Functional Approach to Ketogenic Diet | Mark Hyman, MD

hi thank you for joining us i'm your host nada youssef and today i am back with the one and only dr mark hyman hello welcome dr mark hyman is the director of cleveland clinic center for functional medicine he's also the 11th time number one new york times bestselling author and an internationally recognized leader speaker educator and advocate in his field and today we will cover a whole hour talking about the ketogenic diet for those who don't know it is a strict nutrition plan that is fat that is high in fat moderate and low protein and very low in carbs so before we begin please remember this is for informational purposes only and it's not intended to replace your own physician's advice so thank you so much for coming back i'm so glad to be here hey everybody so let's talk about the ketogenic diet what is it what is it and how did it start well a ketogenic diet has been around for a long time and it's typically been used in neurology to treat epilepsy or seizures that don't respond to anything else so when nothing else works they put children or adults on a very high fat diet so the body burns fat instead of carbohydrates and that's extremely effective for treatment-resistant epilepsy it's a hard diet to do and recently it's been increasingly used in other medical conditions and it's also kind of caught the popular imagination and people are using it who don't have medical conditions so there's a whole range of people now using it and we can talk about the pros and cons of all that great all right well i kind of want to talk about the food pyramid what we had and how it kind of flipped everything around so what are we looking at right here well you're not looking at us because we're hiding here we have we have you know the uh interesting thing was uh in the 60s uh and the 50s there was a doctor named ansel keyes who was a scientist who concluded that fat was evil that it caused obesity that had more calories than carbs and then it actually also led to heart disease and so the research on that was only cause and effect sorry the research on that was only showing correlation not cause and effect and so the assumption was made based on relatively weak data that fat was the enemy and in fact scientists related to him that were also in the field at the time dr heggstead and doctors tear at harvard were funded by the sugar industry to write a report in the new england journal medicine that said sugar's fine fat's bad and then the guy who was the author of that paper was paid by the sugar industry he ended up being the guy who ran our first dietary guidelines which told us to eat less fat and eat more carbs that turned into the food pyramid which was looking like this eat fats and oils only spray in fact except fats and oils were only at the top here it wasn't even that much it was like a tiny little bit so the idea was to eat six to 11 servings of bread rice cereal and pasta every day now at this point in our culture we understand that seven or 11 servings of bread or pasta is not a health food and yet that was what our government told us in the 1992 food pyramid which correlated exactly with the increase in obesity and type 2 diabetes in america and around the world because the whole world took on this dietary guidelines advice and that's really led to our current crisis of obesity and carbs were thought to be healthful and fat was thought to be harmful and then we now have actually increased the sophistication of our nutritional research we've had much more data many more studies and it's really clear that fat is not the enemy in fact according to the 2015 u.s dietary guidelines they removed any limit on fat they say eat less than 30 percent of your diet is fatter 35 of your calories is fat and and if you were for example having heart disease they recommended even greater restrictions some people said less than 10 percent of your diet is fat and the us government based on the advice of experts in the dietary guidelines committee concluded that the evidence for that was not there and that the evidence that fat was harmful wasn't there and that we needed to actually change our guidelines so the new guidelines have no upper limit on total fat in your diet none and they also say to reduce refined sugars and reduce refined carbohydrates they also eliminate any restriction on dietary cholesterol because they found it wasn't linked to heart disease so all of our past advice is still haunting us and there's still many low-fat products on the market they're still low-fat yogurt which basically has more sugar per ounce than a can of soda and and we have this meme where people are loving egg white omelets and skim milk and unfortunately it's not matching the science so this food pyramid has really led to a crisis in our society and a crisis in our economy because of the burden of chronic disease one in three medicare dollars are spent on type 2 diabetes we we are seeing you know one in two americans with pre-diabetes or type 2 diabetes 90 of people with pre-diabetes are not even diagnosed maybe up to a quarter people with type 2 diabetes are also not diagnosed so this is a huge problem and the dietary guidelines have shifted but i think our our beliefs have not and i think people are still enamored with diets that are low in fat now it's changing and there's a whole movement around paleo and ketogenic diets which i think is concerning in some ways because it sort of misses the bigger picture and we've talked about that and even when you look at the our sad diet um that's what the plate is is yes this is our new this is our new improved guidelines which i think is an improvement for sure but it's interesting how it talks about protein but not carbs or fat and then it talks about fruit and grains dairy and dairy and it doesn't say what kind of vegetables so you could be eating potatoes you could be eating white flour you could be eating you know various kinds of protein and cereal cereal and it's not really necessarily healthy in fact dairy the us dietary guidelines tell us to drink three glasses of milk a day as an adult and two glasses as a kid to be healthy there's no evidence for that in fact the government the congress based on the work of a number of people was asking the national academy of sciences gave them a million dollars to review our dietary guidelines process and they found that a lot of the recommendations were not based on good evidence that they ignored large amounts of evidence about for example low carbohydrate diets about saturated fat and that they had undue influence from the industry for example the dairy industry is linked into the dietary guidelines process through various people on the committee who are involved with the dairy industries consultants or on boards or other other things so we have a corrupt system where we're seeing dietary guidelines that actually don't match the science in fact you know those got milk ads they were funded in part by taxpayer dollars along with the dairy council and eventually they were taken off the air and out of magazines because the federal trade commission that governs truth in marketing basically said there is no evidence got proof instead of got milk and there was no evidence that it protects against bone loss that it helps kids grow be healthy that it's necessary for all the things that they said it was good for in fact it may not be it may increase the risk of fractures increase risk cancer increase the risk of gut issues autoimmune diseases and many other things so we are now sort of moving towards a more scientifically whole and uh and scientifically rigorous review of our diet and our guidelines which hopefully will happen in the 2020 guidelines and correct me if i'm wrong you've mentioned if you wean your baby off of breast milk there's no need to go no to anything i mean there's i mean we're the only species that feeds our kids milk after weaning that's a mammal uh in fact there's there's no biological requirement for dairy or milk some populations do well with it but the truth is that milk we eat now is not traditional milk it's not right from the cow it's not unpasteurized it's not on homogenized it's not raw milk which is traditionally what we've eaten for thousands and thousands of years yeah there were risks for that and you've got all kinds of diseases which is why laurie louis pasteur developed pasteurization that's been a good thing in some ways but uh it's clear that our current milk is not the milk it used to be there was a study for example done in the uk where they looked at milk that was homogenized versus milk that was not homogenized and you think what's the difference it's just not separated but in fact the homogenized milk had really bad effects on cholesterol whereas the unhomogenized milk did not which is fascinating because it's the same amount of milk it's milk it's the same thing but the way it's processed and refined in a way that's sort of changed the structure of the milk has a profound effect on your metabolism and your biology so i think we we kind of have to think about these dietary guidelines this this sort of my plate as an improvement but not necessarily what we need to get to i want to talk about cheese because i know cheese is a big thing with ketogenic diet is she's okay to eat the ketogenic diet well um cheese is not necessary is not necessarily essential for a ketogenic diet okay you can do a vegan ketogenic diet you can do a dairy-free ketogenic diet a lot of the fat may come from dairy in some ketogenic diets but it's not essential and i don't think it's it's it's a good idea in in most cases to use a lot of dairy especially our modern dairy which is full of hormones pesticides antibiotics and it's not necessarily all food so i think uh you can use uh healthy dairy and if you can use grass-fed dairy grate if you can use dairy that hormones and airbox great if you can use goat and sheep probably even better and there's certain goat and sheep cheese that are better i think those are fine you can use raw milk cheese from sheep or go those are allowed okay now i want to kind of jump in and talk a little bit about ketosis what it is and how to get there okay so why why what is this whole thing about ketosis why why is it relevant well biology is very smart so we as humans have adapted to starvation we have hundreds of genes that help us adapt to starvation and historically what would happen is we would have periods of abundance and periods of scarcity so we're really good at that so we if we found a patch of berries or a bunch of wild fruit we would just munch down on that stuff we'd store it all up for the winter and then you know we would put it in our bellies and have belly fat and that was a good thing and then we'd go through periods where there were kind of lean times and there wasn't enough food and so our bodies can shift from carbohydrate metabolism to fat metabolism so you have two fuel sources you have a backup fuel source so it's like having a like a prius you have your gas engine and you have your electric engine right so we we can adapt now when we went into ketosis a whole series of things happened that were pretty interesting they were all about increasing health so they sort of affected your body in a beneficial way when you see the body switch from burning glucose to burning ketones which is what fat produces in the body a number of interesting things happen one your metabolism speeds up two your hunger goes away three you turn on the ability of the fat cells to release fat and burn fat so it increases fat burning whereas carbohydrates actually shut off carbs carbs shut off fat burning it literally locks the fat in your fat cells and when i mean carbs i don't mean like broccoli which is a carb in fact the truth is that even if you're on a ketogenic diet a lot of your diet can be carbs which is vegetables all vegetables are carbs right so it depends on the quality and the type of carbohydrate that matters so when you when you look at your diet you you have a ketogenic diet it actually increases muscle mass it increases fat burning it cuts your hunger it may stimulate all kinds of beneficial effects in the body to reduce inflammation so there's really profound benefits to it in fact it's the opposite of what you think if you're eating a diet that's 60 or 70 or 80 fat it actually should worsen your heart disease risk profile but it turns out it doesn't in a review of a study looking at over 260 patients they found that out of 26 cardiovascular risk factors 22 out of 26 improved like the type of cholesterol you have your triglycerides your hdl your blood sugar your blood pressure your insulin your inflammation levels all those things improved whereas the control group none of them improved so it's it's actually contradictory in your mind because most people think of fat as causing worsening heart disease worsening cardiac risk factors and so it's really important to think about that yeah okay now with ketosis how long does it take to get to ketosis if you start a ketogenic diet when you switch and what it is essentially is a 60 to 70 80 fat diet probably five percent of carbs are less and 20 or so percent protein it's not a high protein diet people think of atkins and paleo if you eat a lot of protein protein can convert to sugar in the body which is not necessarily what you want so it's mostly fat in fact a ketogenic diet was the diet developed by jocelyn dr jocelyn for which the jocelyn diabetes center harvard is named and his approach to treating diabetes was 70 fat you know basically 25 protein and 5 carbs that was the treatment of the day before there was insulin because they couldn't these people had a disease of carbohydrate intolerance for diabetes so it's very powerful and i think um the the uh ketogenic diet helps you to switch into a different type of metabolism which helps protect against diabetes and other things now when you do the ketogenic diet there's a lot of and your question is how long does it take to adapt to it sorry it can take it can take up to about three or four weeks to really switch over you've literally got to switch your engine over and you have to do it right and if you don't do it right you'll end up with what they call a keto flu which is if they're weak and tired and dizzy it's because when you when you stop eating a lot of starch and sugar your insulin levels drop which is a good thing and insulin makes you retain water and retain salt and so you will lose a lot of water a lot of salt you can get low blood pressure you can get dizzy you can get ache you lose magnesium so making sure you have plenty of salt plenty of water lots of magnesium can help prevent that good good now when when we do the ketogenic diet there's a lot of talk about macros can you tell me what they are and why they're needed sure but i think it might be good to go back a little bit and talk about who this is good for oh yeah definitely because i think you know right now it's a popular creation of culture if you look on amazon the top books are all ketogenic diets in terms of diet books and everybody's doing it this is a therapeutic diet it's not for everybody it's for very specific indications and it can be extremely beneficial for those indications but it's not for everybody so what are those reasons that you would think about doing a ketogenic diet one is if you are a type 2 diabetic there's great evidence that you can reverse up to 60 of type 2 diabetes in a year the average weight loss in the study where they looked at this was 12 or 30 pounds they had a hundred percent of people get off the main diabetes medication which is called the oral hypoglycemics and 96 got off insulin or dramatically reduced their insulin so this is a powerful intervention for for type 2 diabetes now there are other therapies that can work there are other diets that can work for example calorie restricted diet protein sparing modified fats and other things can be helpful but those are not easy to sustain you're on a calorie restricted diet it's not fun you're on a protein modified fast which is shakes you're not going to live on that your whole life so there's real indications for a ketogenic diet and metabolic disease if you're morbidly obese if you have insulin resistance without type 2 diabetes it can be very helpful as a short-term strategy to help you reset your metabolism doesn't have to be forever clearly for epilepsy it's standard of care for treatment-resistant epilepsy there are other neurological conditions where they're seeing improvements and benefits for example there's research on brain cancer glioblastoma and ketogenic diets there's research on autism showing it's very effective treatment for autism alzheimer's i personally see many alzheimer's patients dramatically improve on ketogenic diets and so it's not for everyone but it can be extremely powerful for those who who want to use it and by the way many people uh may not do well on a ketogenic diet so it's very individualized there's no one-size-fits-all diet it's like our traditional state for history has been ketogenic yes we would flip in and out of ketosis as hunter-gatherers but the key is in and out we're not constantly on this for our life now there are some people who can sustain it for decades and i know those people and they do well there's other people who don't do well on it so you have to look at your own biology your own numbers the way you feel your metabolism and really personalize the approach sure okay and then back to macros because i know a lot of people start counting macros so i kind of want to talk about what macros are and should we be counting macros are basically protein fat and carbs and there's also fiber in food and calories now the quality is what matters people want to count carbs but you know you could have a great ratio of protein fat and carbs but it could all be from french fries and refined vegetables deep fried in and gross feedlot hamburgers and you know potatoes like that right so you could have plenty of the right ratios of protein fat and carb but it can be from very poor quality food the key is quality and if you focus on quality you will get results if you get rid of the junk and eat whole foods if you eat unrefined foods meaning foods in as natural state as possible a carb can be a you know buckwheat grain or it can be white flour those are both carbs or both grains but they have very different effects on your body you can eat a white starchy potato as a vegetable or you can eat broccoli and they have profoundly effect different effects on your biology you can eat wild salmon and wild fish and sardines or you can eat a feedlot beef which is not great for you or the environment or the animal so you really want to focus on quality and the right approach now the number of proteins fats and carbs you eat really depends on your own health and your own biology for example for myself if i eat no carbs i will lose too much weight and it won't be good for me i need a little bit that's my metabolism other people who for example are type 2 diabetic morbidly obese they do phenomenal on these diets and we see dramatic results in three weeks or even in three days reversing type 2 diabetes getting them off their insulin off their medications uh it's very impressive so we have to be smart about how we do it we have to do it i advise you with a doctor or a health professional who understands this who knows how to follow you and can treat you but it's it's a very effective therapeutic guide for many people now can you talk a little bit about blood ketones is that how you measure ketones yeah so there's there's two kinds of ketosis most people think of ketosis and when i was in medical school you learn about ketoacidosis which is when you have very high levels of ketones you're type 1 diabetic it's a life-threatening condition and it's very dangerous however we're talking about here is nutritional ketosis which is a very low level of ketones and and that helps to stimulate your metabolism cut your appetite release fat from the fat cells improve your your immune system and it's um it's done by measuring like a blood sugar stick a finger stick what your ketone levels are and it should be between you know 0.5 and 1.5 typically is what what you want to get and you can get those machines at a drugstore and it takes a minute to sometimes get into that for people but it's a very powerful tool for people who are struggling with any kind of serious metabolic or neurologic conditions do you do it right after you eat or do it in the morning you do in the morning but you can check it any time because if you want and you know people kind of pop in and out or go up and down depending on what's going on but in this study that i was talking to you about there was in a year that 83 of people were adhering to the diet because they measured their ketones they were able to corroborate the fact that they were in ketosis it wasn't just oh i i did the diet but a lot of people say they do what they did they actually don't um and so this is a way of validating that people are able to adhere to it that it's effective and that they validated their results by measuring okay now i'm going to talk about some kind of confusion with ketos and meths and things like that atkins diet i hear a lot about the comparison about atkins or modified atkins diet yeah hopkins is not necessarily the same thing yeah atkins is tons of steaks and protein and uh and it has a similar effect in reducing insulin but high protein loads are not necessarily great for us and also they're not great for the environment and also they're not great for animals and also they uh transform the protein into glucose in the body when you eat excess protein so it's called gluconeogenesis which means making sugar from nothing basically and it's making sugar from protein as opposed to from eating carbs and so it's not at inside also atkins is high you can have processed meats and bacon and i i lots of dairy i i'm not a huge fan of the atkins diet from that perspective there's a modified acting which is a sort of a new and improved vacuum which is slightly better but i think it's it's very different than an atkins diet now you talked a little bit about too much protein i want to talk about too much excessive fat so if i'm in the absence of glucose i'm on ketosis and i'm eating fat how much of that is is too much is my body storing is it first of all is it burning the the the stored fat or the dietary the fat that i'm eating how do i know how much yeah well you have this great graph of the insulin you want to pull that up because i think you know most people don't understand that biology this is just basic biochemistry and here's the deal when you eat carbs you increase insulin when you eat protein you can also increase insulin when you eat fat insulin doesn't go up and you need insulin to store fat you need insulin to store fat so for example if you take a type 1 diabetic these people's pancreas are completely done they're not making any insulin these people can eat 10 000 calories a day they're starving because the food is not getting in their cells and they're actually losing weight eating 10 000 calories a day because insulin is required to actually store fat to store your body fat the word for fat in the diet and the word for fat on your body are the same word they probably shouldn't be and they're different so eating carbs makes you fat eating fat makes you thin that's what i wrote this book called eat fat get then it's about this biology and and so when you when you cut down the carbs and you eat fat you're not spiking insulin so you don't store fat and you don't you can't store fat in the absence of carbs and insulin it's very you just burn it and you burn your own fat and you burn the fat and turns into ketones which is a very effective and efficient metabolic fuel it's a very clean burning fuel think of it as diesel or as sort of super jet fuel you know the ketones are like jet fuel whereas you know carbs are like dirty diesel and i think i think you you basically have to use the biology to understand what's happening here but getting off of the starch and sugar will help drop the insulin your fat won't get stored and i honestly if i eat too much fat not enough carbs i will lose too much weight in fact this one study on animals was fascinating they put the animals on a a very high fat diet very very low carb versus a high carb low fat diet and they measured everything it was fascinating they had to keep increasing the calories in the high fat group so that they wouldn't lose weight and then when they open them up and they try to keep them the same weight when they open them up and i don't know people don't like animal studies but it's very instructive when they open them up the ones who were eating the high carb diet the rats or the mice their belly was just full of fat and the ones who were eating the fat had no body fat and they had increased muscle mass and a faster metabolism really really oh that's that we've been we've been lied to so yeah not on purpose everybody thought they were doing nobody's trying to make anybody sick but i think yeah we just we we made assumptions based on weak science and now we have better science yeah yeah now we can do better now can i just take ketone supplements to induce ketosis so there's a whole market out there now for ketone supplements or we call exogenous ketones so you can take a pill or powder and actually boost your ketone levels um i don't think all the data is in on that i think it does suppress insulin which can help when you lose weight and help in some ways but we don't know if having natural ketosis or exogenous ketones really is is the way to go and i would be nice about to take a pill there is a hack or trick for example using mct oil which is a medium chain triglycerides a special type of fat comes from coconut and it's used in a lot of elemental foods for people who can't digest anything because it goes right into the right into the bloodstream as opposed to into the lymphatic circulation like most fat and it has to get burned it stimulates your mitochondria it increases metabolism helps reverse insulin resistance helps increase cognitive function and brain function your brain loves ketones they say though you need 25 percent of your diet and glucose goes to your brain yes but it actually works better on ketones and i see this over and over whether it's me or alzheimer's patients or autistic patients or epilepsy patients the brain just gets much sharper and clearer can we talk a little bit about the side effects i know we talked a little bit about the keto flu but what about acetone breath i've heard well yeah you you can get bad breath because the yeah the acetone breath can happen um the the constipation can happen if you're not getting a fiber so the problem is when you have too much fat and not enough fiber which usually comes from plant foods and by the way you can eat a lot of plant foods on a ketogenic diet and you can be vegan keto too by the way and i have a friend who's a type one diabetic who's vegan keto and her blood sugars are better than mine wow and you know she's type one diabetic it's pretty impressive um it that it you know you actually have to um regulate your your symptoms by by doing it the right way so for example you need more fiber which you could take as a supplement resistant starch thing some plantain flour acacia flour other flowers other other things can be very effective in actually building the microbiome which you need which can be damaged sometimes a very high fat diet so having enough fiber enough plant foods it's really building the science of how to create a healthy approach to a ketogenic diet which i think we're still evolving okay i want to talk about some of the things that people might be doing they're on the keto diet and they're not losing any weight um you know like the body actually not being on ketosis because you said it takes a few weeks and and the carb level has to be really really low to get onto ketosis correct yeah um and then eating too much in general not eating enough i've heard people that actually fast or like intermittent fast while doing keto is that a thing uh there is a yeah you can do intermittent fasting for example you can have nothing between you know um you can sorry between an 88 hour window let's say from noon to 8 or 11 to 7 if you fast for 16 and eat during eight hours that's a way to also do very similar things to a ketogenic diet without actually having to do a ketogenic diet but you have to eat high quality food you can't just eat whatever you want someone said oh you do whatever you want on intermittent fasting not necessarily we see the metabolic effects are not great when you do that so it's important to eat a healthy whole foods diet if you're doing intermittent fasting but it can actually achieve a lot of the same benefits and you can combine them you can also do cyclical ketogenic which is where you go in and out of it and there's some evidence that that might be better just like we did historically but it really is is personal i think you have to really look at what happens when the individual does the program and who's the right person to do it it's not for everybody it's a therapeutic diet it's a medical diet i don't recommend everybody go on it i think it's important for those patients who need it the truth is though many patients and people in america will benefit because like i said one and two is pre-diabetic or type 2 diabetic and those are the ideal patients for this can you talk a little bit about the cyclical keto diet yeah so so the idea is that is that historically as hunter gathers we would binge and fast and binge and fast right because it was just about food scarcity and access so typically carbohydrates weren't available a lot of the year in fact you look at the grizzly bears and i remember visiting uh admiralty island in alaska which is fascinating and it's the highest concentration of grizzlies anywhere in the world uh it's kind of scary these guys walk around with shotguns and you stay in this whole spot and you watch the grizzlies and they're in the beginning of the season in early in the year they're they're fishing they're eating all this uh salmon from the rivers and they're just going and binging on salmon they don't gain any weight when you look at them toys in the summer they've gained 500 pounds because they binge on berries the alpine berries in the summer so they're eating all this sugar they're binging they're giving them 500 pounds they basically come diabetic and hypertensive and then they go to sleep and they don't eat all winter and then they burn all those stores and they start again so the problem with us we just keep eating all winter so cyclical ketosis is the idea of going in and out of ketosis in a cyclical way to help mimic the more natural state and actually achieve a lot of the same benefits and there are there are other there are other diets like the 5 2 diet which is basically eating whatever you want for five days and two days not eating or restricting your calories dramatically which stimulates all these metabolic benefits so i think in terms of aging in terms of metabolism in terms of weight in terms of cognitive function these can be very effective approaches i need to find what's the right sweet spot for you some people do very poorly on low carb diets and people do much much better on a very high fat diet so it really depends on the individual okay i'm going to ask you one more question then we're going to go to our live questions how does the keto diet affect athletes and athletic performance a lot of people if they want to bulk up they look at keto and they're like oh there's not enough carbs yeah yeah well we all were trained that we should carb load before we go for a run or before we do exercise or before a competition uh the evidence for that was pretty weak uh and the truth is you carb load you can store 2500 calories of carbohydrate in your muscle in the form of glycogen but if you're doing a long endurance athlete and you're doing a long a long race or something you're going to burn through that and hit the wall right that's the wall now if your body's burning fat you probably have 20 or 30 or 40 000 or more calories of fat stored in your body so if you can burn the fat you're going to keep going like the ever ever ready bunny and and the other thing that people should know about is that there's a lot of research on this by doctors bolek and finney they wrote a book called the art of low carbohydrate performance which debunks a lot of the myths about athletes and ketogenic diets and there was a interesting story of a guy i read recently who was an elite athlete a mountain climber guided many many people up mount everest and he never could do it without oxygen he would always poop out and had to use oxygen and he decided to try a ketogenic diet and it turns out that he actually was able to sum it without oxygen using a ketogenic diet there was another guy who a very successful entrepreneur decided he was sold his business and was going to becoming an elite athlete and he rode his boat literally from hawaii to california and california hawaii and he would use all these carb loader things these goos and uh sweet things and he ended up doing doing blood tests after his thing and the doctor told him he was pre-diabetic and here's an elite athlete who's being told he is pre-diabetic and he's doing all this exercise and it's not working uh it turned out you know it was because of the high starch diet another guy i knew was another elite athlete a doctor peter tia and you can read his stuff he's got a great blog online and he he writes about his own story where he was an another elite athlete would swim from la to catalina island which is miles and miles and back and he was overweight he had extra body fat and he was an elite athlete and again he used all these sort of carb loading things for his performance turned out uh he went to the doctor again and was pre-diabetic and he changed his whole view and shifted to a diet that was super high in fat and was able to fix his diabetes lose 30 pounds and actually become an even better athlete so i think there is evidence for short-term sprinting you might need a little carbs but for for most people i think um you know you don't need to be on a high carb diet to be an athlete okay great are you ready for some questions from our audience all right so i have uh pauline is the ketogenic diet safe long term i think there are long-term studies in epilepsy uh and and looking at what happens to cardiovascular risk factors and other things uh i think my view is probably not uh known yet i think we still don't have enough people doing it over a long enough time to really say that it's effective and safe over 20 or 30 years i do think as a therapeutic diet in other words if you're 300 pounds if you're diabetic it can be very effective to get your systems unstuck from the metabolic crisis it's in and put it in a healthier state and i think that's that's really where i was using it i think in alzheimer's patients you know i don't really worry about long-term i worry about how they're doing in the moment and if they're functional if they're engaged their memories better if they're actually to be able to sort of improve their quality of life i don't worry about long-term but i think i think it's really important to realize that this is a therapeutic diet in other words if you if you are on blood pressure medications and your blood pressure's high but then you change your diet you exercise you lose weight you fix everything and your blood pressure is normal you don't need to keep taking the medication you stay in this optimal state that's created by uh living in a healthy way okay great and just a reminder i just want to thank anybody for just uh who just joined us right now remind you that this will also be recorded and will be posted afterwards on facebook and youtube nancy wants to know is it possible to live a ketogenic diet and be a pescetarian oh for sure uh you can be a vegan keto you can be a pesco vegan vegan keto you know i think the challenge with fish is that you know most of the fish we have today in the world is contaminated fish is nature's perfect food except that we've polluted it all it's got micro plastics heavy metals like mercury pcbs so i would encourage people eat small fish i call it the smash fish which is wild salmon mackerel anchovies sardines and herring now they may not be your favorite foods i like those fish particularly but uh they are extremely uh helpful and uh i think safe to use and i think you just want to track your mercury levels and and see what's going on but it's tough we live in a polluted world and you know it's pretty frightening with microplastics now and fish yeah now carolyn's been on keto since april and started having hives um and she's itchy could it be related it could be i mean i think you know they're changing your gut microbiome that happen if you're not eating a fiber uh if you are uh maybe not uh eating a lot of dairy that you're not used to you might become allergic so there's there's there's reasons why okay and then trisha wants to know if it's safe to be on keto while breastfeeding great question no one's ever asked that before but i i think it can be sure i think it absolutely can be if you look at someone who's breastfeeding who's type 2 diabetic or who's very insulin resistant or pre-diabetes or diabetes is a pregnancy then it it you know it probably is a good idea because the more insulin resistant you are there's worse outcomes for the baby particularly while pregnant and then after breastfeeding less of an effect but i think it's important to keep yourself healthy sure and then bethany how do you know if you're in ketosis and what are the best tips to not get kicked out of ketosis so again using not the urine ketone strips but the blood strips which is a like a finger stick is the best way to know your ketosis and there are ranges that you can tell if you're in nutritional ketosis to not get kicked out of it is really dependent on your your carbohydrate load okay i'm going to just read a nice comment from janice says dr hyman and functional medicine saved my life it has saved my heart kidneys and no more diabetes too i am no longer on medication i have a new lease on life and i'm recommending this program to everyone i meet amazing well you know we actually had a woman come in uh to our functioning for life program and we have a functional keto program which is uh great it's a it's a way for people to do this under medical supervision the programs are filling up like crazy and people are having great experiences but we had a woman come the other day who was morbidly obese she had heart failure with an it would call an injection fraction of 35 should be 50 or more and under 50 is not great she had type 2 diabetes for decades more on insulin she was hypertensive and she did this program and she came back and shared her story she started in march and this was in july she shared her story she not only lost 43 pounds which was i think secondary but her heart function improved her ejection fraction went to 35 percent to 54 which is medically unheard of even with the best medical care treatment drugs she had uh reverse lower diabetes she got off insulin in three days three days three days she she normalized her blood pressure and she got off all her cardiac meds she also had liver liver problems fatty liver and elevated liver function tests and also kidney function problems she had renal insufficiency and she reversed her renal insufficiency her kidney issues there went back to normal her liver went back to normal and she got off all our cardiac and kidney and diabetes medications so it's pretty remarkable what happens when you apply this to the right person in the right situation that's amazing um kelly uh how about diet sodas do they hurt if you're doing the keto diet that's a great question i think you know there's a lot of debate about this issue now in the literature but i think there's enough a smoking gun around the role of artificial sweeteners and harming your microbiome and improving increasing insulin resistance increasing inflammation uh and increasing appetite that i i would really stay away from from these artificial sweeteners a little stevie might be okay but i would be very careful what about what is it called monk fruit monk fruit is a chinese fruit that has no calories and has a sweet taste and that may be okay as well good great but again these are things to use in moderation like i'm going to have monk fruit cake every day right right trisha is keto a good option for someone who has had their gallbladder removed it can be challenging if you're had your gallbladder removed and you might need to take digestive enzymes but there are ways to actually do a ketogenic diet if you have gallbladder removed okay great and then julie i've been semi-strict for 16 weeks lost 16 pounds although i love it why am i not losing more some eight weeks have lost twice as much i don't exercise but started at 15 to 30 carbs could it be i'm not getting enough fats not probably not if you're checking your ketones but it could be other things if you're not exercising your metabolism is you know static you could have microbiome issues you could have hormone issues like thyroid you could have excess estrogen levels there's a lot of other reasons for resistance to weight loss i've written a lot about them in my book particularly blood sugar solution so looking at other factors that affect weight other than just calories or fat or carbs and then kristin i'm using the carb manager app and have been following by the way one thing so when people lose weight what happens is the body stores petrochemical toxins like pesticides cdt plastics flame retardants stores all that in your fat tissue so when you lose weight and this has been documented you release these fat soluble toxins and that can have a negative effect on your metabolism through many ways i've written a number of articles about this toxins and obesity and how the mechanisms are now it's much more well understood i wrote this article i know probably 10 years ago but it's much more understood and i think i think we have to be careful and thyroid can be affected and many other things so if you're losing weight you need to also maybe think about detoxifying using saunas gut detoxification accelerating your own body's natural liver function and so there's a lot of ways to do that that we do in functional medicine you mentioned thyroid is that a side effect i've read something about underactive thyroid yeah if you have a low thyroid function it can cause weight gain and resistance to weight loss and when you lose weight these petrochemical toxins we call these persistent organic pollutants they do interfere with thyroid function okay all right and then i'll go back to kristen i'm using the carb manager app and i've been following keto strictly for two weeks i've only seen three pound difference in weight and feel very bloated i'm wondering how to follow the keto diet with less dairy and what food sources to eat that are higher in fat than protein also i'm concerned about my sodium cholesterol are these adverse future health issues from this diet now so many questions listen so i'm gonna go back to that so the weight issue again may be related to some of the things that i mentioned uh it could be that you're not in ketosis it could be that you know dairy is causing inflammation uh and that that may be something you need to stop and do a dairy-free keto and there's many books on it and ways to do it i think in terms of sodium you typically lose sodium when you are in a ketogenic diet that's why i said before you your insulin goes down you don't retain sodium you pee it out with lots of water so you might need extra sodium as far as cholesterol it's fascinating you see some people i put people on you know basically a butter and coconut oil diet which is high in saturated fat and their cholesterol drops 100 points their triglycerides drops to 300 points their hdl goes up 30 points other people different effects may be harmful effects so you have to look at your own biology we all are different we all have genetic diversity we all have individuality biochemically and metabolically and it's really important to look at what your numbers are because not everybody responds the same and so some people genetically don't respond as well to high-fat diets or may not able to eat saturated fat they may need more monounsaturated fat or other polyunsaturated fats or fish oil so you have to sort of look at how to modify this to the individual okay and then carl wants to know are the keto urine strips an accurate way to know what levels of ketosis we're in no okay because i explained about the blood is much more accurate way okay great and then uh what are john wants to know what are some type tips and tricks to avoid the cravings and withdrawals from avoiding sugars and carbs if i find this to be my biggest issue my other question is how do you live in a home with others who do not follow the diet plan and usually you don't honestly i mean it's tough i mean the best the best tool for changing your lifestyle is peer support is you know group around you who's also doing it and it's encouraging you if everybody's saying here have a piece of cake here i have a cookie here and it's all in the house i mean i basically make my home a a safe zone like sure i like ice cream and i like cookies and like everybody else but and i and i don't give myself the chance to have that stuff in my house because if it's there if i'm stressed or i'm tired or have something happen then i might go for it and so i sort of typically will not do that and if i want to have chocolate you know if i have to drive five miles to get an ice cream i'm probably not gonna do it so i think it's important people understand how to create their environment that protects them uh also if you are are you know not in that space it's it's really hard to do so and willpower yeah yeah really part of the question was uh let's see i kind of missed that one well let's see i have lisa how important is water intake on the keto diet extremely important if you don't drink enough water you can get weak tired dehydrated because again you lose a lot of water and you're taking a lot of salt yeah right so you need a lot of water and then adam i'm a very lean guy i'm overall pretty happy with my weight if anything i'd like to gain a little muscle how do i know the right amount of carbs to consume for long-term maintenance well again it's not how much carbs what carbs so i always joke and say that the most important thing for long-term health and longevity is eating a lot of carbohydrates and what i'm talking about as vegetables and some fruit plant foods not necessarily tons of grains or tons of beans which are okay in moderation but are not staples because those are full of starch and over time especially in our current society with everything else can be a problem now there's some people who do well with a lot of that and who have great metabolism they can eat whatever they want i mean i i know people who can eat all the crap in the world they never gain weight they may not be fat but they may not be metabolically healthy so it's important to know that so i think um yeah i think i would i would uh just check on the kind of carbohydrates you're eating and again if you're lean healthy and fit you look at your metabolic parameters the ketogenic diet probably isn't right for you but again i would say the a low glycemic diet is right for everyone and what i mean by that is a diet that doesn't raise your blood sugar and insulin because that is the single thing that drives heart disease cancer type 2 diabetes alzheimer's and much more so it's really important to understand that concepts you can eat a diet that's a wide variety of starches and carbs but if it's low glycemic if it's low glycemic then it's okay some people in the world have diets that are 70 80 carbs and have high levels of longevity why because they're eating whole foods because they're eating non-starchy carbs because they're not eating sugar you know a coca-cola is a carb but so is broccoli very different right so following up donna wants to know what are you drinking what am i drinking i'm drinking a green juice which is basically uh celery cucumber spinach romaine lettuce kale lemon and parsley with no fruit juice because fruit is just like having soda so this is very low in sugar uh and it's high in phytochemicals got 800 milligrams of potassium and vitamin k and vitamin c all kinds of good stuff so besides that do you usually just drink i drink water i drink water coffee water black coffee i put sometimes put almond milk in it something to make a bulletproof coffee okay uh but yeah i i typically drink water water okay good filtered water yeah filtered water and then tiffany what about keto after gastric bypass is it safe uh yeah i think uh yes i think many people fail gastric bypass half of all gastric bypasses fail because people you know haven't really changed their way they eat i know a guy who was a doctor who had a gastric bypass lost 200 pounds and then decided he could cheat by having m m's all day long so he would just have huge bags of m m's and i'll eat little all the time instead of having a big meal which would mess up his stomach he had m m's and he gained back hundreds of pounds so yes it could be very effective for people for maintenance and people typically who get that big are carbohydrate intolerant there's a large group of the population is carbohydrate intolerant okay and then diane wants to know what would a dinner plate look like my dinner plate typically is three-quarters vegetables okay what kind of vegetables because i know there's non-starchy vegetables so all the salad vegetables are fine okay but not a lot of potatoes and and large starchy veggies so sometimes a little bit of sweet potato can be fine if it's keto you can have less things like winter squash and sweet potatoes but green beans and all the broccoli family all the lettuce stuff you know there's just any in any kind of non-starchy vegetable is fine and then you have a small piece of protein maybe you know the size of your palm fish or grass-fed meat or if you or organic chicken or you could use tempeh which is high in protein or tofu if you're vegetarian and then you would eat a lot of fat with that for example you could put a lot of olive oil all over the vegetables if you're not allergic to dairy you can have grass-fed ghee or butter uh over your your um your food so i think it's very high in good quality fats i add mct i'll have a fat shake in the morning for example uh my shake might be nuts and seeds which are also high in fat would have coconut oil i might put mct all in there i'll have avocado in there and i'll put it in with a bunch of berries and make a make a smoothie and that's what i call my fat shake and i'll have a fat salad for lunch which would be a lot of salad greens so i'll use arugula which i like but i don't use ice cream lettuce that's not good and i would put on nuts like pumpkin seeds toasted i'd put olives which were full of fat and pumpkin seeds have fat i'd put avocados which have fat i put olive oil it has fat and i'd have usually some fatty fish like sardines or or herring or mackerel or or salmon and i would that would be my fat salad and that's sort of how you you kind of use these whole foods as a vehicle for different kinds of fats okay so aaron's actually talking about the starchy veggies and fruits and carbs but do they have the same effect on you as grains uh starches kind of carbs yeah um you know if you take you know an heirloom peruvian fingerling potato probably okay if you take a starchy idaho yukon potato probably not okay that's not how potatoes were involved and they're super starchy yeah and the frying is that yeah uh if you're eating uh you know some black rice or buckwheat or quinoa you're probably okay but if you're eating too much of that you're quickly will get out of ketosis because those are high in carbohydrates but they're for most people they're fine and beans the same thing you know if you want to be in ketosis it's going to be hard to eat a lot of beans but you can have if you're if you're have metabolically sort of fixed yourself sure you know you can have beans every day and you know half a cup of beans a cup of beans okay okay great and then again this just a reminder for our audience if you're interested in exploring the ketogenic diet as a treatment option for your medical condition it's best to consult with your physician and then debbie wants to know well she says hi cleveland clinic i'm a patient in your functional medicine department hello i need to jump start again what do you recommend you got the floor what's wrong with you i don't even know so um i guess i mean start a ketogenic diet right well not necessarily it's not good for everything yeah so so what do you what do you uh what do you say for debbie she wants to jump start well i think you know i've created something called the 10-day detox diet which is our renew diet and that is essentially 50 fat so it's not ketogenic but it's high in fat it's very low in carbs and starchy carbs it's high in plant foods vegetables nuts and seeds and fruit and that can be very effective to helping people jump start their biology now sophia says i've tried the detox diet it is great but so hard to keep us especially staying carb-free any tips well what's your goal i mean if you're if you're healthy i mean you don't have to i think it's important to sort of get to that sweet spot where you feel healthy when you're biologically healthy where you're sort of finding what that sweet spot in your diet is like i said i don't think most people should stay on a ketogenic ketogenic diet forever i think it's therapeutic and it should be used as a medical treatment but not for everybody and then cheryl anyone that cannot or should not follow this diet yeah of course you know if you're a kid unless you're obviously diabetic which many kids are and if you're very thin if you you know have eating disorders if you have uh certain metabolic issues that i think make it risky i would i would be very careful okay and then kathy must know any recommendations for fiber please how necessary is fiber fiber is essential especially on a ketogenic diet so i like acacia fiber you can use resistant starches like potato starch like plantain starch there's various supplements you can take that are fiber supplements glucomannan is a great starch so these have no calorie source but they're high in carbohydrate content so but they're very low in what we call net carbohydrate contact meaning if you take the fiber that it doesn't really raise your blood sugar doesn't get absorbed it feeds the good bacteria in your gut really important we need probably you know 30 to 50 grams of fiber in our diet every day and we get about eight to 15 on average and hunter gatherers had 100 to 150 they 800 species of plants wow that's amazing well terry um says dr hyman i think you should clarify a keto diet versus functional keto diet folks seem to be confusing the keto diet full of cheese and bacon with functional keto diet which is more about healthy fats yeah so no bacon i mean it's not it's not the top of the list of health foods i think we we really need to understand quality so you can have a poor quality ketogenic diet by having refined vegetable oils deep fried foods this is not healthy you can eat a bunch of dairy not necessarily healthy so eating a high quality diet is important across the spectrum of any diet whether it's mediterranean or low fat or high fat or keto it's really the key take home messages real food whole foods fresh food frozen is okay but eating food that's in an unprocessed state is critical okay now linds wants to know about alcohol and keto what do you recommend well i think you want low carbohydrate alcohol if you eat a beer i mean drink a beer we used to call that a barley sandwich in canada where i went to medical school it's very high in carbohydrates if you have wine less so but still so 10 ounces of beer five ounces of wine and one ounce of hard liquor that's sort of all the same equivalent terms of you know its effect so i think having one ounce of one ounce of hard liquor is probably better than having a 10 ounce beer and so tequila things like that are fine and then again it's the dose that matters so should women going through menopause do keto the same way younger women do again it depends on the person i don't think it's the right diet for everybody who goes through menopause or maybe a lot of really thin women who are healthy and fit they don't really need to do that i think uh there there uh there's really an emphasis here on personalization so it really is not should menopause women be on keto no the quenchers who should be on keto and when and for what okay and then leona um can you talk about keto drinks and supplements um there are keto drinks you can get keto shakes for example that are made of whey protein mct oil there are supplements that we talked about earlier i think the data is out on these exogenous ketones and how they affect you the shakes may be more food based which are i think better so i think it really depends on what you're looking to do and then bhara dwaja wants to know is it key is is it keto diet is it harmful for your kidneys uh no in fact like i said it can help reverse kidney failure we've seen many patients who have kidney insufficiency who change their diets and really help improve it high protein diets can be harmful but keto is not high protein okay speaking of protein uh marni my nutritionist recommended 90 grams of protein after my gastric sleeve surgery is this too high or proper for keto diets well it depends so you know if you're 500 pounds 90 grams of protein is probably not enough if you're 100 pounds it's probably too much so it really is is depending on what your protein needs are depending on your level of activity and your overall goals so typically we've been told the between 0.8 and 1.2 grams of protein per kilo kilos 2.2 pounds so for the average person it is about you know 70 to 90 grams of protein if you're an athlete sometimes more so it really depends okay and then laura can you address what someone who's strict keto and still not losing weight might be doing wrong i have hypothyroid and postmenopausal female well i think that's it what are the other factors that are going on is it your thyroid is it hormone levels is it your gut flora is it environmental toxins stress is it sleep i mean there's a lot of reasons people don't actually lose weight for example if you have sleep apnea you're not going to lose weight right right sherilyn uh what's the difference between keto and protein sparing diet a protein sperm modified fat is essentially shakes that are higher in protein very low in calories it's basically a liquid diet that can be profoundly effective in helping people reverse metabolic conditions but it's not sustainable you're not going to be on a calorie severely calorie restricted shake diet your whole life so the question is how do you eat in a way long term that's going to help you if you go back to eating the way you were before you're on a protein spirit modified fast you're going to end up with the same metabolic problems so it's about understanding how to switch to a whole foods diet and a ketogenic diet can often have the same benefit or more i call it uh you know basically having a gastric bypass without the pain of surgery vomiting and malnutrition oh my gosh okay and terry wants to know can you discuss fruits what types of fruit can i eat and should not be eating well i think it's interesting i think you know if you look at the data overall people who eat more fruit are healthier and long-term and do better even diabetics but i think those are population studies and there may be other confounding factors where people eat fruit are probably healthier in general and they're not having chips so maybe the other factors that are causing this i have had patients who have continuous glucose monitors where they have 24 7 track of their blood sugar and they tell me when they eat certain fruits they see their blood sugar just goes off the chart like a plum who knew so i think it really depends on the person if you're highly carbohydrate intolerant if you're severe type 2 diabetic no you can't eat a ton of fruit until you fix your metabolism but the goal isn't to be restrictive your whole life the goal is to get to be metabolically resilient to fix things so that they work better so you can function and have more we call it metabolic degrees of freedom more flexibility in other words if you're a marathon runner you can even what you want you're not going to gain weight right because you have create a lot of resilience and flexibility if you're a someone who's fairly carbohydrate intelligent you look at a bagel and you just think about eating carbs your insulin goes up you literally can gain weight so you have to figure out how to get to that place of resilience and that's what functional medicine is it's a way to help people and our functional keto program for those people who want to try it is a very powerful set of tools and also instruction it's a six week program it's done in a group people are together helping each other and it's super powerful we only have a few spots left but uh in this round but it's it's in the filling up fast if you're interested give us a shout at the center for functional medicine at cleveland clinic and i'll tell them it is ccf.org f m keto so if they want to sign up now financialmedicine.org cleveland cleveland clinic ccf.org fm keto okay got it there okay i'm gonna give you one more question before i let you go um sorry if i butchered your name what about the rebound effect if weight loss is quick weight gain is fast how does someone keep the weight off after this diet well i think again it's there is an after it's you know probably staying more low carbohydrate not necessarily keto range which is less than 30 to 50 grams but probably less than 100 grams and and having a whole foods high quality diet if you go from any diet and you go back to what you're doing you're going to create the same metabolic story so you have to learn how to eat well for the long term great all right well that's all the time i have for today but before we go if you are interested in learning more about the center for functional medicine ketogenic program download your free guide at ccf.org keto intro and anything else you want to end with no that's great we'd love to see at the center we'll help you out and there's enough people out there would benefit from it that i think is going to make a big difference yes and for the latest cleveland clinic news information follow us on facebook twitter instagram and snapchat at clevelandclinic one word and we'll see you again next time

Channel: Cleveland Clinic

Views: 554,521

Keywords: keto diet, ketogenic diet, Mark Hyman, Dr Mark Hyman, Cleveland Clinic, Functional Medicine, Facebook Live

Id: a9CgKW6d5jQ

Length: 60min 17sec (3617 seconds)

Published: Mon Aug 20 2018