Muscle for Life with Mike Matthews - Dr. Brad Dieter on the Ketogenic Diet for Fat Loss and General Health

Episode Date: December 1, 2019

Almost every day, I’m asked about the hugely popular ketogenic diet. I’ve written about it some time ago and more recently had Dr. Eric Helms here on the podcast to talk about it in the context of lean bulking, but as keto has become THE next “it diet” and science is always moving forward, I figured it’s high time to address it again. That’s why I invited Dr. Brad Dieter on the podcast to discuss all things keto including its advantages and disadvantages for weight loss and general health, how to get (and stay) in ketosis, what ketones are and if you should supplement with them, and more. In case you’re not familiar with Brad, he’s trained exercise physiologist, molecular biologist, and biostatistician with Master’s and Doctorate degrees, as well as the COO of Macros, Inc and a member of the Legion Athletics Scientific Advisory Board. Needless to say, Brad’s an accomplished chap with the experience and scientific chops to tackle a complicated subject like the ketogenic diet. So, if you want to know what the keto diet is good for, and whether or not you should give it a shot, this episode is for you. 4:44 - What is the ketogenic diet and how did it start? 7:12 - Would the ketones spillover be after fat gain? 9:06 - How does energy balance affect the results of a ketogenic diet? 11:04 - Do you need to be in a calorie deficit to be on a ketogenic diet? 12:12 - Why is it that if you eat more carbs you tend to lose fat more efficiently? 18:27 - What are the advantages of a ketogenic diet? 25:26 - Where is the carbohydrate cutoff to maintain a state of ketosis? 28:21 - Are there situations where you recommend a ketogenic diet? 30:01 - What kind of health benefits do you get from a ketogenic diet? 34:32 - Are there any health conditions that a ketogenic diet could help with? 36:31 - Can a ketogenic diet help with skin issues? Mentioned on The Show: Macros Inc Brad’s Instagram Science Driven Nutrition Want to get my best advice on how to gain muscle and strength and lose fat faster? Sign up for my free newsletter! Click here: https://www.legionathletics.com/signup/

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And if you're not in the United States, your order is going to ship free if it is over $99. So again, if you appreciate my work and if you want to see more of it, please do support me so I can keep doing what I love, like producing more podcasts like this. To shop and save now, head over to www.legionathletics.com, L-E-G-I-O-N athletics.com, and use the code FRIDAY19, numerals one nine at checkout, and you'll save up to 30% on your entire order. Hello, hello, and welcome to another episode of Muscle for Life. I hope you are having a great Thanksgiving Day weekend. I hope you ate way too much and enjoyed it just as much. Every day at this point, or every other day at least, I am asked about the hugely popular ketogenic diet

and this is something I've written about some time ago. I think I also did record a podcast actually around the same time that I wrote a long article over at Legion and more recently I think sometime in the last six months or so I had Dr. Eric Helms here on the podcast to talk about the ketogenic diet in the context of lean bulking in particular, muscle gain. But as keto has become the next it diet, mainstream fad diet, and as the science is always moving forward, I figured that it would be useful to address it again. And that's why I invited Dr. Brad Dieter on the podcast to discuss all things keto, including its advantages and disadvantages for weight loss and general health, how to get and stay in ketosis and what that means, what ketones are and whether they are worth supplementing with and more. Now, in case you're

not familiar with Brad, he is a trained exercise physiologist, molecular biologist, and biostatistician with a master's degree as well as a doctorate. And he is the COO of Macros Inc. and a member of the scientific advisory board of my sports nutrition company, Legion Athletics. So needless to say, Brad is an accomplished chap with the experience and the scientific chops to tackle a complicated subject like the ketogenic diet. So if you want to know what the keto diet is good for and whether you should give it a go, this episode's for you. Here's the interview. Hey, Brad, welcome to my podcast. Thanks for taking the time. Yeah, of course, Mike. I really appreciate you having me on. And I know we've connected quite

a bit over the last few years, but it's nice to sit down and have a good long form conversation here. I'm looking forward to it. Yeah, yeah, same. This is one that is timely because the keto diet is hugely popular these days, something I still get asked a fair amount about. I did write a pretty long form kind of definitive guide type of article on it a couple of years ago, but there's plenty of developments that are worth discussing between then and now. So that's why I thought it'd be great to get you on the show because you can go into probably more of the details than I can. I'd have to definitely bone up on what has changed since I wrote that original article. So I'm looking forward to learning a bit myself.

Yeah, absolutely. And so I think a good place to start would be just, let's just start at the top. And so for people who I'm sure most people listening have heard of the ketogenic diet, but maybe don't know exactly what it is, probably don't know how it started and what a true keto diet is. Because there's an ongoing kind of debate, right? Is the mainstream keto, which is often high protein, that wasn't the original protocol. And of course, the original protocol was a medicinal diet. Why don't we just start there? What is the keto diet? And where did it come from? And then we can probably get into maybe why is it such a thing now? Why is it getting

so much attention? And then get into weight loss and general health? Yeah, absolutely. So I think, you know, maybe the best place to start that conversation when we talk about, you know, what is it and why did it become popular and those sorts of things is to maybe just briefly cover kind of what human metabolism looks like at kind of the most basic fundamental level is, you know, really we have primarily three ways of producing energy in our body. You know, one is through a system called the creatine phosphate system, which is really just like a immediate, super fast available source of energy. We get creatine through our diet, but we just store very small amounts of it. And it's not really a major focal point of what we

think about it in terms of, you know, how we eat as it relates to metabolism overall. But then we have essentially carbohydrate metabolism and fat metabolism that our body uses to produce most of the energy for our body. And our body can really go between carbohydrate and fat metabolism at will based on a lot of factors. One is what types of foods are you eating? How much are you eating? And have you eaten recently? And then the other one is, you know, your physical activity. Are you exercising really hard? Or are you just kind of moving around at a very low intensity? And those are the kind of things that dictate whether your body is using more carbohydrates for fuel or more

fat for fuel. And then there is a additional way that your body can make energy. And this is through the process that involves ketone metabolism. And basically, what happens with a ketogenic diet is your body is in a state where it's metabolizing so much fatty acid that you basically can't utilize all the fatty acid your body is trying to use to make energy. So there's kind of this spillover, and that spillover becomes ketones and then your body can metabolize those ketones. And there's a lot of specifics in there, but that's kind of the fundamental way that it works. Now, and that spillover would be after fat gain as well, right? Because certain percentage would just be stored as body fat over immediate energy needs. Yeah. So that's kind of the next topic to

dive into is, you know, a lot of people have this idea of the ketogenic diet is you produce ketones when you either consume a very high amount of fat or you don't consume any carbohydrates. But the real truth is there's several ways that you can be in a ketogenic state. One is if you just don't eat any food, if you have no calories coming in, your body will start increasing fat metabolism based on hormonal changes that occur when you don't eat for a long period of time, you know, a day or two or longer. And then just the lack of any calories present, your body will start utilizing so much fatty acids that you'll start producing ketone bodies. You know, you can be in a ketogenic state just not eating either fat or carbohydrates, right? And then another way is you can consume an adequate amount of calories and just have a very,

very low carbohydrate intake. And then you can also be in a ketogenic state. And then if you're eating a moderate amount of carbohydrates, but you're eating a fairly large amount of fatty acids, you can sometimes also kind of trigger a ketogenic state as well. So those are kind of the three ways that your body can be in a ketogenic state. And so this idea of, you know, really a ketogenic diet is much less dependent on what the exact food you're eating and really understanding what is your body doing and why would you need to produce ketones in the first place. So you can really achieve, you know, a ketogenic diet by either just going incredibly low calorie, you can do it by going, you know, pretty low carbohydrate and pretty high fat intake, or you can just consume a very large

amount of fatty acids. And you can also then kind of trigger the ketogenic state. And those all look like very different approaches to eating food. And they can all result in very different outcomes, right? And some of those scenarios, you may gain weight. Some of those scenarios, you may lose a substantial amount of weight. And that would be driven by energy balance, of course. We're going to be wondering if that's not clear to them that the ketogenic diet is just like any other diet. It's not a way to hack calories in and calories out. Yeah, exactly. Right. And one of the interesting things about it is, you know, this idea of a ketogenic state being really beneficial for fat loss kind of comes from two ideas that we think are related, but they're kind of independent of each other, right? One is, is your body using

fat for fuel is one idea. And then another idea is, is your body in a state of energy deficit or energy surplus. And we kind of have this notion that if you're burning a large amount of fatty acids, you should be losing body fat. But in reality, it doesn't matter how much fatty acids you're burning, if your energy balance isn't taken into account. Sure. Because if you're eating a ton of fat, well then, yeah, you're going to burn a lot of fat because your body has to. It doesn't have a choice. I mean, it might prefer as far as immediate energy needs go, it might prefer carbs, but if you're not eating carbs and all you're giving it is fat and it's got to do what it's got to do. And of course, then your fatty acid burning would be quite high, but that doesn't mean that you are getting leaner, right?

Exactly. Right. And there's been some very good research studies, especially over the last five to 10 years that have really looked at that. So we've, there's been some very good research studies, especially over the last five to 10 years that have really looked at that. So we've, there's been studies where we've taken people and kind of fed them a ketogenic diet or kind of a low fat diet, basically the opposite, and then tracked two things, kind of tracked their, their body fat oxidation. So how much fatty acids are they burning for fuel? And then what's happening to their body weight and their actual stored body fatness. And we definitely see that those two don't always correlate hand in hand, right? You can actually have an increase in total fatty acid oxidation, but you can lose less body fat than somebody who's maybe oxidizing a little bit less, but their, their calorie balance

is different. So we really just kind of have to separate those two ideas. And that's what the research shows us too. And the idea I know that people who push the keto diet, sometimes something they'll say is they might give you that and say, yeah, sure, you need to be in a calorie deficit. But by eating a high fat, low carb diet, you're improving your body's ability to burn fat. And therefore, you're going to lose fat more efficiently given a calorie deficit and that hasn't really been borne out in the research though right no and in fact the the research suggests that either they're pretty equivalent you know whether regardless of what amount of your diet is coming from fatty acids for weight loss, the efficiency is pretty similar across groups. If anything, the research has maybe shown that a lower fat intake is actually more efficient for weight loss than a high fat intake. And there's been several studies over

the last three or four years that have kind of shown, you know, in very highly controlled settings that typically is the case from like a fundamental, you know, human biochemical perspective that that appears to be the case. They're either, you know, human biochemical perspective, that that appears to be the case. They're either equivalent or the kind of lower fat, higher carbohydrate intake may actually be more beneficial for weight loss. And why would that be for people wondering like mechanistically, because that goes so against the grain these days, like what you're saying that falling to lose fat most efficiently, I should be eating more carbs, not less. Yeah. And so what it really comes down to from what we can tell is it's kind of multifactorial.

One would be in kind of very tightly controlled settings. We see that the dietary fat is stored more efficiently than dietary carbohydrates. So if you just kind of think about it from like a fundamental biochemical perspective, if you consume carbohydrates and then you have to store it as fat, that carbohydrate has to undergo a pretty big transformation in the body, right? It has to be turned from glucose into fatty acids and that process requires energy. But if you take consumed fatty acids and all you have to do is kind of stick three of them together with a glycerol molecule and store it, that takes a lot less energy to do that. And so there's been some studies that have kind of quantified that efficiency. And storing carbohydrates as fats is about 15 to 20% less efficient than storing

dietary fatty acids as stored fat. So that's kind of why we see what we see in terms of the very fundamental perspective. And then there's also the factor though, right, of glycogen stores and that if you are low on glycogen, for example, because you did a really intense workout or something, that your body will preferentially top off glycogen stores before storing carbohydrate as fat, right? Yes. And that's kind of the order of operations in your body. The first thing you'll do is, depends a little bit, but primarily what you do is you'll kind of restore some of your liver glycogen first, because that's really the primary place that

maintains glucose homeostasis. And then you'll kind of top off your muscle tissue. And then, the rest will be either utilized for fuel for that day, or it will be kind of stored as fatty acids. But that storage is still pretty small. Yeah, I mean, I'm sure you've seen some of these overfeeding studies where it took, I remember in one it took, I think it was upward, it was like 800 to 1000 grams of carbs a day for a couple days before. I mean, you know this, but people have seen the processes to nova lipogenesis, the process to turn a carbohydrate into fat. So before that really started to kick in, I mean, these guys had to eat a ton of carbs. Yeah. And I've always wondered like, did they

just take these people to Olive Garden or how did you get somebody to eat that much? Cause that's like, that's an obscene amount. One of the guys who works with me did that. He wanted to do it eight weeks. He made it six weeks. It was the most absurd lean bulking program you can do both in the gym and outside gym. So in the gym, it was, I think he got it from knuckles and it was knuckles is like most ridiculous. This is going to kill you kind of program. And it was 30 to 40 hard sets per week for lower body and similar for upper body. Mostly so your lower body is going to be your squatting, leg pressing, deadlifting, a lot of leg pressing, fair amount of squatting, fair amount of deadlifting.

And I believe the upper body was a lot of bench pressing, some military pressing, and then probably some dumbbell work and some fun accessory work as well. But I mean, it was a ridiculous, it was a two a day. He was in the gym three hours a day and he was paying attention to his rest times. He wasn't dirtling around. He was trying to get his workouts done and just get out of there. So those were the workouts. He was eating a thousand grams of carbs a day and keeping his fat to like 60 grams. He was eating a loaf of bread a day. Every morning he would heat up a loaf of bread in our toaster oven and would eat that throughout the day. He was eating a huge bowl of pasta with low fat tomato

sauce for dinner, was eating a fair amount of fruit, had to keep his vegetable intake fairly low because you eat too many vegetables. Yeah, you can't, you don't have the appetite. And so, I mean, it was ridiculous. And again, so he's 23. So he's invincible. He's like, I might as well, this is the only time I'll be able to do something like this. So I might as well do it. And he made it six weeks until he, everything hurt too much, particularly his joints. He thought he could go eight weeks before deloading. And yeah, I think, I don't think there was a deload in there, but he made it six weeks. And when he lost, he didn't gain as much fat as you might think. Anybody listening, 5,000 calories a day.

Obviously, he was burning a lot of energy through his workouts, but still. And his fat gain was a bit lower than you might think just listening to what I just told you. And that was partly due certainly to keeping his fat intake relatively low, certainly burning a lot of energy and burning a lot of glycogen in these super intense workouts. So yeah, to that point, you can do it. It's just gross. It was, he's very much just a kind of routine discipline, who cares, do it kind of person. But by the end, he was like, I feel disgusting. All my joints hurt. This was fun, but I'm done. Yeah. And so when you see in those like

really obscene cases, you know, that there's not a lot of, you know, what we'll call de novo lipogenesis, it starts to tell you a little bit of like, okay, what's really going on in the human body? And where do we really actually see a lot of this, you know, fat gain and fat loss coming from? So that's been one of the interesting things about a lot of this research is it's kind of said, okay, you know, here's a really good, really good mental model of how to think about what actually matters for weight loss. And it's pretty clear at this point where a ketogenic diet per se doesn't have any magical weight loss properties. And we'll talk about maybe some potential benefits of it in a second. But that diet doesn't really have anything magical per se. The state of ketosis

itself doesn't have any magical weight loss properties either. So those two things, it's kind of like, okay, well, there's nothing magical about it, but that doesn't mean it's not, it can't be a valuable tool for some people in some circumstances. And what would those circumstances be? Because if there's no metabolic advantage and many people probably are not going to be generally as full as they would be if they were eating more carbs, I think that the research is clear on that as well, that most people are going to feel fuller eating more carbs. And especially if they're eating nutritious stuff that they should be eating and their carbs aren't just like sugar and candy and whatever.

Yeah. Pixie sticks. Yeah. Yeah, exactly. So then what would the advantages of the keto diet be? And I guess we can just stick to weight loss and then we can probably shift to health because that's kind of a different discussion. Yeah. So when we think about, you know, weight losses, we know there's a lot of things that really help dictate it. Adherence is a big one. There's appetite control. There is variety of food selection. And those are some of the big things that actually dictate in the real world how well

do people succeed at weight loss. And so we've done some literature review and kind of meta-analyses type approaches. And we've kind of looked at all of the ketogenic diet literature. And what we know is that adherence to a ketogenic diet doesn't appear to be any better or worse than other types of diets, right? Which is interesting. I would think it would be worse because it's not enjoyable for most people. I mean, I've never done it myself because I'm not interested in doing it, but I've heard from quite a few people over the years who have tried it. And it's rare for me to find someone who says they truly enjoy it. Yeah. And the sad part about that statistic is, is that it's not that the ketogenic diet's great.

It's that every other diet also has really horrible adherence rates, right? So typically, after the first six months, regardless of what diet you're on, adherence is about 50%, right? So it's not like there's this huge benchmark where it's saying, oh, yeah, it's as good as everything else. And everything else is 85%. It's like, well, they're all pretty miserable. So that's the first thing is it's from an adherence perspective, it's really no better or worse than anything else. Now, when it comes to like, what dictates people's, you know, calorie consumption of food behaviors is, food behaviors is having a pretty restricted food environment where you can kind of only eat a certain amount of things, on average, usually

reduces people's overall caloric intake, right? One is when you don't have a variety of foods, you just don't consume as much. And we've pretty much shown that in most of the scientific literature. So typically, people who adopt in practice a ketogenic diet, they kind of stick to the same foods. It's pretty restricted. There's not a lot of variety. So they tend to eat less calories overall.

You also, you just can't eat a lot of the stuff that people often like to overeat, right? Yeah, exactly. Right. So you've kind of removed a lot of those food environment things. And then kind of depending on which study you look at, and then also how you kind of practice a ketogenic diet, there are some approaches to ketogenic dieting where appetite is lower than other. Food satisfaction and appetite is better controlled with a ketogenic diet than other ones.

And those types of approaches typically look like, you know, moderate protein, very high vegetable content, and kind of moderate fat intake. protein, very high vegetable content, and kind of moderate fat intake. The ones where we see kind of poor appetite control and higher caloric intake is where we see people who'd have a pretty low protein intake and just a very, very high fat intake, right? Where they're getting most of their calories from nuts and seeds and bacon and really fatty cuts of meat and avocados and some of these really energy dense things instead of adopting a more... It's probably fairly low fiber then too, right? Yeah, fairly low fiber and a lot of the things that really dictate appetite control. And one of the most interesting aspects of kind of this area of the literature is, if

you look, a lot of the work was done on this in kind of the 1990s when they were kind of looking into the low fat studies, you know, the cardiovascular low fat studies of the work was done on this in kind of the 1990s when they were kind of looking into the low-fat studies, you know, the cardiovascular low-fat studies of the 1990s. And they really tried to quantify the effect of dietary fat on appetite. And almost across the board, as people increase their percentage of their diet from dietary fat, they increase their daily calorie intake. I mean, virtually every study that I've pulled up has shown that. It's not as satiating per calorie as a carbohydrate on average or as a protein on average. And it typically tends to cause people to consume more calories overall. And I think it's like for every 10% increase of your daily calories that comes from fat, it's about 150 to a 200 calorie a day increase of how much you're

actually consuming, which is really interesting. Hey, if you like what I am doing here on the podcast and elsewhere, and if you want to help me help more people get into the best shape of their lives, please do consider supporting my sports nutrition company, Legion Athletics, which produces 100% natural, evidence-based health and fitness supplements, including protein powders and bars, pre-workout and post-workout supplements, fat burners, multivitamins, joint support, and more. Every ingredient and every dose in every product is backed by peer-reviewed scientific research. Every formulation is 100% transparent. There are no proprietary blends and everything is naturally sweetened and flavored. To check everything out, just head over to legionathletics.com. And just to show how much I appreciate my podcast peeps, use the coupon code MFL at checkout, and you will save 20% on your entire order if it is your first purchase with

us. And if it is not your first purchase with us, you will get double reward points on your entire order. That's essentially 10% cash back in rewards points. So again, the URL is legionathletics.com. And if you appreciate my work and want to see more of it, please do consider supporting me so I can keep doing what I love, like producing podcasts like this. Adding some fat to a meal of let's say protein and carb will increase satiety somewhat, right? But it's just the gram for gram, you're not going to get the same bang for your buck as you will get with protein or carbs, which also just contain fewer calories. So if you're going for maximum fullness, fat is not the way to get there.

Of course, you need to have fat in your diet just for basic health reasons. And having some fat in the meals might make them a little bit more filling. But when you take out the carbs almost altogether, and you drop the protein, just replace it with fat, you just don't get that same fullness from the food that you eat, right? Yes, exactly. And quick question. So, okay, so to follow your whatever, I don't know if there are different flavors of the keto diet these days. I mean, the original keto diet, right, was a low protein, very high fat, low carb for people with seizures, if I remember correctly, right? Yeah. So the original use case for a ketogenic diet was in children who had epilepsy that was kind of untreatable with anything else. And what those

diets looked like is it was about 90 to 95% of their daily calories was coming from dietary fat. That was kind of the most extreme version and approach, but that was what was used as kind of a treatment for these children. And if you kind of look at that literature, that's a pretty extreme intervention for these kids. I mean, there was a lot of side effects and kind of adherence issues that came with it, as you can imagine. Absolutely.

And now what we have is kind of like a more moderate, almost like fitness-y kind of version, right? So it's higher protein. Where is that carbohydrate cutoff though generally supposed to be to maintain a state of ketosis? Because if you eat a lot of vegetables, you actually can get to a fair amount of carbs depending on what vegetables you're eating. It's not impossible to get to 75, 100 grams of carbs a day eating, and not that there's anything wrong with that, but just eating mostly vegetables, like cutting out all the quote unquote carbs that people would normally think, okay, I'm not going to eat the bread. I'm not going to eat the cereal. I'm not going to have the sugar and I'm going to replace it all with fruits. And I guess fruit you even have to be careful with, but even just vegetables, is that generally a concern or is the idea that, oh, well you can eat really as much vegetable as you want. You have to watch your fruit. Is there like a number that you're supposed to, I've always heard 50 grams. Like if you want

to follow a true ketogenic diet, at least as it's being promoted these days, you can eat a fair amount of protein. And I guess there's a debate over that as to the effects in the body and does it take you out of ketosis? I'd be curious to hear your thoughts on that. But then there's also the amount of carbs from any source. If you're going over 50-ish grams, it's not a quote unquote, like purest keto diet. It's one of those things where it's very context dependent. So if you're in a calorie deficit, you're more likely to be in ketosis than if you're in a calorie surplus, regardless of your carbohydrate to fat intake ratio. So that's kind of the first thing. And then the second thing is, it really depends a lot on what's your physical activity level, what is your kind of genetic predisposition. But on average, we published an article where we actually took all of the studies we could and we pulled out

all of the carbohydrate intake data and actually looked at levels of ketones in the blood. And what we see is, on average, anywhere below 100 grams a day pretty much increases your likelihood of being in ketosis. And that 50 gram per day mark is where we start to see it's pretty consistent that people consistently show levels of elevated ketones in their blood, you know, right at about 0.5 millimoles per liter. That's kind of operationally, you know, where that looks. So that kind of 50 to 100 gram range is for most people, when we talk about practical application, that's where most people will kind of fall into a state of ketosis. And that means then that like, you don't really have room for fruit. Maybe you could do an apple

or something, but if you're going to get just four or five servings of vegetables a day, that alone, I'd have to look. I mean, I do that. I have to look at my meal plan. Probably puts you at about 70 to 80 grams of carbs a day. And I don't eat necessarily carbohydrate rich vegetables. I'm eating broccoli. I'm eating onions, mushrooms, lettuce, stuff like that. Yeah. That's kind of for most people, if you're avoiding starchy carbohydrates, you're probably going to fall under that a hundred grams per day range for most people, as long as you're

not eating a lot of fruit. Not being able to eat quite a few of the foods that you like to eat. Are there situations where you still though would recommend it? Would it just be like, well, if you like it, then do it. Or maybe if you are very overweight and you're not exercising very much or some other kind of special circumstance where you'd say, actually, it might make sense for you to start here to try this. Yeah. So I'll recommend it in some regards, you know, usually what happens if I have a client who's, you know, pretty inactive,

pretty overweight needs to lose a substantial amount of weight and kind of high intensity physical activity is not anywhere in the near future. And they kind of like things super simple, they're not overly interested in, you know, tracking their calories. Those are somebody who I will say, okay, let's kind of adopt the principles of this diet, but let's not worry about tracking your ketone levels because it doesn't matter. Yeah. There's no reason to be dogmatic about it. So really what you're talking about is let's just cut your carbs down. Let's just focus on eating some fruit and some vegetables and some lean protein and some healthy fats. And you know that their calories

are going to come into more or less where they need to be to sustain a good amount of weight loss over time. And it keeps it simple, right? It kind of just gives them a menu like here, here are your guidelines. Just kind of eat these things and you'll be all right because nobody overeats green beans. Yeah, exactly. And if they're looking for recipes, I'll even maybe, you know, send them like, Hey, here's some good ketogenic dieting recipes just because it follows most of the principles. And that's kind of how whenever I've used it, I've operationalized it. Say, okay, here's the principles we want to follow. And here's how we implement them. Let's pivot now to health because I think that pretty much covers

everything on the weight loss front. It's pretty straightforward. And as far as the health side of things goes, there are quite a few extraordinary claims that are made about the power of being in ketosis and of ketones and why you should even be supplementing with exogenous ketones and so forth. So here's what we know primarily about kind of the health claims. Outside of very specific medical conditions, you know, such as epilepsy, there's no evidence to suggest that a ketogenic state is any more beneficial for disease management, for, you know, like cardiovascular risk management. There's been some claims about cancer. There's no evidence to suggest that as a standalone therapy that there's substantial benefit there.

And then when you talk about exogenous ketones, I think the thing that people need to realize is, one, these exogenous ketones, they basically tell your body that, okay, I can't store what I'm consuming in these ketones. So I need to metabolize them and I need to stop metabolizing, you know, my stored body fat and my stored body carbohydrates to metabolize these and get rid of them. So you're kind of putting the brakes on your own endogenous metabolism a bit, so to speak. Oh, that's

interesting. I didn't know that. So it prioritizes, it says, well, we need to burn these things before we burn this other stuff. Yeah. It's not dissimilar to alcohol consumption, right's interesting. I didn't know that. So it prioritizes says, well, we need to burn these things before we burn this other stuff. Yeah, it's not dissimilar to alcohol consumption, right? Okay. So where, you know, when you consume alcohol, your body kind of puts the brakes on some of your other, you know, substrate metabolism and says, let's just churn through this first. And that's just because it's a poison, right? It's like, we need to get this out. Well, yeah, it's more just because your body can't store it. So it's just going to be metabolizing it because it doesn't have the enzymes to put it in a storage form in your body.

So that's typically what happens. And then also there's been papers. One of the papers that Lewis Burke published, they actually did urine kinetics. And when you look at what happens is you either metabolize the exogenous ketones or you just pee it out. And a substantial amount of them are just peed out. So that goes back to the common criticism of multivitamins. Like, oh, you just like to have yellow pee. You just like to pee out a bunch of excessive amounts of vitamin C and stuff. Yep. Yeah. So your body will take what it needs and it will pee out the rest.

Interesting. And so on the point of some of these health claims in particular, what are your thoughts on, because something that I, and you hear this, and it is from a perspective of rhetoric and persuasion, it's a smart angle where somebody would say, and it might be somebody with, who has similar credentials as you, for example. So somebody who appears to have credibility and they'll say like, well, yeah, that's what the weight of the evidence says right now, but I'm ahead of the science basically. Like I'm so deep into this and into the physiology of it, into the mechanisms, I'm making a prediction and I'm saying that the evidence hasn't caught up yet. And I've just heard that in connection with some of the supposed health benefits. It reminds me of fasting, a similar thing where this is supposed to be like a powerful biohack for anti-aging is pushed a lot, right? Longevity is pushed a lot. If you think you're smarter than the rest of the world's smartest people, you either are very much the lone genius in the world or it's pretty egotistical. So, you know, the fact that you can be ahead of the curve, but most of the time what happens in the scientific literature is things are published three or four years after the actual studies are done. So the people who've published these studies are three to four years ahead of the people who are reading the literature and interpreting it and then, you know, positing ideas. So they've probably also carried on the next study to answer the question that you're

positing. So that's one thing to keep into consideration. And the other one is there's been a substantial amount of research done on this topic, right? Obviously not every question's been answered, but we do have a pretty good understanding of what the potential health benefits are, what the potential lack of health benefits are, and that anything that we do find that maybe is a much longer term answer is anybody's best guess, because we'd have to do studies for 30, 40, 50 years to see that, and nobody has that data. So people who kind of claim they know the answer are just guessing, right? It's like speculating in the stock market. Some people are going to be right. Some people are going to be wrong, but you're basing it on speculation.

Yeah, that makes sense. Are there any, it could be a health condition or it could just be something like achy joints, which happens in any circumstances under which you would recommend a keto diet. That is a common, I've heard people recommend like, oh yeah, if you're prone to having achy joints, doing a week or two of ketogenic dieting, maybe every month or two or something like that could help. What are your thoughts on that? And then are there any situations where you would go, you know, maybe even if it's not your every day, every month, every year, like the long-term diet bouts of ketogenic dieting might make sense for some people, or maybe it would make sense for that to be just kind of like their general mode of eating.

Yeah. And you know, my philosophy on that sort of thing is there's not a lot of evidence to suggest that there's a substantial amount of benefit, but there's also anti-inflammation is the just on the joint point, just interject. That's the thing that's commonly said, oh, well, the ketogenic diet is less inflammatory. And then that naturally is going to help your joints chill out. Yeah. And so what I would say to that is there's not a lot of evidence to suggest that's the case, but that doesn't mean people can't try it and see if they get a benefit, right? So it's kind of one of those things where just know going into it that this is not a cure-all for everybody for this condition. There may be specific things about you where adopting that approach is beneficial. People who have big

joint issues, you want to try it for four to eight weeks and see if there's a therapeutic benefit. I would have no problem coaching somebody through that. And I've done that before with people and say, okay, let's give this a shot. Let's see what the results are. If we do get results, how did it go? Some people have responded with some benefit and some people have made no difference. That's pretty true, I would say, of most kind of dietary interventions that are geared towards some disease state is sometimes they work, sometimes they don't. Sometimes we know why they work. Sometimes we don't. Sometimes it's placebo effect. So it's kind of one of those things where we have these fundamental principles and then there is some experimentation and kind of guess and check with your clients. And what about skin issues? Have you come across anything that in the literature

or dealing with people that's also a common thing? Like, oh, if you have acne or if you have rashes or different skin problems, then a ketogenic diet can help. Yeah. And there is some evidence to suggest that dietary manipulation helps a lot of those conditions. And sometimes it's not necessarily just the fact that it's gone kind of quote ketogenic, but they've just changed their dietary pattern, right? Maybe they've removed some food that's been causing them issues, some specific food, or maybe they've just... Like maybe it's lactose, right? That's a common, or just I think sugar as well, right? Yes. And we see that with people who go from a normal diet to a ketogenic diet or a vegan diet.

Yeah. Paleo or whatever. Yeah. And it's typically what happens is you just have a big shift in what's coming into your body, and that kind of changes your microbiome, it changes your metabolism, it changes some of the oils that your skin is producing, all that sort of stuff. So it can be due to the dietary manipulation. And it could be that adopting the ketogenic approach worked, or it could just be you're removing a certain type of food. Or maybe even adding, right, adding fats into your diet that were previously lacking. And that now has improved your skin health and your skin appearance.

Makes sense. So I guess as far as health goes, there's really, I think there's, you touched on the disease points. Those are things that are commonly spoken about, but there's no evidence to suggest that it's going to be an anti-cancer diet, for example. And that would be for somebody I would assume who doesn't want to get cancer or does have cancer. Because the two things are there's cancer and then type 2 diabetes are what I often see where it is recommended like, oh, then you should definitely be on the ketogenic diet. There's no medical indications except for some of these very sub-specialty things like epilepsy that there's really like an indication for. Type 2 diabetes, no special indication for a ketogenic diet. Cancer, there's no special indication for a ketogenic diet. There've been some studies that have been conducted and there's some that are

still in ongoing studies, but there's no definitive evidence to suggest that it's kind of an indication for any of those conditions. I see. Okay. Well, great. I think then you could probably just summarize on the health side of things is again, it kind of comes down to, it doesn't have to be an unhealthy, it can be an unhealthy way to eat just as any diet can, depending on how you go about it. But if you go about it intelligently, you can be healthy on a ketogenic diet, but you're not necessarily gaining anything over a balanced diet. So long as you're doing everything else that you're doing to maintain your health so long as you are staying active and maintaining a healthy body composition

and sleeping well and so forth would you agree with that absolutely 100 cool i think that's everything that we need to touch on then on the points of weight loss and health and if anybody listening is wondering why we didn't go over muscle building, it's because about six months ago, Eric Helms came on and talked specifically about that. So if you're wondering about the ketogenic diet and muscle building, I would suggest anybody listening, just go listen to that interview. Eric does a great job breaking down essentially this exact type of discussion, but all around muscle building. A lot of the same is, yes, it can work. It's probably not as good as a higher carb diet for most people, but you can make it work if you want to. And so that kind of just seems to be the theme all around with the keto diet, right? Is there's nothing particularly special about it. If you really want to do it, you can do it. If you like it, you can do it. certain condition that it happens to help, then great. That's of course reason to do it. But outside of those things, like there's no reason to try to force yourself into that straight jacket

just because Dr. Oz says it's the new miracle diet. Exactly. Anything Dr. Oz says you should take with a big grain of salt. Maybe just do the opposite. That should be the first assumption. That's a good heuristic. Maybe just do the opposite. That should be the first assumption. That's a good heuristic. That's a heuristic I use for life in general. What are the mainstream, what am I supposed to do according to media, entertainment, politicians, name it? And then I consider, what if I did the exact opposite? What would happen then? Your life would generally turn out better.

Oftentimes, you're looking at better outcomes, but no, I really appreciate you taking the time to break all this down, Brad. And let's wrap up with telling people where they can find you and find your work, how they can reach out to you. If you probably have a wait list for clients, but if they're interested in your services and you know, anything else you want the listeners to know about. Yeah. Awesome. Thank you, Mike, so much for having me really appreciate the chat and looking forward to connecting again. The best place you can find me, so I'm currently the chief operating officer at Macros Inc. We're a nutrition coaching company. So you can find us just at macrosinc.net. You can find me on Facebook or Instagram, just search my name.

I have a personal website that I've written articles at for the past several years. It's called sciencedrivennutrition.com. If you just Google me, I've written for Examine and T Nation and NASM and a lot of the big organizations and I've done some projects with Mike. So that's been a ton of fun that we've gotten to work together on projects too. So those are all the places you can find me. Awesome, Brad. Well, thanks again. And I look forward to our next discussion. Perfect. Awesome. Thank you. If you like what I'm doing here on the podcast and elsewhere, and if you want to help me do more of it, if you want to help me help more people get into the best shape of their lives too, please do consider supporting my sports nutrition company, Legion Athletics, which is currently holding its biggest sale of the year

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