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Nutritional Ketosis and Ketogenic Diets

I am the chief medical officer over to hell this is going to be the first of four stalks I'm going to be presenting on ketogenic diets and how they are effective and safe in treatment of various conditions this first talk will be an introduction to nutritional ketosis but led me to this field begin with was that I'm a recreational cyclists I like riding a bicycle long distances I've been doing it for over 50 years and very early on I discovered of this when riding a bike for more than an hour or two if I didn't eat when writing I would hit the wall which is what happens when the body runs out of carbohydrate when it's carbohydrate dependent and you feel really lousy in your performance drops and so I very quickly became a carbohydrate Advocate interesting ly that this time 5:40 or so years ago was when the Atkins diet first became popular and acting said you don't need carbs to feel well well well I was young. What's that out to prove Bob Atkins wrong and prove myself wrong it wasn't quite that simple because if you go on a ketogenic diet for a week or two weeks your performance those drop and so my experience had been only in short-term restrictions in carbs so we did a study that lasted six weeks and by the third week of the six weeks performances coming back up and by 6 to 12 weeks their performance was back to or above where they started the body becomes capable of burning almost all of its energy from fat in my research I can make a habit sometimes successfully I'm trying to prove myself wrong prove yourself wrong that's how medical advances were made if you assume there's some things right and you find out it's wrong you can change your understanding and change medical knowledge and that's something that I and my co-founder and collaborator dr. Bullock have made a habit of doing over the past multiple decades in this process back in 1980 I coined a term nutritional ketosis and another term keto adaptation so the first thing you have to consider when listening to someone talk about nutritional ketosis or ketogenic diets is how can you trust what they're saying the reason is that there are a lot of self-appointed experts out there but very few people in the medical Arena have much training in nutrition and most of them have absolutely no training or research experience in nutritional ketosis that is most people get their expertise by reading what other people have done now why should you trust me I mean I'm in MD and I can tell you I had no training and nutrition in medical school back when I went through that process but after I completed my medical education curiosity drove me back to school and I spent four years doing a PhD in nutritional biochemistry because I realize there were a bunch of paradoxes between what I was taught to believe and what the evidence seemed to present so after completing that my PhD I went on to do two years of formal training in clinical nutrition Simpson I published neighbors I've told all three books I've been studying and prescribing ketogenic diets for 40 years the first point I want to make is it nutritional ketosis is a very powerful tool when properly. But it's not simple it's not just a matter of cutting out carbs and the other point is that particular people have medical conditions is not always safe so my goal in in in presenting this information to you is to share the power of of the triple ketosis share the fact that it can reverse and and or prevent very significant medical diseases often times without or taking away the medications that are currently being used for those conditions with this power comes risk particularly as it relates to having being on medication cuz if you reverse the disease and you don't take away the medication you can have major side effects the other important point is that this is much more complex than just taking away sugars bread rise popped potatoes and other things to be safe it has to be much more scripted than that get in the diet right in front of the other nutrients in the diet is pretty complex and it's not something that a simple slide or even the simple talk is going to be adequate in order to do it safely and the other important point is there are some medical conditions where people should not do this type of diet and I'm in pause briefly and in this talk and more completely in than in labor talks let's discuss what's a ketone compounds that the body makes from Fast and the body meaning the liver makes two compounds from fat which are classified as I put this in there quote ketones and I won't get into the need to be made from body fat that is fat we've eaten before in-store door. That we eat and then this place through the blood after deductions are difficult to transport there in what are called lipoprotein particles and these are the things that you were measuring we measure cholesterol and triglycerides and things like that and because doctors were worried about these things you might imagine that having too much of a mess up is a problem will turns out that ketones when fats are in the liver are made in the ketones you no longer have to worry about lipoproteins cuz he's are water soluble particles they float to the blood they move into cells easily and so it's a much more efficient fuel for the body to use once it's in the bloodstream inadequate levels I can feed the brain can feed your heart and your muscles and I will mention in a few minutes you can do other important things as well now how do we know what can feed the brain while they were actually some less a dangerous experiments done back in the 1960s where patients who'd been fasting for a week so they had quite High Ketone levels within infused with insulin which drove the blood sugar down to an extremely low-level to the point where it should cause people to pass out and as long as there are ketones in the blood brain function just fine so we know that ketones are a very efficient and effective brand fuel we've discovered in The Last 5 Years that ketones are a very potent signal talk to our genes and some of the genes has talked to are the genes that protect us from things that we call oxidative stress or free radicals and this is really important because these are the root causes of a number of diseases including type 2 diabetes heart disease inflammatory bowel disease high blood pressure and also people with seizures often times have dramatic results when it's not so much about fuel as it is about reducing oxidative stress and inflammation and this is a very very important topic in terms of understanding how can you tell if dogs can be used to mark of the improve some chronic diseases we understand how they do it at the molecular level and this is important in terms of moving this field forwards and making Optimum use of the state we call Nutritional ketosis where did nutritional ketosis come from and why do we have to Define that as a term over a century ago. Figured out that when people whiz work but called type 1 diabetes 2 diabetes typically of younger folks where the pancreas stops making any insulin that all they aren't can't use glucose at all for fuel and the body over produces ketones do ketones build up to very high levels and that's called ketoacidosis when keep them build up the smell this that these ketones inside you know this is a uncontrolled diabetes and they realized that changes the acid levels in the blood and that's ketoacidosis but these are vastly elevated levels of ketones so figure the same number of Plenty would be extremely high level of ketones but if you're eating a well-formulated ketogenic diet your blood levels are not wanting your bug blood levels will be in the range of 5 to 3 so is 110 that very high level and yet if you eat say orange juice and bagel for breakfast after breakfast your Ketone levels will not be .52 3.1.2 so 1 and 10 times higher in nutritional ketosis and I'm tired of that is ketoacidosis and so we Define this state of nutritional ketosis as being a safe blood level where ketones function to feed vital organs in the body when you're not eating a whole lot of carbohydrate you can see it in the green zone between 5 and 3 or 4 that's what we call the optimum ketones are ketones have beneficial effects in terms of feeding the brain and other organs in the body and as you can see if you were in Portal starvation which we don't recommend because of negative effects on lean tissue and an organ function total starvation ketosis and you don't get anywhere near the risk of ketoacidosis about 10 these are very distinct States differential personal ketosis from diabetic ketoacidosis in the medical literature and we kind of assumed that we can just tell people to keep those are good for heart and muscle and brain that that would be a good thing but really exciting things have happened in the last five years the reason we know that this is it's not a rumor word-of-mouth there are some very solid scientific papers in the medical literature now indicating on chest and she looks like inflammation goes. We actually know precisely how the next optimize control for some inflammatory diseases let's kind of get to a little bit more practical information how does one get into diabetes or they're severely overweight or have hypertension very often those people have what we call insulin resistance that is their body has begun to lose its response of this to this hormone in which is the hormone that causes blood sugar to go into cells and also manages body fat metabolism so if you're insulin resistant you probably have to get your daily total carbohydrate intake down somewhere between 20 and 50 g of carbohydrate per day if you want to think about that and turn to macronutrients that's less than 10% and dropping times less than 5% of your total daily energy intake come from carbs and slept very card restricted and the more insulin resistant the person is the lower they have to go to initially get into a state of nutritional ketosis restricting carbs this is not a high protein diet protein like carbohydrates stimulates insulin production and exacerbates Insulin resistant so I have to be moderate in protein enough protein to maintain healthy function of our organs but not so much that it raises in someone's and then the other key point of a well-formulated ketogenic diet is this is not a calorie-restricted stop eating when you eat X number of calories per day this is a diet when it's done right is eating to satiety that is when you finish a meal you should be satiated and you shouldn't be hungry till it's time for your next meal and then when you do that if you're eating very little carbohydrate in moderate protein is the majority of your dietary calories have to come from fat and we'll come back to the safety issues around is it okay to eat that much fat to have my calories and the answer is yes and hopefully I can convince you of that later on the only thing that is very important in a well-formulated ketogenic diet is getting enough vegetables provide enough minerals maybe fiber to provide satiety from pills that you come from fresh real food and so we suggest three to five servings of non-starchy vegetables per day and I realize this is just an overview and something where are you need to understand the serving sizes they will you adjust the protein to the size and gender so a small woman is going to need less protein than a very tall guy there are variations in this that require individualization so this is not a cookie cutter or one-size-fits-all by I want to point out that there are lots of low carbohydrate diet out there but not all of them are either ketogenic or Tatian Sopris is a paleo diet or a primal diet or a low carbohydrate Mediterranean and certainly not intermittent fasting those do not how far they have their not sustained enough or they have too much protein so if you look at this slide here where the on the vertical axis it's the amount of carbohydrates as per cent per day and horizontal is protein you can see that the standard American diet I think s a d is a sad as a good term for that which is high in carbohydrate and moderate in protein and low in fat is way above a the low carbohydrate level if you cut some carbs out of diet add more fat that would be a Mediterranean diet but it's still not low carb but as a general rule most people in the nutrition field will call anything under thirty percent of calories is carbohydrate a low-carb diet and so a paleo diet carbohydrate and only 50% or less fat so it's not that high in fat but the combination of the carbohydrate and protein are enough that it prevents the body from making ketones and so that is not the fall into the ketogenic diet range so you can see that to get to a well-formulated Kinney Drugs and it's kind of a small island of keeping protein in moderation between red roughly 10 to 20% keeping carbohydrates under 10% so if you're 20% protein and 10% carbs and you're holding your weight stable that is after. Of time here and wait and maintenance that means the 70% of your pretty scary but that's how long does a ketogenic diet and that can be done not just for weeks or months that can be done for years and decades in the best way to measure it is 2 lb top prick your finger like people with type 2 diabetes or diabetes do to measure blood sugar in there a special strips for Ketone meters that can actually measure your blood ketones and they're very accurate and you don't need to do that forever you need to do that long enough to know what level you get to if you're eating a certain range of foods so one of the keys to success here is you have to be sure that this is safe if you do this and do it in a way that is not safer than your ulr part actually carry significant risk so as a general rule even if you're otherwise healthy and you just want to lose some weight or improve your energy level you should let your doctor know what you're doing if you have type 1 diabetes which is not a witch has a case where the body is not able to make enough insulin you'll need specialized medical support there are some people Advocate using this type of diet with type 1 diabetes but it takes a specially trained physician who knows how to do this to guide you and it's something that has to be done was very close to provide the same is true with type 2 diabetes but often times with type 2 diabetes we can get people off of some or most of their medications and again that has to be done by a physician but then the supervision doesn't have to be quite so close because you're no longer taking the medication security risk the third situation where you would need careful medical support and have your doctor be directly involved in what you're doing is if you have high blood pressure and your on cuz you getting off tonight we need to withdraw all those medication if you have a heart condition or if you have a significant liver or kidney disease that needs to have careful evaluation to see if you have enough function of those organs in order to be able to manage the adaptation to the Stars successfully most doctors aren't taught how to do this some of them will be and beware of Physicians who don't have the experience in doing this the final point about safety is this is not as I said not just not restricting carbs and protein important minerals include sodium if you don't have enough salt or sodium in your diet you'll have a bunch of symptoms which include lightheadedness dizziness fatigue when exercising and constipation and those are not side effects of nutritional ketosis those are side effects of not having enough salt it just so happens that when you're in nutritional ketosis your kidneys get much more efficient and you have to provide it on a routine basis in order to maintain that your well-being and function on this type of Lifestyle an additional mineral that's very important for heart muscle function is potassium and you got that from broth to get that from vegetables and you get that from eating unprocessed Meats we don't normally have to supplement that if you get the vegetables meat and hopefully make your own homemade broth in order to maintain adequate potassium intake 1/3 mineral we deal with a lot between people with diabetes is magnesium a mineral that most Americans don't get enough seems that people with diabetes have a significant problem maintaining adequate amount and a major sign of magnesium deficient or deficiency is muscle cramps weather after exercise a recurring at night and that's easily managed if someone is knowledgeable and how to replace magnesium but don't just accept cramps as a as a necessary effect of this that easily man by someone who knows how to do this other minerals include calcium for bones and and nerve and muscle function and that maintained by adequate vegetables Dairy and cheese and also from homemade broth we rarely have to supplement calcium people when they have the normal food intake that's appropriate for a well-formulated diet and vitamins are sometimes it concerned cuz I'm not eating or not eating enough fruit and where my vitamins going to come from and it turns out that vegetables are an excellent source of the vitamins that you would normally a tribute to fruit so you find a people don't need additional vitamins with this but if if one wants to take a Multiverse standard multivitamin it'll do no harm but probably not necessary is a healthy normal metabolic State this is not something that you should only do for a week or two at a time because longer is unsafe know this is something one can do for money years and decades it's achieved by reducing sugar and refined carbohydrates in most starchy foods but in the meantime you're eating real foods then plenty of foods and even those Authority this is as I mentioned a very effective disease reversing way of living and if you have diseases that can be reversed with this you need medical supervision for today for taking medication for those diseases because the good news is you have to take him away the bad news is if you don't take him away he can have serious side effects so it has to be monitored by a knowledgeable position to do this right, it results in improve well-being and function and the knee thing is this is not a calorie-restricted approach you don't have to go away from the table hungry Natural Instincts Empower you to succeed when you do a well-formulated ketogenic diet that happened when one goes in the nutritional ketosis and across the top on the left hand side are fat cells where we store energy that energy can be released by the brain we can put the heart on their other interesting thing it appears to feed the justice system which is intriguing and reduces inflammation and inflammatory bowel disease often times get better on a well-formulated ketogenic diet clearly ketones and fast can feed the muscles but it also reduces inflammation including many people with asthma notice that their symptoms get better there's emergency science not on people but in little worms grown in test tubes and in mice grown in cages that pay well for me to Jack. Actually improve longevity by reducing oxidative stress and then many athletes now and again during South Bay to go beyond Marathon distances like triathlons or long distance running more extreme and duration Sports their turn into a ketogenic diet because the body can run mostly on fat and the person doesn't run out of energy and doesn't hit the wall so it again this is a has a multitude of effects many of them best beneficial but I want to get across the idea it always has to be done under adequate with adequate information that adequate supervision to be safe..................................... thank you .