Everything You've Always Wanted To Know About Ketosis But Were Afraid To Ask.

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Foreign. Hey folks, it's Ben Greenfield and I've got a question for you today. Do you know what the similarities are between epilepsy, type 2 diabetes, obesity, cardiovascular disease, metabolic syndrome, polycystic ovarian syndrome, irritable bowel syndrome, heartburn, fatty liver disease, Alzheimer's, Parkinson's, dementia, mental illness, schizophrenia, bipolar, depression, narcolepsy, sleep disorders and cancer, autism, migraines, chronic pain, brain injury, stroke, and chronic disease. I know that was quite a list. But everything that I just listed has been shown to be affected in some way, and usually positively affected by a low carb, high fat, ketosis based diet. And my guest today, Jimmy Moore, is going to tell you all about this. So first of all, Jimmy, welcome to the show.

What's up, Ben?

Not a whole lot. So for those of you who don't know who Jimmy is, he's like one of the world's leading low carb diet bloggers and podcasters and he's been on this show before. Last year he wrote a book called Cholesterol Clarity, which he penned with Dr. Eric Westman. And I believe Eric worked on you with this other book as well, right, Jimmy?

He did, yeah. He's my co author again.

Gotcha. And Dr. Westman is a practicing internist. He's a low carb diet researcher. And in the podcast episode that I did with Jimmy last year, we talked about the shocking truth about cholesterol and why you probably don't even need to test for cholesterol. I'll link to that in the show notes for this episode, which you can grab over@BenGreenfieldFitness.com but Jimmy's back now with this new book that pretty much answers everything you've always wanted to know about ketosis. It's called Keto Clarity, your definitive guide to the benefits of a low carb high fat diet. I just started to read it and haven't finished it yet. But basically Jimmy shows you in the book how a low carb diet goes way into more than just what we all think about it for, which is to lose weight, but also produces a pretty powerful therapeutic effect on a lot of the things that I was talking about earlier and can also be a pretty cool biohack for physical performance and for mental performance. So we're gonna delve into some of the stuff that Jimmy talks about in the book today and kind of get into everything you've always wanted to know about ketosis, but maybe we're afraid to ask. So, Jimmy, thanks for coming on, man.

Yeah, man. This is my heart and soul the last few years, so let's bring it.

Yeah. And that's what I actually wanted to talk to you about, was that, like, you started this whole thing off with an n equals 1 experiment in nutritional ketosis. And I'm curious. You delve into it in pretty good detail in the book, but can you give us kind of an overview of what your N equals one experiment actually was?

Yeah. So I've been eating Low Carb since 2004, very famously, lost £180 that year on the Atkins diet, and did very well. And then over the years, it slowly started coming back on again. Some of the weight and some of the health issues. Nothing major, but some things that showed up in blood tests. And I was going, okay, what's going on here? I'm eating low carb. I should be losing weight. I should be controlling a lot of these health issues, and the blood markers should be just beautiful. Unfortunately, they were not. So in 2012, I read a book called the Art and Science of Low Carbohydrate Performance. Who I know you're very familiar with Dr. Jeff Folich and Dr. Steve Finney. And in there, they talked about measuring for blood ketones and this concept known as nutritional ketosis. And I was like, all right, nutritional ketosis and blood ketones. I've only heard of urine testing for ketosis, and I've heard of ketosis, but didn't know what this nutritional ketosis was. So it turns out through manipulation of the various macronutrients, you can produce ketones in the blood, which is the active ketone body that you're looking for. It's called beta hydroxybutyrate. And if you do that, then you're able to find all these benefits, which you know yourself. Ben, goes well beyond shedding fat. It's the mental clarity, the hunger control. I mean, we tell all about it in keto clarity, but just bunches and bunches of great benefits that you get from doing this. So I put it to the test. I had gained some weight. I had had some trouble with the sleep and had trouble with various aspects of my health. And so I started putting myself into A purposeful state. Testing daily, morning and night, sometimes multiple times, every hour on the hour. Testing. Yeah. I was one of those people doing the test for a year. And at the end of the year, I lost a pretty good chunk of weight, and I noticed all the intangible benefits. That's what really caught my attention. It really made me spontaneously start to intermittent fast, which was providing me side benefits. I never intended to intermittent fast. It just happened because the ketones were satisfying me so much. So, yeah, it was pretty spectacular. And it was that experiment that I said, you know what? I need to tell people about some of the lessons I learned from all this. I need to go find some great experts like Ben Greenfield to be a part of this project. So we had 22 total experts for Keto Clarity, plus myself and my co author, Dr. Westman. We think we put together a pretty definitive guide to low carb high fat diet that unfortunately has never been written. There's been books out there about weight loss for ketosis, and there's books out there with epilepsy, but really, nobody's ever kind of come at it from a total health perspective. And here's the bigger thing that we're hopefully answering with this book. Nobody's ever given you a practical guide about how to get there. And so hopefully that's what Keto Clarity does.

Yeah. And that's actually something I wanted to ask you, was you talk about how to get there, and you've got some things that we haven't talked about before in this podcast before. And by the way, for people listening in, like, we have talked about ketosis before. I've got an episode with Dr. Terry Wahls. There's another episode we've done with a guy, a researcher, named Dominique d', Agostino, and a few episodes with Peter Attia. And I'll put links to all those if you want to listen to them over@BenGreenfieldFitness.com KetoClarity But, Jimmy, one of the things that you talk about first is that you have to find out what your carbohydrate tolerance level is.

Yes.

Can you explain what the carb tolerance level is exactly and how people can find out what their carb tolerance level is?

Absolutely. By the way, Dr. Wahls and Dr. D' Agostino are both experts in the book as well. So, yeah, carb tolerance is kind of a sliding scale from person to person. I mean, you're a real fit guy, Ben. You probably haven't had a whole lot of metabolic resistance issues in your Life, unlike a man that you're talking to right now that used to weigh 410 pounds and has, you know, issues from the past that rear their ugly head even all these years later. So you have to figure out what your personal carb tolerance level is. Now you might say, well, how do you do that? Well, well, we give some major steps in the book about how to do that. First of all, if you have no clue and you just want to tinker around, go down to 20 and on a week by week basis, just up it 5 to 10 grams each week and see how you do, you know, and somebody like me, my tolerance level is right around 30 grams. I can do 30 grams of carbs and be fine, but If I do 50, 60, 80, 100, I know I'm going to run into problems. Whereas somebody like you.

What do you mean? Like, when you say problems, what do you mean?

Weight regain, hunger, cravings, irritability, mental fog starts to come back in.

In other words, when that stuff happens, are you out of ketosis?

Yes, that's where I was going. In other words, it's a telltale sign that you're not producing ketones, which is kind of the purpose of limiting those carbs. You're trying to get into ketos.

Yeah.

Interesting. Another way you do that is look at your triglycerides. People have their cholesterol panel run. I know we did a podcast on this last year, but one of the telltale signs that you're eating way too many carbs for your tolerance level is your triglycerides will come back over 100. Now your doctor.

So it's more the carbs than the fats that are gonna rise. Triglycerides. Like that.

Exactly. Carbohydrates is probably the number one reason for hypertriglycerolemia, which is high triglycerides. And so you want to get that level optimally under 70, but definitely under 100. If you're over 100, you probably should titrate back on your carbohydrates. And that's one way you can find that tolerance level. And then another thing is the blood glucose monitor. Those are so ubiquitous, everybody in America and around the world should own a glucometer and test your blood sugar. And if you eat a given food and your blood sugar rises well above 140 and doesn't come back to baseline within two hours, guess what? That's probably not a very good food for you to be consuming either. Especially if it's a carbohydrate based Food, you need to bring back the carbs. So practical ways for people to do it. Very easy testing to do. And you can find that carb tolerance level. First and foremost, it's the K. We did an acronym in the book keto. It's the K and keto keep carbs low.

So when. Oh, by. By the way, I should mention I. I just pre ordered this Q. I think it's called the Q Me device. It was like QMe.com or something like that, but it'll allow me to test glucose and triglycerides and that type of thing with, oh, wow, a drop of blood in my iPhone, so.

Oh, I need one of those, dude.

Yeah, and I've used those. I think you were using breath ketone monitors in the past.

I was actually using urine ketones originally when I first started Atkins, and then I switched to the blood ketones during this one year experiment and only recently, in like the last eight to 12 months, I've been tinkering around with various breath ketone meters. There's actually several that are on the way. There's one being in development in Japan right now for your smartphone that you'll be able to blow into. And yeah, this is emerging technology that I think by the year 2015, 20, late 2015, early 2016, we're gonna see breath ketone meters on the market.

Cool.

I like it very ubiquitously.

So this whole carb tolerance level thing, though, it's gonna change for athletes, right? I mean, and the reason I'm asking that is just because, like, for me, training for Ironman and like, I've had some days where, you know, I'm out there doing hardcore exercise for, you know, three or four hours some weekends, and I can eat a ton of carbs and still be in ketosis. So when you were writing this book, did you find any general consensus among athletes and, you know, crossfitters or extreme exercisers about what worked for them for carb tolerance levels?

Yeah, certainly athletes are a different beast than the rest of us mere mortals, as I'll call it, because you can tolerate more. And I think just the physical being able to burn off those carbs gives you a little bit more leeway, more ability to handle more carbs. Unfortunately, most people out there aren't those elite athletes like your hardcore listeners of this podcast are. And so I wrote it specifically for them in mind. But yeah, if you're an athlete, you know, keeping your carbs to your tolerance level, it's going to be a bit higher for you, especially if you're primarily being a sugar burner. And you want that to fuel you. You know, you want to be eating more carbs. And I know you actually told me on race days that you want to fill up the glycogen stores, but you're still a fat burner, you're still producing ketones. So you kind of got a healthy mix of both.

Yeah, well, and to clarify on that, like by filling up the glycogen stores, a lot of people see that as like pancake breakfast and pasta feeds. And for me, filling up the glycogen stores or keeping them from getting total exhausted during the race, all that means is like I'll use about a hundred calories, which is like a fourth of what you'd see recommended for carbohydrate intake during exercise. And I'll take in that hundred calories from Superstarch. I use this stuff called you can Superstarch, which is a super slow release starch. And then all my other calories come from MCT oil and amino acids. And then the only other thing like for, for a super long day like an Ironman triathlon is I'll add in around 100 calories or so of like a solid food like a gluten free bar at the end of each hour or something like that. But it's still like it's a drop in the bucket compared to like I used to go for, for a day like an Ironman, I'd eat almost 50 sports gels like the fructose maltodextrin based gels, nuts and, and you know, you just get fermentation and free radicals and all sorts of nasty stuff going on.

Yeah, I remember interviewing Timothy Allen Olson on the Living La Vida Low carb show. He's an ultra marathoner, very successful one. And he said the same thing, that he used to have multiple of those goos in an hour and now he's lucky if he uses that in a two, three, four hour period. You really don't have to have as much when you're fueling your body primarily with the fat now.

Yeah. And now what I'm using for some of my spartan races is just nut butter. And that works pretty well too.

Yep, that sounds good.

So yeah, it is. So you also talk about something in addition to this carbohydrate tolerance level called a personal protein threshold. How's the personal protein threshold fitted into this?

Yeah, that's the O in keto overdoing protein is bad. I think a lot of people don't realize and we're going to talk about some mistakes I made in my low carb diet. And this is one of the biggies that people make, is they automatically, oh, well, if I keep my carbs low, then I can eat all the protein and fat I want. Well, unfortunately, for the purposes of ketosis, if you are sensitive to carbohydrate, you're probably gonna be pretty sensitive to protein, too, which requires you to not go too heavy on the protein. Now, I know the media likes to call a low carb diet a high protein diet. It's really not a high protein diet. Never has been. By definition, a ketogenic diet is one that is high in fat and moderated. So when we're talking about finding your personal protein threshold, that's what we're talking about. Don't go overboard on the protein. And you might wonder why. Well, there's this long g word that we talk about in the book called gluconeogenesis. And if you consume too much protein for your body to use, guess what happens to the excess? The liver says, hmm, let's turn that into glucose in the body. And so it's not the same necessarily as eating carbohydrate, but it does produce the same results. It will kill your ketones. So moderate down that protein. Now, I told you, my tolerance level for carbs is right around 30. My protein threshold is right around 80 to 100 grams of protein in a day, which is what, about 6 ounces of meat, maybe for the whole day? And I'm cool with that. I just then supplement it with lots of fat, and I'm good to go.

Okay, so you were talking about measuring blood glucose and measuring triglycerides to kind of get an idea of your carb tolerance level. Is there something similar for proteins? Like, are you measuring insulin or something like that?

Yeah, you certainly can measure insulin. That helps with that. Yeah, I mean, there are different things that you can do for. For measuring for your protein threshold. I think getting the carb tolerance down first, and once you dial that in, then you look at the protein and you can use those same parameters. Look at triglycerides, look at blood sugar, because it will show up in your blood sugar. If you're overconsuming protein, that'll shock some people. They'll be like, wait, wait a minute. Protein's not supposed to raise my blood sugar, just carbs. Protein can do it, too, if you're doing it in excess.

That actually shocked me the first time that I realized that. And this was like, a few years after I'd Gotten out of school, where I'd studied nutrition and had a personal training certification and everything. And then I saw data that a steak can jack up your insulin levels higher than eating, like, a loaf of bread, which is crazy. And that's when I started to realize that maybe protein isn't the best way to kind of hack yourself into stable blood sugar levels. One question I have for you, and I don't remember seeing this anywhere, but you may have looked into this. Have you ever investigated the difference between some of these hydrolyzed protein sources like collagen or gelatin or branch chain amino acids or amino acid supplements, versus, you know, protein from meats and fish and things of that nature?

You know, I didn't look at that specifically because most people, if you can just get them to eat meat without freaking out, that's probably half the battle. So. So, no, I haven't actually investigated that.

Yeah, I was just curious, just because from. From the data I've seen, it's a little bit less insulinogenic than.

Oh, wow.

Than whole protein. So it allows an athlete, for example, to be able to get enough amino acids on board to repair muscle without actually jacking up insulin levels. So that's something.

Dr. And would, by extension. Would, by extension, be more ketogenic, too.

Yeah, exactly. So let's say. Let's say, because we have a lot of athletes that listen in, it's evening, and you don't want to go out of ketosis or you don't want to jack up your blood glucose or your insulin levels, you could do for, like, an evening snack, maybe some coconut oil, a little bit of nut butter or something like that. But then to add in even more amino acids, rather than doing, like, whey protein or protein shake or some meat, you can just use, like, amino acid powders or amino acid capsules or use, like, you know, an organic gelatin source or hydrolyzed collagen or something like that, and you get amino acids without. Without all the. All the protein calories and the insulin response from protein. So.

Wow. I'm gonna have to look into that now. You got me curious.

Yeah, there we go. Your next book can be called Protein. There you go. You got some word other than clarity that rhymes with protein. So the next thing is fat. And one of the things that you talk about is how much of the total amount of fat that you eat can be saturated fat. Can you get into that? Because obviously, there's a ton of different types of fats, like avocados and olives and olive oil and seeds. And nuts and butter. And it's like, how do you decide what kind of fats are gonna be the best fats to eat when you're on a ketosis based diet?

Well, the two that are thethe very, very best that you want to be gravitating to are the saturated fats and the monounsaturated fats. So saturated fat is butter, meat, cheese, whole food, you know, fats, real food fats, like God made them. Monounsaturated fats, avocados, olive oil, avocado oil, macadamia nut oil, that kind of stuff. You want to be consuming those kinds of fats, the ones that we've been told are healthy. And I know we talked about this with cholesterol clarity, the vegetable oils. That is not the kind of fat we're talking about. So please do not hear this podcast and go out and run it out and buy a big jar of mayonnaise and put it on top of everything, because that's pure soybean oil. It's vegetable oil. Fats, highly inflammatory. You're gonna be, I guess, counterproductive to what you're trying to do to get healthy. And definitely with everything that you're doing, it's all the real food based fats. So we're not doing fake fats.

I think people probably know though, that vegetable oils are bad. That's kind of. It's pretty common knowledge.

Your audience knows that?

Yeah, my audience does. But if my audience is, is looking at, say, like, how much butter should I eat versus, you know, extra virgin olive oil? Is there like a percentage out there, like the, the actual percentage of saturated fat that your diet should be as a percentage of, like your total fat intake?

You know, I think it's going to vary from person to person because we all have different kind of like the carbohydrate tolerance level and the protein threshold. I think we all have to figure out what fats are gonna keep us fuller, what fats are gonna allow us to intermittently fast for hours on end. What are the fats that, that you need to feel satisfied? I'm kinda infamous because I carry around Kerrygold butter with me everywhere. When I'm sure you saw me at Paleo fx, you know, I'm sitting there eating my meal with like a half a stick of Kerrygold butter, and people are like, is that really good? I'm like, for me it works because I need that amount to keep me satisfied, to give me all the benefits of ketosis. But for that fat, I can't get the ketosis that I need.

Okay, so do you know if there is any number out there in terms of just like, how much saturated fat is too much?

Yeah. People ask that question, what is too much? And my answer is generally, if you throw up, you probably ate too much of it. I think it's going to vary. I think, you know, tinker around. And that's a major thing we put in the book. Ben was, you know, don't ask me about macronutrient ratios. You know, I eat kind of 80, 15, 5, but that doesn't mean you need to eat 80, 15, 5.

Maybe you can get them 80% fat, 15% protein, 5% carbs.

You got it. And then like my wife, for example, she can eat like 55% fat, 30% protein, and the rest carbs and still be in ketosis better than me. So it's gonna vary from person to person. You kinda have to tinker around with this and find what's right for you. And that's kind of the overriding theme we tried to communicate in keto. Clarity.

Okay, got it. Yeah. I wish I had the number in front of me, but I think somewhere Dr. Paul or Paul Jaminet goes into perfect health diet, he has some percentage, and I want to say it's between like 20 and 30%, like, in terms of saturated, of, like, your total fat intake, not your total diet, but your total fat intake should be saturated. So it's like, roughly like a third to a quarter, I want to say, is what he goes into in his book. But I don't have the number right in front of me right now. But if anybody's listening in, you can check out the it's the perfect health diet book is the book in which they talk about that a little bit. So, Jim, you talked about, or you kind of alluded to mistakes that people make when they're doing nutritional ketosis. And in your book, in chapter 10, you go into five low carb mistakes. And this is kind of a. It's actually a topic near and dear to my heart because I wrote an article a while back about, like, four mistakes people make on a low carb diet. And I find that people read that article and they think I'm like, an enemy of low carb diets. That's not the case. I'm just like, be, be careful. But whatwhat were youwhat were the mistakes that you found that people make when they're eating a low carb diet?

Yeah, andand these were all mistakes that I personally made. And then Saw over and over again in emails from people, we already talked about the protein 1. Definitely over consuming protein because we've all thought it was a high protein diet. So people are like, okay, chicken breast is okay. Eh, eh. You gotta back off on the chicken breast, guys and eat more of the fatty meat. So that was a big one.

I tell all my clients if they're gonna eat chicken breast, they have to drench it in mct.

And even then you're still getting an absolute amount of protein that is probably gonna kick you into gluconeogenesis. So yeah, yeah, it' sit's gonna be problematic. Another big problem, and we kind of alluded to this one as well, is you rely on the urine ketone test strips. If I get one email over and over and over again, Ben, it's this. I'm testing with the sticks and the sticks tell me I'm in ketosis, but I'm not feeling any, any different. I'm not losing weight, I'm not feeling, I'm hungry and blah, blah, blah. And I'm like, how are you testing for ketosis? And oh, with the urine. Is there any other way? Yeah, there actually is. So that's when I point them to the blood ketones and then they start testing blood and they see they're 0.3. Well, that's below the level of nutritional ketosis. And so you've got to stop relying on the urine ketone. And the other thing the urine ketone test strips do for some people is once they're keto adapted, you lose your urine ketones because the acetoacetate becomes beta hydroxybutyrate, goes out of the urine and it starts spilling in the blood.

So you just get better at utilizing ketones. So your urine shows fewer ketones.

That's right. And so that freaks people out because they think, oh, well, I'm not doing well. So then they start trying to, you know, change things when they're doing just fine, they're feeling fine, they got all the hunger control, all the cravings under control, ketosis is rocking and rolling, and yet they're not getting that verification about it on the urine strips. Which is why in the book we have a whole chapter on why urine's probably not best. Blood right now is the gold standard for testing. But there's emerging technology with the breath being pretty good too.

Okay, got it. What are a few of the other mistakes people make?

Yeah, and we've talked about this one a bit too. Not eating enough saturated and monounsaturated Fats. And I'm probably, probably gonna be writing a blog post on this soon. But I think we are fat starved nation. We have for far too long been told fat is the enemy in our health, and we've obediently, you know, cut down on it. Even those of us who know fat's not harmful, I think maybe subconsciously in the back of our minds, we still aren't eating enough saturated fat in our diet and monounsaturated fat. So if we ate more of those things, ketosis would happen so much easier. That's why I have a little bit of butter in just about every bite of food that I eat, because I want the benefits that I get from having that fat in my diet. And all these years we've cut it, it's time to add fat back, baby.

Nice. Yeah. It is kind of interesting how, like, even me having been in ketosis and having done the low carb thing for a while, like, it's still. It seems hardwired into the back of my brain sometimes, this whole, like, fat phobic thing. And I think it, for me, it's from back in the days when I was a bodybuilder and you would literally strain your cottage cheese and your yogurt just to make sure that it was as fat free as possible. It's weird because my kids have grown up on sardines and butter and oil and avocados, and they'll just like, you know, they'll eat a piece of beef and just like, eat all the fat around the bone and not even think twice about it because they haven't been brainwashed, basically. So it's really interesting. Okay, so you've got more mistakes that you talk about in the book, but I want to just cover a couple other things that you discussed in the book that I think would be helpful for people. One would be in chapter 14, you go into 10 reasons you might not be producing adequate ketones. What are some of the reasons that people might find that they're not producing ketones? Because obviously, the whole idea here for the therapeutic and the brain and the performance benefits is you want ketones. So if people aren't producing adequate ketones, what's keeping them from doing that?

You know what? I think the biggest one is? And I believe it's number one in that chapter. People just assume if you're low carb, you're just automatically gonna be ketogenic. And I've seen that on some of the forums that are out there. They're like, well, I'm Eating ketogenic, I'm like, what does that mean? I always ask that go, what does that mean? Well, I'm just keeping my carbs low. You do know that's like one leg of a three legged chair, three legged stool to get into ketosis. Being low carb does not automatically mean ketosis. Now most people can probably eat 50 grams or less of carbs and find ketones. And I'm sure in 2004 when I did the Atkins diet, I wasn't exactly measuring everything, but I bet I was producing adequate ketones to be seeing the results that I did. But it's not an automatic thing. So you have to be mindful that it's not just low carb. You really do have to moderate down the protein and eat plenty of fat with that low carb. That really is the trifecta that helps you get there. Gotcha. Another one is people just assume they're in ketosis because they're eating the low carb and they're not really testing. So if you're not testing, it's like not stepping on a scale. How much do you weigh, Bench? Well, I don't know because I don't step on a scale. So if you don't test, there's no way for you to know. So you kind of have to test. If you're not testing, that might be why you're not producing adequate ketones, because you're in the dark. You really don't know how well what you're doing is helping you or not.

Have you ever. And this is something that I kind of thought about a little bit when you were talking about how being in ketosis isn't just about eating low carb. Have you ever run into folks who have used like these liquid ketones to still eat lots of carbs and somehow fill up their bodies with ketones that way?

Yeah. And with MCT oil and ketone esters and all these other beta hydroxybutyrate salts. I've heard all these things.

Yeah, like there's this supplement called Ketoforce and yeah, like you can actually buy like from labs, beta hydroxybutyrate salts. And have you ever like. Do you talk about that much in the book or is that something that you run into much?

Can I just tell you, I think those products are counterproductive to what we're trying to communicate in the book because I think they can be helpful in a short term need for energy for like an athlete like yourself. I think in the short term they can be amazing because those Things. I'm not sure about some of the other ones, but I know MCT oil can boost the ketone levels in your body for like a two to three hour period, and then they're gone. It doesn't stay sustained. I would much rather see somebody try to pursue ketosis nutritionally through manipulation of the macronutrients. So the carb level low, the protein level moderate, and plenty of fat, and do it naturally without the need for those things because I think overall and in the long term, you're going to see more benefits from doing it. Yeah. Okay. Those other things can allow you to have a few extra carbs, a little more protein than you would have. But what are you really trying to do here? Are you trying to artificially raise ketones or are you trying to do something therapeutically that's gonna be natural and sustainable over a long period of time? I'd rather have the latter.

Yeah, I think you make a good point that, like, the exception would be athletes, for example, who may not care about the health benefits of keeping chronically elevated levels of blood sugar at bay and may just want to, like, for example, ketones. I don't think we've talked about this yet on this podcast, but ketones are a preferred fuel for the diaphragm, for the heart, for a lot of these tissues that you're getting used. Yeah. During endurance activity, for example. So like marathon or a triathlete or something like that. And you could technically still eat carbs, still eat whatever, a couple of energy bars an hour, and you take something like beta hydroxybutyrate salts and also be dumping ketones into your body and kind of have, from a performance standpoint, the best of both worlds, but from a health standpoint, all those things that you talk about and that I opened up this podcast with, in terms of health benefits, you're not getting those if you're not keeping blood sugar levels low. Right, right.

And I think that's a hallmark of true nutritional ketosis, is you're gonna have elevated levels of ketones in the body, but that also comes with a simultaneously lowered level of blood sugar. And I haven't personally tested to see what would happen. Testing for, you know, like with MCT oil or some of these other products. We were just talking about ketone esters, beta hydroxybutyrate salts. What would happen to your blood sugar at the same time? Does it stay elevated or does it go down in response to those higher ketones from these means? I don't know the answer to that. Do you know?

No, but I bet I see no reason why it wouldn't stay elevated.

Right.

Because ketones don't by nature mean that your blood glucose is low. You could technically have high levels of circulating ketones and also high levels of circulating glucose. The two are not going to cancel each other out necessarily.

Well, and definitely for type one diabetics, that's kind of the issue du jour is ketoacidosis is the hallmark of very, very high blood sugar and very, very high blood ketones. And we could talk about that if you want to. Kind of the difference between what we're talking about with nutritional ketosis and that diabetic ketoacidosis, two very, very different metabolic states.

Ketosis doesn't mean ketoacidosis, you mean.

Right, that's exactly right.

And what's the main difference between the two? Just to clarify, for people.

Yeah. So if you have any beta cell function at all, with your pancreas being able to squirt out insulin into your body, guess what? It's impossible for you to get into ketoacidosis. This is only for people who are type one diabetics and those truly insulin dependent, type two diabetics who cannot make any insulin at all, they have to be wary of diabetic ketoacidosis. And what that is is extremely high levels of blood sugar in excess of 240 and then extremely high blood ketone levels reaching closer to 20 millimolar on the blood ketone. Now, the highest reading I've ever gotten on blood ketones is something like maybe 6.7, I think was my highest reading, but my blood sugar at the same time was like 63. So the hallmark of nutritional ketosis, though, by contrast to diabetic ketoacidosis, is you're going to have that lower level of blood sugar in conjunction with a moderately high level of ketone. So I got Nowhere near the 20 millimolar with my 6.7. But the biggie was my blood sugar was lowered. So that's a huge one. I know people worry about that. And one of the chapters in the book, we kind of take on all the criticisms that the major health organizations have about ketosis and they all call it a dangerous toxic state. Well, they're talking about ketoacidosis and they're extremely right that that is a dangerous state, but that's not what we're talking about with nutritional ketosis.

Yeah, yeah. It's a really good clarification. That's a good explanation of it too. So in your book you go into like this 20 day kickstart keto meal plan. You've got some low carb, high fat recipes in there, good food shopping list, bunch of cool stuff. And I know that some people, they don't like to necessarily hear me talk about diets to manage disease, but really, I mean, I wouldn't bring this stuff up just off the cuff if there wasn't some really good research behind it. And you guys go into this research in the book now. One last question I wanted to ask you, Jimmy, was the emerging areas of research on the use of ketones, like what are you starting to see, folks looking into now for ways that ketosis could be used or the effect that ketones have on the human body that are things we're going to be hearing about in the future.

Oh man. This is the most exciting part of the whole book and we go through it thoroughly. In chapter 1816, we kind of give an overview of how to look at studies and which studies are most important. Because just because the news media highlights a headline that talks about a quote study doesn't mean that study really means anything to humans. So we kind of give a here's how to read studies primer at the beginning of 16, we also share the strong evidence for ketosis. In that chapter, chapter 17, we look at the good evidence of things we have up to one year. Strong evidence is anything we have two years and beyond. Good evidence is up to one year. But chapter 18 with the emerging areas that you were talking about, this is so exciting because there's so many areas of our health that could be improved with a ketogenic diet. It just needs to be proven in a scientific control, clinical trial, things like cancer. This is a big one. I'm actually going to be moderating a panel at the Ancestral Health Symposium on this very subject of ketogenic diets and cancer. They've never done a 90 minute panel discussion on any topic before, but they're giving us 90 minutes for this one. So we're real pleased we're going to have some of the leading voices on this on that panel. Dominique d', Agostino, as you mentioned earlier, as well as Colin Champ, Dr. Colin Champ from Pittsburgh. So yeah, that's a big one. Autism is another one that's kind of emerging now. Fibromyalgia and migraines. I know one that Rob Wolf talked about at Paleo FX was traumatic brain injury. This is a big one as well. And there's several examples of that. People who have seen improvement with that I know. Dr. Terry Wal is wanting to do a ketogenic version of her diet to help people with traumatic brain injury. Gum disease, tooth decay, acne, eyesight. Interestingly, my wife Christine went pretty darn ketogenic. And she has been blind in one eye since birth and pretty bad vision in the rest. In fact, she was supposed to be totally blind by now. She found the year that she got hardcore ketogenic, her eyesight for the first time in her entire life. Life got better. She didn't have to. She actually had to change prescriptions, but in the other direction because it got so much better. And we think it's because her blood sugar got normalized and. Yeah. So we need more research on these kinds of things. Als, Lou Gehrig's disease, multiple sclerosis, aging. I know that's a big one of. One of my experts, Dr. Ron Rosedale, talks about aging quite a bit. Kidney disease, on and on and on. I mean, there's so many issues that this really needs more testing in the coming years, and I think we're gonna see it. Hopefully books like mine at least spur and shine a spotlight on the need for that more research and the quality research. Let's stop looking at mice and thinking, thinking it means something to humans. Let's do human studies. Let's help these people. That could be helped with a ketogenic diet. The. The anecdotal evidence is there now. Let's prove it in the lab.

Yeah. Cool. Cool. This is a really good book. It's the most comprehensive book on ketosis that I've seen before. So keto clarity is what it's called. I'll put links in the show notes to some of the previous podcasts I've done with Jimmy and some other experts on ketosis over@BenGreenfieldFitness.com ketoclarity I definitely recommend you grab this book. Pick it up. I mean, even if you're not interested in ketosis, you're going to learn a lot about just like, fats in general. And it's a really, really good primer on kind of how the body deals with fatty acids. So really good stuff. And, Jimmy, thanks for writing this and for coming on the podcast, man.

Thank you, man.

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