 Okay, so we're going to start this panel by asking each one of you guys What is the reason you would do a keto diet? What is the main reason you're you're doing a low-carbohydrate? So let's let's go ladies first. I Came to the weight loss state for the mood stability. I Used to have a type 2 bipolar disorder and I've been off meds for almost 10 years So most people start keto as a tool for losing weight. In my case, I actually started keto to gain weight This is something that Wasn't very open until a few years ago I was anorexic and I started keto because I found that it helped me in a way found control cravings And so it helped me gain the good type of way I actually don't do a ketogenic diet any more metabolic flexibility But if I was kiteboarding and got dropped on my head and had a TBI or traumatic brain injury or some type of pathology Then I would be definitely ketogenic. I've actually been carrying a ketogenic gasker in my kiteboarding kit just in case They didn't give me a mind. So It started there Okay, then I have a couple of pre-written questions and we're gonna go open to open Mike What's the difference between a ketogenic diet and an ancestral diet? Can they coexist already completely different because the meme is that oh, I'm doing pale or you're just eating bacon and Fat is that is that true? Can they coexist? What's the difference between them? I think that a ketogenic diet can be done in a completely non-ancestral way and probably it would be very hard to replicate the ancestral diet completely anyway but I do also think that an ancestral diet would be ketogenic if not Necessarily all the time a lot of the time and so I think they they overlap I Agree very much with amber. I think that depending on exactly where the population leave They would be either in some seasons ketogenic or in that degree of ketosis or of course They leave that more closer to the equator. Of course, they would not be ketogenic all the time or even even For key a genetic I like the definition of nutritional ketosis, which is probably point five millimolars of ketones VHB So if you're using that as your cutoff of at least an entry point then you can try a bunch of different approaches to see where you end up um a substantial overlap between diets of our ancestors and A more sane or a kind of we're chatting up here before they hit his mikes about The idea that you know carbs aren't necessarily the devil they may be in certain cases with specific conditions But if you're an ultra marathon runner if you're a high-level jiu-jitsu person And you're not taking in some amount of carbohydrate that would kind of blow the traditional ketogenic model You're gonna blow it your sport. They'll stop. I mean like there's just Very very old data and even the people that sort of run keto a lot of them will actually train low and compete high I really liked Mike's point about what what ketosis actually is and if you're going to think about it from the point of say point five millimoles then That's very different from what someone might think automatically when they think about a ketogenic diet that's being used there Therapeutically where you might want to be in the two millimolar range And so sometimes when people are arguing is a ketogenic diet Ancestral or worse such as such a group ketogenic they're arguing past each other because one of them is thinking there To be ketogenic you have to be at this very deep level of ketosis and it has to be all the time And so I'm thinking about that quantitatively does clear up a lot of things Speaking of ketosis and Quantifying that is it necessary to quantify ketones for let's say weight loss I think that that ketones themselves can be a real red herring for weight loss Yes, it can show that you're burning fat. It doesn't say where that fat's coming from also Just being in the state of ketosis can sometimes be sufficient to reach a lot of Goals health goals including weight loss, but then having more ketones doesn't necessarily mean that your goals are being reached more efficiently if you follow the fallacious reasoning to its end point you would think that adding more ketones from the outside or adding more fat might cause you to lose weight and maybe it does in certain contexts, but not necessarily Yeah for fat less specifically I tend to say Chased results because people get They started here using exogenous ketones or adding fat and they forget that They're already getting results. They don't just need to be more fat or more ketones ketones are as you know Like I said, it really depends on where those ketones come from or where they are generated either the benefit or Yeah, I agree. We have to keep in mind what we're actually looking at So that's just a marker of the blood levels of ketones That doesn't really tell us anything about what's coming in or what's going out It'd be like filling your bathtub and just looking at the level of water in there It doesn't tell you how much water is coming in or how big a drain there is on the top It just tells you the level and so I think some people get stuck in My ketones are an I know so I need like, you know Four more tablespoons of butter to lose weight to get my ketones up and it's just kind of a down one spiral from there That started way down the spiral and then it got progressively worse. Hi I mean we see it all the time. I mean when we kind of live in a ketogenic community in our community across all Spirons We'll just get repeated and people say Well, I think they've lost 35 pounds and remiss symptoms of type 2 diabetes They no longer have the issue the you know with PCOS They don't have issues of endometriosis like all of these things is naturally good. I got they don't hit 0.7 Then you know Finnegan Bowling to say that I'm not ketogenic and therefore bad things are gonna happen More is better within we have to say calories don't matter because for a lot of people myself included to get I mean I am nothing but lard and salt for two years. There's no palatable way to be frozen lard and salt Never did I test above 0.6 That's right I mean I just think it's an absurd conclusion to say more ketones equals more fat loss It just needs more use of that But you know the head amber it's either from your plater But both at the same time at least after we get past where the metabolic inefficiency state your keto where You know the body doesn't really have all of the enzymes operating in all of the receptors You've got that nearly as rapidly as it does later. I could write an analogy that once Someone said to me is like trying to determine the speed of your car by looking at the gas gauge So yeah, so you're looking at energy levels and trying to determine if having more ketones Means that you're losing more fat. It's not just available energy You know we got into the trouble with vitamin D when we figure out how to test vitamin D levels And then we can just apply some vitamin D You can see there's like vitamin D floating in the bloodstream, but is it really activating the receptors? Or you know when you convert some like vitamin D, you're having different pathways activated But you know if you have no vitamin D levels Ingesting a little vitamin D can be beneficial for certain out of conditions. Is there any benefit to exogenous ketones? Mike you talked about TBI Is there any benefit to having exogenous ketones in your bloodstream? I would say the data is still preliminary, but my bias if I get whacked in the head What happens is you're gonna have a massive energy crisis Right, glucose metabolism gets all screwed up. You're gonna have a high amount of inflammatory mechanisms things of that nature And I always look at what's the potential upside what's the potential downside if I can do a ketogenic diet We've got pretty good data to show that there's probably not a bunch of huge downsides Just the other issues you can talk about later the upside that is it probably hasn't been entirely clearly defined But for me personally, I'll take that risk because I'm mitigating the downside and I'm not really sure of the potential upside So ketones there can possibly have a direct anti-inflammatory effect and they also serve to pinch it as another fuel source While your brain is going through that process of trying to heal So I want to tack on to that really quickly One of the interesting things about ketone salts or ketone esters is it's kind of a novel place in human and evolutionary Physiology because ketones are a byproduct of either a starvation or a human starvation or of an endo Disagree with my conclusions here, and that's okay But they are functionally the fuel of the absence of carbohydrate But we see a lot of people using exogenous ketones who are not depriving themselves of carbohydrate and so it is a very weirdly novel environment That you're introducing that doesn't exist in the history of human physiology throughout all of ancestry we At least not that we have any markers or indicators of or anything in the genome that would indicate that to be And so it's it's an interesting place This stop and think about for just a second to say is it harmful probably not in small doses But when people are desperate and they're trying to lose weight or remiss symptoms of the condition and they're doing this thing where they've decided Their doctor doesn't know what they're talking about and therefore they're gonna do it on their own And somebody tells them that they cured Ebola with exogenous ketones They'll buy it and they'll do it and literally I Spoke going at a conference. It was actually a local USA two years ago She was spending $1,500 and one fun exogenous ketones There's a real downside to these things for people or this is a fraternity true But you know that's Believering the point. I apologize, but it's just in it's a I think that there are applications, right? You know neurodegeneration oncologic care for certain cancers Yeah, sure run those ketones as high as you can but again it circles back to the fallacy that more is better And it's just completely lacking in evidence. So I'm actually gonna agree with you I don't think that that we do have a precedent for high ketones with high glucose well except for diabetes, right? And that's not a state. We really want to replicate But to your to your other point That there may be certain situations where you want to get Ketones high as quickly as possible like in the dramatic range or if you didn't happen to be ketogenic that day that you had that accident Maybe you want to do that really quickly or if you have someone who is a patient and isn't complying or if you have someone Who's insulin is up for other reasons that don't have anything to do with? Normal physiology and it's preventing their ketones from going up high that could be a reason But we don't know exactly which of the benefits of the ketogenic diet are coming directly from the Ketones we know we know some of them because there are some studies where ketones are given and we can see that there are anti-inflammatory effects for example, but when you change the context all those pathways are up to change So it's it's not no you brought up a really interesting point when you You mentioned that the effects of the ketones, but we need to also appreciate that BHP and high doses actually shows a down-regulation Insensitive like this in the adipocyte so if we're trying to lose fat, I mean again shifting away from a therapeutic context There is actually a potential detriment to running ketones extremely high because it is going to down-regulate the life-alysis so What would be the not just specific populations, but like let's say you want to try keto a ketogenic diet Where would you set that protein intake is you know, do we want to restrict a protein intake to prevent? Protein to the genesis do we want to keep protein high to prevent muscle loss where what would be your recommendations for protein intake? So you you phrased it in a way that is I'm really glad you said what would be a good starting point And I think that the best starting point the easiest starting point unless like we were talking about earlier There's an immediate therapeutic need to get really high ketones Then I think you should start ad libitum actually Cut out the carbohydrates to some low level and then eat fat and protein to What's desired and see where that gets you and then only if that's not getting you the results that you need Then you might start playing with higher fat or higher protein and you know, it's funny You said it was controversial and and I agree that it that it can be I don't know if it is among this panel, but Some people think that if you in particular for weight loss that if you want to lose more weight you have to You should be cutting the fat down and raising the protein up and other people Are saying that you need to cut the protein down and raise the fat And I think there are really good arguments on both sides And we're not really sure why one would be better for one person and why the other would be better for another So I think a lot of personal experimentation is warranted Okay, so for starters, I would say it really depends on the context Even though you said that a general application. I Wouldn't really do that You know my general recommendation because for for us, especially in people who we work with if we see that the person is over 40 I would and of course depending if the person wants to actually Review macros and count. I would give a specific recommendation if the person just wants to start the diet I would go very much like with Amberset Just eat basically meats and some side veggies if you would like vegetables and Pretty much eat at leave. That's my usual recommendation if the person actually wants to You know lose weight and actually wants to count macros. I'd rather have a focus on Whole foods that include both protein and fat basically just use a fat that comes along with the protein and If we get people that are over 40, I would put a little more emphasis on protein because I'm very Pro protein in the sense that I prefer people to avoid Psychopenia at any cost and I see people especially Women that are afraid of eating protein and so when they started kidney diet They end up on 35 40 grams of protein at a because of the fear of you know getting bulkier or Not losing weight because of the protein and then yeah, they may lose weight at the start But at the expense of also losing lean mass and then they saw and that's how you actually down-regulate your basal metabolic Rate because you're losing muscle mass, right Yeah, I agree that the context matters I mean there's a study looking at protein synthetic response in younger people age 20 versus average age of 71 They used weight protein as a supplement the younger people got a pretty good response from 20 grams the older people needed 40 grams So they needed twice the amount to get the same acute response But if you're looking at a therapeutic thing where you're really trying to get someone into a high state of ketosis for whatever reason I agree kind of what they said look at their diets you where they're at probably cut back on carbohydrates Most of my experience if I'm doing that you probably need to get below 50 at a minimum to start out and see where you're at From there, then you're just balancing to see do I want to scale back protein a little bit What are the pros and cons of that or maybe you don't want to add a little bit more fat? But yeah, I have concerns about having a very very low protein intake especially in an older population No, I would completely echo the sentiment here. There's There is just much less data of harm from over-eating protein than there is from harm of under-eating protein Then we can have a complete sidebar in the hallway about plant versus animal proteins and all that fun conversation But setting aside all of that and just saying when in doubt generally a little bit more is not going to hurt you Within the context or the framework of having like a proper amount of calories relative to what you're trying to accomplish Whether that's weight loss whether it's therapeutic and you don't need to concern yourself necessarily with that whether it's like catechic losses or Do we have any questions Jody so our first question is For a keto diet, would you recommend that for digestive issues IBS? different different digestive struggles I Personally would recommend a plant-free diet for digestive issues often the biggest problem with digestion is too much fiber and or Susceptibility to plant toxins because of increased intestinal permeability that make plants that otherwise might be very healthy or benign become a difficulty in digestion and autoimmune diseases I can actually answer this because I'm a practitioner and I see people with IBS so it depends Yes, it doesn't probability big problem What I've seen a lot of times is that people are not trying to get to the root cause of what's causing the IBS It could be you know an infection parasites. It could be toxic load it could be an autoimmune response to To you know, whatever you're eating So investigating what the root cause of the problem is and maybe use a you know Very small diet or a restricted diet where you're eliminating carbohydrates, you know a ketogenic diet tends to be a little bit more hypoallergenic and Working with that frame That can be very very beneficial for IBS The problem that I do see at my practice is that sometimes when you start doing really small narrow diets You feel a little bit better and you keep narrowing down and narrowing down and then you end up with orthorexia So if you have a very narrow diet trying to investigate what the root cause of the problem and then reintroduce stuff in order to have you know Social lifestyle and so you can enjoy your life. That would be Very beneficial, but yeah starting with a ketogenic diet. It's a very good starting point because it tends to be very hypoallergenic I would send them to Guillermo or someone who's a practitioner But in general probably some type of elimination type diet and I agree with this point then the question I always tell clients to go back and ask their doctors. How long do I run this? How long do I feel good? Whatever markers you're using and then how do you expand it back out on the other side? So I see a lot of people just do elimination type diet They felt amazing and now they're convinced that they have to only eat four foods the rest of their entire life I mean, there is data out there that clearly shows that eating a ketogenic diet is a stensibly important to say it damages gut microbiota I'm not sure that that's a conclusion. I'm willing to science yet. Maybe somebody here is going to be like you're a idiot and you have a bug So I have seen a ketogenic diet cause more distress and more problems in certain individuals and to be honest The idea of doing the AIP type thing and getting to the four or three The rest of their life So the next question is that it can you get the benefits without ketosis to avoid the problems of the microbiome deficiencies down-regulating pathways So what would be I guess coming out of coming out of ketosis? How would you do that effectively or can you do that? I would say the question is how do you transition out of a ketogenic type approach? I do work at the fair amount of those people and the short version is if you're going to ketogenic diet you can have some changes at the muscle level in relation to insulin So just giving them a boatload of carbohydrates usually isn't going to go very well I find that just slowly working out their carbohydrate amount works good. If I had a choice I would give that probably a post-exercise seems to be tolerated a little bit better And then just slowly kind of working that up see how they feel you get fancy measure like glucose and things like that But what I usually find is people just get too hyper aggressive and they go screw ketosis I don't want to do that anymore. I don't need all the cards I can find. Oh, I feel horrible now. What happened? It's like you probably went a little bit too hard too fast and your body wasn't prepared to handle it In our case what we do very much is that approach It's not like we tell a client. Okay, you can have a 40 50 extra grams of carbs And then go and have a donut or something now It's like okay We transition from keto to a semi-pallet approach and then the cars are gonna have like you said probably post-exercise Good healthy type of cars and truth here are some vegetables there potato, etc. And then it takes probably in our case I'd say four to six months to have someone from probably 20 grams of carbs To about a hundred and twenty one hundred and fifty without any stomach or any issues whatsoever So there is clear physical resistance that happens in a chronic ketogenic state But there's also the up-regulation of fat capacity to take fat directly in the cell tissue. So From that perspective yet you have to kind of play with Slowly moving scale because if you don't it's just bathroom time like crazy. And maybe that's just me This one is about the concerns about Sorry, I just wanted to add something When I first started a ketogenic diet 20 more than 20 years ago. I was very influenced by Lawn McDonald who He talked about doing a cyclic ketogenic diet, which a lot of bodybuilders did and so there was a period in my life where I was on a Very low-carb diet throughout the week and every Friday night I would go to the bar and have fries and beer and it was fine for me I don't know if that would address the person's question about whether that would fix problems with the microbiome But I'm not sure that I know that we know that the ketogenic diet gives problems to the microbiome But but it's not always the case that I think some people can really tolerate Rapid switches back and forth and that can maybe address concerns about Chronic ketosis and you could do a ketogenic diet with keto brownies and keto pizza And then and then go and have beer and chicken wings or you can do and you know vegetables and and meat and then To cycle in carbohydrates you can use root to verse and you know, so you can do it smartly This one is about the concerns about the ketogenic diet And I'll just list off like three things here that overlap a few questions. Any worry about amptour stimulation and cancer No Problems of cardio with cardiovascular disease or cancer and then also another person asked about microbiome Deficiencies and downright healing in a pathway. I want to add to that nutritional deficiencies by excluding or groups of foods Any opinions now? There's a way to eat like a composition and all of that. The same thing happens in the Paleo space and the Keto space Is such a complicated cascade that this idea that in tour or stimulation equals cancer is just it's dead on a rival to People that really look into some of the stuff does that mean that? We should constantly stay in a state where we're stimulating that pathway or no, but that's kind of the point We should be eating should probably have to do with the fact that we should too much in nutrition And so we're constantly stimulating that cascade of anabolism and that in itself is problematic But it ain't because of the fact that I think people to be honest I think this I want to add about m tour m tour is a signal it takes in a signal of getting fed And so there's really no way to constantly keep m tour down without not eating So you have to eat something and and I agree with tyler that the best way to approach that is to To separate the signals so you stimulate it and then you stop stimulating it And one advantage that I think a ketogenic diet has in that respect is that you can go much quicker from the state of Fully fed and stimulating m tour even with a with a huge steak You know as much as possible with protein And then the amount of time it takes to get back into that Autophagy phase where m tour is being inhibited has got to be I don't think we have exact times in any study But it's got to be quicker than the two or three days of fasting that it would take from a high carb diet And so I like to think that If you're on a ketogenic diet, you're probably in a state of optimal autophagy overnight Compared to somebody who's on a high carb diet and has to wait for three days of fasting And do that in a targeted way over and over in order to get those benefits Yeah, I just would like to complete a complete amber that people are now really fasting because of autophagy and there are various ways to Generate autophagy certain types of foods strength training Exercise of course, but also ketogenic diet. So if you're doing a ketogenic diet by percent You're in periods of autophagy and then of course you're in a fat state You're going to turn a little bit up or up, but then you're going to turn it up. So it's down. So it's like a switch It's a ging and jang you have periods of growth and creation and then you have periods of sanitation in a way The other thing I would add is if your overall dietary approach is more restrictive, whether that's a keto meat in whatever There's like you said, there's definitely ways you can do it and do it well You just have to be aware that it's going to take you a lot more Effort and it's going to be a lot more conscious to do that The less restrictions you have in general you have the opportunity to eat more variety and probably Miss a lot of those micronutrient deficiencies. So it doesn't necessarily mean that one is going to be worse than the other You just if you're going to be a vegan and do it a very healthy way You can do that But there's a lot of other things you have to pay attention to Because you're taking an approach that is more restrictive to start with I tend to When people ask me this question, I just give them a certain types of examples For example, people tend to say well, you cannot restrict that whole micronutrient And if you actually do a well A well-prepared ketogenic diet Most people I'm not saying a lot end up eating more vegetables than they were eating before Like at 20 or 30 or 50 grams of carbohydrates That's a lot of food volume coming from vegetables and people tend to say oh with vitamin c well instead of having an orange Just look at for example Broccoli it has more vitamin c when compared to 100 grams of Orange juice or potassium and they show your banana Well, just look at red meat and look at avocado for example and so on and so forth I haven't found yet a single nutrient that you cannot get on a well-firmly ketogenic diet in similar Or even better quantities I've been so far almost 20 years in keto And i'm not that yet Yeah, but I I will just say that When I say these people tell me you've been on ketosis for 21 years. Like you've never had a pizza Like it doesn't it's not like that. It's like I may go out of ketosis for I don't know five Six seven times a year when I feel like if I have a want to have a slice of pizza I want I want to carve or whatever something that I do bridge sporadically. So I'm not really Completely in ketosis all the time pretty much like people who are not in ketosis may go into ketosis overnight because they've been fasting for 12 or whatever hours Nothing happens people that go Just by chance into ketosis don't that so the same happens to people that have been doing keto for a while The only thing I would add is that you Like if you do any new dietary approach if I don't talk to your physician have a basic blood panel at least run Do whatever intervention you're going to do and have another blood panel run at that point I have seen very very circumstances some just wonky numbers from people that have done a ketogenic diet It's definitely not the norm. It's definitely I'd say more of the exception Most of the other data we have you know the betrari foundation things like that We don't see a lot of long-term issues But anytime you're doing a different intervention you want to make sure you know What your own data is just in case there is something that's odd about your specific physiology So and we're going to throw this over your way because I know you've talked a little bit of how you already eyes probably change with respect to the macronutrient composition of diets and it's not by any means my area of expertise, but I don't want to put you on the spot but in response to like using blood markers as an indication There may be some complications to that that we haven't really thought Thank you. Yes, uh