The Peter Attia Drive - Qualy #43 - What are Peter’s thoughts on fasting and ketosis for females?

Episode Date: October 17, 2019

Today's episode of The Qualys is from podcast #26 – AMA #3: supplements, women’s health, patient care, and more. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/   Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/  Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD 

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So without further delay, I hope you enjoy today's quality. What are your thoughts on fasting and ketosis for females? Well, you know, again, it's a real tough question because I find all questions of nutrition to be so individual that it's hard to answer them sort of in a one-size-fits-all, sort of one-stop-shop approach. That said, I think there are a couple of things women need to be thoughtful about. If any woman is having an issue with fertility,

I couldn't make a case, I can't make a very compelling case for nutritional ketosis if a woman is trying to get pregnant. And I'm sure this is just going to piss off a lot of the keto herd, but because, of course, if you're in the keto cult, you believe that ketosis is the optimal state for everything, including, you know, global warming. But the reality is if you look at the FGF levels and also if you just think about it from

an ancestral standpoint, the higher the level of ketone during our evolution, the more likely we were separated from food. And the more likely you're separated from food. And the more likely you're separated from food, the less genetic pressure you should have to be reproducing at that point in time. And this concept is so well preserved in biology. I mean, we had a great discussion with David Sinclair recently to talk about this. And it's even true in the case of the certuans, which would be one of the more important regulators of our aging and including our reproductive stress. So I think when you look at the FGF21 data and the ketosis data, there's a very, and I

don't want to bastardize this because I wish I'd known that I was going to be asked this question. I would have looked up the paper. It's from a researcher in Texas. I think he's a, he might be at UT Southwestern, but he's, if you search, you know, and his name's, first name's David. I'm blanking on his last name, Beans of an M though. But if you... Mangle, Mangle's dwarf.

Yes, yes, that's him. I saw him present at a meeting once and it was remarkable data that looked at the differences in a male and female brain in the presence of changing FGF-21 levels. And it was so cool to see this difference. The pituitary gland is one of the very few pieces of tissue in the body that has what's called portal circulation, the liver being the other one. So the pituitary has a direct connection via the pituitary stock to the hypothalamus. The long and short of it is in a calorie restricted state when ketones are elevated, it suppresses FSH and LH and women, but not in men. This is super interesting to me, and it has a profound evolutionary, I mean again, maybe I'm just

making up a story to fit this, but if we're going to subscribe to any of Ockham's razor, this would be a great application. In a period of famine, you would want women to stop reproducing. You would want to shut off FSH and LH. You would want men to have no impairment on their testosterone level. That's all the more time that they should be out there and able to get food. So again, I've always been kind of a little bit careful

of suggesting that a woman who's trying to get pregnant be in ketosis. Now look, I know what's gonna happen. Everyone's gonna say, well, I got pregnant when I was in ketosis, yeah, obviously it's possible. I mean not suggesting it's not, but if we're talking about optimization, the second thing, of course, is should a woman be in ketosis during pregnancy? And the answer is, I simply don't know the answer. Clearly, we evolved with mothers being in ketosis and having children.

I mean, it's being possible for our species to be here. If mothers were not in ketosis during pregnancy, I mean, we didn't have buffets. But that said, is it optimal? You know, again, just because something happened in sort of our evolutionary time history, does that mean it's optimal? No, almost not at all. So it's a general rule. And again, I don't like to make general rules when it comes to nutrition. I'm not convinced it's necessarily the best strategy, just like I don't think it's the best strategy for kids, unless they have seizures or something else, for example. So, you know, a far better strategy is just like,

don't eat junk food, you know, don't eat sugar, don't eat highly refined carbohydrates, but, you know, should one restrict carbohydrates to the point where they're in ketosis as a very deliberate act. I'm not convinced that's the case. And of course, when you start to look at things like maternal diabetes or gestational diabetes rather, that's where it gets a little tougher because ketosis can be a very effective

tool for treating type 2 diabetes. Gestational diabetes is not type 2 diabetes, but it has some of its features. So again, I really, I hope there are some obstetricians out there who Spend a lot of time on this problem because it is a huge problem. There are many women who go through this my sister I probably have talked about this in the past and I don't think she'd mind me talking about it And if she does I'm in trouble, but you know my sister had an operation when she was quite young that took out two thirds of her pancreas So during her first pregnancy she got gestational diabetes Which was to be expected because she had like a third of the insulin producing capacity two thirds of her pancreas. So during her first pregnancy, she got gestational diabetes, which was to be expected because she had like a third of the insulin producing capacity.

And then it happened again during the second pregnancy. And then after that second pregnancy, she actually got type two diabetes. Over the course of a year, going on a ketogenic diet, actually working with a company called Virta Health that I'm an advisor to an investor in, although that is unrelated to the fact that my sister was getting care from them, she'd lost 50 pounds. Her hemoglobin A1C went from somewhere in the 12s to in the 5s in the course of a year, and then she got pregnant again. Well she decided to go off the ketogenic diet, but still be much more diligent and strict, and despite that, she still requires insulin during this third pregnancy. I suspect she'll have a much easier time recovering following

this pregnancy. But one of the things that's been frustrating, which maybe goes back to this, the question prior to this is her obstetricians, like, they have no insight, like they have not a thing to offer her as far as how she should be thinking about managing her blood sugars, other than just crannicam or insulin into her exogenous insulin. And this is why context matters and there's no bumper sticker. You could have the question, thoughts on fasting and ketosis for females. You could have somebody with the constellation of abnormalities that is metabolic syndrome, insulin resistant, type 2 diabetic, and maybe

for that person, their fertility might be an issue. And going on a ketogenic diet may get them in a healthier state. Yeah, exactly. It might actually improve their fertility because of the inflammation and all the other stuff that could be happening as a result of what you just mentioned. So, yeah, I, I, well said, I hope you enjoyed today's quality. Now sit tight for that legal disclaimer. This podcast is for general informational purposes only does not constitute the practice of medicine, nursing or other professional health care services,

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