The Dr. Hyman Show - What Is The Best Approach To The Ketogenic Diet?

Episode Date: November 6, 2020

What Is The Best Approach To The Ketogenic Diet? | This episode is brought to you by ButcherBox. We have all heard a lot about the benefits of the ketogenic diet in recent years; it has been shown to be an effective tool for weight loss, controlling and reversing diabetes, and improving brain function and overall whole-body health. So how does it work? Is it necessary to eat lots of meat and dairy if you are keto? And do you need to be keto forever to reap its benefits? Dr. Hyman explored these questions in his conversations with one of the leading voices in the Paleo/Primal and keto movements, Mark Sisson, and with Dr. Carrie Diulus, who has found a vegan-keto diet to be the best approach for her when it comes to managing type 1 diabetes and maintaining a healthy weight.  Mark Sisson is the founder of the popular daily health blog, Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/Paleo, keto, and Whole30-friendly kitchen staples. Dr. Diulus is an orthopedic spine surgeon, vice chief of the medical staff, and director of the Spine Wellness Center at the Crystal Clinic, in Akron, Ohio. Prior to that, she was both a spine surgeon for the Center for Spine Health at the Cleveland Clinic and also a medical director in their IT department. Dr. Diulus’ surgical practice focuses on minimally invasive spine surgery.  Her clinical interest involves strategies for improving patients’ musculoskeletal health and surgical outcomes by improving metabolic health with dietary and exercise strategies. She has type 1 diabetes and has published and is involved in ongoing research at Boston Children’s on the use of a low carbohydrate diet in the management of type 1 diabetes.  This episode is brought to you by ButcherBox. Right now, ButcherBox is offering new members a free turkey with their first box. To take advantage of this special offer from ButcherBox, just go to ButcherBox.com/farmacy. Find Dr. Hyman’s full-length conversation with Mark Sisson, “Do You Have To Eat A Ketogenic Diet All Of The Time To Get Its Benefits?” here: https://DrMarkHyman.lnk.to/MarkSisson Find Dr. Hyman’s full-length conversation with Dr. Carrie Diulus and Dr. Ethan Weiss, “Is It Possible To Be Vegan-Keto?” here: https://DrMarkHyman.lnk.to/DrEthanWeissDrCarrieDiulus

Coming up on this episode of The Doctor's Pharmacy. A lot of people who first come to keto do so because they, I heard that I can eat 4,500 calories a day and not gain weight. You know, and I'm like, well, yeah, some of the science shows that, but that's horrible. Hey everyone, it's Dr. Hyman. One of today's episode sponsors is ButcherBox. Now, one part of my life that I'm consistently grateful for is good food. It helps me take care of my health and preparing tasty meals is one of my favorite ways to show love for people in my life.

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for Doctors Pharmacy listeners. Just go to butcherbox.com forward slash pharmacy. I know you'll love ButcherBox as much as I do. And now let's get back to this week's episode of the Doctors Pharmacy. Hello, everyone. I'm Kea Perot, one of the producers of the Doctors Pharmacy podcast. The ketogenic diet or keto as it's called has gained a lot of popularity in the past couple of years. But what does it really mean? How does it work? Do you have to eat loads of meat? What if you're vegan? Can you also be keto? Dr. Hyman recently dove into all of these questions

in his recent conversations with one of the leading voices in the paleo and primal and keto movements, Mark Sisson, and his conversation with orthopedic spine surgeon, Dr. Cary Dioulas. So humans are like hybrids, right? We can run on carbs or fat, on glucose or ketones. Or ketones. So we are born with this amazing machinery that allows us to be metabolically flexible. The concept, which I've tried to popularize over

the past couple of years, metabolic flexibility basically means you can derive energy from the fat stored on your body, the fat on your plate of food, the carbohydrate on your plate of food, the glucose in your bloodstream, the glycogen in your muscles, or the ketones that your liver makes. Those are some— So you've got a lot of options. You've got a lot of options.

And if you become metabolically flexible, the body goes, you know what, I don't even care where the energy comes from. I'm not at the effect of shifting my energy switch over from ketones to carbohydrates or glucose to glycogen. The body becomes adept and efficient at burning enough of these different substrates under different circumstances that it becomes irrelevant. I mean, the main thing is, how do you feel? And if you feel great and if you feel good and energetic, then I don't care. That's a clue that you're probably doing something good. Exactly. So back to what is a ketogenic diet.

A ketogenic diet is a diet that basically recognizes that we have not set ourselves up to become good at burning fats. And so we need to eliminate that one fuel that we've sort of relied on relentlessly for 10,000 years, that regular supply of carbohydrate at every meal. And if we reduce or eliminate carbohydrates for a certain period of time, the body responds, the epigenetic response of the body to turn on certain enzyme systems and upregulate certain gene systems that will build the metabolic machinery to burn fat at a higher rate and more efficiently. And what that looks like is that we have these little powerhouses in our muscles and other cells that are called mitochondria. And that's where the fat combusts. That's where

the fat burns. Well, people who are what we call sugar burners and are reliant on carbohydrate every couple of hours to get through the day, they never really, the body just has no reason to build more of these furnaces, of these little powerhouses. And so you get by with, as long as you continue to eat, you know, a breakfast of waffles and or pancakes and or toast and then have a bagel. The American breakfast is basically sugar for breakfast. Sugar for breakfast.

And, you know, promoted by then the cereal industry and Anita Bryant back in the, you know, you got to have your orange juice. That's right. Oh, yeah. And then that sets you up for a horrible day. So we go back to this, you know, if I want to develop metabolic flexibility, I have to take away the carbohydrates as a source and kind of prompt, gently prompt my body to respond by becoming better at burning fat. And we call it fat adapted.

And when you become fat adapted and your muscles start to get comfortable burning fat as the primary source of fuel while you're moving about your day, not just sitting around doing nothing but while you're walking and then eventually while you're exercising. And you get to the point where you can derive 85%, 90% of your energy requirements from fat if you become good at this. Your body fat or the fat you're eating? Exactly, your body fat or the fat you're eating. Exactly, right. Yeah, but when you become metabolically flexible,

you're able to derive all this energy from your stored body fat. And then an amazing thing happens, which is the liver, when you withhold carbohydrate, which becomes glucose eventually through the digestive process, when you withhold carbohydrate— And just to be clear for people, when you say carbohydrate, you mean refined starchy carbs. You don't mean broccoli, right? Okay, so we can make that distinction. I mean all carbohydrates, but I'm going to put a big asterisk by broccoli and say that when you go keto, you can eat as much vegetables as you want.

That's right. Okay, so green leafy vegetables. And they're all carbohydrates. They're all carbohydrates, but they're locked in a fibrous matrix. So what we're talking about is how accessible is the amount of sugar or the carbohydrate that you take in real time to the body. And if it's made less accessible because it's locked in a fibrous matrix, as in the case of broccoli, that's fine. Or any vegetable. Any vegetable. I mean, but, you know, for picking on my favorite vegetable. So you not only become good at burning fat, but then the body starts to, you create these ketones

in the absence of glucose. And people would typically say, well, you know, I'm feeling woozy because my blood sugar's low. My brain isn't working because my blood sugar is low. That's why they feel like they need to have a meal. That's why they feel like they need to have a snack because they get, you know, they have these wild blood sugar swings throughout the day because they've been so dependent on a regular supply of carbohydrate to keep their glucose up. Well, when you cease doing that for some length of time, the body gets wise. And the brain goes, well, look, I know how to burn ketones.

I just haven't done it for a long time. So the brain becomes quite adept at deriving energy from ketones. So the brain, let me put it one way, which is that there is no dietary requirement for carbohydrate in human nutrition. Yes. So you should just unpack that because there are essential amino acids for protein. There are essential fatty acids from fat, but there is no such thing as an essential carbohydrate and we don't need them. Correct.

Now, we don't need them and I'm not suggesting that we should never consume them, but the reality is we don't need them because we have this elaborate and elegant mechanism that takes stored body fat and, in the absence of any food, allows us to live for five, six, seven days, not just survive, but thrive and be mentally alert and to be willing and able to hunt for the source of food. Because remember, throughout most of human history, we didn't have three square meals a day. We had food, and then we didn't have food. And so the design of the system, and again, this elegant system, phase one of the system says, the brain, when it comes across food, you've got to overeat because you don't know where the next source of food is going to be.

And so when you overeat, you take the excess amount of energy that is in the food and you store it as fuel that you get to carry around on your body. By the way, conveniently located right over the center of gravity, the belly, the butt, the hips, the thighs. It's such an elegant system that we would be able to carry this fuel with us for long periods of time and not worry about, oh, my God, it's noon and I'm going to get hangry because there's no food around or there's no deli nearby, there's no taco truck. You have the ability to use that fat for energy. You just, you'd use that fat for energy, and that's how the system's designed. So, unfortunately, we get to today where we've lost the ability to so we're very good at storing fat and we still are wired to overeat but because i mean yeah there's like

200 genes that protect us from starvation yeah but none that help us deal with abundance and excess so it's an artifact of civilization so we kind of have to override that with our cognition but one way to do that again is to use a ketogenic way of eating for some period of time. Again, not necessarily for the rest of your life. What is keto? Define keto. So keto to me is cutting carbs back to 50 grams a day or less. Which is what is 50 grams in terms of a food?

Like a bagel? Yeah, pretty much. Like a bagel with some jam on it and you're already over the top. You know, or any, like if you got rid of bread, pasta, cereal, rice, cookies, candies, cakes, sweetened beverages, sweetened drinks,

and all you had was, oh my gosh, real food. Broccoli, Brussels sprouts, cauliflower, salads. You would be fine. You would be within that 50. You'd be hard-pressed. Could you have grains and beans? No.

So you don't have grains and beans on a keto, on a true keto diet. Now, we'll talk about what keto looks like. Keto, okay. Or paleo keto, or what are we going to call it? Your pegan version of keto. What's it going to be? Keegan. Keegan, okay.

It's a Keegan diet. At the end of a couple of weeks, though, you have shifted your metabolism to one of greater efficiency and... So it takes like three weeks to adapt to it. You need to make sure you have enough fluids and sodium and magnesium because otherwise you feel the keto flu. And some people still get the keto flu, but it's not like the flu. You feel achy and tired.

That's your brain going, where's my glucose, dude? And until the brain kicks in and says, wow, these ketones are amazing. The liver can make up to 750 calories a day worth of ketones. Wow. Like, chew on that for a second. That's unbelievable, right? The liver makes ketones. The brain thrives on ketones.

The brain prefers ketones. Yeah, the brain does way better on fat than on sugar. Well, on ketones, yeah, because the brain doesn't burn fat, but it burns ketones. Ketones, which are derived from fat. Are derived from fat. So you have this substrate, this fatty, this fat substance that then can become combusted by itself as fat. Part of it can be used to actually make glucose if needed. That's why you don't have an external need for carbohydrate and glucose.

And then you can make up to 750 calories a day worth of ketones. And so when you become this closed loop, this closed system, the only reason you need the amino acids are for structural, for repair, for building and repairing things. Not to make sugar. You don't want to combust. So people have a false idea about keto, that it's all like steak and bacon and cream and all this stuff. It's not necessarily that.

No. In fact, you can eat too much in the way of, well, I mean, a lot of people who first come to keto do so because they, I heard that I can eat 4,500 calories a day and not gain weight. And I'm like, well, yeah, some of the science shows that, but that's horrible because that's a bad idea because, first of all, if you want to burn off your stored body fat, eating 4,500 calories a day will never tap into your stored body fat. That's just trying to prime the pump with this external source of fuel that's fat

that's circulating through your bloodstream. And that amount of calories, because you're not generating insulin, which is a nutrient storage hormone, the nutrients have nowhere to go. The body has to figure out, how do I burn this stuff off? How do you know if you're doing a ketogenic diet properly? Well, the main thing is, can you go a meal or two, skip a meal or two, and just feel just fine? And if you can, you're—

It cuts hunger. So when you have ketones, it cuts your hunger. The number one benefit from all of this is getting control of hunger, appetite, and cravings. That's what everyone reports when they finally hit that keto zone. Many people connect the idea of the keto diet with eating lots of meat and dairy. But in her conversation with Dr. Hyman, Dr. Keri Diula shared that a vegan keto diet has been the best approach for her when it comes to managing type one diabetes and maintaining a healthy weight. Initially, I was doing protein powders and things like that, because that's what I could get down. But now it's been several years now, and it's

blossomed into, you know, I eat a lot of the same things that people on a ketogenic diet eat in the sense of the macros and the vegetables. So lots of non-starchy vegetables, broccoli, asparagus, Brussels sprouts, kale, you know, cauliflower. All of those with healthy fats like avocado, olives, olive oil, nuts and seeds. And then the protein sources are things like edamame, tofu, black soybeans, lupini beans, you know, hemp seeds are a great source of protein. And you can make a ton of, you know, really delicious things that way. And I did it thinking, all right, I'm going to do this for a little while. Yeah, not only is she an orthopedic surgeon, she's a biohacker, but she's a great chef and makes the most amazing keto foods. So I did it for a while. And a bunch of lab markers that, you know, are inflammatory markers and things like that

got better that I'd been struggling to bring down. So my high sensitivity CRP, which is a marker of inflammation, improved. My lipid profile improved. So I've been sort of riding it at this point where I've said, you know, I will keep doing plant based low carb until I run into a reason to consider it. And I may I mean, four minutes from now, I may add fish back if there's reason that I, you know, want to add fish back. And you supplement with things like fish oil and B12 and algae oil for the omega-3s in the sense of, I mean, anybody, a lot of people need to supplement with B12, but anybody who's fully plant-based needs to supplement with B12. There's no perfect diet for everyone and each person needs to find what works best for them.

As Dr. Hyman says, your body is the best doctor in the room and it will tell you what works and what doesn't by how you feel. Regardless of what diet you follow, it is always important to focus on the quality with an emphasis on real whole foods over processed industrial junk. I hope you enjoyed today's episode. If you'd like to learn more about anything you've heard, I encourage you to check out Dr. Hyman's full-length conversations with Mark Sisson and Dr. Keri Dioulas. Until next time.