 today we are going to talk about ketogenic diet. I know you guys have been hearing about this ketogenic diet everywhere and from everybody. I think it's time to hear from a doctor who actually knows what he's talking about. We are not gonna make blank statements. We are going to tell you who is the right person for keto diet and who is the wrong person for the keto diet and what to watch for. Again this is Dr. Ahmed Ergin and let's get started. So you guys are watching YouTube videos and everybody talks about keto. Some people put a doctor in front of their name because they're a real MD but you just want to throw out the you know the titles to look more important. Now guys remember not everything you watch is true. Those general statements you may actually harm yourself quite significantly. Now I have been getting some hostile comments because people think that I do not support keto. That's not true. I support keto for the right patient. Now some people said oh keto has to be for everybody. Well that's not true and we are going to talk today why the keto is not the right diet for everyone and who is the right person for the keto diet. Now let's briefly discuss about the definition of a ketogenic diet. It is simple. Everybody talks about this. Again to talk about keto you don't have to be a doctor. You can be a dietician. You can be anything. You don't have to be. You can be a karma kind of can talk about keto diet. It's not a rocket science but who is a good keto patient is where a doctor comes in. I do not recommend anyone to jump into keto diet and without talking to a doctor that that can have severe consequences that you don't want to have. It's like you know let me give you an example about it from a relationship standpoint. You may see a hot girl or a hot boy. You may say oh my god this is gonna be the love of my life and you just jump into it. You do everything. You spend all your money. You spend all your time for that person without really understanding what they're all about. Without thinking about the consequences of the relationship. Without looking at all the negative aspects of this person. So when you're in love everything is blind. So if your goal is to just lose weight and get your diabetes under control and you do not look at all the other consequences of a diet then you are going to have a problems with it. So it's better to understand what it is and what it's not and if you are a good candidate for that. Now of course I'm going to tell you a lot more detail than you typically see in a keto video from a medical standpoint but I still do not want you to go ahead and start keto on your own because I don't want you to get into trouble. Again you don't want to treat yourself. You don't want to doctor yourself. You want to make sure you talk to a doctor. It doesn't have to be us. You can just talk to your primary care doctor or a medical knowledge or a diabetes doctor who has understanding of a keto diet. So how was keto diet found? Actually initial studies came around for the childhood epilepsy. They found that the kids who were not eating a lot of carbs had less epilepsy and did the studies and they found that the ketogenic diet actually reduces the seizures in kids. Also there has been some studies short-term studies that it actually works for diabetic patients but how long it works and which diabetic patient is the candidate for the keto diet is the question. As you all know your body turns into fat when you actually eat fat so that's only fuel that you need to burn. Other people will get more energy. They will have mental clearness although initial transition period may be difficult. You may get a keto flu. You may have electrolyte abnormalities. All these minor things that can happen to even the healthiest person. But the question is can everybody go on a keto diet? Will everybody have symptoms of keto diet? So these are the things we are going to talk about. So a lot of people think that the keto diet works and I agree with that. Keto diet works but the question is how long it works and the question is what happens after a prolonged keto diet right? So let's talk about this. So you guys all know the good side of the keto right? So your blood sugar goes on if you're diabetic and you start losing weight and all that good stuff but what are the things that you really do not know about ketogenic diet? Number one you may lose a lot of muscle. Now what happens when you're in a keto diet guys? Yes you lose weight but you feel tired because your muscles run on glucose and primarily glycogen has to be stored in your muscle for you to be able to work out. So if you're a guy or a girl who loves going to the gym you are going to have problems in terms of your performance at the gym. Your muscles will crave for glycogen and the glucose and your weight lifting cardio will suffer through it. Now the problem is if you trade your exercise for the diet you're not really doing great for yourself because once you stop exercising your muscle mass goes down and that's because you're gonna feel tired on keto diet. So especially if you're working out if you're not working out that's not a problem but I think you should everybody should work out. Now when you work out your muscles will get weaker and if you don't use those muscles use it or lose it. So you're going to have less muscle mass. Now your overall metabolism is determined by how much muscle you have that's why guys lose weight a lot easier than the girls because guys are more muscular. So if you have less muscle mass you're going to it's going to be a lot easier. So let's say you're going to keto diet you lose a bunch of weight and but you also lose a lot of muscle. So what happens if you come off of keto diet and start eating sugar then you are going to gain a lot of fat but you're not going to gain a lot of muscle unless you start working out like crazy. The problem is once you fall off the wagon and you did not exercise for a while it is very hard to get back into it. So as a result I would suggest be very careful about not losing your muscle and if that's the case I would suggest eating some carbs right before or after the exercise at least to keep the exercise going. I would call this a modified diet and that works for me. I try to be on a low carb diet not necessarily keto diet because when I'm a keto diet I just don't feel like working out hard and I like working out hard. Another major problem with people who go on a keto diet and sometimes go on a dirty keto diet right they do not understand the whole concept of medicine. So when we treat diabetes we are not just trying to bring your blood sugars down that is just maybe one in a ten goal but when you don't know about everything your goal is about okay I need to bring my blood sugar down but that's not everything. When you have diabetes that is end of the story it's like you're the insulin resistant you already have underlying possible cardiovascular disease your blood sugar goes up at the end of the story. So it's like you know after the storm comes over you're trying to fix things but the thing is you really need to pay attention to everything else that goes around diabetes what are they cardiovascular disease heart attacks and strokes so if you're controlling your blood sugars without reducing your risk of heart attack and stroke then you're probably going to die young with a wonderful blood sugar that's not what we want right so you want to bring the blood sugar down along with the risk of cardiovascular disease statistically speaking again that's that's numbers numbers talk then numbers are generally right two or two thirds of diabetics die from heart attack and stroke before they become they go blind before they become dialysis dependent or they before they lose their feet and stuff like that so your primary goal when you have diabetes to avoid heart attacks and strokes before you worry about dialysis so if you're going to keto diet right and then you start eating bacon or red meat all this animal fat you are going to have a major problem with your cholesterol now not only that on keto diet you're not able to exercise well because your muscle mass go muscle mass goes down your muscle needs glycogen and glucose so you end up ignoring the exercise part just because you're enjoying the weight loss and all this good stuff your blood sugar is down you're enjoying this but what you don't see your LDL starts climbing up because of the animal that you're eating your HDL which is the good cholesterol goes down because you stop exercising HDL only goes up when you do cardio and enough cardio it's not just walking the dog and you know going to the park and having a mile or two you know the HDL will go up and that is a very important protective factor from heart attacks is that you have to keep exercising now exercising for an hour cardio for example is not just going to be easy when you're in a keto diet so when you're in a keto diet make sure your doctor monitors your cholesterol and make sure your LDL stays below 100 and your HDL stays about 50 possibly better if it is about 60 so if you're not paying attention to your LDL HDL and even triglycerides then you're going to have major heart problems or stroke and that's not what we want guys problem with keto diet guys if you have stage 4 or stage 5 kidney disease that is the time you have to be really careful about your protein intake so the problem is that high protein that you're getting yes you're getting more fat but you're getting also high protein that diet as well is going to put stress on your kidneys and you make progressive dialysis more so as a result so let's say you're a guy with a kidney function GFR down to 30 or 25 and then you just watch this keto videos everybody talks so great and you're going to keto diet you may find yourself going to dialysis in the next year or two if you are very sick about this keto diet just because it's been shown that the high protein diet actually kills your kidneys especially if your kidneys are already weak so if you have a perfect kidney function you're great you're just a new diabetic that doesn't apply to you but if you have been diabetic for 15 20 years and you already have significant kidney disease you have to be extremely careful and another thing that happens with the keto diet it makes you dehydrated so unless you chunk a gallon or more water every day along with the electrolytes you are going to be prone to kidney stones so if you have a family history of kidney stones or if you already had a kidney stone I would approach this very very carefully because if you have a kidney stone once you're going to hate your life it is worse than childbirth every woman says that if they have a kidney stone versus a child delivery it is horrible and it can last days it can come back on and on and on so you have to be extremely careful now if you see a doctor and if you are potentially somewhat high risk for kidney stones you may go on a potassium citrate which can actually alkalinize your urine and reduces the risk of developing kidney stones this actually has been studied in kids with epilepsy they use a keto diet to reduce the risk of seizures but they develop more kidney stones so you have to be extremely careful drink a lot of water if you're insisting on going on keto diet you have to drink a lot of water a lot of electrolytes and maybe use a potassium citrate as well. Diabetes channel I'm going to talk about diabetes here so if you are on insulin or a sulfonylurea agent such as galiphozide, glimopride, gliboride, amaryl whatever you name it they're different brands as well but most of these are generic but regardless if you're on any insulin or a sulfonylurea drug and if you go on a keto diet and cut the carbs to almost nothing you are going to have severe low blood sugars now severe low blood sugars can lead to coma can lead to accidents can lead to falls so you need to really consult with your doctor with your endocrinologist preferably or diabetes doctor to make sure that you are slowly gradually cutting down on the carbs or making a major cut on your insulin now every time you make a cut on your insulin or your medications the response may not be like just like what you foresee so you may you may have still have to be monitored now with good good thing about sugar and bees we monitor you guys remotely so you check your blood sugar band it pops up on my screen so I know you have a low blood sugar so I can call you and let you know what's going on so this kind of close monitoring has to be done for every diabetic patient not just on keto diet but I think from being accountable standpoint I think that's also the greatest way to go remote patient monitoring is the key but again if you're on an insulin or sulfonylurea agent make sure you talk to your doctor another problem from a metabolism standpoint now it looks very glorious you lose a bunch of weight on keto diet right but the problem is it is so hard to maintain so you end up losing fat and the muscle as we discussed and then suddenly there's a party suddenly there is some social events suddenly there's a family gathering Christmas kicks in Easter Ramadan whatever you're celebrating and suddenly all this carbohydrates available and everybody's eating you're like I cannot eat this I cannot eat that they're gonna look like you're a little weird guy so or they may just actually say oh you're such a great willpower and so forth but regardless of the case you're going to miss the enjoyment and that can happen occasionally now once you get back into that sneaky carbs situation your body will taste it again and you're going to have cravings again the thing is if you lose if you lose your willpower and if you get back into carbs you are going to accumulate so much fat back into your body and that fat will go around your organs now sometimes we call insulin resistant patients skinny fats so some people are actually very skinny especially smokers for example they look skinny from a distance but if you you know when they do autopsy studies on these patients for example for one or the other reason they see that there's a lot of fat around the liver around other organs around the intestines body accumulates the fat around your organs not under your skin and that is the biggest problem for insulin resistance so you don't have to look fat from a distance but you can still be fat inside and that is a huge problem for insulin resistance so guys if you're losing weight and you don't think you're gonna stick with keto you're gonna go back to carbs don't even start the keto diet because you're going to lose muscle and then later you are going to gain all the fat around your organs which is going to be worse now the biggest problem is the keto diet can lead to dehydration now another patient group with diabetes who should not be on keto diet if you're on SGLT2 inhibitors what are they? Jardines, Farciga, Invocana and Stegalutra these are the four SGLT2 inhibitors in the market if you're one of these agents first of all these agents can make you prone to diabetic ketoacidosis and if you put yourself in the ketosis then you're looking for trouble another problem is that these agents they actually work good in a way because they make you urinate blood sugar and you're losing 300 calories on average a day by just using these agents but then they also make you dehydrated because every time you urinate glucose it attracts the water with it so if you're using these Jardines, Farciga, Stegalutra or Invocana you have to stay hydrated now if you're going on a keto diet that's going to make you dehydrated why? because a carbohydrate actually hold the water just like when you urinate carbohydrates or sugar in your urine and you lose water with it any time you cut down on the carbohydrates your body will lose water so as a result initial weight loss that you see oh my gosh this is working so great is actually water you're not really losing weight in the first couple weeks in the first two weeks you mostly you lose water and the problem is if you do not replace it you're going to get dehydrated again that increases the risk of kidney stones that increases the risk of kidney failure so let's think about this if you have underlying chronic kidney disease and you become dehydrated what happens you will go into acute on top of chronic kidney disease and you're going to lose more kidney function so you definitely don't want to do that if you have a chronic kidney disease especially or if you have other medications or other risk factors that can make you dehydrated you have to really make sure that you are under care of a doctor who cares about you who will monitor you closely and will prevent any problem and if there is any problem they have to intervene and make sure you do not go into severe dehydration status so what else happens with dehydration so you're not only losing water with keto diet but you're also losing sodium and potassium now potassium is very very important for your blood pressure so if you're not having enough potassium you have to make sure that you are supplementing potassium it could be it could be potassium pills it could be electrolyte drinks you have to make sure that you are getting your potassium back in otherwise your blood pressure may spike now another problem is that you're losing sodium as well now when you lose sodium you that's one of the reasons that you feel like keto flu so losing sodium and potassium are the two major electrolytes in our body will put you down so you want to replace your sodium but you have to be careful especially if you have a high blood pressure it is a thin balance there so like unless you have a gauge in your body which you don't know it's right so you just replacing but you don't really know how much you're replacing so that is the problem with the keto diet so how much potassium should you replace how much sodium you should replace you're just making estimations or guesstimations and the problem is it may not be correct and if it is not correct your your blood pressure may spike or you may not take enough sodium and that may cause problems in your bones now sodium is not just important for your overall fluid status but also it's important for your bones as well so if you are having chronic sodium loss that can lead to bone loss and in diabetics actually that's a problem because patients with diabetes are more likely to have fractures so their bones are more fragile now if you lose sodium then you're actually losing bone as well so as a result in the long term if we stay with keto yes your blood sugar may be great but you're going to be losing bone down down the road so you have to be really careful what you're gaining and what you're losing so blood sugar control is not everything you need to control your blood sugars in the right way I'm not saying go take medications you don't have to take medications but you have to know exactly what kind of diet how much exercise and we have a lot of videos about these so one diet will not fit all keto diet will work for the healthy diabetics young diabetics new diabetics that's it anybody who has problems who have other complications kidney problems the hydration problems medications that can cause low blood sugars history of kidney stones all those people should be extremely careful about keto diet now what happens also when your electrolyte balance is off you will you will become more irritable you're going to have balance problems and you're going to have dehydration problems now you also will be constipated right so constipation happens because of dehydration again your bowels needs to absorb some water from your body in order to keep your stool soft and in order to keep you regular so what happens when you're when you're dehydrated you become constipated and believe me that's not fun if you're not going to the restroom for a week you're going to have major discomfort in intra-abdominaly so you have to really make sure that you're actually having some non-starchy vegetables and fibers in your diet still so that you can actually keep going if you are not moving your bowels and if you are having a lot of processed meats that is the remedy for colon cancer yes you may have wonderful blood sugars but you may die from colon cancer because you stayed on the keto diet for so long so again this is a balance you have to know if you have if your proto colon cancer you have to know your family history you have to get your screenings done and so forth again that's another reason to make sure that if you're on a keto diet for long term you have to make sure that your doctor knows about it and you're on top of it so to avoid problems electrolyte disturbances I would still suggest eating healthy vegetables that are high in potassium that could be broccoli this could be avocado a flex seed chia seed spinach could be great sources of potassium and fiber so you need to make sure that you are choosing non-starchy vegetables that can be good for your keto diet to avoid problems with lack of fiber and lack of potassium and I'm Dr. Ahmed Ergin I am the founder of sugarmds.com we primarily focus on diabetes and diet make sure you go to our website at sugarmds.com and click on diabetes education for a lot of educational articles now of course YouTube video make sure you subscribe to our channel give a thumbs up and make sure you turn the alerts on so you can be notified for the new videos also on the description below make sure you guys check our Facebook as well and create our group in there so that you can communicate with the fellow diabetics and and be part of the community