 And in the book you make it very clear that we don't understand some fundamental things about ketosis and ketones. And so let's start with what don't we understand? Well, I guess the best place to start is what we thought we understood about ketones. And ketones and ketosis have been known about since the late 1800s. And I hope that a lot of people in the keto community know that the ketogenic diet, the actual word, ketogenic diet, was founded in 1930 at the Mayo Clinic as a treatment method for children with seizure disorders, epilepsy. How did they figure that out? Because that does not seem like a super obvious, at least for me as a lay person, not a super obvious conclusion to draw that that's sugar-based. Well, what they found was that children who had severe epilepsy spent so long post-seizure and it's got a medical term called post-ictal state where they're okay, they're not seizing, but they're not really waking up. And they spent so many hours in this post-seizure state, repeated seizures and then just kind of in a coma that they didn't eat very much. And they were literally starving. And they made the observation that kids who were starving because they had so many seizures paradoxically had less seizures the more they were starving. And so research just first at Boston and then at the Mayo Clinic said, wait a minute. We know that ketones happen when you're starving, that's when it happens. So it must be that ketones are doing something to these kids' brains. And are there other ways other than starvation to produce ketones? And one of the ways they found was, well, look, if you deny carbohydrates and really cut back on proteins and give kids mostly fatty, then they will make ketones even though they're not starving to death. These kids did very well on a ketogenic diet. 50% of them had complete seizure control. Recently, I got a young man who's a high school student who, despite two meds, was still having seizures so bad he was in special ed and falling way behind. His mother brought him to me in my clinic in Santa Barbara. And we put him on my ketogenic diet which is kinder and friendlier. When the kid woke up, he's off of his medications. He's now... Was he doing any kind of keto before that? No. Okay. Not at all. So went from meds to meds and keto or keto only? Keto only. We took him off his meds. He woke up, wasn't drugged, and now he's taking advanced classes and he's actually playing soccer for his soccer team in high school. And he could not do any of this. I mean, can you imagine a kid with a severe enough seizure disorder to be on two meds now actively playing high school soccer just by changing stuff? When did this come back into vogue? So I had somebody on the show when this was still inside Quest. His son had seizures, epilepsy, and he said they didn't even tell him about ketogenics because they said compliance was so low that they didn't even mention it to parents anymore. And he had to go to his own research and he found some obscure article in a journal from the 1950s. And he was like, hold on a second, did the same thing, put his son on, boom, total remission has not had a seizure in like 20 plus years. Yeah. Well, that's a great point. So the ketogenic diet, the high-fat ketogenic diet for seizures, once Fina Barber to all in Dying Latin came and the new seizure drugs came, it died because kids couldn't do an 80% fat diet. They actually had growth retardation and they just wouldn't follow it. So what happened actually in the 80s was people discovered medium chain triglycerides, MCT oil. And this oil was the miracle oil that some of these TV shows were done. And what they found was that MCT oil could convert into ketones in the liver and we'll get into why that happens. And they found that if you put kids on a MCT oil-based diet, you could give them far less MCT oil, far less fats and you can give them tons of carbohydrates, which I'm a parent and grandparent now and you cannot deny children carbohydrates as much as we think we should. So these kids could have more carbohydrates, more protein. They could grow and develop normally, but they'd still stop their seizures. How much do you have to reduce the carbohydrate intake if you're using MCT oil? You can't just, you can't just add MCT oil, right, you stop and modify. Really? So no matter how much carbohydrate I'm intaking. What's amazing is, and this is human studies, you can take a tablespoon of MCT oil, which is not much, and you can actually within a half an hour generate a generous amount of ketone body production from the liver. At least .5.81 from one tablespoon of MCT oil. I've never tried it, so I can't deny it, but man, knowing how hard it is to produce ketones without it, that's scandalous. Yeah, and that was the beauty of this. So when I, you know, I actually started writing this after I wrote the energy paradox, which we've talked about, and I was trying to explain, you know, where ketones fit into all this in terms of energy production. And as you know, I like to back up what I say with research, either my own or somebody else's, and as I was trying to explain how beneficial ketones were for energy production, for protecting mitochondria, for turning mitochondria into fat-burning efficient machines, when I started looking at, you know, the research to back up what I was saying, I went, holy cow, I'm wrong about this, and so is everybody else. Ketones aren't some fantastic- How did you deal with that? Most people cannot, especially if they've talked about it publicly. They can't change their position. Hopefully that makes me one of the more believable nutritionists around, because I'm always willing to say I was wrong. So what was the first thing that made you go, wait a second, I don't think we were on the right path? Well, one of the most amazing things, and I've had a ketogenic diet in all my books. In the last 20 years, I've had a ketogenic program for my patients, and looking back, when you actually look at the list of things I allow on my ketogenic diet, there's tons of carbohydrates, and yet it works extremely well. And I've been using MCTO for my program from kind of day one. So I've written that ketones make you an efficient fat burner, and I firmly believe that. And I approve how ketones actually make your mitochondria incredibly efficient at making energy. Right. And probably the best way to explain this is we know that ketones were discovered during starvation, and nobody quite figured out why they were produced until the 1930s. But then how ketones came about to be known, what they did, really started in the late 70s, 80s, up to the year 2004, at both Harvard with George Kale and Dr. Owens and Dr. Veach at the NIH. And they wanted to know, okay, what were ketones doing? We don't do things by accident, and so they started to look at, okay, human beings clearly have starved for multiple times. We didn't have... As a species. As a species. We didn't have 7-Elevens next to us, we didn't have fast food, we didn't have refrigeration, we didn't have storage systems, and we had to find or kill food, and there were famines and there were times and not much food. So we were designed, when we found food, to store a lot of it as fat. And I've written about this in previous books, great apes, interestingly enough, only gain weight during fruit season. And fruit season doesn't happen year round in a jungle. It really only happens in the summer and early fall. We gained weight because the winter and spring was actually times of less food. So it became beneficial to take fruit and convert it into fat so we can make it through the winter. And that defect, it's actually a genetic mutation that allowed great apes to do that. We inherited it as well. So we're really good at storing fat. Yes we are. Yes we are. In fact, we're... I'm better than most. We're called the fat ape for a reason. We best all apes at storing fat. So when we don't have any food, normally, and I talk a lot about it in this book and you and I have talked about this, most of us should have metabolic flexibility in our mitochondria. And mitochondria are the little energy producing organelles that take the food we eat and produce ATP, our energy currency. And mitochondria, for anybody that doesn't know, are like aliens inside of our cell. They have their own DNA, which is crazy, and I still don't understand how that's possible. But nonetheless, it is true. And at some point, two cells combined and they were able to handle oxygen by the mitochondria wrapping inside of the cell, which is bananas, and there's actually a gaggle of them inside of every cell. Yes. There's a bunch of them. Unlike our high school biology textbook that might have shown one or two mitochondria per cell, there can be thousands of mitochondria. And they're actually in golf, they're in golf bacteria from two billion years ago. And they actually carry, you're right, their own DNA. And the cool thing about that, an important part of the book, is that mitochondria can divide and make more mitochondria without the cell they're living in dividing. So if a mitochondria gets the right stimulation, and that's part of the book, they'll make lots more of themselves and to share the energy level. Well, getting back to starvation, normally, you and I, hopefully, when we run out of sugar, we can immediately start burning free fatty acids fast. And that's the flexibility you're talking about, burn sugar, can burn fat. We should be a hybrid car. If we burn gasoline, we'll call that sugar. When the gasoline runs out, we've been storing energy in our battery. And when the gasoline runs out, we switch over to battery power until we go fill up at the filling station. Unfortunately, here's the weird thing. 50% of normal-weight individuals have no metabolic flexibility. 50% of us. Just because of modern diets. Modern diets. We're eating all the time. We're never in a quote-unquote starvation phase. Correct. If you're overweight, 88% cannot shift between burning sugar and fat. If you're overweight, if you're obese, 99.5% of people cannot shift to burning fat. What does that mean? Why does that matter? Well, you normally, if you and I stop eating tonight, whenever, about eight hours after we stop eating, we should actually run out of glucose as a fuel. And we should shift over to burning free fatty acids and ketones as a fuel until we get our next meal. That's normal. And by 12 hours of not eating, we actually ramp up ketone production to pretty much take over our brain's need for fuel temporarily. And your brain actually, if it runs out of sugar, starts dying. So the implication for that... So the brain is never without sugar? Believe it or not, the brain normally would run out of sugar in about eight hours after we stop eating. Normally runs out of sugar. And it shifts over to using ketones as a temporary fuel. The reason it can shift over is once we stop eating, we start liberating free fatty acids fat from our fat cells. So you're saying it would die if we didn't have ketones? Correct. Got it. Okay. So normally those free fatty acids come out of fat cells. Every one of our cells except the brain can use free fatty acids as a fuel and use them very well. And this has been, again, proven at Harvard and the NIH. Our muscles love free fatty acids. My research on the heart years ago showed that the heart prefers burning free fatty acids instead of sugar. It's favorite fuel. In fact, we protect the heart during heart surgery by putting fats into the heart. How? Through the veins and the arteries, I invented... You inject fat? Yeah. Well, we dissolve it in our cardioplegia. Whoa. So without that metabolic flexibility, then what happens? What happens is what we're discovering right now is that your brain cannot get life-saving ketones to burn as an alternative fuel. And your brain runs out of glucose as a fuel because you don't have any available. And your brain, for several hours a night, until you eat again, neurons die. And there's no doubt that our epidemic of Alzheimer's and Parkinson's and memory loss is laid at the feet of our metabolic inflexibility. Okay, so that is certainly terrifying, but means that we can do something about it. So going back to where we left off. So we go into starvation mode, we start kicking off these ketones. That feels like the sort of story up to before this book. People understood that. So where do you begin to go, wait a second, we have a problem here? Okay. So we can make ketones. When we make ketones from free fatty acids, they go to the liver and the liver generates ketones. Now the liver, interestingly enough, can't use ketones as a fuel. They're incapable. They don't have the enzyme to do it. Can it use free fatty acid? Yes. Okay. A liver loves free fatty acids. Which it gets as fat is oxidized, we get free fatty acids and we can snatch them out of the bloodstream and use them. Right. And they're a great fuel, fabulous fuel. So what everybody thought. But they can't cross the blood-brain barrier. That's the problem, right? Because they're too big and fat, if you will. So as luck would have it, ketone bodies, ketones are water-soluble, small fats. And they can get through the blood-brain barrier. So the brain can use ketones until glucose arrives the next morning or for several days. Now that piece of the puzzle wasn't known. So people like Cahill, people like George Beach said, wow, ketones are clearly what made humans survive for a long time because we could use them as a fuel without burning up our muscle to make glucose. We can convert muscle protein into sugar. It's called gluconeogenesis. And they actually showed that if you literally had to live on glucose as a fuel, your muscles would be gone after about a week of starvation. So the only way for gluconeogenesis to happen is from muscle tissue. Yeah, but you can also make gluconeogenesis from breaking glycerol molecules off of triglycerides and convert that into glucose. So there is a way to get sugar from fat. Got it. We're really good at turning sugar into fat. We're really bad at turning fat back into sugar. We just don't have the enzyme system to do it. If you found this video helpful, I think you're going to love this one. So bluzone is a term that describes areas in the world that had some of the longest lived people per percentage of population and the healthiest longest lived people in population.