Dr. Stephen Phinney - 'Interactive Workshop – Optimising LCHF for Weight Loss and Health'

so salt is another one of those yeah dangerous thin ice places to go as a physician because the standard of care is at least in the u.s. is still less salt is better and that yeah I think our current u.s. recommendations are for two point three grams of sodium per day and that's based on preventing coronary disease and mortality and people with hypertension which is a minority of the population so the assumption is that in order to treat that minority the whole majority should do the same thing and so there's there actually was a I think I was going to turn out to be a classic watershed study published in two years ago in the New England Journal of Medicine by a group at McMaster University in Hamilton Ontario and it's based on data from what is called the pure P ure study and that's a study of dietary and lifestyle factors in a couple hundred thousand people in 17 different countries and they did something novel around assessing sodium and health rather than asking people so how much salt did you eat yesterday keep a record and write down all the salt you ate and how much salt is there in that Thousand Island sauce right you know the sugar withdrawal isn't quite as many grams of sodium but you have to read the back of the label and measure precisely in you know people particularly in real life daren't going to do that kind of measurement and it's notoriously inaccurate so what the McMaster group did to assess how much people so they salt ate yesterday they had them get up in the morning and pee into a cup now that doesn't measure all of the urine output the last 24 hours but they did the study where they took people who collected at 24 hour carefully done 24-hour urine collection which does reflect sodium intake because we don't store now have a place to store reserved salt in our body it's either in the circulation of the fluid between the cells or it's out of you and when they do that morning voice first void morning analysis and showed that the correlation with the 24-hour urine is very close then they took they got morning voids from a hundred and two thousand people in 17 different countries and then followed their health statistics for the next three point nine years I'm plagued by being able to remember numbers like that what they found was that the level of sodium excretion associated with the lowest mortality was not 2.3 grams so it wasn't 1.5 and there are some sodium mavens that our National Institutes of Health in Washington DC or say we should all be 1.5 it's even better needing to one of the lowest mortality was seen between sodium sodium excretion is between 4 & 5 grams per day now this was published in somebody's obscure blog somewhere as an opinion it would be worthless fact they've got managed to get through the review process through than one Journal of Medicine suggests that there is some credibility to these numbers so and then there have now been similar studies done in groups of patients with mild to moderate congestive heart failure congestive heart failure leads to fluid buildup in the lungs and and the edema swelling in the lower extremities of the body and our treatment for decades if not longer has been salt restriction and then use diuretic medications to make the body clear salt and water out of the body and for those people the standard has rigid standards been 1.5 grams of sodium intake per day and what they find is people who eat 1.5 in grams of sodium per day versus people leave 3 with similar degrees in this chest of heart failure guess what guess which group has the higher mortality 1.5 and that's now published so the this myth that less salt is low salt is good and even less is better is you know had that bubble is you know scientific least has been burst the problem is how do we push that knowledge out to healthcare practitioners you know who you know got their education twenty thirty like me forty years ago and that's the challenges is how do we move this into the the knowledge base of the people at the practicing level failure patient facing practical level so that's the general population for a low carbohydrate diet particulate ketogenic diet it's been known for at least fifty years that there was a phenomenon which used to be called the natural recess of fasting not really if you've ever learned Latin is the latin term for sodium and naturist means excretion of sodium is accelerated during fasting and it also is true when you're in nutritional ketosis so kidding the kidney handling of salt changes markedly when you be get into the key to adaptive state it accelerates the excretion of sodium which means you're even more vulnerable to the side effects of not enough sodium so you know when you're on ask so what about salt how much it has to be individualized but our typical approach unless somebody has very significant hypertension or severe edema that hasn't responded to a well form of the ketogenic diet is unless those that small percentage of our of our patients bubi toes criteria everybody else we start with five grams of sodium per day if you don't Eve used to have three or less you will have all those side effects and symptoms that on the web is frivolously called the Atkins flu and I guess Bob Atkins can be blamed because he really didn't get that I've been preaching sodium to prevent that since nineteen eighty and he put a bunch of other of our other stuff in his books but he didn't did never really managed to get his head around that one so three grams or less you'll have lightheadedness dizziness rapid onset fatigue when you exercise to feel palpitations fatigue and pass out under heat candy heat stress conditions I'm going to put a patient on my think who'd lost quite a few pounds and looked much better in a bikini and she had before and she went out and joined some people in a hot tub without having had any broth or bullion that day and every time she stood up to get out of the hot tub she'd pass out and finally I get a phone call herself out from the hot tub say what can I do and we had to have someone go to the restaurant and get her a cup of broth and yes and besides lightheadedness dizziness fatigue and potential for passing out the other one is constipation say well how does salt prevent constipation I've seen more fiber eat more bulk but this the colon is a aggressive water recovery organ and if you don't have enough circulating volume in your in your circular blood volume in your circulation it will cause excess fluid retention from the from the colon and cause hard stools and that causes constipation and I've had people say I didn't believe you I was sure you were completely full of crap figuratively speaking but I tried it and it worked until getting enough sodium is actually a very simple solution how much is too much well if you look at the curve on mortality for from the pure study even up to 8 grams a day the rise in risk going up to 8 grams a day is less than the rise in risk going to 2 grams on the earth and the other idea of the direction so there's actually a fair degree of safety in that range as long as you don't have severe hypertension or severe fluid retention and the best way to deal with those initially is to do nutritional yow get into nutritional ketosis and the Natura sis of fasting is far better than a lot of the drugs we use the diuretic drugs we use treadmill applies fluid but that was a bit of a tirade let me ask the gentleman here what yeah yeah sodium chloride is 40 percent sodium 60% chloride so when JEB folic and I look at fat circulating in the blood we look at biomarkers of what the body has done with fats and carbohydrates that that person was eaten and we see distinctly different divergent patterns across a population of people and one of the fats we look is that is something that unless you eat a lot of avocado or macadamia nuts is very little in the human diet but we see set in some people a lot of it in their bloodstream and that's a marker of converting carbs to fat going the other extreme if you see very little of it in the bloodstream those people haven't converted carbs to fat and they're about 10% of the population who can eat a very high carb diet like the ordinate or the kind of the diet that dr. McDougall promotes there's about 10% of the population who could eat those a very high carbohydrate diet and not convert be converting carbs into fact called lipogenesis those people are very well by probably genetic inheritance are very well suited to that type of diet so I'm not saying everybody we all you know we don't all fit in the same cookie cutter that the opportunity here in the next five to ten years is to come up with robust biomarkers of people's tolerance to the macronutrient mixes that they eat so there are you know a lot of people you know if if they're you know in the u.s. we have 300 million people if 10 million of them can do when a hike our very low-fat diet great let let them go this 30 million people I wanted to worry about yeah but the majority should not be being advised to eat something that benefits only a minority and so when people say everybody should follow my diet meaning MacDougall's or or Ornish's or together I think there's there's a certain amount of hubris there that it's not justified and I hope I never have a diet named after me and I hope that the diet I have is a is baby or the recommendations I do make the people are based on science and are based on the individual character is characterization characteristics of the person I'm talking to rather than treating that person as an average you know individual of which they are very few know in the back so mega 3 and Omega 6 are two classes of polyunsaturated fats that are essential for human wellbeing and function and the kind of identification of these and then of essentiality and animals than any humans goes back to the animals in the late 1920s and in 1960s 1970s we began to define the requirement for those but I have to push back against people who said well that a certain percentage of your fat intake should be omega-6 or a certain percentage should be omega-3 because somebody on a or nurse or McDougall program eating 10% of the energy is fat to get that minimum essential amount which could be a high proportion of 10 percent but I need 70 percent of my calories as fat maybe 75 ah and yet I don't have seven times the requirement for omega-6 and omega-3 so I don't deal with percents I deal grams per day with the advent of corn soybeans sunflower safflower cottonseed oils in our agricultural food supply which are all very rich in omega-6 none of us you can't eat an omega-6 deficient diet yeah no matter what you eat even if you eat don't eat any vegetable oils yes kee pork and chicken there's a lot of omega-6 and pork and chicken and you're going to get enough omega-6 so I have seen cases of mega 6 deficiency in humans but that was people fed a chemically defined intravenous the formulation had no fat in it at all omega-3s are much more worried about because omega-6 and omega-3 compete for utilization and incorporation in membranes in Vita high omega-6 intake then even inadequate what should be an adequate amount of omega-3 is not enough because it's getting pushed down by all that omega-6 so typically what we tell our patients to try to get away from grams and ounces of stuff is three meals of a wild-caught fish or credibly farmed fish which means that they're using not you know vegetable meal but actual ocean fish by bycatch to feed like you know farm salmon nowadays luckily they've moved to more and more bycatch in the food supply so three fish meals per week and you'll typically get enough omega-3 as long as you keep your omega-6 moderate so we basically tell people aboard avoid corn soy safflower sunflower cottonseed oils although there are increasingly high mono and saturations of safflower sunflower coming into the market and that's a good thing but yeah you have to really look for them so the simple answer is fish if you don't eat fish you can have fish oil as long as you buy it from a reputable manufacturer who tests for methyl mercury and PCBs to make sure that you're not getting toxic products in the fish oil and for fish oil one gram per day if you don't have your very not at high risk for heart disease or two grand two to three grams a day if you're at high risk for heart disease and that's where I think Tim Noakes comes up with the three gram dosage and that can be bonded at a very modest price they don't go out and buy really really expensive stuff that's a long answer but actually when we work with our patients participants in our program we devote half an hour to an hour worth of time over the course of the year in educating people on the types of fat and then you know it's hard to just say it all once people get it so it's it's a difficult problem of figuring what composition when you're eating most of your calories as fat and but our biggest problem is keeping the omega-6 intake low little louder survey okay adequate amounts of potassium and magnesium on the ketogenic diet the first thing is I rarely supp have to supplement potassium if I can get people to do a couple things the first is to eat three to five servings of non starchy vegetables per day because that's actually gional source of potassium and also if they're dark green magnesium because the plate is placed to see magnesium if you want to look and see magnesium look for green because the mineral in the center of the chlorophyll molecules magnesium so if you have iceberg lettuce that's pale barely green and crunchy it may be a good thing to put you know a nice high-fat cheese dressing on to but you know it doesn't have much much magnesium in it but so if you have the dark green stuff that's where magnesium comes from so potassium and the other is making one's own meat broth bone broth is a also a reasonable source of potassium the other is don't eat a whole lot of processed meats so if you look at what goes into a I know what you call it here in Australia we call them hot dogs you know in the US and if you look at the amount of magnesium and potassium you know four ounces of hot dog versus 4 ounces of real meat you have four times as much of the potassium magnesium in the unprocessed real meat because when they process this stuff the drippings the cooking reaches out the essential minerals so I don't say don't ever eat sausage or hot dog I just say try to make it a minor component of your your intake your protein our biggest concern around magnesium is for whatever reason people with type 2 diabetes appear to have a failure of the kidney to adequately conserve magnesium and we see a lot of signs and symptoms of magnesium depletion which includes we call neuromuscular irritability so people have resting tremor besides having too much coffee if they have when we do a reflex test if they have reflexes that are brisker than normal but the most common symptom that they have is is cramps either after exercise or at night and when people start on the ketogenic diet oftentimes these people build up muscle while they're losing body fat which requires more magnesium we actually make their cramping worse by starting on a ketogenic diet so if some we asked very carefully do you now have you in the last few weeks had muscle cramps and if they do we put them on a slow-release magnesium supplement because giving fast released magnesium as a laxative it just goes through we don't want a lack sation effect we want an absorption process and we do that it's kind of preventive maintenance with any any history of muscle cramps because if your heart has a cramp you die and there are problems in the past with poorly formulated ketogenic diets that have actually increased current court cardiac mortality from sudden sudden death not plaque buildup but now the heart going into L going into a non pumping rate State and so again we pay a lot of attention numerals I love the question on page 80 so let me check me out aids of the performance book not the local card living book the blue performance book there there's a chapter in there on fluid and mineral management hmm so in the eye okay so there is a two and a half page section in there on on magnesium and how to manage it and you know I did I had wanted to write that chapter and put it in the low carb living book we net didn't get around to doing it so I'm only stuck into the performance particularly for athletes but for the for the the muscle mineral issues but it's probably one of the more important chapters I've written in terms of basic physiology and you just don't find that in medical textbooks so nice to have gotten that written and published in green green shirt in front here what would you do to support the body if for instance you're getting a high c-reactive protein connected topi would be something else so if you have a high CRP level the one thing I worry about measuring one test particularly CRP is pretty much a butterfly in the breeze you know too much direction you know it so when people go to a physician to get blood tests done they're oftentimes not feeling well and CRP will be market you have even a slight flu CRP will be ten times normal so if you have a single abnormal value the first thing I would do is before I tried to treat it I would retest it the actually the simple commonly done test that is a more stable variable still will go up with with an infection is the white blood cell count and that been around for 100 years humber 100 years and it is I think a more robust measure so if you're serious ERP is high but your total white blood cell count is in the lower half of the normal range I wouldn't worry about CRP at all and the other is it appears to us that it takes at least 12 weeks of being continuously in nutritional ketosis to really get the inflammation process dialed down six months mm-hmm and again I don't want to get into personal details but yeah and then the other is make sure you add in adequate omega-3 fat because it is does have anti-inflammatory effects but it takes again months to because if you have even pick on me if I have 10 kilos of body fat I wish I had just dead kills body fat if I take one gram a day that's 10,000 gram so I take 1 gram of fish oil per day that's like going out every day and putting a teaspoon full of ink into a swimming pool how soon does it take to turn it blue it takes a long time so the equation time for changes in dietary fat it a little bit longer the woman behind you there pink like Tessa to actually show that yeah that's an excellent question and one that I don't have that slide with me but I recently actually made the slide if I try to finally explain this so yeah when we one of the most common things that physicians measure in people when they may do blood tests are called electrolytes which is sodium potassium chloride your calculated level of bicarbonate in the blood and sodium it should be tightly controlled in a range between 135 and 145 and we rarely see levels outside that ranch because the sodium in the blood has to balance the potassium inside your cells so that the two the there are two positive ions you can't have a lot of positive out of sodium outside and less potassium inside or vice-versa so when you restrict sodium the blood level of sodium doesn't go down the body shrinks the amount of blood you have in your circulation and you can tell when you look at a person because they look pale okay they're because they're vaso constricted and I give them a cup of warm bullion and they turn pink and so the blood level of sodium does not reflect the total amount of sodium in the body and in the circulation so the simplest test is half of someone lie down quietly for five minutes take their blood pressure and then have them stand up and if it if the blood systolic blood pressure drops 10 millimeters of mercury or more you've got a a volume depleted State dr. Lin here is not only just a change both increase in hydroxybutyrate levels but looking at the amount of instrument they are out of sugars in the blood but also the acid levels within the blood foot condition and it clearly shows this very different but I actually don't have a lid or table but I'm sorry the question is in terms of the mathletes uTorrent hydroxy butyrate but in terms of how exists sure yeah we've at least in my day we measured blood pH in arterial blood which is a much more invasive test and measuring venous blood so we looked at bicarbonate levels and in in my metabolic research subjects whether they're on a very low calorie ketogenic weight-loss diet or my bike racers who were on a high fat weight maintaining diet I don't recall the number of total subjects I had was been over 100 and we've never seen anybody's bicarbonate level under 19 and to be an acid emic you know it's 17 15 or lower and you know when someone's in ketoacidosis their levels of bicarbonate or under 10 so we've not measured actual measured pH but using the bicarbonate as a surrogate we see Keeton emia without acidemia up to levels of beta hydroxy butyrate above you know the most we've seen even with starvation is 7 millimolar you don't begin to get into the acidemia where the way that bicarb falls into an abnormally low range until you get the maybe our drugs be above tab so yeah we haven't spent a whole lot of time trying to do more invasive studies when we feel that that provides you know adequate the fact that you can be Keaton emic without acid emic and that's what the buffering system that we've evolved to have that's what it's meant to do sorry I kind of talked around your question but for 70% I don't measure it because I because I base I eat to satiety I let my instincts tell me what to eat and we find it takes people six months to a year tell them they to do that before they come to trust the fact that that once you get the carbs out of the meal low enough down that you're either out of the they're intolerant range and this dr. Kristofferson showed you how you eat and your insulin goes up and you get people off that roller coaster and our natural characteristic or our natural instincts actually serve us very well but for me we're talking in excess of 200 grams of fat a day because I'm eating less than 50 grams of carbs that's 200 calories I eat somewhere in the range of 80 to 110 grams of protein a day that's about 400 calories that's 600 I burn probably 25 to 2,700 calories per day and all the rest comes from fat and that's an excess of 70% of and then that puts me in the range of 1,800 to 2,000 calories of fat per day and as at the dinner table last night we had this wonderful buffet and excellent foods and some of them more moderate and protein there was some keys on the dessert table so that was good but we had to ask for a dish of melted butter to come to the table so we can all get heart fat intakes up to the point that we wouldn't wake up really hungry in the market so I kind of encouraged people to experiment with themselves they can you know you can do the quantified self thing and waste often and but eventually I think what people learn is when they get their carb intake down to within their personal tolerance and keep protein moderate that the instincts you were born with are your best guide and better than having a scale measuring spoon and and all that stuff thank you [Music] question is effective kids Jenna tada on osteoporosis the simple answer is no there is a lot of there's a lot of opinion and Dogma out there that the acid of the tree of ketose of nutritional ketosis will cause bone wasting but in a study that Geoff Bullock did looking at calcium balance in people he found that calcium excretion in the urine went up when he put people women and men with metric women with metabolic syndrome on a ketogenic diet so if you looked at urine calcium excretion it would worry you but what they discovered is that gastrointestinal absorption of dietary calcium the GIP the small bowel is it doesn't absorb calcium very well at all so most of the calcium we eat goes through calcium absorption went up with a ketogenic diet not because they ate more they became better at absorbing it and so you would see more coming out but the first statement balance we were actually doing in our two year-long study of our diabetic and pre diabetic people in Indiana we're doing DEXA dueled x-ray absorptiometry measuring body composition but also bone mineral density in this population over two years compared to our control population so we will have real data that but you know it's gonna have to wait another year to have to to get across the finish line on that one but yeah it's this very important question I think there's still answers you know good solid science to be done to give you the proper answer the gentleman back [Music] in terms of coronary risk I think the the problem with VLDL cholesterol is if it's calculated from a standard lipid panel which gives you measured total cholesterol measured HDL measured triglycerides and then they calculate the VLDL from the freedom equation the free - well equation is very inaccurate for either high triglycerides or low triglycerides so having the actual either vapp test or NMR test and measure v LDL particle size and number is looking to be the only really valid direct test but if the triglycerides HDL ratio is less than 2.5 almost everybody will have what Ron Cross Ron Krause calls pattern a that is the low a thorough Jennison rath origin issah t so I'd have to diff say that you'll stepping back a little bit this field is in great flux there's still a lot of Mythology and there's some need for more science but the neat thing is that this work is now seriously in progress and I want to say wait awhile but I would not worry about particularly about the calculated LDL if your HDL is for a male is above 50 and if your triglycerides are under 125 and then there are people like me who have an HDL as last time as measured was 105 my triglycerides were 60 and my internist says I don't know what's going on Steve but my calculated LDL by the way is 160 he says aren't you worried about that I said no anyway we see comes through the clinic all insulin-resistant glucose welcome my hba1c comes down the DEXA scan their body composition changes the feeling healthier fitter but they get really connected when they get on the scale and what you see on the deck sir do you see an increase in lean body mass but what I've seen in I've had an opportunity to lock quite a few people up in a metabolic Research Board there voluntarily did it because they knew they're going to leave his way and I've had quite a few females who came in basically with relative sarcopenia and when I asked them so what what do you mean in the last couple years I've been trying my darkness to lose weight I've been going to Weight Watchers I've been and they're restrictors and when they try to restrict fat they end up restricting protein and to some degree potassium and magnesium and people in the agricultural community animal husbandry who if you were trying to raise pigs or chicken their cows you want to build lean body mass you've got to get enough potassium and magnesium into those animals and certainly enough protein if you're strictly knows you're going to lose even though you're eating adequate calories you're going to lose lean body mass and I had a I think she's noted in as a case study and here she was in a group of people we had them locked up for six weeks we had them eating 700 calories a day the average person in the group she was in lost 14 kilos in six weeks on seven or eight hours a day and and someone half of them were exercising for two hours a day and half weren't by the way the group that exercise for two hours a day didn't lose weight any faster than the group that didn't exercise that was a puzzler but this woman only lost I'm sorry I'm thinking pounds and it's so 14 pounds not cute 14 pounds in six weeks she only lost seven pounds and she was incensed that I'd killed her metabolism now we were doing urine collections to look at protein breakdown products coming out we were doing met we we were feeding in precise amounts of protein going in and that's called nitrogen balance we looked at how much protein goes in the mouth we look at how much protein breakdown products come out of the body but we had all those urine samples stored up when we analyzed them after the study was over and to our amazement she was excreting much less protein than she was eating which means she was recaptured she built seven pounds of lean body mass in six weeks in the metabolic ward a silver pound of lean body mass per week while eating only seven eight hours a day which is metabolically impossible when we submitted that paper for publication to three different journals it was refused refused as being preposterous but it was valid data that that she had relative sarcopenia and so she basically lost much less than expected but her adipose tissue loss was exactly the same as all the others in the group so she didn't defy the laws of physics or thermal thermodynamics but we've seen lean body mass gains in people when they get nutritional ketosis right which again doesn't make any sense because exercise physiologist tell us that the primary driver of muscle buildup in the body is the signal is insulin so again this shouldn't work but it turns out that there is another signal which is called branch chain amino acids we don't get into that biochemistry but the body's handling of branch chain amino acids markedly changes when you go into nutrition with ketosis and it takes over from as a bodybuilder muscle building signal so again it's the laws are different when you live in the land of nutritional ketosis the same way when I fly here for rent a car I need to learn to drive differently than I do in California because the laws are different and it's the same when you go through this transition so I didn't really answer your question but yes there are women who are very resistant to losing body fat and I won't bore you but there was a study of identical twins unfortunately all males done in Quebec and published in the 1990s where they showed that the ability to preserve body fat either by caloric restriction or by added exercise is an inherited characteristic so some people just genetically predisposed to be much more conservative of calories when subjected to privation by calorie restriction or by pushing the body to expand the calories with exercise and that's why the women we had the metabolic ward when they did two hours a day of exercise over multiple weeks didn't lose body fat any faster because to our horror it pushed down their resting metabolic rate and the body became very conservative when because it views that viewed exercise as a stress not as meant as a beneficial thing and that again that's an inherited characteristic it varies from one to another so when you see a skinny marathon runner get up in front of you say cix as I've run 80 miles we can look how thin I am you should do it too you have to ask yourself am i his or her identical twin if not I'm need to add or ignore the advice from a single person giving an example of what they do so I try never say do what I do because it works for me because I think that's flawed advice unless I have a clone or identical twin other question this okay my reading from you're working you know to get all of my interpretations that it takes quite a while your body to become key to adapted but it's very quick for you to go the other way if you picked me fall off the wagon so you have a Christmas Day or or something where you eat thank you very quickly go back to two why is that if the bodies if the preferred state is to affect them no the question is it seems that it's very hard to get into nutritional ketosis it takes weeks of being very consistent but one big meal or even one day of eating lots of carbs can shut it all off the analogy I use it's like you live on top of a tall sand dune it's easy to slide down and a lot of work to get back up your question is why is that and I don't know who designs a source code for where we come from but the figure that dr. Kristofferson showed of how many teaspoons full of sugar there are in different foods is compelling when you realize you only have one teaspoon full of glucose in your blood is any one point in time so eating a cup of rice steamed rice is basically a metabolic emergency if you want to keep your blood sugar less than twice normal keep your blood total blood sugar under 200 or US milligrams per deciliter or under 10 millimolar posts you know after a meal you know can you imagine what you would do if you had a big buffet with you know bread and pasta and and sweet desserts and so that's a metabolic emergency and the body has to respond to that in the Mergent way and that's why I think just you know a day of carbohydrates holiday going on jimmy moore's proves and eating at the other end of the ship now the car high carb ass not the low carb man yeah is a mortal danger to the body and so it has to deal with that with red lights flashing and and Claxton's blaring and that's why I think you have that negative instant negative response to a high carb meal so what we find when people become key to adapt it and then have elapsed is now we do they feel emotionally that they feel physically no and sometimes we you know our coaches have to ask them you know tell me how you felt about that well I felt really guilty but how do you feel physically the next day I just didn't feel good for two days I just yeah and you know recognize the connection between the carbs and that lethargy and and impaired well being in function and then internalize that and we get people to learn over time you know you basically become conditioned to avoid the lapses because you know that how how negative the feeling is going to be and that then becomes a self-reinforcing process and so I can't yeah you can't tell people not to do it you have to they learn when they do learn from the negative negative stimulus when they do and internalize that and turn that into more consistent management and you know our our expectation is based on our experience whether we're doing the study is more than 50% of our participants will have sustained a state of nutritional ketosis out to two years and in so doing have put their diabetes not just reversed it but that the definition of remission is not your blood Sugar's normal today it's you've been two years off medication maintaining a normal a 1c but I I'm not sure I'm answering your question but you know it's not why that happens but we know that this negative and help people respond to that information that feedback by avoiding having lapses and the other is teaching them to find replacement things that they really enjoy now you can have delicious unctuous savory foods and you know I don't like to get into this thing of there's this a fat around quote fat bombs let me talk about negative connotations that but you know there you can have the confections that are good but you know those are not things that people want to eat when they're trying to to reduce body weight now those are things that people could potentially you incorporate in maintenance as long as they can control the the intake but starting to preach song so the question is what are my thoughts on incorporating fasting Jim by which you know there are many different definitions of fasting I have a somewhat contrary in view to the what is the current fat around intermittent fasting my point of view is from a metabolic perspective up to 16 hours and a 24-hour period can be completely benign as long as during that 24 hour period you get adequate fluid and potassium and sodium because if you're not eating food in that time period you're not eating potassium magnesium get enough sodium once a human being passes 24 hours of no source of calories protein carbohydrates or fats coming in the in order to maintain gluconeogenesis at at least a moderate level even if you're in ketosis the body starts breaking down protein bodies the body's pre-existing protein lean tissue and by day 3 and there are many studies published starting in the classic one was by Benedict in 1919 so going back almost a hundred years there are many studies showing by day three the rate of protein breakdown is equivalent to losing 3/4 of a pound of lean tissue per day now there's a popular book that just got published that says that protein wasting during fasting is negligible even out to a month and if you look at the quoted papers they're there but the data is misstated and I am concerned that lean tissue losses if it's if somebody does say three days of fasting every week the amount of protein lost in those three days is greater than the amount of lean tissue that can be regained in the other four days and when Jimmy Moore you know he's going on on record saying he did 25 out of 30 days of fasting a year ago and by DEXA his body compositional change was 10 pound he lost 20 pounds 10 pounds was fat and 10 pounds was was quote lean and one of his advisers told him don't worry that was mostly water but realize that muscle is 75% water and 25% protein so that yeah the that 10 pounds of lean tissue loss would take at least under optimum refeeding conditions would take that 1/4 pound today is 40 days to recover that concerns me and and then the other the other risk of when somebody has been fasting for a long period of time is when that person starts eating again they are extremely vulnerable to a condition called refeeding syndrome and this was basically became well-known during the Second World War when either people who had been incarcerated in prison camps or had been abandoned or lost in lifeboats and had had no food for a week or more if they took pity on these poor starving people and gave them copious food many of them would suddenly die and that's called reef now that's that's refeeding syndrome and that's due to we believe acute shifts of minerals out of the blip on the blood stream in the cells causing a impairment of a heart function and I am very concerned that a a fad approach to fasting is going to lead to major pushback from the health care authorities when we start hearing of sudden death occurring and I'm old enough to remember something called the look would protein diet back in the in the u.s. back in 1976 a physician inappropriately wrote a book saying just take this this liquid protein which is basically gelatin three times a day take a vitamin pill and take a 1 gram of potassium a day by the way the gelatin is protein but it doesn't unlike meat doesn't contain potassium and magnesium so people who did this for three months or longer and then when they ate sick we had sixty cases reported to our Centers for Disease Control of sudden death and that those sudden deaths were not blamed on refeeding syndrome we're not blamed on that abysmal formulation of that ketogenic diet we was blamed on ketones and it shut down the science and basically put the science I'd done at that time under a cloud for 20 years so I get kind of worked up when when I see when I see people take taking liberties with the truth around fasting [Music] that's fine but that periods of fasting belong beyond 24 hours the risk begins it doesn't mean that people can't do that if the your diet for the other six and a half five and a half days of the week if you're doing say 36 hours of fast the other five and half days of the week your intake is excellent not just in terms of protein but in minerals that could be fine but until I said but until somebody actually does the research and shows that has long-term positive sustainability for people and I'd ask you to look at the recently published book and where's the research that they've published don't misquote research has been done on before shot me research that this works to help people reverse their diabetes and reduce their percent body fat and keep it that way for a year or two system in the state where your rates of gluconeogenesis are higher than in a normal individual and the primary fuel for gluconeogenesis could be muscle breakdown fibrous so in that situation they're fasting as a ketosis individual are you potentially feeding that goes in there Genny pathway more readily so therefore putting your leg tissue the greater risk where something normally in 24 hours apart but they look at the agenda trait might not be higher though so there's no drag on that lean tissue is that a false assumption to be look if I can try to summarize virtually if your key to adapted you're better able to preserve lean tissue against there are multiple angles of this elephant that we guys wearing blindfolds people are palpating with prolonged fasting two weeks are longer the rate of protein breakdown actually comes down markedly so when you first start the first day of fasting there's very little net protein breakdown second egg goes up the third day is that it's at its peak which is equivalent for the average person of three for some pound of lean tissue loss per day when you get out to two weeks you're down to a third of a pound of lean tissue loss you've got to 28 days of total fasting you're down to a quarter pound of lean tissue loss by the way only one quarter of that quarter pound showing up as your rhea so if you're only looking at your rhea nitrogen in the urine you'd only see what looks like one ounce of lean tissue loss but there's ammonia and create creatinine and others so it adds up to a quarter pound but the point is if your key to adapted maybe you're at that six gram per day nitrogen excretion rather than the 14 but people haven't looked at this and until they've actually done that research I think it's you know unethical to write in a book that people should go but people should go out and do this on their own so I'm not saying it's wrong I'm just saying we don't know what the truth is but there are reasons to be concerned based on the past history and when in my lifetime you know I've seen this field get shut down by misinterpreting the cause of of deaths that work that work early for me lated approach and you know again one day when you're not not fasting that when you're fasting that eating you're not only not eating protein you're also not eating potassium and magnesium and those are the two minerals when when inadequate lead to the cardiac dysrhythmias and potential sudden death I don't a blow out of proportion but it concerns me because I I can't live another 40 years maybe I can't if I you know we're like these these these worms the in the agar but you know I can't wait another 40 years to have this come around again this as a metabolic option I want to see us capture of this and turn this into their life-saving mainstream medical intervention you know in the next few years and so I am a little defensive about you know what other thing people think might be minor threats is I was treating he's fast but in that fasting actually taking environment so you're not having to get your hands up to the point that they cannot use anything but glucose to reproduce so that's the theory behind and that's what I was doing so I just wanted to say that I know Jason put another little drink we diabetics and plastic but he talked to that plastic using bone broth so his fasting is and I know Jamie Moore's fasting was taken by rock and butchery so he was actually getting glucose so followed by that because I think assignment things were my question in relation to the performance book so I'm also trying to be an athlete and I am doing a repeated bit spring pipe exercise so it's not a long-distance marathon pipe situation some horrible so on and repeated as a short chapters and on a day where the normal fear so it's against that old learn to drive me outside right but the normal theory would be I was going to come I've got multiple sessions in one day I've had to keep loading up on simple powers because that's what you were that's my energy back so in peak PV genic state other than taking bone broth to make sure that also exercise but is there anything else for a day of exercise like I don't want to be replacing counsels of not using files but is there something to undertake this mean CT or is there something that I can use to make sure Wow first thing is I think I've given you a number of instances today where Theory turned out to be absolutely wrong so theories are good ways to formulate hypothesis due to do objective testing and the other is we individuals vary one from another so you know one has to be careful basing recommendations on individual case histories whether yours or somebody else's but if it works for you you've discovered something extremely useful first point second point is Geoff Bullock right now is running a for the first time I'm aware of a prospective trial of a well formatted ketogenic diet as an adjunct to breast cancer chemotherapy in women with node-positive breast cancer so we're not you know he's not doing the study to prove that you can cure breast cancer it's just in the can in conjunction with the standard of care came by adding nutritional ketosis do we prove improve outcome and so again we've we're seeing a crack in the armor now if some resources coming in that we can actually run studies like this on the question of fueling intermittent exercise I think in inter very interesting two cases that came to prominence recently is in the Tour de France Chris Froome who won in romaine bar day who came in second were both low carb athletes they won't we don't know precisely what carbs they ate during but if you look at the Tour de France it's not the same intensity all the time but it's varying intensities from high intensity you know attacking and Hill or beating out on an attack versus in the pack with your del mystique in front of you breaking the wind but this is the first evidence we have from a major sport like that varying intensity that a low-carb strategy can can be a winning strategy we have seen as this works amazingly well in prolonged individual endurance events like hundred mile runs so again you kind of have to feel what use your instincts to feel what's right for you as you do this but people who find increasingly that they when they thought they needed carb supplements in the during the active so they train low and low carb and then during the the the exercise they actually consumed carbs people are finding increasingly that that is more of a mental than the physiological necessity and when they break their you get their mind around the fact that they can actually do the exercise without carbs at all so I was mentioning in the car coming over today there's a german-born physician in British Columbia who's in his late 60s who has been doing a half ironman every year for almost thirty years and recently went low-carb and just out of perversity did his most recent half ironman on zero in race calories and came within twenty two minutes of his all-time personal record and he was struggling to understand how that could be and it you know the human body is one when keto adapted is remarkably effective at utilizing and even a skinny person the skinniest ultramarathon runner has thirty thousand calories of body fat that's a male and probably for females more on the range of forty thousand so there's even in very thin people there's there's plenty of fuel there and it's just you know figuring out what it takes to be adapted and then figuring out how little you can take in and still have to have the benefit of that one more question gentleman here congratulations the plasma study but just before I officially put into context with all this longevity talk now or other societies catching up medicine is a ketogenic diet I think the future is going to be individualizing nutrient intake - the characteristics of that person rather than the population mean and coming up with robust economical biomarkers that can guide people but you know Jeff's and my guess is that in the u.s. population that easily 2/3 of the population can have near term consumer perceived benefit that is self reinforcing characteristics of a of a well formulated ketogenic diet to reduce the burden of disease and improve well-being and function but you know I certainly hope that we're not kind of leading to this idea that everybody should suddenly turn 180 degrees and go low-carb I hope that we can use this in a wise individualized way to do help each individual find what's right for them and so symbol answers like I can't tell you what the future holds but I think it's really exciting that that we actually have a lot of science coming to this I'm thrilled that I came back after two years and dr. Rooney says gosh you know you came and talked to us two years ago and it stimulates to think about in a different way that's neat and you know I can hope I in not too far from that I can retire and sit back and sort of watch all this happen so I really appreciate your attention and your questions and before we do it again [Applause]

Channel: Low Carb Down Under

Views: 309,176

Rating: 4.8731642 out of 5

Keywords: Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, LCHF, Low Carb High Fat, Ketogenic Diet, Well Formulated Ketogenic Diet, WFKD, Low-Carbohydrate Diet, Nutritional Ketosis, Dr. Stephen Phinney, Steve Phinney, Jeff Volek, Intermittant Fasting, Verta, FASTER Study

Id: 5AGiUFzldwk

Length: 65min 30sec (3930 seconds)

Published: Fri Dec 16 2016