Researchers note that subjects taking between 40 to 90 units of insulin before the study were able to completely eliminate their insulin use while also improving blood sugar control! They also point out that this effect happens “immediately upon implementing the dietary changes” so people with type 2 diabetes need to monitor their blood sugar closely and likely adjust their medication dosages/needs with the help of their doctors.
Ketosis and fasting also activates an anti-aging cellular cleanup process called autophagy (auto = self, phagy = eat). Autophagy is when a cell eats its own defective parts in order to recycle nutrients and keep the different parts functioning like new. In addition, autophagy can protect against neurodegenerative diseases, viral and bacteria infections, and cancers.
Our body needs some time to get used to ketones being elevated in the blood stream to begin using them effectively and efficiently for cellular energy. By consuming an exogenous ketone supplement, you get the body adapted to ketones faster and using them as an energy source before the body has built the metabolic machinery to produce its own ketones effectively.
At some point, the pancreas is literally burned out and can’t produce enough insulin to keep even basic blood sugar under control, let alone after a high-carb meal. This state is end-stage of type 2 diabetes where insulin injections become necessary . Type 2 diabetics do not produce less insulin than normal, but the insulin resistance increases the need for insulin. A diabetic pancreas is eventually unable to supply this increased demand.
I am sorry you had this experience. I feel that this educator was not giving you good advice. All my women who want to lose weight are recommended to consume 30 grams of good carbohydrates at each meal, and 15 at each snack. If you were not trying to lose weight, I would have recommended 45. I find this is all it usually takes to begin to lose some weight as you start to get active. Patients set their own goals with motivational help from their Certified Diabetes Educator. Our intent is never to insult, and you should not have gone through that. It sounds that you have now found the right path. There are many CDEs who could help you, so see what tools and motivation others may offer. I wouldn’t let one bad apple spoil the whole bunch. Many CDEs are also diabetic.
I believe the keto diet caused the TIAs, as did the RD that I worked with at the time. The choking (dysphagia) was not an issue until the second stroke .The TIA caused the aspiration. Yes, I believe it was the diet. If it works for you; Great! But this should never ever been tried on a man that was already sick, CBGs out of control and elderly to boot. The wife said she got it from a website such as yours. There should be warnings posted that this is diet is not for everyone and for goodness sake talk to a professional before jumping on the trend bandwagon. It can cause (and did) irreparable harm.
First – let’s admit that there are several different types of diets that produce dramatic improvements in weight loss and diabetes. The vegan diet is one of them (and one which also reduces risk in most other diseases better than the others) – but it is by unquestionably by far the very best diet for the environment and the survival of the planet. High protein (high meat and/or dairy) diets are absolutely TERRIBLE for the environment and are not sustainable in any way. A vegetable diet will END world hunger because we DO have enough earth to grow enough vegetables for everyone and we definitely do NOT have enough earth for meat eaters even at current levels.
AND i’m losing weight! I’m losing about 1 lb per week and actually have the energy again to workout regularly. If you have diabetes, you know how fatiguing of a disease it can be. I feel less sluggish, more “awake”, just better in general, while restricting my carb intake. Yeah, I miss some fruits, but I sure as heck don’t miss what I felt like after eating them. Besides, berries are allowed on keto 🙂
It’s also worth mentioning that if you have a history of irregular periods, any type of eating disorder, or a thyroid disorder than it may be best to begin this type of dietary program only while being guided by your doctor or a nutritionist. Pregnant women or those who are breastfeeding should not start the keto diet to be safe. A professional can help you ease into an alkaline keto diet in a moderate, safe way if you’re unsure of how to do this on your way, giving you feedback so the diet won’t negatively interfere with normal hormone production, appetite, sleep or mental focus.
Insulin resistance is caused by several mechanisms, one of which is chronically elevated insulin levels. So what increases insulin levels? Mainly sugar. A poor nights sleep can do it too, but sugar is a big one. This can be sugar that is part of our diet or carbohydrates that are broken down to glucose or other simple carbs. Proteins put together with fats can also be converted into sugar, a process called gluconeogenesis. However, it is really the effect of dietary refined sugars and starches (flour) causing blood sugar and insulin spikes (not protein). These insulin spikes from added sugars and flour are then often followed by a blood sugar crash, leading to a sense of discomfort, even sweating, and usually a craving for more high-carb foods.
Carbs turn into glucose (aka sugar) in the body. Eating too many carbs causes your blood sugar to spike. When you switch from carbs to fat for energy, you stabilize your blood sugar. Keto can be particularly beneficial for diabetics, who have high blood glucose levels. The keto diet may even cure diabetes — many diabetics are able to come off their medication when switching to keto. Find out more about keto and blood sugar here.
Common complications of diabetic ketoacidosis include very low blood sugar, or hypoglycemia, and swelling of the brain (cerebral edema). As such, when a person is in ketoacidosis, there is such a high level of ketones produced that can push a person into cardiac arrest (heart attack) or kidney failure. Hence, the very important reason for taking occasional keto breaks go give your body a bit more nourishing carbs.
And, it's important to recognize that both study teams acknowledge that as exciting as their findings seem, a large, randomized controlled trial is still needed to more closely assess a variety of components that may be contributing to the successes found in both studies before the findings can be recommended to anyone outside the study groups1,2 he says.
Jalali says people following the diet have the best chance of keeping the weight off if they stay on it long term. And that’s not always easy to accomplish. The weight may come back if you go back to your regular eating habits. And regaining weight may lead to other negative effects. “Chronic yo-yo dieting appears to increase abdominal fat accumulation and diabetes risk,” notes Clark.
One aspect that is not often mentioned is carb cravings. Before I started a keto diet, every day I would have serious starchy- or sweet- carb cravings that were uncontrollable and HAD TO BE satisfied. The high-fat keto diet has pretty much eliminated those carb cravings. It is wonderful to not be under the control of those cravings anymore. I think the high success rate of keto diets is that you are not hungry and have no cravings.
Other causes of diarrhea on the keto diet include consuming a diet low in fiber (fiber helps ward off diarrhea by bulking up stool) and eating processed low-carb foods like shakes and bars that may contain sugar alcohols. These sugar alcohols can ferment in the gut and cause gastrointestinal discomfort. Yawitz suggests limiting foods labeled “sugar free” if you’re prone to gas or diarrhea when you eat them. And you may want to gradually adjust your carbs downward and your fats upward. “Also build your diet around [naturally] high-fiber, low-carb foods like avocado and nonstarchy vegetables such as broccoli, cauliflower, and asparagus,” she says. Other keto-friendly ways to get more fiber include chia seeds, almonds, and coconut.
The basis of the muscle wasting argument stems from a misunderstanding of the brains glucose requirements. If ketones didn’t exist the brain would require much more glucose than it does in the presence of ketones. During a low carb diet the brain would be forced to break down protein to obtain this glucose. It would do this through either dietary protein or in the absence of sufficient dietary protein, it would go after body muscle. Fortunately, once ketosis kicks in the brain is able to obtain 70-75% of its energy requirements from ketones. The remaining 25% is much more easily obtained from dietary protein and thus body muscle is spared.
In March 2018, our friend Vickie, who is a type 1 diabetic, told us about the keto way of life. She shared some interesting data Dr. Ken Berry puts out on YouTube. The things Dr. Berry said made total sense to us and we decided we needed to give keto a try. Both I and my girlfriend decided to give this Keto way of life a try. We officially started on March 5, 2018.
The researchers hypothesized that the positive effects that the ketogenic diet has on migraines are due to how ketone bodies inhibit neural inflammation and enhance brain mitochondrial metabolism. The ketone bodies do this by blocking high concentrations of glutamate (commonly found in both migraine and epilepsy sufferers) and reducing oxidative stress.
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My son started the Keto Diet (not perfectly) with the ok of his Dr and a Different Oral Chemo at the same time. Last Tuesday an MRI indicated no new growth or no new tumors. We don’t know if the new Chemo, Keto diet, lots of prays or what has stopped the tumors from growing.I found your site after looking for possible adverse reactions to Keto Diets, and appreciate your research. His platelets are low now and never have been low before. This is stopping the next Chemo treatment. I understand that being on Chemo for 12 months could have created the low platelets and now the possibility that the Keto Diet could also be causing low platelets is frustrating. They will do a new blood test Tuesday to see if the platelets have increased. Any suggestions about how if possible to increase the platelets on the Keto Diet would be helpful.
One of the keto researches commented, (I think it was Steve Phinney) that change will come about only because enough of the the public will be become educated about this and will demand that the ADA change their recommendations because those recommendations are just wrong. What is the proof they are wrong? If you eat 45-60 g of carb daily, you will continue to have diabetes, and the epidemic will continue as it has for the last 25 years.
It’s only dangerous to not get enough carbs at each meal if one is taking too much meds or insulin for the amount of carbs they are eating! Restricting carbohydrates doesn’t lead to hypoglycemia unawareness, but having lots of lows and lots of highs will (and decreasing insulin and carbs leads to way fewer highs and fewer lows, or at least it can). On the other hand, being in ketosis does make low blood sugars less negative as an experience. I still feel my lows just fine, but they are less of an emergency because my brain still works (feeding on ketones) and by body doesn’t freak out and release tons of adrenaline that then makes me want to eat a house. Mind you, I still wake up and know immediately if I’m low, I know from experience and how it feels in my head and body but without the crazy shakes. This is not unawareness but it is less reactive.
Roxy, I started at 283 in February 2018. I am now 212 with the hope to make 100lbs lost by Feb 2019. KETO is a life choice and comes with changes that have to be made! My mantra at difficult times in the beginning was to be different i must do different! Also most modern foods pizza and tacos can be adapted to keto way of eating. Just takes research and a little planning. I have tacos weekly!
Weight loss is the primary reason my patients use the ketogenic diet. Previous research shows good evidence of a faster weight loss when patients go on a ketogenic or very low carbohydrate diet compared to participants on a more traditional low-fat diet, or even a Mediterranean diet. However, that difference in weight loss seems to disappear over time.
Some studies have shown a positive connection between ketosis and lower levels of ketosis, but as Paoli et all conclude in their paper Beyond Weight Loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets, there is persuasive, although not yet conclusive, clinical and physiological evidence that the ketogenic diet could be effective in reducing the severity and progression of acne and randomized clinical trials will be required to resolve the issue.
While there have not been large studies that show the relationship between the ketogenic diet and cancer, we will be publishing a case study about that topic. The author failed to comment that pediatric patients with epilepsy are on the diet for usually about 2 years with no harmful effects. Before the false studies about heart disease and fat, the low carb diet was a respected way to lose weight. Studies into our metabolism show we can use both fat and carbohydrate as fuel. So stepping away from our high carb diet- I am sorry to say that we eat more carbs since the 70s with most of it processed and we now use high fructose corn syrup to sweeten products and we have a wide spread childhood obesity problem. If cholesterol is a concern try plant sterols and stenals to block cholesterol from the receptors in the body. So much more can be said about a keto diet than this article states
Why not just rest on the opinion that it is not a fad diet and has been around for a long time as a diet that works for some people. Some of our youth on reddit may be doing it because they have diabetes (like my Son) Many of these kids are getting this from the poor American diet and low activity because of computers and phones. So if they can take a break from that and try to take an active and creative interest in this diet (which is a good diet for some) then why not just be respectful of that. My Sons doctor put him on this diet, we are doing it as a family and loving it! His blood sugar is normal after 1 1/2 months and we have all lost weight. BTW most if not all the foods you tried I would def eat! ???? There is def some concern about doing this way of eating carefully and making sure we are in balance with our nutrients. We have cheat meals once a week, so not feeling deprived at all!
Given all the buzz, adopting a ketogenic diet may be the perfect weight loss plan, especially if you have diabetes, or want to try this approach to lose those troublesome extra pounds. After all, it’s a very low-carb meal plan that promises effective weight loss while also lowering your blood sugar to the point where you could possibly stop taking medication. By all accounts, the “keto” diet, as it’s widely known, may even reverse type 2 diabetes, at least for some lucky individuals.
The truth is, I could have drank all the water in the world, and it wouldn’t have solved the problem, because the diet kept me from holding it. I was on the diet approximately six months when it started happening, with warning signs, in retrospect, a month before. When I wrote my story on a blog, I was contacted by a law firm who wanted to investigate my story, because they had a few other clients with similar experiences. I declined their services.
I’ve been type 2 for about 15 years was pretty stable with diet and Metformin for 10 years. But eventually started trying more aggressive treatment like Victoza and without fail in 4 years I was on slow acting insulin. I lost weight lowered carb intake to 40mg or less in the morning my breakfast has been no carbs. People need to realize every diabetic is different you must manage it how it keeps you with good A1C levels. I myself got off insulin for a year and half but my fasting levels slowly increased again. Reversing diabetes is not possible. Reducing the effects is possible and more likely the better you monitor yourself and do what you need to do. Depending on medications or diets or counting carbs will all help but not cure the diabetes. These all are things that reduce its ability to affect your health negatively.
Adding salt to food might be new to you, since most people are used to being told to limit salt intake. However, when you’re eating a ketogenic diet of less than 60 carbohydrates each day, you’ll need to make up for this loss of salt. That being said, those with high blood pressure who take medication should check with their doctors before making a change.
The kidneys play an important role in metabolizing protein, and it’s possible that eating too much of the nutrient can have a negative impact on kidney function. While ketogenic diets are supposed to be much higher in fat than they are in protein, many keto eaters make the mistake of loading up on lots of meat, Mancinelli says. The result? You could end up eating way more protein than you actually need.
This article is a perfect example of the misinformation regarding diabetes and insulin resistance. The authors stance against the ketogenic diet is a simple, “its just too hard, I cant live without fruit.” She projects her lack of willpower to her audience. Ketogenic diets are a great way to reduce insulin levels and get to the root of the problem.
I teach ADA. I saw 49 people in 8 months. All except 1 lost weight and had A1C reduction. 16 reversed their condition. All this on ADA diet. ADA works, you just have to follow it. Keto will work also, I just do not believe that it is healthy in the long term. We need more study results, and evidence that it works before we recommend that everyone should go on a keto diet. I would recommend that any of you who are on keto diet, and who are adamant that it works, and that ADA does not, should look for clinical trials and become subjects. We will need to know scientifically that it works, not just by word of mouth. And we will need to see medical evidence that it helps. If there is science behind it, I am sure that ADA will get behind it. Their are medical programs where you can be followed on a keto diet. Look for those.
One of the boldest claims about the keto diet is that it can help combat cancer by effectively "starving" cancer cells. It's a claim based on a phenomenon dubbed the "Warburg effect", which, in simple terms, describes how cancer cells are more reliant on sugar than healthy cells. So, the idea is that sticking to a low-carbohydrate diet will make it harder for cancer cells to thrive.
“Your liver produces ketones all the time, but the rate depends on carbohydrate and protein intake,” says Jeff Volek, Ph.D., R.D., a professor of human sciences at Ohio State University. When the majority of your diet is made up of of carbs and protein, ketogenesis slows. Replacing carbs and protein with fat will put your body into ketosis, thus ramping up ketone production. This takes about three days to induce.
2. A ketogenic diet helps to increase your level of energy as well as reduce hunger. Since the ketogenic diet uses body fats as a primary source of energy, your body will have a more reliable source of energy. This will make sure that you have a lot more energy to use throughout your day. In addition, since fats are more satisfying, you will find that you fill full for longer periods of time.
Registered dietitian Julie Stefanski is based in York and has specialized in the ketogenic diet for more than a decade. She also advocates for anyone starting keto, especially individuals who have not seen a doctor in more than a year, to first see a physician and/or registered dietitian to have their lab work checked and monitored. She also notes there are certain medications that cannot be used while on a ketogenic diet.
Nine most popular diets rated by experts 2017 There is a wide variety of diets for losing weight, gaining weight, or living healthily. This article looks at nine of the most popular diets based on how many articles cover them, how popular they are, and how much feedback we receive about them. Diets include the ketogenic diet, the Zone diet, and the raw food diet. Read now
The crazy thing is it is not hard, if it matters. Sure I can see it being hard for someone who does it to lose weight, then when they get closer to their ideal, they want to have treats, etc. Well, for a type one diabetic there’s no end in sight, this is it, and it’s a relatively complication free life (many people reverse their complications when they bring their A1C down to normal) vs. one with inevitable complications. So, perhaps it was too hard for you after a year (you didn’t say, but I assume you are not a type one diabetic), but that is a choice you can make. Not I.
There is nothing inherently difficult about following a ketogenic diet. We have many patients who do this very easily over many years. The metabolic benefits significantly outway any perceived challenges from limiting particular food types. Uptake would be far more widespread if nutrition professionals left their predujical opinions of SFA’s behind. Finally, given the expertise in Ketogenic Diets at Harvard, Dr David Ludwig, for one springs to mind, I am surprised the author did not avail themselves of the local expertise.
The keto diet involves getting up to 80 percent of daily calories from sources of healthy fat, a significant change for most of her patients who were accustomed to running on carbs, caffeine and sugar for energy. It became clear that something else had to be adjusted in order to prevent the side effects associated with the keto diet. This is when she came up with the idea to focus on restoring alkalinity first and foremost.
Obesity is one of the principle risk factors for diabetes and following a ketogenic diet has been shown to help with weight loss. According to scientific article published in 2014, “A period of low carbohydrate ketogenic diet may help to control hunger and may improve fat oxidative metabolism and therefore reduce body weight.” Many prediabetics struggle with being overweight so a keto diet can help promote weight loss, which can help to decrease the chances of developing full blown diabetes.
The good news here is no! All the evidence points to the fact that a low carbohydrate diet actually does lower blood glucose and A1c levels and does contribute to weight loss. The problem is we do not yet have enough large studies, over enough sustained years to support evidence that people with diabetes can remain on a highly restrictive Ketogenic Diet for the rest of their life and also not have other consequences to their health.
The weight and body mass index of the patients decreased significantly (P<0.0001). The level of total cholesterol decreased from week 1 to week 24. HDL cholesterol levels significantly increased, whereas LDL cholesterol levels significantly decreased after treatment. The level of triglycerides decreased significantly following 24 weeks of treatment. The level of blood glucose significantly decreased. The changes in the level of urea and creatinine were not statistically significant.
Examples include non-starchy fruits and vegetables such as leafy greens, mushrooms, bell peppers, and berries. The trace minerals and vitamins found in grains can also be obtained at higher percentages in good-quality meats and dairy products. Moreover, compounds such as phytates and tannins in grains hinder the bioavailability of several minerals.13
There is one precaution with keto and children who are under their ideal weight, though, and you will need to decide if the risks outweigh the benefits – being in ketosis is a natural appetite suppressant. This will vary from person to person for how much this affects them, but if your child seems even affected by this appetite suppressant property, you may find that the GAPS or SCD diets are a better fit for healing the gut and encouraging weight gain.
The keto diet is NOT what you seem to picture. I laughed at your description as I was eating lamb chops, cauliflower rice, broccoli, followed by cheesecake. How deprived I was! You should relook at what the diet really is. By the way, my cardiologist highly recommends keto. Most people see a drastic decrease in their triglyceride/HDL ratio. Looking at total cholesterol or LDL alone is 20 years out of date! Even the AHA has caught up, and now says that it’s NOT how heart health should be judged.
Nutritionists frequently advise clients to reach for more healthy fats and protein to stay full throughout the day. With this in mind, it makes perfect sense that a ketogenic diet would be about as good as it gets for staying satiated. One study from the American Journal of Clinical Nutrition found this type of low-carb approach was more effective for weight loss and managing hunger than a similar high-protein diet with a greater percentage of carbohydrates. One 2013 study even suggested the eating plan may suppress hunger hormones more effectively than other weight-loss programs.
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It is now evident that high carbohydrate diets increase fasting plasma triglyceride concentrations (47–51) and decrease HDL cholesterol concentrations (52–55). These changes are associated with enhanced atherogenesis (55). However, it has been shown that short-term ketogenic diets improve the lipid disorders that are characteristic of atherogenic dyslipidemia (56). It has also been found that sugary drinks decreased blood levels of vitamin E, thus reducing the amount of antioxidants in the body. It has been proven, beyond a doubt, that disrupting the oxidant-antioxidant status of the cell will lead to various diseases of the body (57).
Based on what we know from the available research, is the keto diet safe? The evidence is clear that the KD can reliably help to treat obesity and improve insulin resistance, but the long-term impact of the KD on cardiovascular risk factors, liver disease and glucose tolerance is more controversial. Experts agree that genetics seem to play a role in how different people respond to the KD, meaning some may be more likely to thrive on very low-carb diets, while others are more susceptible to developing side effects.
Well… what are many people on a Keto diet trying to do? Lose weight right? I would guess that prior to discovering the Keto diet many of these people were caught in the trap of low fat dieting. This lead to months or years of low fat intake and consequentially low gallbladder activity. The gallbladder wasn’t needed to digest fat and so it sat idle and stones were more likely to form. Once they made the shift to a ketogenic lifestyle and their fat consumption increased upwards of 1000%, the gallbladder kicked into high gear. If the previous period of low fat dieting had caused stone formation they are going to have to deal with flushing those stones out now while on a high fat Keto diet.
One of the most-cited worries about the keto diet is the long-term impact it may have on heart health—especially because people with diabetes are at greater risk for heart disease. In the small Diabetic Medicine study that found people with type 1 improved their A1Cs on a keto diet, participants had higher triglycerides and LDL (“bad”) cholesterol. This raises concerns about the diet’s longer-term heart health implications, as do the results of research published last year in The Lancet. That study followed more than 15,000 adults for 25 years and found that people who consumed less than 40 percent of their calories from carbohydrates were significantly more likely to die from heart disease than those whose diets contained 50 to 55 percent of calories from carbs—especially if the foods that replaced those carbs were rich in animal fats and proteins.
People this is crap. There is no Keto drink that will get you into ketosis within an hour. The main factor of eating Keto is to eat WHOLE UNPROCESSED foods. Which definitely does not include a magic fix drink. People that eat Vegan, Paleo and Keto have one core thing in common… to try their best to eat whole, natural, unrefined and unprocessed foods. We may not agree with what we eat per say, but I believe that we can all agree that drinking a “magic drink” or taking a “magic pill” to get us into any state is absolutely ridiculous. It’s exponentially offensive to those of us that are trying to educate and help others and especially offensive to those that have lived and succeeded living a whole lifestyle. Travis, get off this feed. Your doing nothing but trying to capitalize on people’s vulnerability.
It is important to understand that the statement that carbohydrates are “nonessential” is not only factually inaccurate, it results in adopting a low-carbohydrate diet or ketogenic diet that increases your risk for a wide variety of chronic health conditions that may ultimately shorten lifespan, decrease your quality of life, and accelerate your risk for chronic disease.
Mostly likely, yes. A common finding is that focusing on eating an alkaline diet in addition to a low-carb keto diet will dramatically help curb side effects for many women (and men too!). The reason is because of high nutrient intake, enhanced detoxification and reduced reliance on “uppers” like caffeine (some even overdosing on caffeine) and sugar for energy.
“Both alcoholic ketoacidosis and diabetic ketoacidosis create medical emergencies due to the rapid change in the body’s acid-base balance,” Dr. Gonzalez-Campoy says. “The rapid drop in the pH of the blood, which is called acidosis, can depress the nervous system and muscle function, causing a person to become unconsciousness due to vascular collapse.”
We have solid evidence showing that a ketogenic diet reduces seizures in children, sometimes as effectively as medication. Because of these neuroprotective effects, questions have been raised about the possible benefits for other brain disorders such as Parkinson’s, Alzheimer’s, multiple sclerosis, sleep disorders, autism, and even brain cancer. However, there are no human studies to support recommending ketosis to treat these conditions.
Obesity is nothing except fat stored in a body due to unhealthy food choices and a sedentary lifestyle. No doubt there are a lot of ways to reduce your weight naturally with a strict diet plan or a tough workout, nowadays people usually prefer to use supplement because they are to fast in showing results and easy to manage. We all know that keto products are considered the best way to get rid of from extra fat. The series of keto products offer many products works on the principle of ketosis(low carbs state) keto trim is also a chain of this series. Keto trim is a weight reduction formula, this formula initiates the process of fat reduction rate in your body and makes your body energetic by converting your fat into energy. This product helps you to fight against your body fat and make your body looks super slim.
I am a 7 year stroke survivor that is partially paralyzed from the stroke. I work part time and while working I walk at least 2 miles at work three to five times per week, but I can only walk 1 mph if even that speed. Which I know average speed is 3 mph when walking. I am 40 pounds overweight due to not being to do cardio workouts. I take aspirin daily as a blood thinner. I have considered getting on the keto diet. I drink sweet tea and one dr pepper per day along with coffee and water. I talked to my dr about this diet all he could tell me was he hasn’t researched it enough but knew of someone that lost weight on it. For my health I need to maintain a healthy weight and not be overweight. I have a b12 deficiency along with folic acid. I have not been taking any supplements for either.