What Is The Best Approach To The Ketogenic Diet?

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.

Hello everyone, I'm Kaya Perowne, one of the producers of the Doctor's 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 Diulus.

So humans are like hybrids, right? We can run on carbs or fat.

On glucose or ketones. Or ketones. So we're, you know, we are born with this amazing machinery that allows us to be metabolically flexible. The concept which I've tried to popularized 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.

I have a clue that you're probably doing something good.

Exactly. 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 bodies to turn on certain enzyme or enzyme systems and upregulate certain gene systems that will build the metabolic machinery to burn fat at a higher rate and more efficiently. And how that, 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 big--.

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've got to have your orange juice. That's right. And then that sets you up for a horrible day. So we go back to this, you know, I want to, if I want to develop metabolic flexibility, I have to take away the carbohydrate as a source and kind of 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. So, 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 gonna 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. So you're talking about the five fiber 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. Or a vegetable. Any vegetable. I mean, 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's 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 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. 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 with 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 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 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 around the corner.

You'd use that fat for energy.

You'd use that fat for energy. And that's how the system's designed. 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, 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. And that's- which is what is 50.

Grams in terms of a food? For like a bagel?

Yeah, pretty much like a bagel with some jam on it and you're already over the top. 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 to find.

Could you have grains and beans?

No. So you don't have grains and beans on a keto diet. Now we'll talk about what peatoh looks like. Or paleo keto or what are we gonna call it? Your paleo version of keto, what's it gonna be? Kegan.

Kegan.

Kegan 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.

It'S just 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 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. You don't want to combust.

So people have a false idea about, you know, 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. you know, 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, you know, 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, because 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. Caryn Diuluis shared that a vegan keto diet has been the best approach for her when it comes to managing type 1 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 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.

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 soy beans, lupini beans. Hemp seeds are a great source of protein and you can make a ton of really delicious things that way. And I did it thinking, all right, I'm gonna do this for a little while. Yeah, not only is she a big.

Surgeon, is she 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 are inflammatory markers and things like that got better that I've 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, 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 want to add fish back.

And you supplement with things like fish oil.

B12 and algae oil for the omega-3s.

Yeah.

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. Carrie Diulus. Until next time.