucial for understanding your body's insulin sensitivity and risk for developing insulin resistance, a condition where your cells become less responsive to insulin. Insulin resistance is associated with aging and can lead to type 2 diabetes, cardiovascular disease, and other age-related disorders, including neurodegenerative diseases. Interestingly, epidemiological studies have found that individuals with lower fasting insulin levels and higher insulin sensitivity, such as centenarians, often exhibit increased longevity. This suggests that maintaining lower fasting insulin levels through lifestyle choices like diet, exercise, and possibly intermittent fasting could support healthier aging and extend lifespan. # Vitamin D What is Vitamin D and why does it matter? **Vitamin D** is a crucial nutrient and hormone vital for overall health and plays a significant role in longevity. It supports bone health by aiding calcium absorption and has broader effects, including muscle strength enhancement, inflammation reduction, and immune function improvement. Research indicates that vitamin D influences longevity genes and may impact aging processes and age-related diseases such as cancer, heart disease, and cognitive decline. Vitamin D is also utilized and correlated with immune function. Maintaining adequate vitamin D levels, through sunlight exposure, diet, or supplementation, could be beneficial for extending lifespan and improving health span, underscoring its importance beyond just bone health. # Male Performance Panel What is our male performance panel? {% hint style="info" %} Last updated: May 16, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} {% hint style="danger" %} This article is about to receive a near-term update from our research team. {% endhint %} This panel is designed around the selection of specific male performance related biomarkers. While serum testosterone levels in isolation cannot be "optimized" to a specific target without a broader clinical context (due to individual variability in androgen receptor density and sensitivity), when evaluated *within* the context of a clinical consultation, they are much more useful metrics. These biomarkers have been selected as follows: * [Total testosterone.](/biomarker-panels/male-performance-panel/total-testosterone) * [Free testosterone.](/biomarker-panels/male-performance-panel/free-testosterone) * [Sex-Hormone Binding Globulin.](/biomarker-panels/male-performance-panel/sex-hormone-binding-globulin) * [Plasma Zinc.](/biomarker-panels/male-performance-panel/plasma-zinc) * [Serum Magnesium.](/biomarker-panels/male-performance-panel/serum-magnesium) {% hint style="warning" %} **Disclaimer:** The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others. {% endhint %} # Total testosterone What is total testosterone and why might it matter for human performance? **Testosterone**, a steroid hormone, plays a crucial role in overall health, sexual function, and athletic performance. Maintaining optimal testosterone levels is vital for athletic performance as it aids in muscle development, enhances strength, and boosts the body's oxygen-utilizing capacity during physical activity. In men, testosterone not only supports muscle growth and strength but also fortifies bone health and helps prevent age-related bone loss. Testosterone levels fluctuate through the day, thus testing should occur no later than 10 AM (and preferably 7 AM) for correct interpretation. # Free Testosterone What is free testosterone and why does it matter for human performance? **Free testosterone** refers to the portion of testosterone in the bloodstream that is not bound to carrier proteins, such as sex hormone-binding globulin (SHBG), and is therefore available for use. In contrast, total testosterone encompasses both free and bound testosterone, providing a comprehensive measure of the hormone's presence in the blood. The distinction between these two forms is crucial because only free testosterone is bioavailable and can exert its effects on the body. This includes aiding in muscle development, enhancing strength, and boosting the body's oxygen-utilizing capacity during exercise. For men, maintaining adequate levels of free testosterone is essential for bone health and preventing age-related bone loss. # Sex-Hormone Binding Globulin What is SHBG and why does it matter for human performance? **Sex hormone-binding globulin (SHBG)** is a protein produced mainly in the liver that binds to sex hormones in the blood, controlling their activity. High SHBG levels mean more hormones are bound and less are available for use, potentially leading to symptoms of low testosterone in men and high testosterone in women. Low SHBG levels indicate fewer hormones are bound, allowing more to be active. SHBG plays a crucial role in regulating hormone levels, affecting health outcomes like muscle mass, bone density, and fertility. # Plasma Zinc What is plasma zinc and why does it matter for human performance? **Plasma zinc** is crucial for human health, particularly for testosterone production, immunity, and cancer defence mechanisms. Zinc cannot be well-stored in the body, so regular dietary intake of zinc is important in preventing deficiency. Zinc deficiency can lead to reduced testosterone levels, affecting sexual development, fertility, and overall health. Zinc plays a vital role in the synthesis of testosterone, and its status is closely linked to serum testosterone levels. Studies have shown that zinc deficiency is associated with hypogonadism in men, and even marginal zinc deficiency can significantly decrease serum testosterone concentrations. Zinc supplementation has been shown to increase serum testosterone levels in individuals with zinc deficiency, highlighting its importance in modulating testosterone levels in normal men. An adequate level of zinc is essential for immune function and modulation of cancer risk due to its role as an antioxidant. # Serum Magnesium What is magnesium and why does it matter for my health? Optimal **magnesium** levels are essential for maintaining health and promoting longevity. Magnesium is involved in over 300 enzymatic reactions, supporting functions like muscle and nerve operation, blood glucose control, and blood pressure regulation. It's crucial for bone health, energy production, and DNA synthesis. A deficiency in magnesium can lead to various health issues, including cardiovascular diseases, diabetes, and osteoporosis, which are associated with aging. Adequate magnesium intake can help mitigate these risks, potentially extending lifespan and improving the quality of life by maintaining cardiovascular health, supporting metabolic functions, and reducing the incidence of chronic diseases. # Testing options in progress Current biomarker panels being prepared We are currently working on offering: * A wider biomarker panel (50+ biomarkers). * An in-person strength & longevity assessment offered by a certified personal trainer (e.g. grip strength, carrying strength, non-laboratory VO2max step-testing, etc.). * DEXA scans for body composition. * VO2max laboratory testing. # What is Optimal? An overview of who we are and what we do. {% hint style="info" %} Last updated: May 16, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} **Optimal** is a members-only service that helps individuals to optimize their performance and longevity. Our approach to is substantially different from the standard primary care model. A standard family doctor exists to **diagnose, investigate, treat, and prevent** disease**.** That is to say—it is a disease-centred model. Our approach is different. Instead of centering our care model exclusively on disease, we look at things in terms of a more fulsome view of **full-stack human optimization.** In the context of health, optimization comes down to two things: * Extending human healthspan and lifespan (longevity) by way of an intensive, high-resolution focus on primary prevention over and above the typical template of advice that gets offered ("eat well, sleep, exercise, etc."). * Increasing human performance in [cognitive](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915811/) and physical domains - [without having to exclusively rely on biologically costly pharmaceutical interventions](https://tim.blog/2024/02/02/no-biological-free-lunches/) or supplements that have a very poor evidentiary basis for actual efficacy. Our superpower is our **core feedback loop**—the ability to offer biomarker testing to check whether or not your efforts at optimization are *working* or not. In a typical primary care scenario, the goal of your primary care provider is to keep your biomarkers outside of the the "abnormal" zone—and that's it. While this is a vital (and heroic) role within the context of our existing healthcare system, our already-overwhelmed public healthcare system does not have sufficient resources to provide much in the way of "bonus" optimization beyond keeping you "out of the red." The lens of human optimization has a different strategy altogether. Instead of settling for high-normal/borderline or "average" metrics, we want to aim for *the best possible* metrics aimed at improving healthspan, lifespan, and human performance.

ApoB - we have reason to believe that lower is better, even if values fall within a normal range.

For people who are dedicated to being their best possible selves, that's where we come in. Our protocol coaches provide individualized assessments and feedback to assist you in shifting your biomarkers into a more optimal range, and in so doing, achieve the concomitant benefits in longevity and performance. By "full-stack," we mean to address multiple layers of human optimization: * VO2max (Cardiorespiratory fitness) optimization. * Dietary optimization. * Supplement optimization. * Heat exposure optimization. * Natural testosterone optimization. * Sleep and circadian health optimization. * Long-term ASCVD risk optimization. * Long-term metabolic health optimization. * And so on. ## What we don't do Optimal does not currently provide any of the following services: * **We do not replace your family doctor.** Our lab-testing panels are intended to locate normal but otherwise-suboptimal biomarkers—not to diagnose or detect an underlying disease. In the event that we identify an abnormal lab value with our lab-testing, you will be referred to a provider in our primary-care follow-up protocol. * **We do not prescribe medications.** While our PHC-NP's do have the authority to prescribe medications, we do not offer pharmaceutical treatments through our existing membership model. ## What are we working on providing? We are currently working on providing the following services: * DEXA scans for body composition analysis. * VO2max testing in an exercise laboratory setting. * Continuous Glucose Monitoring (CGM) for dietary optimization (determining your glucose and insulin response to various * An individualized meal delivery service with portions and calories titrated to your individual needs. * An in-person clinic service for more comprehensive baseline assessments with more tests and more biomarkers. # How does blood panel testing work? How does blood-panel testing work with Optimal? {% hint style="info" %} Last updated: May 16, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} Our clinic administrative staff will guide you through the process of biomarker panel testing. There are two options: 1. Going to a Gamma DynaCare laboratory in-person for a phlebotomist to draw your blood (included in base membership fee). 2. Mobile-team testing where a Gamma DynaCare affiliated phlebotomist comes directly to your home to complete the blood draw (additional $100 cost per blood draw). Additional details will be provided to you directly following member signup. # How our membership works An explainer for how our current membership model works. {% hint style="info" %} Last updated: May 16, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} Our base membership ($600/yr) get you the following: * **Baseline blood panel (screen for suboptimal biomarkers) with results provided in a custom biomarker report** * **Baseline longevity consultation with protocol coach (45m)** * **Protocol coach follow-up check-in #1 (25m)** * **Repeat follow-up blood panel (to check for biomarker optimization) with results provided in a custom biomarker report** * **Protocol coach check-in #2 (25m)** * Access to add-on panels + add-on coaching sessions for 1 year * Preferential access to in-person experiential events for 1 year (events will be open to the public but members of Optimal will get preferential access to sign up first). * Preferential access to annual Human Accelerator event (annual retreat) for 1 year * Access to additional add-on tests for 1 year (VO2 max, DEXA scans, CGM, larger & wider biomarker panels) (*pending*) * Access to online dashboard for viewing results with protocols built-in (*pending*) **The bolded items comprise our core program.** [Click here to read more about how protocol coaching works within the context of our membership model.](/general-f.a.q./how-protocol-coaching-works) We have two panels that you can select with your annual membership: * [A focused longevity panel that offers biomarker testing focused on extending healthspan and lifespan.](/biomarker-panels/focused-longevity-panel) * [A additional male performance panel that offers biomarker testing focused on optimizing male hormones through natural means and without relying on pharmaceuticals like TRT.](/biomarker-panels/male-performance-panel) # Who are your protocol coaches? What kind of medical providers do we have for you to consult with. {% hint style="info" %} Last updated: May 16, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} Our protocol coaches are licensed Primary Healthcare Nurse Practitioners (PHC-NP's) with expertise in human optimization. * **Lisa Dufour** is a licensed PHC-NP. She completed a Bachelor of Science (Honors) in Life Sciences at Queen's University and then went on to do a Master's of Science in Biochemistry at Queen's University. Following this, she completed a Bachelor of Science in Nursing at York University and a Primary Care Nurse Practitioner Master's program at Laurentian University. * **Ting Na (Tina) Xu** is a licensed PHC-NP. She completed her Bachelor of Science in Nursing at the University of Western Ontario. Following this, she completed a Master of Nursing at Ryerson University and a Primary Health Care Nurse Practitioner program at Queen's University. # How protocol coaching works A different approach to human optimization. {% hint style="info" %} Last updated: May 16, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} The concept behind a "protocol coach" is a fusion of two roles: * A standard primary healthcare clinician with multi-system knowledge and clinical skills in different body systems (e.g. cardiac system, endocrine system, etc.). This is the kind of expertise you would expect to encounter from any good primary care provider working in the standard healthcare system. * An individualized coach with domain knowledge in human optimization through the implementation of various exercise, dietary, and supplement-oriented protocols. This is more analogous to the type of specialized insight and advice you might expect to see from a health-oriented podcast with a higher resolution of detail. Under our current membership model, protocol coaching is divided into three appointments: 1. **First consultation (45m)** - Your PHC-NP will conduct a longevity consultation and take a medical history that includes a detailed inquiry into performance and longevity related lifestyle factors. They will also help you to interpret the findings of your **baseline biomarker report** derived from your initial blood panel. A limited initial trial of 1 or more protocols will be individualized and recommended to you with the goal of improving of maintaining biomarker optimization. 2. **First follow-up appointment (25m)** - Your PHC-NP will check-in to see how you're doing with protocol implementation and where you might be facing challenges. Additional protocols will be individualized and recommended as needed. 3. **Second follow-up appointment (25m)** - Your PHC-NP will check-in to discuss your **repeat biomarker report** derived from your second blood panel. The feedback from lab testing will inform whether or not your protocol strategy has been successful and whether or not additional tweaks are required to achieve further optimization. After completing the core program of 2 biomarkers tests and 3 appointments, you can add-on additional sessions and biomarker testing reports for the duration of your membership year. # Do our protocol coaches prescribe medications? i.e. do you prescribe TRT, GLP-1 drugs, etc.? {% hint style="info" %} Last updated: May 16, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} Our protocol coaches do not prescribe medications. Protocol coaches provide a combination of protocols and Over-The-Counter (OTC) supplement recommendations. At this stage, we are a strictly non-pharmaceutical service offering as most of our members are preferentially interested in non-pharmaceutical tools. In the future, we plan to offer a concierge membership service (a Human Optimization Lab) with a much wider scope of services. # Does Optimal replace my family doctor? i.e. does this replace or complement the existing public primary care system? {% hint style="info" %} Last updated: May 16, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} Optimal does not replace your family doctor. We are intended to work **alongside** your family doctor by offering human optimization services over and above what the publicly funded system is able to provide. # What happens if I have an abnormal lab result from a blood panel? What's the follow-up protocol here? {% hint style="info" %} Last updated: May 16, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} Publicly-covered lab testing from a standard family doctor exists to **diagnose, investigate, treat, and prevent** disease**.** That is to say—it is a disease-centred approach. Conversely, **Optimal** is *not* intended to detect or diagnose disease, but to *optimize* your biomarkers. Sometimes our blood panels will incidentally detect biomarkers with an abnormal value that may be suggestive of an underlying disease. In this situation, our PHC-NP's will proceed with our standard follow-up protocol: 1. With your consent, we will direct you to follow-up with your family doctor and send them your biomarker results and a clinical note. 2. If you do not have a family doctor, and you wish to have one, we will attempt to connect you to a family physician who is accepting new patients in order to address this issue. 3. If you do not have a family doctor, and you do not wish to have one, we will direct you to one of our partner walk-in clinics to assess this issue. You will either be provided with a copy of your results to bring to this clinic, or, alternatively, with your consent, we will fax a copy to this walk-in clinic so that you do not need to bring any documentation. 4. In exceptional (and notably rare) circumstances, a substantially abnormal biomarker result may require our clinical staff to direct you to a hospital for immediate physician assessment on an urgent basis. # How do Optimal events work? Are these parties or workouts? Both? {% hint style="info" %} Last updated: May 16, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} Optimal events fall into two categories: 1. **Fireside chats / informational events with a social mixer attached.** These are free and open to the public, and intended to provide access to live, engaging experts with domain-specialization in areas relevant to human performance and longevity and to connect with other members of the community interested in the same space. 2. **Experiential events.** These are paid events where right-of-first-attendance is preferentially assigned to Optimal members at a relative discount prior to being opened up to the public. Experiences will be centred around guided workouts with a performance and/or longevity theme (e.g. hitting Zone 2 target HR, building functional carrying-strength that leads to stronger grip measurements, etc.), with some workouts being complemented by more formalized lectures and/or blueprint-style food. To stay up to date on our events, check out our [free Substack newsletter.](https://beoptimal.substack.com/) # What's your annual human accelerator event? Is this a conference? Or more of a retreat? {% hint style="info" %} Last updated: May 16, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} **The Human Accelerator Event is a special annual event we run for our members.** We're working on something special for our inaugural event—but we can't talk about it yet! # How can I get in touch with you? Links below. {% hint style="info" %} Last updated: May 16, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} Find us on the following platforms: 1. Twitter: [@OptimalToronto ](https://twitter.com/optimaltoronto)(feel free to DM us too) 2. Substack: [beOptimal.Substack.com](https://beoptimal.substack.com/) 3. [Book a 15m chat with one of our founders here.](https://calendly.com/peter-va2_/30min) # Join our interdisciplinary team We're looking for new team members! {% hint style="info" %} Last updated: May 16, 2024 Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here. {% endhint %} We're a bootstrapped company actively building out an interdisciplinary team that is mission-oriented around full-stack human optimization. If you have background in any of the following areas, we'd love to talk to you: * Developers (full-stack web) * Clinicians (MD's) * Contract researchers (academic domain expertise in endurance exercise, exercise physiology, epidemiology and assessing the quality of scientific studies, clinical nutrition, longevity, male hormone health, sleep). If you're interested in working with us, [book a 15m chat with one of our founders here](https://calendly.com/peter-va2_/30min) or e-mail peter \[AT] beOptimal \[dot] ca.